Inspection on 19/06/07 for Walm Lane Nursing Home

This inspection was carried out on 19th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Walm Lane Nursing Home 17/06/08

Walm Lane Nursing Home 28/06/06

Walm Lane Nursing Home 17/02/06

Walm Lane Nursing Home 29/09/05

Walm Lane Nursing Home 09/03/05

Walm Lane Nursing Home 06/01/05

Similar services:

Ashlong House

Norbury Crescent (30)

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Henry Nihill House

Birchwood

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

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

CARE HOME ADULTS 18-65 Walm Lane Nursing Home 141 Walm Lane London NW2 3AU Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 19 & 22nd June 2007 10:00 th DS0000022945.V341679.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000022945.V341679.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000022945.V341679.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walm Lane Nursing Home Address 141 Walm Lane London NW2 3AU 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 8450 8832 020 8830 7426 Ibexbrook Limited Amanoollah K Juhoor Care Home 21 Category(ies) of Past or present alcohol dependence (0), Past or registration, with number present alcohol dependence over 65 years of of places age (0), Past or present drug dependence (0), Past or present drug dependence over 65 years of age (0), Dementia (0), Dementia - over 65 years of age (0), Learning disability (0), Learning disability over 65 years of age (0), Old age, not falling within any other category (0), Physical disability (0), Physical disability over 65 years of age (0), Sensory impairment (0), Sensory Impairment over 65 years of age (0), Terminally ill (0), Terminally ill over 65 years of age (0) DS0000022945.V341679.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 21 persons over the age of 18 in need of nursing care. Date of last inspection 28th June 2006 Brief Description of the Service: 141 Walm Lane is a nursing home that provides accommodation to 21 adults over 18 years. At the time of this inspection there were 2 persons with older person care needs 17 young adults in the home. The primary care needs of the older adults are nursing and personal care and those of the younger adults are dementia, mental health and alcohol dependency. The home is a large detached building on three floors. It is located close to Cricklewood Broadway and Willesden Green with good access to a variety of shops and local amenities. The home is about 5-10 minutes walk from Willesden Green underground station and is easily accessible by buses which travel down Walm Lane. There is parking for about 3-4 cars in front of the home. Walm Lane and most of the surrounding areas contain resident parking or parking meters. There is also a small area with shrubs and bushes in the front of the home and a large garden at the back of the home accessible to all residents. Accommodation for residents is found on all three floors and a mezzanine floor in 17 single bedrooms and 2 double bedrooms. There is a shaft lift but the mezzanine floor is not served by the lift. The home currently has 3 bathrooms and one shower for the 21 residents. There are 4 bedrooms, no bath and 1 small toilet on the second floor. The home has a smoking room with a kitchenette facility. The communal areas are on the ground floor and consist of a main lounge/conservatory and dining area. The home charges £850-£900 for younger adults depending on the needs of the residents and £800 for older people again depending on the needs. DS0000022945.V341679.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains the findings of a key unannounced inspection. The inspection started on Tuesday 19th June at 10:00 until 15:30 and continued on Friday 22nd June from 10:00 until 13:30. The last inspection in the home was a random unannounced inspection on the 12th of January 2007. This followed on from the key unannounced inspection which took place on the 28th June 2006. The random inspection showed that progress was being achieved in the home with requirements which were imposed on the home during the key inspection in June 2006. This report will show that the service continues to improve. A significant number of requirements have been met, 3 remain to be met or have partially been met. To find out about the service that the home provides, I spoke to residents who live in the home, toured some of the premises, observed the interaction between staff and residents, looked at the personal care of residents and sampled records that are kept by the home. I am very grateful to all residents who shared their experiences of living in the home with me and to the manager and all his staff for their kind welcome and support during the inspection. What the service does well: One of the main assets to the home is the commitment of its staff to care for the residents who are accommodated in the home. The personal and health care needs of residents are generally met and care staff support residents in a sensitive manner while acknowledging their choices and wishes. The management of medicines in the home is of a good standard to ensure the safety of residents. Residents who are accommodated in the home have a comprehensive preadmission assessment before they are offered a place in the home. They are also offered the opportunity to visit the home and are provided with the information to decide if they want to live in the home. Residents can decide about the activities that they want to be involved in and they are supported by the activities coordinator and staff in these endeavours. Wholesome and homemade meals are provided to residents in the home according to their choices and tastes. The home provides a homely, clean and odour free environment for residents. Bedrooms of residents are personalised and homely. DS0000022945.V341679.