CARE HOME ADULTS 18-65 3 Whiteheart Avenue Hillingdon Middlesex UB8 3EP
Lead Inspector Pauline Griffin Unannounced 6th May 2005 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 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 Stationary 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. 3 Whiteheart Avenue Version 1.10 Page 3 SERVICE INFORMATION
Name of service Whiteheart Avenue, 3 Address Hillingdon, Middlesex, UB8 3EP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 561 8098 Mr Koosraj Ramaya Unthiah Mr Koosraj Ramaya Unthiah Care Home 3 Category(ies) of Learning Disability (3) registration, with number of places 3 Whiteheart Avenue Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: YES. Only Service Users residing in the home prior to their 65th birthday may be accommodated after their 65th birthday. Date of last inspection 23/11/04 Brief Description of the Service: The home is a house in a quiet residential avenue about one mile from Uxbridge Town Centre. Public transport links to other neighbouring shopping centres are a short walk away. The home is registered for three adults with learning disabilities with an exception for those who pass the age of 65 and who have been residing in the home for a long period of time prior to this. The three Service Users are all male who have lived in the home since it was opened in 1988. The property is a bungalow that has been extended. It has a twin bedroom, a single bedroom, lounge and a kitchen/dining room. There is a staff team consisting of the Registered Person/Manager, the Deputy Manager (who is the wife of the Registered Person) and four part time staff. The three Service Users attend day centres five days per week and have a programme of activities for weekends and evenings. The Registered Person owns another home for two Service Users with learning disabilities in the same road. 3 Whiteheart Avenue Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and carried out as part of the regulatory process. The inspection was carried out over 6¾ hours during the course of one day. Two service users were interviewed with the Registered Person/Manager, the Deputy Manager and a care worker. The inspection included the examination of staff records, a service user file, policies, procedures, logs and maintenance records. A recorded programme of activities both inside and outside the home for the service users has been produced following the previous inspection when this was identified as a shortfall. The Social Worker responsible for the service users has re-assessed their day care needs and one service user is now attending a different day care service with favourable results. No 3 and No 27 Whiteheart are owned and managed by the Registered Persons, Mr and Mrs Unthiah. Both homes operate identical systems and use the same practices. The inspection reports for both homes reflect this and the outcomes for both homes are similar. What the service does well:
The staff team is stable and have a detailed knowledge of the service users and their needs. The staff team totals seven including the Registered Person/Manager and Deputy Manager. Three staff members have achieved NVQ level 4 in care management and one has completed the NVQ level 2. A further member of staff is studying for the NVQ level 2. The home maintains good recording systems and has a comprehensive set of policies that are used in supervision and training of staff. The home is comfortably furnished, clean and homely. 3 Whiteheart Avenue Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 3 Whiteheart Avenue Version 1.10 Page 7 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 Standards Statutory Requirements Identified During the Inspection 3 Whiteheart Avenue Version 1.10 Page 8 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 at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2 & 5. The home has had no new service users since it opened in 1988 but satisfactory procedures and assessment formats are in place that are appropriate for both prospective user’s or for the ongoing assessment of existing service users. EVIDENCE: The home has an individual folder for each service user that includes a Statement of Purpose, Service User Guide and a signed Contractual Agreement between the home and the Service user. Service users funded by the Local Authority have individual contracts in place. There is a health record for each service user with details of appointments with professionals and the outcomes. One service user had received new glasses following a bi-annual visit to the optician and commented on how much better he could see with them. One service user had visited a consultant at the hospital accompanied by the Deputy Manager on the day of the inspection. The service user indicated that the outcome of the consultation has been a positive one. 3 Whiteheart Avenue Version 1.10 Page 9 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 at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 & 9. Service users have opportunities to express their needs and preferences on the various aspects of their daily lives. Service users are risk assessed and monitored when making choices like making shopping trips and using public transport without an escort. Service users are assisted to stretch their abilities to help them to be more independent. EVIDENCE: Service user plans and assessments were comprehensive, up to date and well maintained. There are individual life skills charts noting what percentage of support from Staff is required for each everyday task attempted Service users have individual bank accounts. They are assisted to withdraw cash and spend their money with appropriate guidance from Staff. Staff Meetings include participation from service users and they have a separate fortnightly meeting with notes recording their comments and preferences regarding the service they receive. Each service user has a separate amount of cash available to spend and detailed records are kept of expenditure. One service user had chosen to go into Uxbridge unescorted, and showed great satisfaction at the prospect of this, and was proud to show the library book he had chosen from the public library when he returned.
