Care Home: 237 Kenton Road

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What the care home does well We found that the care home has a welcoming atmosphere. People living in the home indicated that they were happy living in 237 Kenton Road. There were signs of ‘well being’ exhibited by residents. We were told that residents participate in everyday living tasks to ensure that they keep and/or develop their skills in carrying out household duties and other activities. The resident’s bedrooms are individually personalised, and people using the service told us that they were happy with their bedrooms. Care staff are motivated, and care about providing a quality service to residents. The home provides varied and appropriate training for staff to ensure that they are competent to carry out their roles and responsibilities in providing care and support to people using the service. Residents’ contact with relatives and others (as agreed by the residents) is fully supported and enabled by the care home. The home has an attractive accessible garden facility, which is well maintained. What has improved since the last inspection? Several care plans of people using the service have been developed so that they are more ‘person centred’ (where it is evident that the person using the service is central to and takes a lead in their plan of care), and the information is more accessible to staff, and residents. There have been recent improvements made to the environment of the home. Several areas of the home have been repainted or are in the process of being redecorated. We were told that prior to the manager being appointed there had been a period of time, where the quality of the service had declined, and staff morale was rather low. Since being in post the registered manager has (and continues to) worked hard to ensure that developments and improvements are made to service provided by 237 Kenton Road. Feedback from staff told us that the atmosphere, staff team work and morale has improved considerably at 237 Kenton Road. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 What the care home could do better: The process of updating the care plans should be completed, and it could be more evident that people using the service have their care plan, and any review of it, explained/read to them if they are unable to read or have significant communication and/or sensory needs. There could be further development and improvement in the format of some records (i.e. service user guide, menu on the top unit, some policies/procedures that might be of particular relevance or of interest to people using the service), to improve the accessibility of information to residents who might have difficulty in reading, or who have English as a second language, or have visual sensory needs. There could be further improvements made with regard to the environment of the home. Some areas in the home (including bathrooms) could be redecorated, and some carpets (including some resident’s carpets) could be cleaned or replaced. Some maintenance issues should be attended to. The care home should have access to a computer, with access to the internet to ensure that the manager and other staff are able to communicate more effectively and efficiently with stakeholders and others, as well as be more able to carry out a number of tasks, such as record keeping more effectively, and be able to seek relevant up to date information to continue to improve and develop the service. Key inspection report CARE HOME ADULTS 18-65 237 Kenton Road 237 Kenton Road Kenton Harrow Middx HA3 0HQ Lead Inspector Judith Brindle Key Unannounced Inspection 8th December 2009 08:25 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service 237 Kenton Road Address 237 Kenton Road Kenton Harrow Middx HA3 0HQ 020 8907 6953 020 8907 2896 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) www.caretech-uk.com CareTech Community Services Ltd Keith Parkes Care Home 12 Category(ies) of Learning disability (12) registration, with number of places 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 12 16th January 2007 Date of last inspection Brief Description of the Service: 237 Kenton Road is a care home providing personal care, and accommodation for 12 people who have a learning disability. Care Tech Community Service Limited owns the care home. The home is separated into two parts. There is accommodation for six residents on the ground floor unit, and accommodation for six residents on the first floor unit of 237 Kenton Road. Each unit is self-contained, with separate entrances. The bedrooms are all single, and each unit has its own communal space, toilet, bathing facilities, kitchen, and office. The home is located in Kenton, within a few minutes drive from Harrow and Kingsbury. It is close to a variety of shops, restaurants, pubs, a post office and other amenities. There are bus and train public transport facilities located close to the home, and there is parking for several vehicles on the forecourt of the premises. Information and documentation about the service provided by 237 Kenton Road, and details of the fees, can be obtained from the registered manager. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means the people who use this service experience good quality outcomes. The key unannounced inspection took place throughout a day in December 2009. There were two vacancies on the ground floor unit. There has been a change of manager since the previous key inspection (16th January 2007). The current manager has been in post for approximately a year. The key unannounced inspection focussed on spending a significant period of time with people living in the care home, talking with them, and observing interaction between residents and staff. We also looked for signs of ‘well being’ with regard to the people living in the care home. Several of the people using the service, due to their varied needs have significant communication needs, and are unable to respond to questions other than to a limited degree, so observation was a particularly significant tool used in this inspection. Documentation we looked at included resident’s care plans, risk assessments, staff training records, and some policies and procedures. We also considered the previous key inspection report, and the annual service reviews of the service that have been carried out by us. We