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The service users’ guide needed to be updated to contain information about the range of fees charged by the home. The contract/statement of terms and conditions of the home with residents/representatives must also be reviewed to reflect recent changes in the Care Homes Regulations 2001. While residents/representatives are given the opportunity to be involved in drawing up their care plans and risk assessments according to their wishes, it is not clear when they would be involved again in reviewing the care plans and risk assessments. This could be clarified to ensure the continuous involvement of residents/representatives in the care of the residents. Residents have a number of risk assessments in place in their care records, but they do not always have a risk assessment with regards to them developing individual living skills such as when taking part in chores, preparing a meal or when going out. Risk assessments must also be carried out with regards to offering residents a key to their bedrooms by balancing their rights to privacy with the risks DS0000022945.V341679.R01.S.doc Version 5.2 Page 7 involved. The locks provided must be of a type that can be disabled by staff in the case of an emergency. Appropriate lancing devices must be used to draw blood for blood sugar monitoring for diabetics to prevent of cross-infection. The home provides accommodation for residents who have in the past misuse alcohol and were or are dependent on alcohol. There is little evidence of support to residents in this area. A number of organisations exist in Brent who may be able to offer some support to the home in addressing some of the issues of substance misuse and dependency as well as providing training for staff in getting a better understanding of the needs of residents in relation to substance misuse. Residents who are wheelchair users must have assessments about the wheelchairs, which are suitable for their needs and which would promote their independence. Residents who are able to propel themselves must ideally have wheelchairs designed for this purpose. Applicants must complete application forms which request for comprehensive information about them, about their work and education history and about making a declaration about criminal offences. Staff must be offered regular training to ensure that they are up to date with all statutory training such as manual handling and fire training. The home must have a quality management system in place. Once a satisfaction survey has been carried out a report must be prepared to summarise the findings of the survey. The home must have an up to date electrical wiring certificate. Risk assessment about the temperature of hot water at the outlets in washbasin must be comprehensive. Water temperature at the outlets of baths and the shower must be monitored regularly to ensure that the temperature always remains within safe levels. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000022945.V341679.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000022945.V341679.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with information and with the opportunity to choose if they want to live in the home. The home agrees to care for residents only after a preadmission assessment of the needs of the residents has been completed. EVIDENCE: All residents were provided with a copy of the service users’ guide (SUG), which was available in their bedrooms. The SUG was on the whole comprehensive but it does not contain information charged by the home as per Regulation 2(bb) of the Care Homes Regulations 2001, as amended in 2006. Care records showed that prospective residents have their needs assessed by the manager or his deputy prior to the home agreeing to take the residents. The information contained in the pre-admission assessment was comprehensive. The assessments of needs of the funding authority were also provided to the home as part of the admission process. I was informed that residents also have the opportunity to visit the home prior to admission and to ask questions and to meet staff and other residents. If they cannot visit then the relatives/representatives of the residents are encouraged to visit the home. DS0000022945.V341679.R01.S.doc Version 5.2 Page 10 Copies of the contract/statement of terms and conditions (the contract) were available in the SUG and there was evidence that residents were given these to sign to show that they have agreed to the contract. The contract was originally written in March 2004 and has not been reviewed since then. While generally comprehensive some sections needed to be updated/reviewed. For example the contract does not clarify what would happen if residents who have to pay a personal contribution to the home do not do so. Arrangements