Inspection on 06/11/09 for Tower House II Residential Home

This inspection was carried out on 6th November 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 03/06/09

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 Andreas Schwarz Key Unannounced Inspection 09:00 6 & 10th November 2009 th DS0000068639.V378511.R01.S.do c Version 5.3 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.V378511.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.V378511.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 8537 1707 Mary Christabell Chongo Mundy Vacant 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.V378511.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 3rd June 2009 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 garden/patio areas in front of the home and at the back. The home has recently been refurbished to accommodate up to 9 residents. But is not registered at present to accommodate more than 3 people Tower House II is owned by Ms Mary Mundy. She has another care home next at number 9 and 10 (Tower House l) There are a lot of interactions between the two homes and many activities are shared as they are next door to each other. The home charges £580 weekly. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.2 Page 5 At the time of the inspection there were eight individuals residing at the home thought to be in receipt of accommodation and personal care services. The home is registered to provide accommodation and personal care for three persons. Enforcement action is being considered. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. The key unannounced inspection started on the 6th November 2009 at 09:30 am and finished on the 10th November 2009 at 16:00. This is the second key inspection for the period 2009-2010. The last key inspection took place on the 3rd June 2009 and during that inspection the home was rated as an adequate (1 star) service. The registered provider Mrs Mundy is also the manager of the home. During the first day of this key inspection the lead inspector Mr Andreas Schwarz, was accompanied by Fay Bennett Regulation Inspector from the Care Quality Commission (CQC) enforcement team. The Commission has also received an application from the provider to increase the number of residents in Tower House II from 3 to 9 as the provider has extended the home (number 11), to include numbers 12 and 13 Tower Road. During the inspection we spoke to all people using the service, relatives, visitors, three members of staff and the provider. We toured premises and looked at a sample of records that the home keeps. We would like to thank all the people using the service, Mrs Mundy and all her staff for their assistance and kind support during the inspection. What the service does well: Prospective residents’ needs are assessed before they are offered a place in the home, to make sure that the home will be able to meet their needs. People using the service in the home generally appeared well cared for and receive a good standard of personal care. 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. Bedrooms of people using the service are personalised and offer comfortable accommodation. What has improved since the last inspection? The home has met thirteen of the twenty requirements made during the previous key inspection. The home has updated care plans and changes in people’s health and needs are addressed. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.2 Page 7 All the residents have been weighed regularly, helping the home to monitor their nutrition and health. The home is recording medication received from the pharmacist to ensure accurate record keeping. Medication has been audited and medication prescribed by the GP is administered. Residents are involved in the menu planning and meals provided by the home are recorded as well as food consumed by the service users. The home is now providing hand washing facilities in the new toilet on the ground floor, ensuring people’s hygiene is maintained. An up to date duty roster is in place, ensuring people using the service are supported by an adequate number of staff. Training records are in place. The home has improved the supervision frequency for staff, this ensures staff are supported appropriately and improves the outcomes for people using the service experience. The home is checking the water temperature regularly, to ensure that people are provided with hot/warm water. The fire assessment has been reviewed and is suitable for the home; ensuring people using the service are protected in the event of a fire. Health and safety certificates are up to date and have been renewed, which ensures peoples safety. 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. We have made nineteen new requirements and found five previous requirements that had not been met during this inspection. The Care Quality Commission is very concerned by the failure of the home to meet requirements and is considering enforcement action to ensure that improvements in the quality of care provision are made. Enforcement action is being considered in respect of the unmet requirements Areas of concern arising from this inspection are as follows: To ensure that prospective and current residents are issued with up to date information the statement of purpose and service users guide must be reviewed and where necessary up dated. To ensure people using the service are clear what support and care is provided by the home a signed and dated contract must be provided to them. The home must make every effort to involve people using the service, or where this is not possible their representative, in the care planning and risk assessment process. If people’s risks have changed this must be recorded in the risk assessments and a new up dated risk management plan must be provided. People having difficulties with their mobility or are at risk of falls, or live on the first floor must have a detailed risk management plan in place detailing how the risk can be minimised. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.2 Page 8 Equipment provided by the home to support people with mobility problems must be in working order, ensuring people using the service can use the equipment safely. Medication administered by the home must be signed for, ensuring that people are provided with the medication as prescribed. All staff administering medication must be provided with training by an accredited training provider. People’s decisions about their end of life care must be addressed and their choices must be recorded and acted upon. To ensure people are protected from abuse all staff must attend adult abuse training. Staff must attend Mental Capacity Act training and the manager must arrange for the residents’ capacity and deprivation of liberty to be assessed. To ensure peoples privacy the bathroom must be able to be locked from the inside. To protect people using the service from falling out of the window appropriate window restrictors must be fitted throughout the home. To minimise the risk of scalding, the home must ensure that the missing hot water indicator is replaced. To ensure that people can have a bath whenever they choose, the hot water temperature must be set to a comfortable temperature. The broken toilet flush in the en-suite facility in room 5 must be repaired, ensuring the occupant can use the toilet safely. The room temperature within the premises must be set to a comfortable level. To ensure the home is free of any offensive odours the home must address the urine smells found during this inspection. To ensure people using the service are supported by qualified staff, a minimum of 50 of care staff must have or be working towards National Vocational Qualifications in Care. Appropriate recruitment checks and documentation must be obtained for all staff. To ensure that people using the service can be confident that staff are skilled and qualified to meet their needs regular training and training refreshers must be provided. To ensure peoples outcomes are improved the registered person must make every effort in complying with requirements made by the CQC. To ensure the quality of care is monitored and can be improved a fully working quality assurance management system must be implemented. To ensure peoples Health and Safety risks are minimised, identifiable risks must be assessed and a risk management plan must be provided. The provider must demonstrate that the primary care needs of individuals admitted to the home fall within the conditions of registration. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 9 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.V378511.R01.S.doc Version 5.3 Page 10 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.V378511.R01.S.doc Version 5.3 Page 11 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): We assessed National Minimum Standards 1, 2, 3 and 4 during this key inspection. 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. All new people using the service receive a comprehensive needs assessment before admission. The statement of purpose and the service users’ guide do not give clear relevant information about the home. The home does provide a written statement of terms and conditions and contract, but the documents have nor been signed and it is not clear if people have agreed the documents. EVIDENCE: We viewed the homes statement of purpose and service users guide. The registered provider Mrs Mundy confirmed that the two documents provided Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 12 during this key inspection are the current documents, which are given to current and prospective people using the service. During the assessment of the service users’ guide and statement of purpose we noted that the documents refer to 11, 12 and 13 Tower House. Mrs Mundy has applied for a variation in numbers and to add Dementia Category as part of the application. This application of variation is currently with the Care Quality Commission Registration team and has not yet been approved. The statement of purpose and service users guide given to us and currently distributed to people using the service is therefore misleading and a service user’s guide and statement of purpose specific to the support provided by Tower House II must be provided. We looked at five care plan folders during this inspection. Two of the folders had an unsigned contract in place and one had no contract in place. The blank contracts had no information of fees or which room is occupied by the person, but had information of the terms and conditions and tenancy in place. People using the service were not able to tell us if they have a contract, but one visitor told us that he thinks that his relative has a contract provided by the home. We informed the registered provider that contracts need to be in place for all people using the service. If people are unable to sign this must also be recorded in the contract. We have viewed five needs assessments during this inspection. The needs assessments viewed were of people being admitted to Tower House, between February 2007 and October 2009. Two of the assessments were of people being admitted to Tower on February 2009 and February 2007. The other three assessments were of people being admitted after September 2009. The assessments viewed have been done by the registered provider Mrs Mundy. All assessments viewed are detailed and of good standard. We noted on two occasions, that assessments have not been signed by the person using the service or their representative. This leads us to believe that the two residents have not been involved in the assessment process. The home must ensure that clear evidence is in place of people’s involvement in the assessment process. If people choose not to sign or are unable to sign their needs assessments, this should be recorded on the assessment document. People using the service, relatives and visitors spoken to during both days of this key inspection told us that service users’ needs are met and that the home is looking after them very well. One comment made by a relative. “My XXX is very well looked after and staff care for XXX very well”. We noted that four of the five assessments viewed indicated that people had some degree of memory loss due to Dementia. Tower House II is not registered to provide a service to persons whose primary need for care at the point of admission is due to Dementia. The provider must ensure individual health care needs are assessed and supported as appropriate by a health care professional. Where a service user develops dementia care needs following Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 13 admission to the home, the provider must demonstrate that these needs can be met. The home does not provide intermediate care to people and National Minimum Standard 6 was not assessed during this key inspection. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 14 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): We assessed National Minimum Standards 7-11 during this inspection. 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. They cannot be assured that risks to their health and safety are being managed appropriately. Residents enjoy a good standard of personal care and their privacy and dignity are maintained. Medication arrangements are generally satisfactory but some improvements are needed to ensure medication is safely administered. People using the service are not involved in decisions about their wishes regarding end of life care. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 15 EVIDENCE: The home has introduced a new care planning format since the last key inspection. The format is based on person centred principles and uses symbols and pictures to make them easier to access. Long and short term goals are set, which are reviewed by the registered manager on a monthly basis. We noted in all of the five care plans we assessed a number of areas not being completed. For example one care plan had no long, mid or short term gaols set, another care plan had the 12/12/09 as a date when goals have been set, and a third care plan had no information of religious and spiritual needs. The registered person informed us that the reason for this is that the care plans are new and still in the progress of being fully developed. We discussed the care plan with one person using the service, who informed us that his care plan is kept in his bedroom, but he has never looked at it and he was not able to remember if staff ever discussed the care plan with him. None of the care plans viewed have been signed or recorded that people were unable to sign care plans. We looked at five individual risk assessments in care plan folders viewed during this inspection. The home has assessed various risks, which individuals may have, but guidance in how to manage the risk is not provided. This could put people using the service in danger as staff are not able to ascertain how to minimise the risks appropriately. We were also not able to establish how the home is involving people using the service in the risk assessment process. Risk assessments viewed, were not signed or dated. People using the service spoken to could not tell us if they have been involved in the risk assessment process. We noted in one of the risk assessments viewed, that the home did not provide details in how to manage the risk, but left the example provided by the person designing the template. The person was a female service user and the example how to minimise the risk injuring the person while shaving, stated “While shaving, sample will cut himself, which could lead to infections”. We viewed a nutritional assessment, which was undertaken on 26/06/2008. The assessment states that it should be reviewed every three months, there was no evidence of a three-monthly review documented and changes, which the person has undergone in the past seventeen months, have not been recorded or updated. Accommodation in Tower House II is on the ground floor and on the first floor. Three people living at the home have mobility problems and use walking aids or need support to walk by staff. We observed one person walking to his chair in the lounge being supported by two staff. A risk assessment or guidance how to support the person around his mobility was not in place. Previous inspections noted that the home must provide assessments about people’s Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 16 ability to negotiate the stairs, if their accommodation is on the first floor. We were not able to find any guidance in regards to this. We observed that people using the service are generally presented with a good standard of personal care. They were also appropriately dressed, according to the weather and the wishes of the people using the service. Residents’ weight is monitored monthly and records have been assessed. The registered person informed us that none of the people living at Tower House II have pressure sores. Regular visits to dentists and opticians are recorded; one person told us that he would go to the optician independently. We viewed medication records of all eight people using the service. All Medication Administration Record Sheets (MARS) have been filled out appropriately. One of the MARS assessed was not signed on the 05/11/2009, but the 60mg dose of Lerothyroxine has been administered as it was no longer in the blister pack. The registered provider informed us that none of the people using the service currently use any controlled drugs or self administer medication. Liquid medication bottles are signed and dated when they were opened. Medication is stored in a lockable medication trolley, which is kept in a locked under stairs cupboard. We viewed the homes signatory list of staff competent in the administration of medication. Eleven staff signed this list; training records viewed showed us that four staff did not attend training in safe medication administration. We noted that the staff not having taken part in training signed the list of being competent in the administration of medication. 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.V378511.R01.S.doc Version 5.3 Page 17 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): We assessed National Minimum Standards 12-15 during this inspection. 