3 Whiteheart Avenue Version 1.10 Page 10 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 at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,16 & 17 Service users have the opportunity to participate in activities that are appropriate to their age and cultural background. In addition, service users have the choice of a selection of popular and well-balanced meals. EVIDENCE: There is a four weekly chart of leisure activities for the group with a variety of choices. Each service user has a chart recording the activities they have carried out as an individual. All three-service users used their vote in the local/general election recently. Each service user has an individual chart of daily living skills that measures the level of assistance required. Service users receive regular health checks and have regular specialist assessments and treatment. Service users have the opportunity to attend a local place of worship of their choice. Meals include a selection of popular and well-balanced food that service users helped to choose.
3 Whiteheart Avenue Version 1.10 Page 11 One service user visits a local church and the group attend a monthly gathering in South all that has a religious basis but is also a social event. The activity book logs a recent visit to a pub for an St George’s Day celebration and a visit to the local Moorcroft School for a fete day. The menu includes a good selection of well-balanced meals and there is a record book of the meals served each day and a log when a service user chooses something different from the rest of the group. There was a selection of fresh fruit in the kitchen in a fruit bowl and good stocks of food in the cupboards and refrigerator. 3 Whiteheart Avenue Version 1.10 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 &21 The healthcare needs of the service users are identified and met. Systems are in place to review and assess the service users’ physical and emotional health needs including specialist needs. Service users’ have access to health services and specialist health care services. The home has a satisfactory policy on the aging process and care of the dying. EVIDENCE: Service users have an annual health check and monthly assessment via the care plan. The home has adopted ‘person centred’ planning that includes health care and staff have received training for the Local Authority in this approach to assessment. Health checks and specialist appointments are logged in the individual service user’s file in a separate section. A range of routine health care appointments was recorded as well as specialist appointments with consultants. There is a satisfactory policy and procedure on the aging process and care of the dying that includes a section on counselling other service users in the home following a death. There is a notification for funeral arrangements and religious observations that is signed by the service user and a note as to whether the next of kin has been informed. 3 Whiteheart Avenue Version 1.10 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 The home has a satisfactory complaints policy that is included in the service user Guide. The home has it’s policy on Equal Opportunities on display on the staff noticeboard that includes abuse and the forms it can take. Staff receive information on Adult Protection through supervision and training. The home has satisfactory arrangements for handling service user’s finances. EVIDENCE: The home has not received any direct complaints in the previous 12 month period. A complaint was received by the Commission for Social Care Inspection (CSCI) in November 2004 that was investigated and completed. The home has applied to the Hillingdon Advocacy Project to obtain independent advocates for the service users who do not already an advocate. The home has a clear policy on the protection of vulnerable adults (POVA) and the Registered person/Manager has recently attended a training course run by the Local Authority. The home also has a ‘Whistleblowing’ policy and the member of staff spoken to at the time of the inspection was familiar with it. One service user was complaining of being ‘pushed’ by others at the Day Centre and said he did not like it. This information has been passed to the Registered Individual and the Placing Authority (London Borough of Hillingdon). The home has a financial recording system for each service user that tracks withdrawals and expenditure. Cash is kept separately for each individual in a