were pleased to speak to several residents and staff during the inspection. Staff were very helpful in supplying all the documentation, and information that was requested by us. The inspection included a tour of both the ground floor and first floor units of 237 Kenton Road. Prior to this unannounced key inspection the manager supplied the Care Quality Commission with a comprehensively completed Annual Quality Assurance Assessment (AQAA). This document includes required information from the owner and/or manager about the quality of the care home, and any plans to improve the service provided to people. All sections of this document were comprehensively completed. Reference to some aspects of this AQAA record will be documented in this report. Prior to the key unannounced inspection, we received three feedback surveys from relatives/significant others about the service provided by 237 Kenton Road. Some information from these surveys will be included in this report. Other information about the service received by the Care Quality Commission (CQC) since the previous key inspection was also looked at. This included what the service has told us about things that have happened in the care home. These are called notifications, and are a legal requirement. 25 National Minimum Standards including key standards were assessed at the time of this inspection. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 6 The registered manager was present during most of the inspection. We thank all the people living in the care home, the staff, and those that provided feedback about the home, for their assistance in the inspection process. What the service does well: What has improved since the last inspection? Several care plans of people using the service have been developed so that they are more ‘person centred’ (where it is evident that the person using the service is central to and takes a lead in their plan of care), and the information is more accessible to staff, and residents. There have been recent improvements made to the environment of the home. Several areas of the home have been repainted or are in the process of being redecorated. We were told that prior to the manager being appointed there had been a period of time, where the quality of the service had declined, and staff morale was rather low. Since being in post the registered manager has (and continues to) worked hard to ensure that developments and improvements are made to service provided by 237 Kenton Road. Feedback from staff told us that the atmosphere, staff team work and morale has improved considerably at 237 Kenton Road. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 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 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 1 and 3 were looked at. People who may use the service and their representatives have the information needed to decide whether the home will meet their needs. People using the service have their needs assessed prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need. EVIDENCE: The care home has a statement of purpose, and a service user guide, which have been reviewed this year. These documents provide information about the service provided to people living in 237 Kenton Road. The statement of purpose was looked at. It was comprehensive, and gave prospective residents the information that they need, to make an informed choice about whether the care home could meet their needs. The ‘service user’ guide documentation was ‘personalised’ (i.e. it included a picture of each person using the service, and the name of their key worker) as well as including other information about the service provided by the care home. The format of the service user guide could be further developed to improve its accessibility to people using the service (and to others), who are 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 10 unable to see, and or have difficulty reading. The manager told us that he had plans to develop an audio version of the service user guide. Other formats could be looked at as well. The resident’s care plan files included a copy of both documents. We were informed by the AQAA (Annual Quality Assurance Assessment) that the care home has a referral and admission policy, and that ‘Care Tech have a well established assessment and placement process, which ensures that each placement is appropriate for the individual’. We were also told that during the process of initial assessment the ‘vews of the service user, family and any other carers are sought’. We were informed that prospective residents are supported, and encouraged to visit the home prior to moving in, and that ‘a transition plan will be put in to place following this, to assist the service user’ in the process of admission to 237 Kenton Road. The AQAA also told us that ‘after admission, a review (with a care manager and family) will be held after six weeks, to assess’ the resident’s progress. We were told that people using the service have the opportunity to ‘talk with staff, and discuss any issues of concern’ and ‘talk-time is held monthly with the service user, to ascertain whether they are comfortable, happy or have any concerns’. There have been no recent admissions to the care home, but it was evident from looking at records, and talking to the manager that a comprehensive assessment of the prospective resident is carried out by the funding/placing Local Authority, as well as by staff from 237 Kenton Road. The manager told us that he is fully involved in the assessment of prospective residents, and that compatibility with the residents was a very important issue with regard to the process of admitting people to the home. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. National Minimum Standards 6, 7 and 9 were looked at. People using the service have an individual plan of their needs, which includes details of the care and support that they require from staff. People using the service are supported, and encouraged to make decisions and choices about their lives, and are supported to take risks as part of an independent lifestyle. EVIDENCE: Each person using the service has a plan of care. Five care plans were looked at. These included care plans recorded in the ‘new’ person centred format, and those that had not yet been updated. The ‘new’ care plans include some large pictures and diagrams about each person’s life and wishes, and are based upon the assessment of the persons needs. The care plans varied in content, but generally included information about the person’s personal care, health care, 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 12 continence management, behaviour, and financial needs. Each of these needs included detailed staff guidance with regard to meeting the persons goals/needs and aspirations. There could be possibly further development with regard to identifying and meeting people’s equality and diversity needs. The care plans were up to date, and included some evidence of being ‘working documents, so updated when the persons needs change and/or they have achieved planned goals. Some information in the care plans was not dated and it wasn’t always clear who had written it. It could be more evident in the care plans that the content had been explained to and/or read to people using the service who have difficulty in reading, or have a visual impairment, and or have significant communication needs. The care plans looked at had been regularly reviewed. We noted that, generally a comprehensive review is carried out every six months, and that monthly reviews also take place. It was not evident from a monthly summary record as to who had completed the record, and whether the resident had been aware of and/or had participated in that review of their needs. We were told from the AQAA that people using the service do fully participate in the monthly ‘talk time’ but this was not always evident in records that were looked at. The AQAA told us that ‘service users are encouraged to take part in preparing for their reviews, and where possible, their views and concerns are recorded and discussed’, that ‘all are invited to attend their own reviews, though some choose not to,’ and that ‘this applies to both their annual whole life review, and internal six month review’. We were informed that some relatives/advocates participate in process of reviewing their friends/relative’s care plans. The staff should sign that they had read the care plan and review documentation. Staff told us that they had knowledge and understanding of resident’s care plans, and participated in updating them. Two residents indicated that they knew the name of their key worker, and confirmed that their key worker supported them with shopping and other activities. Staff spoke positively of their key working role. Residents confirmed that they made choices. These include shopping for clothes, toiletries, food, times of getting up and going to bed, and choosing preferred activities. AQAA told us that ‘objects of reference’ were used to support people using the service to make choices and to communicate. We were given examples such as giving a resident ‘their bag to indicate going to daycare’, and ‘handing a spoon to a visually impaired lady to indicate a meal is ready’. It was evident that residents are supported to make decisions about their lives. We were told that resident meetings take place regularly. Most residents were dressed appropriately, but one resident (living on the top floor unit) was seen to be wearing a cardigan which was frayed at the edge and had a button missing. Staff should ensure that they support residents to always dress appropriately in clothes that do not need repair, bearing in mind how they would themselves like to be dressed. We were told that a person using the service has an advocate. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 13 The care home has a management of residents monies policy/procedure. We were told that all the people using the service have support with managing their finances. Records told us that appropriate records of resident’s income and expenditure are maintained and we were informed that staff check residents monies and records everyday. There was evidence of risk assessment documented in the care plans. These support people to take risks, so able to lead as independent life as possible, and included; road safety, bathing, kitchen, swine flu, aromatherapy, unpredictable behaviour, and car safety. Records showed that they are reviewed. As recorded above, it could be more evident that residents participate in, and are aware of these risk assessments. The AQAA told us that ‘service users are encouraged to take risks as part of everyday life, helped by staff who will discuss any issues with them’. Risk assessments in regard to safe working practices were also available for inspection. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 14 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): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. National Minimum Standards 12, 13,14,15,16 and 17 were looked at. People who use the service are able to make choices about their lifestyle, and are supported to develop their life skills, and to take part in a variety of activities that meet their individual needs. The people living in the care home have their rights respected, and their responsibilities are recognised in their daily lives. Meals are varied, and wholesome. The menu information located in the upper unit of the home could be more accessible to residents. EVIDENCE: We saw information recorded in the care plans about each persons weekly activities. This information was in picture and written format. Some people using the service attended a day resource centre during the inspection. We were told that most residents spend two or three days at this centre. A resident confirmed that she liked going to it. Other activities that residents 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 15 participated in during the inspection were, throwing and catching a ball, an exercise session, watching television, helping to make a hot drink and a resident helped tidy her bedroom. Some residents also had an aromatherapy session. Residents seemed to enjoy these activities, interacting positively (i.e. laughing at times) with the staff and other residents. The AQAA informed us that ‘as there is a high level of visual impairment on the ground floor unit, we have started to purchase noisy games and instruments, and will continue to do so when weve identified what is appropriate’ for people using the service. Staff told us that residents had had holidays and taken part in day trips this year. We were also informed about other