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. People using the service have the opportunity to take part in appropriate social and recreational activities. The home provides healthy, nutritional home cooked food. People are provided with the opportunity to access the community and observe their religious faith. EVIDENCE: The home has an activity board in the lounge, which shows the different activities, which are provided each day of the week. Resident’s participation in activities is documented in their daily notes. We observed staff interacting with people using the service individually and as a group during both days of this key inspection. On the second day of this inspection a Roman Catholic priest visited the home to provide the Eucharist to people from the Catholic faith. We Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 18 spoke to the priest who informed us that he or a designated person visits the home every fortnight. The registered provider told us that people using the service are able to access representatives from other faith groups, such as Pentecostal, Jehovah Witness and Jewish. One of the people we have spoken to told us that he is from Jewish faith, but is not practising. We observed meal times to be quite flexible and people are got up at different times in the morning. The registered provider showed us the activity room, which can be used by people using the service, which has games, arts and crafts materials provided by the home. We observed people receiving visitors during both days of this key inspection. One of the people we have spoken to told us that her family and friend’s visit regularly and she is going out for walks and meals with them. Another person told us that he is going out regularly to ride his bike, go to café’s and follow up his hobby. Two people using the service told us that they can invite and meet visitors in private. The home does not handle people’s finances. Two resident’s finances are handled by a solicitor and the other people handle their financial matters independently or are supported by their family. People using the service spoken to confirmed that they have brought personal possessions when moving in to the home. We observed lunch time on two occasions. Meals appeared to be prepared nicely and people using the service told us that they are happy with the food provided. The home has a menu plan, which shows meals provided by the home are varied, healthy and nutritious. The home records food eaten by people using the service. The home had a restaurant style menu board displayed in the dining room, the home was advised to remove the board as it was very confusing and not clear what meals are provided during the first day of this inspection. The board was removed on the second day of this key inspection. The home is using pictures to make it easier for people to choose and know what they want to eat. The picture of the meal provided during the day is displayed in the kitchen. People using the service rarely access the kitchen and we recommend displaying the pictorial menu in the dinning room. The home has a cook employed, who informed us that she attended a food hygiene course. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 16 and 18 during this inspection. 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 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. There is however a need for staff to be appropriately trained. EVIDENCE: We assessed complaints records; the home did not receive any complaints since the last key inspection in June 2009. A complaints procedure is available in the home and in the Service Users Guide that is offered to all people using 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 three members of staff. Everybody spoken to was clear of the action to take if they come across allegations and suspicions of abuse. The registered manager has had training in adult abuse. The three members of Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 20 staff spoke to told us that did not have any adult protection training since working at Tower House II. We assessed training records of seven staff employed by the home and found that five of these staff have taken part in adult protection training. We discussed the Mental Capacity Act and Deprivation of Liberty assessments’ with the registered provider, who informed us that not everybody living at the home has been assessed by the local authority. The provider must ensure that staff have training on the Mental Capacity Act and are made aware of the Deprivation of Liberty Safeguards as part of that training. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 19, 20, 21 23, 24, 25 and 26 during this inspection. 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 physical environment does not always meet the specialist needs of the people who use the service. Residents can personalise their rooms. They also say they the home is clean, warm, well lit and there is usually sufficient hot water. Toilets are appropriately located within the home, are easily accessible and in sufficient numbers. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 22 EVIDENCE: The home has completed structural and refurbishment work since the last inspection by joining numbers 12 and 13 Tower House Road to the existing registered service 11 Tower House Road. These changes have created the appearance of one large house offering an extra six beds. The registered provider has submitted an application to increase the number of people to be accommodated from three to nine and to add the category of Dementia. This application was in process at the time of this inspection and has yet to be agreed. At the time of the inspection five of these additional six beds were being purchased by local authorities and persons funding themselves. The home had been decorated for Christmas which the provider said had been done to coincide with the switch on of the Oxford Street lights. People using the service said they are happy with the Christmas decorations. The lounge which was one large room had been divided into smaller zoned areas; however a number of chairs had been positioned in a line along the wall at the far end of the room. This gave an institutional feel and it is recommended that these chairs are repositioned more creatively to add a more homely feel. One chair in particular was positioned below a boxed in boiler, this was felt to be unsafe and following discussion with the manager this chair was moved into a safer position. Carpets in the communal areas had been newly fitted and were in good condition. It was noted that one section of the lounge had been left uncarpeted and a