3 Whiteheart Avenue Version 1.10 Page 14 locked cash box. Cash held in separate purses for each service user tallied with the written records. 3 Whiteheart Avenue Version 1.10 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,26,27,29 &30 The furnishings in the home have been reviewed and updated since the last inspection. An Occupational Therapist had made an assessment in the bathroom and provided some further equipment to ensure safety. There was no odour in the home and the smell of dampness noted in the previous inspection had been dealt with. The service users benefit from living in an homely environment that is comfortably furnished. EVIDENCE: A tour of the premises confirmed that all the issues identified in the previous inspection had been addressed. There was evidence that the service users had chosen items themselves for their bedrooms. The bathroom has been assessed by an Occupational Therapist and the equipment provided is suitable for service users with mobility problems. A builder had advised the Registered Person on the damp odour noted in the previous inspection and had assisted in eradicating it. The home was clean and tidy throughout. 3 Whiteheart Avenue Version 1.10 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34 &35 The service users benefit from a well trained staff team who receive regular supervision sessions with the Registered person/Manager. EVIDENCE: The Registered person/Manager and the Deputy Manager have completed the NVQ level 4. Both come from nursing backgrounds and have nursing qualifications. Three of the remaining four Staff have achieved NVQ level 2 and one of those has now achieved NVQ level 4. Staff have received training in mandatory subjects like, food hygiene, moving and handling and first aid and are awaiting (or have already received) update training which has been booked for them. The home has a full set of policies produced to comply with the Care Homes Regulations. Staff sign and date a log book to confirm that they have read and understood each policy. The Registered person uses the Code of Practice of the General Social Care Council in supervision to familiarise staff with the National Minimum Standards for Care Homes for Adults. The home has good recruitment procedures and the staff file examined was complete and satisfactory. Staff receive one to one supervision with the Registered Person every eight weeks and this is recorded, signed and dated.
3 Whiteheart Avenue Version 1.10 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38,39 & 42 The Registered person/Manager has taken training provided by the Local Authority in Person Centred Planning that focuses on the needs of the service user. Service users benefit from the heightened awareness in the management and Staff team of the need to ensure it is run in the service users’ best interests. EVIDENCE: The home operates Person Centred Planning and updates each Care Plan at three monthly intervals or more often if the situation requires it. Person Centred Planning uses an holistic approach when assessing the needs of service users. Service users are invited to contribute to these assessments. Service users are also invited to contribute at the monthly Staff Meetings. The home has produced some formats for quality monitoring but these are not adequate to produce a measurement of the service provided. The quality assurance programme needs to be reviewed to include all available input from 3 Whiteheart Avenue Version 1.10 Page 18 service users, their family, representatives, advocates and professionals connected with the service users and the home. The home has up to date records of all the checks made to the facilities by accredited agencies on things like the gas boiler, water, fire equipment and electrical appliances. Risk assessments made were comprehensive and up to date. Staff have attended moving and handling training updates and have regular fire drills. The home maintains records of weekly water temperature checks and daily fridge and freezer readings. The home’s Health and Safety Policy is included in the Staff Handbook. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x 3 Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 24 25 26
Version 1.10 Score 3 x 3
Page 19 3 Whiteheart Avenue Standard No 6 7 8 9 10
LIFESTYLES Score x 3 3 3 x
Score 27 28 29 30
STAFFING 3 x 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 x 3 Standard No 37 38 39 40 41 42 43 Score x 3 2 x x 3 x 3 Whiteheart Avenue Version 1.10 Page 20 no 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. Standard Regulation Requirement Timescale for action 23/05/05 1 23 121)(a)13 (6) Service Users must be protected from incidents of abuse and action taken and recorded. 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 39 Good Practice Recommendations The system for quality monitoring should be reviewed to include all the elements of the Standard. The system should be based on seeking the views of the Service Users and their representatives and used to measure and improve the service provided. 3 Whiteheart Avenue Version 1.10 Page 21 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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