for dealing with the Free Nursing Care Contribution are not mentioned. The contract mentions that fees are subject to review from time to time but does not clarify when fees will be reviewed and in what circumstances. The term about the termination of a contract is mentioned but the circumstances when a contract can be terminated are not identified. Examples of such reasons could be: inability of the home to meet the needs of the residents, unreasonable behaviour of the residents or their relatives, failure to pay fees or contributions. The contract does not contain information about the provision of equipment such as pressure relief equipment and whose responsibility it is to provide the equipment. As a result of the above it is required that the contract/statement of terms and terms and conditions be reviewed. DS0000022945.V341679.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The standard of care records continue to improve but further improvement is required to ensure that any person reading the record will have a good understanding of the care required by the resident. Risk assessments are lacking in areas where residents are being encouraged to develop independent living skills to ensure that residents’ safety is not being compromised. EVIDENCE: Four care plans were inspected. They were all in good condition and kept safely in the managers’ office. It was noted that two of the four care plans did not contain an assessment of the needs of the residents and the review of these needs. The plans of care to address the needs of the residents were however comprehensive and clear with regards to the action to take to meet the needs of the residents. Review of care plans was detailed and carried out monthly. The review showed progress with meeting the aims and objectives of the plan of care and give a DS0000022945.V341679.R01.S.doc Version 5.2 Page 12 report of what is working and not working well. The deputy manager under the guidance of the manager has been leading on improving care records. Her work is commended. While there has been progress with the involvement of residents in their care records, it was noted that the care plans of some residents have not been reviewed with them for more than six months. It is recommended that the time scale when residents are consulted again about their care plans be clarified. This would confirm continuous involvement of the residents in their care records. Residents have key workers and there was evidence that some key workers were involved closely with monitoring and supporting the residents with their lives and the assistance that they may require. Regular entries were made in the case of one resident demonstrating the support provided by his key worker. Residents were observed in various areas of the home free to move within the home. Some were observed in the garden, some in the lounges and other stayed in their rooms. They have the opportunity to choose what they wanted to do during the course of the day and in what activities they wanted to be involved in. Risk assessments with regards to leading an independent lifestyle, while more comprehensive than previously, were still lacking. Residents normally are assessed as to whether they will be able to go back to the community one day and to live on their own or with support. For those residents who have been identified as possibly moving out of the home one day, there were no plans and risk assessments in place with regards to them developing individual living skills such as cooking, laundry, cleaning and shopping. There were no goals/targets that have been identified and that needed to be achieved within appropriate timescales before the residents would be seen as able to go back and live in the community. Some residents are able to go out on their own and it was noted that they informed staff when they go out. Risk assessments as to their safety and as to whether they are able to go out independently were however not in place. Other residents continue to use a kettle, microwave, iron and fridge. Again risk assessments must be in place for each resident in these cases. During the course of the inspection I observed one resident in a wheelchair with small wheels attempting to self propel by moving the small wheels with his hands. He moved from different areas of the home by carrying out this manoeuvre. It was quite clear that he needed an assessment with regards to an appropriate wheelchair for self-propelling which would promote his independence and dignity. DS0000022945.V341679.