Inspection on 14/11/05 for Wellesley Road

This inspection was carried out on 14th November 2005.

CSCI 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 CSCI 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

Wellesley Road 17/10/07

Wellesley Road 23/08/06

Wellesley Road 30/07/05

Wellesley Road 22/11/04

Wellesley Road 27/05/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

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

CARE HOMES FOR OLDER PEOPLE Wellesley Road Wellesley Road 1 Wellesley Road London NW5 4PN Lead Inspector Ms Pippa Treadwell-Smith Unannounced Inspection 14th November 2005 10:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Wellesley Road Address Wellesley Road 1 Wellesley Road London NW5 4PN 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 7267 0856 020 7424 0999 williamskatherine@camden.gov.uk London Borough of Camden Ann Zita McCarry Care Home 48 Category(ies) of Dementia - over 65 years of age (48), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (48), Old age, not falling within any other category (48), Physical disability over 65 years of age (48) Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th July 2005 Brief Description of the Service: Wellesley Road is a care home providing personal care for up to 48 older people. The home caters for both male and female service users who are aged 65 years and older. The certificate of registration reflects that the staff are caring for people within the categories of dementia, mental disorder, old age and physical disability. The home not only provides long-term residential care but also three separate units for emergency admissions, respite and interim care. The permanent service users are accommodated on the ground floor and the three other services are on the first floor. The units are self contained and staffed separately. They are organised so as not to impact on the lives of the long stay service users. The owned is operated by Camden Council and has been registered under The Care Standards Act 2000. It is situated with good access to public transport, shops and community facilities. The home was purpose built about thirty years ago therefore not all the rooms sizes and corridor widths meet with the national minimum space standards. All the bedrooms are single occupancy however forty of them are slightly below the national minimum space standard and eight of them measure over twelve square meters. The home is three storeys high although accommodation for service users is on the first two floors only. A shaft lift gives access to the second floor; the third floor is not registered. Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day in November 2005 and lasted about 4 hours. The manager was interviewed and assisted with the inspection. The Inspector was able to look around the home and talk to service users and staff. A variety of records, including care plans, financial records and policies and procedures were looked at. What the service does well: What has improved since the last inspection? What they could do better: Areas where the home could be doing better were discussed with the manager and the service manager. Wellesley Road is located centrally in the area that it serves however the design and layout is out of date for the service users who require a care service. Although some work is planned, the building requires a significant investment in order to achieve a practical and comfortable environment for service users, particularly those with a physical disability. Each service user is subject to a detailed assessment to ensure that the limitations of the environment are not a hindrance. Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 6 More work is required to meet the cultural needs of the service users from ethnic minorities. In particular liaising with services who have been supporting the person in the community. There needs to a more formal approach to gaining the views of people who use the service in the home. 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. Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 7 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 Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 When people move into the home, there is an assessment to work out what they want and need so that the staff are able to meet these wishes and needs. EVIDENCE: A sample of care records was taken from each unit. In all cases there was an assessment from Care Managers under the Care Management Approach. This information had been translated into a plan of care. It is evident that the home is expected to accommodate service users with a housing need rather than a social care need in the emergency beds. This has caused some disruption in the home, which staff have had to manage. Just because a person is aged 65 years or over does not infer that they will be compatible with a home for older people. Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 9 & 10 Service users benefit from close attention paid by staff to meeting their health care needs. A more proactive approach is needed to meet all the needs of service users from an ethnic background. In order to ensure the safety of service users, only staff assessed as competent, administer medication. EVIDENCE: The care records of four service users were looked at. There is a care plan available for each person. The plan sets out the needs of each person although in one case, the practice in the home did not reflect the care plan. The care plan for a Chinese service user clearly stated that she preferred own cultural food but this was not actually happening. The home has reported several medication errors. There has been an internal investigation and a CSCI Pharmacy Inspector has done an inspection in the home. The manager has been proactive in implementing the requirements and recommendations from the pharmacy report. There is a policy on the administration of medication together with risk assessments in case service users choose to self-medicate. Staff are assessed as competent by the manager before they can administer medication. This assessment is via Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 10 practical observation as well as a questionnaire. Staff are subject to reassessment. They have access to information about the medication that service users are taking. The arrangements for privacy and dignity are set out in the service user guide as well as the home’s aims and objectives. The manager is also working on a philosophy of care for the home. Service users were very complimentary about the staff. A usual comment being that “The staff are great” and “The home is wonderful”. They said that they felt that their privacy and dignity were respected. They confirmed that doors are closed and curtains pulled when staff are attending to personal care. Service users said that they are known by their preferred name. Likes and dislikes are recorded in the care plan. Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 13, 14 & 15 Staff understand the therapeutic value of visitors for the service users. Service users are able to pick from a range of choices and follow their preferred lifestyle. The meals in the home are good offering both choice and variety. Special diets are provided for medical reasons but not always provided on an individual cultural needs. EVIDENCE: The home has a policy regarding visitors to the home. A visitor’s book is maintained in the main foyer and it shows that there is a steady stream of visitors to the home throughout the day and into the evening. Discussions with the service users highlighted that their visitors are made to feel welcome. The inspector was able to see visitors being greeted at the front door. There is an expectation that visitors are not disruptive to other service users nor have an impact on the running of the home. There is a notice board in the main foyer, which publicises what is happening to the home as well as displaying the latest inspection report. A look at the care plans showed that service user’s likes and dislikes are recorded. Discussions with staff highlighted that they know service user’s preferred routines. Service users are consulted on a day-to-day basis about Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 12 their choices. Although routines exist these can be flexible, to incorporate individual needs and preferences. Service users said that the food in the home was very good. The menus show that choices are available. The inspector observed staff are asking service users which alternative they preferred. As stated before a service user from an ethnic background was not receiving her cultural dietary preferences despite this being recorded in the care plan. Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18 Arrangements for protecting service users are satisfactory and keeping them safe from the possible risk of harm or abuse. EVIDENCE: The home has an adult protection policy and procedure, which is linked into the local procedures. The London Borough of Camden operates a rolling programme of training on adult protection. Discussions with staff highlighted that they had attended this training and had a good grasp of what constitutes abuse and what action should be taken. There are strict guidelines for handling service users’ monies and a thorough and robust recruitment and selection procedure. Staff attend training in respect of dementia and challenging behaviour, which enables staff to manage difficult situations with confidence. Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19 The appearance of this home is homely and comfortable; however there will need to be a significant investment in the home to ensure that it provides an attractive and safe environment to meet the needs of service users. EVIDENCE: Since the last inspection a new call bell system has been installed. This new system allows night care assistants to identify the person requesting assistance; and then to silence the system to prevent too much disruption to other service users. The inspector did receive written confirmation that carpets earmarked for replacement will be done next year. A point in case is the carpet in the main foyer. A new lift is to be installed and once this work is completed, the carpet can be renewed. The previous inspection report referred to the need to repair cracks in and the stairwell and a flaking ceiling in one of the dining rooms. There has been no movement in respect of either repair. It is understood that the cracks in the stairwell are subject to an ongoing investigation into a possible shift of the Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 15 foundations. As the inspector went around the home it became evident that although the quality of the furnishings and fittings are satisfactory that some are in need of replacement. The following areas were noted for attention: • The sliding door to the ground floor disabled toilet is very stiff and service users were unable to manage the door without assistance from staff. This toilet, although classified for disabled use, will not accommodate anyone requiring the assistance of two care staff. The bathroom containing the medic bath is being used as a storeroom. This reduces the number of bathrooms available for service users use; although a medic bath is not always suitable for older people. The crack in the ceiling of the first floor dining room still requires attention. The sluices on both floors require replacement, particularly the one on the ground floor, which has a very rusty surface. Room 40, the lock to the wardrobe door is broken Both the baths on the first floor need replacing as they are pitted and stained. The smoke room did not have curtains and an extractor fan is required. The smell of cigarette smoke was very evident in the corridor outside this room. • • • • • • The home is registered to accommodate service users with physical disablement however there are a limited number of bedrooms, which are of a suitable size. There are also very limited toilet facilities for disabled people. The assessment process must include whether the physical environment of the home is suitable. Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, & 30 Progress is being made to recruiting to vacant posts and establishing a team of well-trained staff who will offer consistency of care within the home. Service users are protected by the home’s recruitment and selection process. EVIDENCE: An inspection of the rota showed that staff are being deployed to meet the needs of the service users. Service users said that they did not feel hurried by staff when receiving personal care. The inspector observed staff spending time with service users. Up to 90 of the staff have achieved NVQ level 2 and some are progressing to the next level. A formal structure of supervision has been established in the home and appraisals are carried out. There is a training plan available and staff confirmed that they had access to relevant training. There is a thorough and robust recruitment and selection process, which is supported by a dedicated human resource department. Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33 & 35 The home is run by an experienced manager. Service users’ views are sought from time to time and acted upon locally but this is not done through a formal process. Service user’s finances are protected by the home’s policies and procedures but on occasions these safeguards are not used. EVIDENCE: The manager is eligible to apply for registration and will be submitting an application. Currently the manager has completed a one day training course in Care of Dementia, and undertaking the Registered Manager’s Award and already has NNEB Certificate in management. Service users are asked for their comments about the service they are receiving through reviews, meetings and comment cards. Feedback has not been actively sought from service users about the services provided through using anonymous user satisfaction questionnaires. The home has a policy on Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 18 handling service user’s personal finances. There is a secure facility for safekeeping monies and valuables and the manager is looking into purchasing individual safes for service users. All transactions are recorded. The policy is for two staff to witness each transaction. The records show debits, credits and balances, which offer an audit trail. Receipts are retained. The financial records did not have a list of staff’s initials and signatures. A look at a sample of records showed that there were not always two sets of initials by each transaction. Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 19 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 1 X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X X Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 20 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 OP19 Regulation 23(2)(b) Requirement The registered person is required to keep all parts of the home used or occupied by service users in a good state of repair. The areas requiring attention are listed in the main body of the report under Standard 19. This requirement is being restated in part. The registered person is required to provide meals to meet the cultural preferences of service users from ethnic minorities The registered persons must seek the views of service users, relatives and stakeholders as a means to reviewing the quality of the care in the home and the overall service. The registered person must ensure that there are two signatures to witness each financial transaction recorded on behalf of service users Timescale for action 30/03/06 2 OP15 16(2)(i) 31/12/05 3 OP33 24(1)(2) & (3) 30/03/05 4 OP35 17(2) – 9 10/12/05 Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 21 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 OP35 Good Practice Recommendations It is recommended that a list of staff’s names with their signatures and initials is maintained on the file used to record service user’s financial transactions. Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wellesley Road DS0000037326.V265562.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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