rug had been placed over this area to prevent people from tripping. Due to the mobility needs of people living in the home, it was recommended that the gap in the flooring be filled in and the rug removed. On the second day of this inspection the home had removed the rug, the hole had been filled and carpet laid over it. The inspector was disappointed to find that the patched carpet did not match the main carpet already laid and it is recommended that this is replaced with matching carpet. The provider stated that all bedrooms had en-suite facilities which consisted of a toilet and wash hand basin. All bedrooms viewed had been furnished with the required fixtures and fittings. Furniture seen was in a good state of repair and radiators were fitted with a cover to prevent injury. It was noted that several of the bedrooms viewed had an unpleasant odour which was discussed with the provider. It is recommended that greater attention is paid to the cleansing of these bedrooms and a review made of these individuals continence support needs. Overall bedrooms were clean and tidy but were cold, personal possessions were seen in all rooms but rooms had not been personalised. In particular bedroom number 2 was in need Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 23 of redecorating, this was discussed with the provider who agreed and stated that the individual had recently moved from another room and had yet to decide on paint colour. The toilet flush in bedroom 5 was broken and must be repaired. At the last two inspections it was noted that bedroom number 2 did not have a window restrictor fitted, the provider must undertake a risk assessment and where needed a window restrictor must be fitted. Room sizes in 11 Tower Road meet National Minimum Standards, room sizes in the part of the home that was number 12 and 13 Tower Road are currently being assessed by the CQC Registration Team, a site visit was undertaken by a Registration Inspector on the 05 November 2009 as part of this application. There are three bathrooms all of which although clean and tidy, appeared bare, cold and uninviting. Bathroom 1 has modern fixtures but the hot water indicator for the wash basin was missing, this must be replaced. The hot water tap for the bath had to be run for a long time and only then reached a tepid temperature. The bath was fitted with a battery operated bath seat for those people with mobility problems. At the time of the inspection this bath aid was non operational, the provider stated that the battery was being recharged and would be returned later that day. In bathroom 2 the inspector noted that the door did not fit the frame preventing it from closing. There was no water running from the hot water tap in the wash basin and water for the bath was also tepid and the flow was very slow. A bath seat was fitted which swung out to the side but did not have a lowering facility. The provider stated that people would sit on the chair and use the shower hose instead of filling the bath with water. It is the opinion of the inspector that this practice would be uncomfortable given the temperature of the room and could cause people to slip on a wet floor when getting down from the chair. The provider stated that the handy man had been fitting thermostatic valves the previous day and needed to return to regulate the water. The registered provider must ensure that hot water and adequate bathing facilities are provided at all times. It is recommended that bathrooms are made more appealing to increase the bathing experience for people using them. It was noted that paper towel dispensers had been provided throughout the home, both the provider and the inspector struggled to use these dispensers and it was agreed that they should be replaced with something much easier for an older person to use. It was discussed with the provider that the use of conventional towels may offer a more pleasant experience and homely feel to the en-suites. We noted that the lounge and bedrooms were very cold on both days of this inspection. A temperature guide in bedroom 7 was reading 18˚Degress Celsius (cool) with 21˚ Celsius showing as ideal. People using the service and visitors confirmed that the home can become quite cold at times. The provider Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 24 said they did not find the home cold but acknowledged that it may need to be warmer for those less mobile. The provider must ensure adequate heating is provided in the home at all times. A domestic help is employed to ensure the home is regularly cleaned. The home has purchased a range of Health and Safety policies, which are compliant with Care Homes Regulations. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 25 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): We looked at National Minimum Standards 27-30 during this key inspection. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service does not support the development of a competent staff team. Training provided is limited, with areas not being identified and not targeted at relevant individuals. Staff are not encouraged or supported in the pursuing of external qualifications such as National Vocational Qualifications (NVQ). The service has a poor recruitment procedure with shortfalls in recording and processes being evident. EVIDENCE: The home provided staffing rotas from 02/03/2009–22/11/2009, we sampled rotas from 02/03/2009-29/03/2009, and the home is providing 2 to 3 staff during the day and 2 carers at night. During the time from 01/06/200928/06/2009 and 03/08/09-30/09/2009, the home has increased the numbers of carers during the day to 3 to 4 carers and 2 carers during the night. During the time the staffing ratio has increased from 3 to 4 carers during the day. The Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 26 home started to admit the additional new people using the service. The home admitted people on 16/09/2009, 30/09/2009, 01/10/2009 and 19/10/2009. Observations during both days confirmed that the home is providing adequate staffing for the number of people living in Tower House II. In addition to care staff the home employs a cleaner and cook. We have looked at training records of eleven staff employed in Tower House 2. We viewed