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered the opportunity to take part in social and recreational activities according to their needs to ensure that they lead a fulfilling life. While their choices and rights are promoted on most occasions, they do not receive a key to their bedrooms to promote their privacy and dignity. Residents are satisfied with the meals that are provided in the home. EVIDENCE: Progress has been made in assessing the recreational and social needs of residents and in compiling a life history of the residents. Once the needs of residents were identified plans were formulated addressing the needs of residents. The manager stated that staff in the home and he, have explored the opportunities available in the community for personal development. The activities coordinator was involved in organising activities for residents and a programme was in place, but the programme was flexible according to what residents wanted to do on the day. On the day of the inspection I was able to DS0000022945.V341679.R01.S.doc Version 5.2 Page 14 observe one-to-one interaction between residents and members of staff. Some residents also went out with the activities coordinator. Older residents in the home were also encouraged to come to the lounge and to engage with other residents and members of staff. They were mostly involved on a one-to-one basis. One of the residents who needed a seating assessment has been referred to the occupational services. This is good practice. An appropriate chair would offer the resident the opportunity to come out of his room in a chair. A number of residents are able to go out of the home. It was noted that the activities coordinator and members of staff support the residents who want to be more involved in the local community and to go out. They sometimes accompany residents outside the home to increase the confidence of the residents outside the home. The residents are able to go for walks, go to the local cafes and shops, which are found close to the home. At the time of the inspection, none of the residents were involved in attending training courses or were in work. I was informed that none of the residents wanted to do this. The manager and his staff are however aware that they may need to promote this strategy for new residents. The care records of a resident showed that he was supported in visiting his relatives and keeping contact with them. A few visitors were also observed in the home during the inspection. It was clear that the home promotes the involvement of relatives in the care of the residents and in maintaining a relationship with the resident. Visitors seemed to know the manager and his staff well. Care plans were in place to address the social relationship of residents. While the choices of residents were respected with regards to day-to-day issues, I spoke to two residents who said that they would have likes keys to their bedrooms, because they did not want people to go into their room when they were not in the home. The statement of purpose mentions on the first page, paragraph 12 that ‘your room is your own and that you will have your own key….’ and in the section on Privacy and Dignity that ‘..we will endeavour to retain as much of your privacy and dignity as possible by… providing a key for your room..’. Since residents were asking for the keys to their bedrooms, the registered person must consider providing these within a risk assessment context and if these are not appropriate for residents then clear records must be made as to the reasons why the keys cannot be offered to residents. Meals are served in the dining area, which is set to make the area pleasant and congenial. On the day of the inspection residents received lunch, which consisted of fish, potatoes and beans. Generous portions of the meals were served to residents. DS0000022945.V341679.R01.S.doc Version 5.2 Page 15 The home has a four weekly menu system. There was normally one choice identified for lunch. However all residents spoken to enjoyed the meals and they all said that if they did not want the main meal then they are offered another choice. Suppers are prepared by the care workers according to the individual choices of the residents, which are requested from residents and written down. The kitchen was in good order and tidy. All records as required by legislation were being maintained. The individual choices of residents were also maintained to show whether residents were eating appropriately. DS0000022945.V341679.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ personal and healthcare needs were in the main being met. There was little in place to evidence how the needs of residents with regards to alcohol dependency were being met. The management of medicines in the home is of a good standard to ensure the safety of residents. The end of life care of residents and residents’ aspirations and concerns for the future are managed in a sensitive manner by members of staff. EVIDENCE: Most residents appeared well cared for. This depended on individual residents who were offered the opportunity to make choices about their personal care. Personal care of residents is addressed in the care records of residents. Nursing care and personal care is provided in the privacy of the bedrooms of residents. While I was in the bedroom of one resident, one member of staff entered the room without knocking. The resident stated that this happens regularly. DS0000022945.V341679.R01.S.doc Version 5.2 Page 17 Residents are registered with a GP and there was evidence of the involvement of some other healthcare professionals in the care of the residents. Records were also kept as appropriate when healthcare professionals visited the home. The care plans of residents were generally clear about the management of the healthcare needs of residents. For example the care plans of residents who were epileptic were clear about how to manage the fits and when to administer prescribed medication to manage the fits. Similarly care plans for residents at risk of pressure ulcers were clear about the prevention of pressure ulcers. The home accommodates mostly