activities that people using the service took part in. These include; attending church, food shopping, getting their hair ‘done’, listening to music and visiting relatives. A resident told us that she enjoyed shopping for clothes and jewellery, and liked having her nails manicured. Staff told us that a Christmas party for all the residents and their (family members/others) had been planned. Residents indicated that they were looking forward to the event. A person using the service told us about another resident’s recent birthday party. The AQAA told us that ‘one service user has expressed a desire to see whether he would be able to do voluntary, or even paid work, and is currently attending Choices 4All and also is ‘being supported by Mencap in this aim’. This person attended an interview during the inspection. Staff told us of the everyday living activities, that residents took part in, with regard to the running of the home. The care plans looked at recorded the activities that each person liked, and what made them happy. We were told that due to staffing numbers the opportunity for residents to take part in one to one activities particularly at weekends was rather limited, particularly ‘upstairs’ as if a staff member went out with one resident it left five residents with one staff member, which was not always assessed as safe. The manager told us that staffing numbers can be used flexibly to enable people using the service to participate in community activities. He gave us the example of him working an evening shift to enable some residents to attend a club. The number and variety of activities/leisure pursuits were recorded in the monthly summary records. Feedback from a relative/advocate of a resident told us that activities for residents could ‘improve’, and that the home could ‘arrange more social outings’. The AQAA told us that the home could ‘develop more activities especially outside the house’. It could be of benefit to residents to have access to a computer, with internet connection. The AQAA told us that this would enable residents to contact family and friends by email. The manager told us that he had taken action to ensure that two residents were each provided with a wheelchair to meet their mobility needs and to ensure that they can more easily participate in community based activities. This is positive. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 16 We were told that both units have regular residents meetings at which they can ‘express choices and receive information, but are centred around menu planning’. Minutes of the meetings are recorded. Staff told us about how people using the service are supported to develop personal relationships, which includes enabling people using the service to access professional advice, education, and support in this area. We looked at the visitor’s book. This indicated that there were a number of people who visited the care home. Staff, records and feedback from the relatives/significant others/advocates of people using the service, told us that resident’s contact with them is promoted (if the resident agrees) and supported by the home. There was information about advocacy that was displayed in the home. Feedback from relatives/advocates of people using the service were positive about the service provided to residents. They told us that they are given enough information about the care service to help them make decisions, the home meets the needs of their relative/friend, they are kept informed of important issues affecting their friend/relative, the home responds to the different needs of people, supports people to live the life that they choose, staff usually have the right skills and experience to look after people properly, and they know how to make a complaint. Comments included ‘my (relative’s) care is good’, ‘we feel that (their relative) is being very well cared for’, ‘we are happy with how the staff are looking after (their relative’s) needs and recreation’, ‘the staff are very warm and caring and the premises are very clean’, and ‘care is very good’. AQAA, and the care plans we looked at told us that each person using the service has their nutritional and dietary needs assessed. Specialist dietary needs were recorded and understood by staff. We were informed that residents tell staff what they want to eat on a weekly basis during a resident meeting. Staff told us about how they gain an understanding of the food preferences of people who cannot verbally say what they would like to eat. This includes talking to relatives, offering choice, and noting when residents leave certain foods. Both the first floor and ground floor unit had a menu. The ground floor unit had meals recorded in picture format. The format of the upstairs menu should be developed so that the information is accessible to residents who have difficulty in reading. The menus indicated that the food provided to people using the service was varied, wholesome and nutritious. Lunch during the inspection were unhurried and staff assisted residents with their meal in a sensitive manner. Drinks were offered regularly during the inspection and staff responded positively when residents asked for a drink. A resident kindly helped a staff member to make cup of coffee for me. Food eaten by residents is recorded. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. National Minimum Standards 18, 19 and 20 were looked at. The health and personal care that people receive is based on their individual needs, and the principles of respect, dignity, and privacy are put into practice. Systems are in place to ensure that medication is stored, and administered safely to people using the service. EVIDENCE: It was evident from talking with staff, residents, general observation, and from looking at records that staff have knowledge, and understanding of the importance of ensuring that the residents have their personal care and health care needs assessed and met. The AQAA told us that residents are involved in decisions about their care; ‘female service users have a preference for female carers to provide personal care, so male staff do not provide such care’. The care plans that were looked at; included up to date Health Action Plans of each person (My Keeping Healthy), which are specific to each resident and have clear guidance to maintain and monitor their health needs. These were