evidence of two people having started their NVQ Level 3 with London College in Willesden. Any other records viewed provided no evidence of staff having appropriate qualifications in care. The home has started providing induction training for staff. The induction is based on common occupational induction standards. We looked at recruitment records of six staff. All staff have an up to date Criminal Records Bureaux (CRB) check. Three members of staff provided two references, one member of staff provided one reference and two members of staff provided no reference. None of the references provided have been verbally validated. Information on peoples’ work history and identification in form of a current passport were in place. The majority of staff employed by Tower House II are from a Chinese background. The registered provider and staff spoken to informed us that the home assisted them to obtain working visas as part of a sponsorship programme. We viewed training records of eleven staff during this key inspection. Staff attended medication training and Dementia training in 2009. Staff spoken to confirm that they have attended this training, but no other training was offered. Staff with previous care experience had evidence of manual handling training, adult protection training, Food Hygiene training, etc. in place. Training has however expired, which could put staff as well as people using the service at risk due to inappropriate manual handling procedures and by not following current guidance. The manager needs to ensure that there is rolling programme of training including refresher updates in mandatory courses Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 27 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): We assessed National Minimum Standards 31, 33, 35 and 38 during this inspection. 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. People can be assured the owner/manager is experienced in the care of older people. There are concerns that the lack of an effective quality management system for the home means that residents cannot be confident that the home is being monitored to ensure that they receive a quality service Health and safety issues are not always addressed appropriately. As a result people who use the premises may be put at risk. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 28 EVIDENCE: Mrs Mundy as the owner of the home is now the manager. The Commission has received her application to be registered as the manager. Mrs. Mundy is a registered nurse and has experience of caring for the elderly. Mrs Mundy informed us that she has employed a deputy manager. We spoke to the deputy manager; she informed us that Mrs Mundy is doing all the care planning, supervisions and managerial tasks at the home. Staff spoken to told us that the registered provider Mrs Mundy is supportive and involved with the care of people using the service. The home failed to meet seven requirements made during previous inspections, which raises concern and questions as to whether the home is being managed appropriately. In addition there have been a number of new requirements made at this inspection which are of concern to CQC. We are considering enforcement action in relation to the previous repeat requirements that have not been met. The home sends customer surveys to people using the service. Copies of these were available in the care files. 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 out 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. We viewed the quality assurance folder, which has forms to monitor falls, visits to health care professionals, injuries, etc. While these forms were in place they have not been used. Staff told us that they have had staff meetings; records showed us that the staff team met on the 08/05/09, 03/06/09 and 05/08/09 to discuss issues around people using the service and the home. People using the service have met on the 20/07/09, 08/05/09 and 05/04/09 to discuss issues around the support, meals, activities and staff. There was a record of these meetings 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. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 29 We viewed a number of Health and Safety certificates during this inspection. The Landlord Gas certificate expires on 14/04/10, the Portable Appliance Test certificate expires on 07/06/10 and the electrical installation certificate is up to date. The home was seen to be recording regular water temperature checks however on the day of the inspection there was no hot water available in any of the bathrooms or en-suites.. The home has a maintenance agreement to service the fire system in place. Fire records such as drills, fire equipment, fire alarm and emergency lighting are in place and up to date. The home has a pro-forma to do Health and Safety audits in place, but forms have not been used and regular Health and Safety audits’ have not been undertaken. 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. 12 Tower House Road has been visited by the London Fire Emergency Planning Authority on 11/04/2008, during this visit the home was judged as to be suitable for the intended purpose. This visit was however prior to the refurbishment work has taken place. The home did not have a health and safety risk assessment available for inspection. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 3 2 X 3 2 2 2 STAFFING Standard No Score 27 3 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 31 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4&5 Requirement The responsible person must provide a detailed statement of purpose and service users guide, reflecting the actual care and service provided by Tower House II. This is to ensure current and prospective people using the service are issued with up to date information about the home. 2. OP2 5 The responsible person must ensure that all people using the service have a valid, up to date and signed contract in place. This ensures that people using the service are clear what care and support to expect from the home. 3. OP7 15 The registered provider must consult with the service user or their representative when drawing up and reviewing the service user plan. 23/01/10 15/12/09 Timescale for action 15/12/09 Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 32 Previous timescale of 31/08/09 not met. Enforcement action is being considered 4. OP7 13(4) The responsible person must provide clear guidance how people with mobility problems are supported safely. This ensures people using the service are protected by robust guidance and the risk of unnecessary falls are minimised. 