people who have in the past misused alcohol and were dependent on alcohol. It was noted that staff have not had much training in understanding addiction and the issues with regards to substance misuse. More links could have also been made with agencies in the community who provide support and counselling for people who have or who have had an addiction to prevent relapse. Some of the organisations available in the local community are: Brent Drugs and Alcohol Team, Brent Community Alcohol Service, Brent Alcohol Counselling Services and Substance Misuse Management Project (a service provided by Brent PCT). One resident was however attending a Drug and Alcohol service, but the referral was made by his placing authority. A range of risk assessments is used by the home such as pressure sore risk assessment, falls risk assessment, nutrition risk assessment and manual handling risk assessment. While some of these may be valid for some residents, particularly older people, they may not be valid for all residents such as younger adults, whose main needs may relate to substance misuse or memory losses. It was suggested in the last random inspection that the home clarifies its procedure for the use of the risk assessments so that all nursing and care staff are clear about the risk assessments that need to be completed for individual residents and the criteria for determining the timescale for a review of these. The management of medicines in the home was inspected. Medicines were appropriately recorded when received in the home, when administered and when returned for destruction as necessary. A copy of prescriptions is also kept to supplement the audit trail of medicines. The medicines were stored in a medicines trolley and in a cabinet which are located in the manager’s office. Risk assessments were available for residents who receive medicines in an altered state. This is good practice. The home has at least one resident who was diabetic. It was noted that nurses were using a lancing device for self-testing when monitoring for the blood sugar level. To prevent cross infection the manager must ensure that a lancing device for professional use is available in the home for the testing of blood sugar levels in diabetic. DS0000022945.V341679.R01.S.doc Version 5.2 Page 18 The home has started to address the section about the future of residents. For younger people this may relate to the wishes, aspirations and concerns of the residents about the future and for others this may be about the wishes and instructions of residents about end of life care and death. The deputy manager and some care workers have attended training on end of life care. DS0000022945.V341679.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously by the home. There are safeguards in place to ensure the protection of residents. EVIDENCE: The home has received one complaint through a local authority about standards of care. This complaint has now been referred to the second stage of the local authority’s complaints procedure. The complaint procedure of the home is provided to all residents in the service users’ guide. Residents spoken to, said that they would approach the manager if they had any concerns. The manager is well known to all residents and visitors to the home. Staff were aware of the need to report any suspicions or allegations of abuse to the person in charge of the shift. There was evidence that staff have received training on abuse during induction and were booked to attend training provided by the Brent Local Authority. There have not been any allegations of abuse since the last inspection. The management of personal money of residents was checked. The proprietor is no longer a named person on the bank accounts of residents. In cases where residents are unable to manage their own finances, the relatives of the residents or the relevant placement authorities take responsibility for managing the personal money of the residents. The personal money for two DS0000022945.V341679.R01.S.doc Version 5.2 Page 20 residents was inspected. The balance of money kept in the home for each resident was accurate and receipts were kept for all expenditures. It was possible to audit trail individual expenses. Residents also signed when they are given money for personal expenditures. Overall the personal money of residents was being appropriately managed. DS0000022945.V341679.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26, 29 and 30. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The environment is appropriately maintained and decorated for the benefit of residents who are accommodated in the home. EVIDENCE: The home is found in a residential area of Willesden Green. There is parking for about 3-4 cars in the grounds in front of the home and parking on the road is restricted. The front areas of the home were adequately maintained. The exterior of the building was also in good condition. It was noted that the curtains in the bedroom in front of the home needed to be removed for laundering/washing, as they looked stained. The manager said that there were blinds in the room and that the curtains would be removed. There was evidence that redecoration of the home since the last inspection has taken place. I observed a workman decorating the reception area on the day of the inspection. Some corridors and bedrooms have been repainted, albeit all in the same colour. It was not clear what consultation was in place with regards DS0000022945.V341679.R01.S.doc Version 5.2 Page 22 to involving residents in choosing the colour scheme for their individual rooms and for the communal areas. For example, there was no discussion in residents meetings about the colour scheme that residents wanted for the home. There was some minor building work in the home at the time of the inspection. The new linen room was yet to be fully completed. Communal areas were appropriately decorated and furnished. There was a smoking room, which has been fitted with an air purifier and there was a opening in the ceiling for fresh air. The manager stated that the door to that room from the main communal area would be fitted with automatic closure before the 1st July when smoking legislation comes into force. As the time of the inspection that door was left opened. It was noted that there was appropriate number of armchairs, dining tables and chairs in the communal areas for residents. The bedrooms of residents continue to be personalised and were appropriately decorated. Residents were observed moving in different areas of the home. Some were seen in their bedrooms enjoying their own company while others were seen in the communal areas. A few were observed in the garden. The home does not offer bedrooms’ keys to residents (see section under Lifestyles). The home has 3 bathrooms spread over the home and a shower on the ground floor. As identified during the last inspection a number of toilets then did not have grab handles around them to assist residents with impaired mobility. Only the toilet on the ground floor has been fitted with grab handles and the toilets on the mezzanine toilet and the second floor were yet to be fitted with grab handles. Access to the laundry room is through the smoking room. Staff accessing these areas are likely to be in a cigarette smoke environment. Risk assessment must be carried out with regards to staff accessing the smoking areas either when attending to residents in the smoking area or when carrying out laundry duties. The linen room, which used to be on the ground floor, has been transferred to the mezzanine floor. This room has yet to be fully completed. Resident’ clothes are washed on the premises and all bed linen and towels are contracted to be laundered. It was observed that the clothes of a resident have been washed and left on his armchair. He said that care staff will be ironing his clothes later. The home has a sluicing disinfector and procedures were in place for the safe disposal of clinical waste and for medicines to be destroyed. DS0000022945.V341679.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides staff in adequate numbers to meet the needs of the residents. The recruitment procedure was adhered to most of the times for the safety of residents. Yearly updates of statutory training were not always provided regularly to ensure that all staff were up to date with training. EVIDENCE: Staffing during the morning shift consists of one nurse and four carers. There are one trained nurse and three carers from 14:00 20:00 and an extra carer from 14:00-18:00. The manager is supernumerary but will assist where required. He is also a trained nurse. Most of the staff have been in the home for some time and therefore they are familiar with the residents and provide a continuity of care to the residents. There is a chef from 08:00 to 14:00 seven days a week to prepare breakfast and lunch and care staff are responsible to prepare the supper. They are also responsible to do the laundry. Cleaning is the responsibility of the domestic workers. The activities coordinator works 16 hours a week and mostly during the main part of the day when most residents are awake. DS0000022945.V341679.R01.S.doc Version 5.2 Page 24 The personnel files of two members of staff were inspected. One was for a newly recruited trained nurse. It was noted that the application form used in this case was not comprehensive enough to include a full work history, education history of the applicant and a declaration with regards to whether the applicant had any criminal conviction. References and CRB checks were in place. There was however no evidence of a PIN check with the NMC. The applicants did not complete a medical questionnaire to provide information on their immunisation status. An induction form was produced to show that the new applicant has had an induction. The manager stated that he would use the common induction standards from skills for care as part of the induction of new carers. He added that 8 out of the 12 carers that the home employs have completed the NVQ level 2 and are waiting for their results and certificates. Some carers also confirmed that they have completed their NVQ portfolios, which have been sent for assessment. Although the home did not have 50 of care workers trained to NVQ level 2 yet, in principle the staff are nearly qualified. Therefore the standard was considered as met. The training that has been provided to staff in the home was assessed. It was noted that staff had received some statutory training, but not all of them have had yearly updates in manual handling and fire training. Following conversations with members of staff, I concluded that a lot of them would like to have more training in understanding addiction and substance misuse. As the home now provides accommodation for residents who have in the past misused substances such as alcohol, consideration must be given to providing this training to members of staff. There were dates recorded when staff have had supervision. On the whole there was an improvement with the frequency at which supervision was taking place and staff were on the whole receiving supervision once every two months. A policy on supervision was seen and the manager and his deputy were mostly responsible to carry out supervision. Progress achieved in this area is noted. DS0000022945.V341679.