5. OP8 23(2) The registered person must ensure that equipment provided to support people having a bath is working properly. This enables people using the service having a bath safely and comfortably. 6. OP9 13(2) The responsible person must ensure that all medication administered is signed for on the Medication Administration Sheet. This ensures medication administration records can be monitored and people using the service are administered the medication as prescribed. 7. OP9 13(2) The responsible person must ensure that only staff competent in the administration of medication administer. This ensures people using the service are protected from staff not being competent in medication administration. 8. OP10 23(2) The responsible person must 01/01/10 ensure that the bathroom door in DS0000068639.V378511.R01.S.doc Version 5.3 Page 33 01/10/10 01/01/10 01/10/10 01/01/10 Tower House II Residential Home bathroom 2 can be locked from the inside. This ensures people can use the bathroom in privacy. 9. OP11 15(1) The responsible person must address wishes of people using the service in case of illness and this must be in their care plans. This ensures people using the service are involved in decisions about their end of life care. 10. OP18 13(6) The responsible person must ensure that all staff employed have attended adult protection training. This ensures people using the service can be confident, that they can report abuse and appropriate actions will be taken. 11. OP19 24 The registered person must not admit people if they do not meet the conditions of registration. This ensures the home is fit to provide support and meet the needs of people using the service. 12. OP19 13(4) 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 Previous timescale of 30/09/08 and 31/08/09 not met. 13. OP21 23(2) The registered person must DS0000068639.V378511.R01.S.doc 01/01/10 01/01/10 15/12/09 01/01/10 01/01/10 Version 5.3 Page 34 Tower House II Residential Home replace the hot water indicator on the hand washbasin in bathroom 2. This ensures people using the service can use the hot water tap safely. 14. OP21 23(2) The registered person must ensure that hot water is available at any time for people using the service to use. This ensures people using the service can maintain the hygiene and the risk of infections are minimised. 15. OP24 23(2) The responsible person must ensure that the toilet flush handle in the en-suite bathroom in bed room 5 is repaired. This ensures people using the can use their en-suite facilities safely. 16. OP25 23(2) The responsible person must ensure that the temperature in communal and individual areas as constantly kept at an ideal temperature of 21˚Celcius. This ensures people using the service are comfortable in their environment. 17. OP26 23(2) The responsible person must ensure that the home is free of any offensive odours. This provides a comfortable and healthy environment for people using the service. 18. OP28 18(1) The responsible person must ensure that a minimum of 50 of care staff employed have or DS0000068639.V378511.R01.S.doc 15/12/09 15/12/09 15/12/09 01/01/10 01/04/10 Tower House II Residential Home Version 5.3 Page 35 work towards appropriate qualifications in care. This ensures people using the service are supported by staff qualified to do so. 19. OP29 19 The registered provider shall not employ a person to work at the care home unless they have obtained information and documents specified in paragraphs 1 to 9 of Schedule 2. Previous timescale of 30/09/08 and 31/08/09 not met. Enforcement action is being considered 20. OP30 18(1) The responsible person must ensure that staff receive appropriate training in manual handling, adult protection, Health and Safety, Food Hygiene and medication. This ensures people using the service can be confident that they are supported safely. 21. OP30 18(1) The responsible person must ensure that all fulltime staff receive a minimum of three paid training days per year. This ensures only staff appropriately trained provide support to people using the service. 22. OP31 36 The management of the home must ensure that requirements made by the Care Quality Commission (CQC) are complied with. DS0000068639.V378511.R01.S.doc 23/01/10 01/01/10 01/01/10 01/01/10 Tower House II Residential Home Version 5.3 Page 36 Failure to meet requirements may lead to enforcement actions taken out by the CQC. 23. OP33 24 The registered provider shall establish and implement a system for evaluating the quality of the services provided at the care home. Previous timescale of 31/03/08, 31/10/08 and 30/09/09 not met. Enforcement action is being considered 24. OP38 13(4) The registered provider shall ensure that all unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Previous timescale of 30/09/08 and 31/08/09 not met. Enforcement action is being considered 23/12/09 23/01/10 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 OP15 Good Practice Recommendations We recommend displaying the pictorial menu in the dinning area as supposed to the kitchen which is rarely accessed by people using the service. Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 37 2. OP18 We recommend that care staff and manager receive Mental Capacity training and Deprivation of Liberties training, to ensure they are aware which procedures to follow. We recommend providing paper towel dispensers, which are easier to use for people using the service. We recommend repairing the carpet in the lounge with a matching piece. We recommend positioning the chairs in the lounge more creatively, which would provide a more homely atmosphere. 2. 3. 4. OP19 OP20 OP20 Tower House II Residential Home DS0000068639.V378511.R01.S.doc Version 5.3 Page 38 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@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. 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