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39, 40 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is appropriately run by the proprietor and the manager to ensure that the aims and objectives of the service are met. A quality management system to evaluate the quality of the service is not yet in place to ensure continuous improvement of the service. Most health and safety issues are managed appropriately, but a few issues were noted which could put residents at risk. EVIDENCE: The home has been managed by Mr Juhoor for about 5 years. He is a trained nurse and he was in the process of completing the Registered Manager’s Award. He is closely supported by the proprietor, who deals with the physical aspects and the business side of the home. The manager is closely supported by his deputy who leads on clinical issues. DS0000022945.V341679.R01.S.doc Version 5.2 Page 26 There were minutes of staff meetings available for inspection and minutes of meetings with residents. Progress has been made with regards to involving members of staff and residents in making decision about the way the home is managed. Staff spoken to, were pleased that they were being more involved in deciding about the care of residents and as a result were able to take ownership for their actions and felt more valued as a member of the staff team. For example key workers were more involved with supporting their clients for whom they were key workers. A few requirements remain to be fully met by the home. It is the responsibility of the management team to ensure that these are met within the appropriate timescale as these are made under Care Homes Legislation. The home has in the past carried out satisfaction surveys but a report summarising the findings of the survey was not available. The service users’ guide mentions that the home would be using the Blue Cross Mark of Excellence quality system, but there was no evidence that this was in place. As a result the quality management system remains to be developed to ensure that the quality system is appropriate to monitor the quality of the service. The manager stated that the policies and procedures in the home have been reviewed according to appendix 3 of the National Minimum Standards for Younger Adults. It was however noted that there was no evidence that policies and procedures have been reviewed on a regular basis by the proprietor/manager. For example the health and safety procedure has not been reviewed since 2002 and the procedure for dealing with pressure sores have not been reviewed since 2001. The manager has been involved in carrying out risk assessments that were identified as lacking during past inspections. He has carried out a risk assessment residents’ access to fire doors, which are found in the bedrooms of residents. He has also carried out a general risk assessment of the hot water outlets in washbasins and has decided that there was no need for thermostatic valves at these outlets as the control measures that were in place were adequate to manage the level of risk posed to residents by the hot water from the taps. Inspection of one risk assessment mentioned that the water temperature must be within 42-43 degrees centigrade but it was not clear how this could be achieved without thermostatic valves. There was therefore a possibility to improve on the risk assessments. It was also noted that there was no regular monitoring of hot water temperature at the hot water outlets of bath and showers to ensure that the thermostatic valves fitted at these outlets were working properly. An up to date wiring certificate was still not available in the home. An electrical wiring inspection had revealed that some urgent work needed to be completed. DS0000022945.V341679.R01.S.doc Version 5.2 Page 27 This has not yet been completed and therefore a certificate for the safety of the electrical wiring system has not been issued. A Portable Appliances Test (PAT) certificate was available for inspection. A number of multi-way adaptors were noted in use in a number of residents’ bedrooms. Multi-way adaptors can overload an electric socket and cause overheating and fire. (Electrical safety, www.london-fire.gov.uk ). The proprietor must review the use of multi-way electric adaptors in the home with regards to the risk posed by these. A fire risk assessment was available for inspection and there was evidence of weekly fire detector checks and fire drills. Monthly emergency lights tests were also carried out regularly but a fire emergency plan was not available for inspection. There was a health and safety risk assessment in place. Residents who used the small kitchenette did not have individual risk assessments in their care records. Some residents in the home are wheelchair users. There was no evidence that their wheelchairs were regularly checked for safety and maintained. DS0000022945.V341679.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 3 28 X 29 2 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 3 3 3 x 2 3 x 2 x DS0000022945.V341679.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? 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 YA1 Regulation 5 Requirement The service users’ guide must contain information about the range of fees which are charged by the home to ensure that residents are fully aware of the financial costs of moving into a home. The contract/statement of terms and conditions of the home with residents/representatives must be reviewed to make it more comprehensive. The needs of residents must be comprehensively assessed and kept under review to ensure that all the needs of residents are comprehensively identified so that plans of care can be drawn up to meet the identified needs. That the time scale when residents are consulted about the review of care plans be clarified to ensure that they are continuously being involved in making decision about their care. The registered person must ensure that care plans and risk assessments address the DS0000022945.V341679.R01.S.doc Timescale for action 31/08/07 2 YA5 5 30/09/07 3 YA6 14 (1,2) 31/08/07 4 YA6 15 31/08/07 5 YA9 13(4) 31/08/07 Version 5.2 Page 30 promotion of the independence of residents, and the development of skills as identified by the assessment of needs while focusing on the safety of the resident and of others through appropriate risk assessments. Risk assessments must be formulated in relation to equipment used by residents in their own bedrooms such as kettles, irons etc. (Repeated requirementtimescale 31/04/06 and 30/09/06 not met) 6 YA9 14 That residents are assessed with regards to the wheelchairs that would be appropriate for their needs and which would promote their independence. That the registered person carries out risk assessments about the need to provide a key to the bedrooms of residents while carefully weighing the rights of the residents and the risks involved. The locks must be of a type that can be overridden by staff in cases of an emergency. That staff receive training in understanding substance misuse and addiction. To prevent cross infection the manager must ensure that a lancing device for professional use is available in the home for the testing of blood sugar levels in diabetic. The registered person must ensure that toilets are fully accessible to residents as per a risk assessment by ensuring that the appropriate physical aids are in place such as grab DS0000022945.V341679.R01.S.doc 31/08/07 7 YA16 YA26 12(4)(a) 31/08/07 8 9 YA19 YA35 YA19 18(c) 13(3) 31/10/07 31/08/07 10 YA29 23(2)(n) 31/08/07 Version 5.2 Page 31 11. YA34 17(1), sched 2 12. YA35 18(1)(c) 13. YA39 24(1) bars (Repeated requirementtimescale 30/10/06 partly met). All applicants who wish to work in the home must complete a comprehensive application form and must have a full work and education history. All staff must receive yearly updates in statutory training such as manual handling and fire training. The registered person must establish and maintain a system for evaluating the quality of the services provided in the home. Reports and actions plans must be formulated following satisfaction surveys (Repeated requirement-timescale 30/11/06 not met) That the risk assessments with regards to water temperatures at the outlets in the bedrooms of residents be made more comprehensive with regards to the control measures in place to manage the risks. Checks of the hot water temperature particularly at the hot water outlets in bathrooms and showers must be made at least monthly and these must be recorded. A copy of the electrical wiring certificate must be available for inspection to ensure the safety of the home with regards to the wiring system. Copies of this must be forwarded to the Harrow CSCI office. The proprietor must review the use of multi-way electric adaptors in the home with regards to the fire risk posed by DS0000022945.V341679.R01.S.doc 31/08/07 31/08/07 31/08/07 14. YA42 13(4) 31/08/07 15. YA42 13(4) 31/08/07 16 YA42 23(4) 31/07/07 Version 5.2 Page 32 these. 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 YA19 Good Practice Recommendations In order that residents needs are comprehensively assessed, the home should clarify its procedure for the use of the range of risk assessments in use in the home so that all nursing and care staff are clear about the risk assessments that need to be completed for individual residents and the criteria for determining the timescale for a review of these. That contact be made with organisations in the community to support residents with their needs in relation to addiction, alcohol dependency and substance misuse It is recommended that the home has a formal training and development plan for staff. Evidence must be kept to show that the policies and procedures in the home are kept under constant review to ensure that staff are always working according to best practice and changes in legislation. 2 3 4 YA19 YA35 YA40 DS0000022945.V341679.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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