in 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 18 picture and written format, and had been signed by the manager. It could be more evident that residents have been informed of these plans. Treatment/care provided to residents from health care professionals (including the GP, dentist, chiropodist, psychiatrist, and optician), was recorded. Attendance at specialist clinics and hospitals appointments was also documented. We were told that advice was sought as and when required from health and social care professionals, and referrals were made in accordance to residents needs, and their changing needs. The AQAA told us of that residents are supported to lead a healthy lifestyle Records told us that the home had guidance in place with regard to minimising the risk of, and responding to a possible outbreak of swine flu in the home. The home has a medication policy. We were told that all the people using the service require support with taking their prescribed medication. Medication is stored securely. Medication administration records were up to date, and there were no gaps in recording. Staff and records informed us that all staff receive comprehensive medication training when they start their job, and prior to staff administering medication to people using the service, they receive an assessment of their competency to administer medication. This includes gaining evidence that staff have knowledge of the medication policy, and of the medication that people using the service are prescribed. A staff member told us that external and ‘in house’ medication training ensured that they felt confident, and were skilled to administer medication to people using the service. We were told by staff and records that staff receive refresher medication training regularly, and are monitored ‘every six months’ with regard to administrating medication to residents. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. National Minimum Standards 22 and 23 were looked at. People who use the service, have access to an effective, robust complaints procedure, and are protected from abuse, and have their rights protected. EVIDENCE: The care home has a complaints procedure. A summary of which is recorded in the service user guide. The complaint procedure is recorded in written format, and includes some pictures. The format could be further developed (i.e. audio, DVD, or primarily in picture format) to ensure that it is more accessible to people using the service, particularly those who have a visual impairment or have difficulty in reading. There was one recorded complaint. It was evident that this had been responded appropriately. The home has clear and robust policies and procedures with regard to the protection of people using the service, including the lead Local Authority safeguarding guidance. AQAA told us that the home could ‘continue to explore ways of communicating adult protection issues to service users with complex communication needs, such as audio tapes’. This would be positive. Staff and records told us that staff had received training in safeguarding adults. Staff who spoke with us were aware of what to do if they are told of an allegation of abuse or had a suspicion that abuse has occurred. We were told that that safeguarding adults training is also included in the staff induction programme, and in the National Vocational Qualification (NVQ) level 2 in health 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 20 and care, which most staff have achieved or are in the process of achieving. The AQAA told us that there have been no safeguarding referrals within the last twelve months. The home lets us know about notifiable incidents/accidents, and records them appropriately. AQAA told us that the home has policies/procedures with regard to counter bullying, dealing with violence and aggression, equal opportunities, diversity, and anti-oppressive practice, and whistle blowing. The care plans looked at included clear guidance with regard to meeting the needs of people using the service who could on occasions challenge the service. We noted that the home has up to date information with regard to the Mental Capacity Act 2005/Deprivation of Liberty safeguards. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. National Minimum Standards 24, 26, and 30 were looked at. The layout of the home enables residents to live in a clean, safe, well maintained, and comfortable environment, which supports and encourages their independence. There are areas of the home that could be redecorated/better maintained. Residents bedrooms, meet their individual needs, and are individually personalised. EVIDENCE: The home is located in Kenton and is close to Harrow, and Kingsbury. The house is within walking distance of a variety of community facilities and amenities, which include shops, a large supermarket, restaurants, cafes, a post office, banks and parks. The care home is a large detached house, which is divided into two separate parts, both managed by the registered manager, but run as separate units. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 22 We were told by the AQAA and staff that the home has had significant redecoration and maintenance carried out recently. The upper part of the home was having the kitchen painted at the time of the inspection. The AQAA gave us examples of improvements to the environment that have been made. These include; six bedrooms having been redecorated , ‘five to the colour choice of the service user, the other being a vacant room prepared for potential new service user’. We were also told that the ground floor kitchen and dining room have been completely refurbished and redecorated, with ‘all the equipment, flooring, cupboards, and furniture replaced’, and that ‘new seating for the ground floor lounge has been ordered’, a second office/quiet room is now available on the ground floor, and that there were plans to purchase more garden furniture. There remain a number of areas in the home that could be better maintained, and more attractive. These include; replacing carpets in some communal areas and in some residents bedrooms. The bedroom carpet of one resident was torn and could have been a trip hazard. A staff member applied some tape onto the tear/rip during the inspection, and we were told that the carpet would be replaced shortly. A carpet in another resident’s bedroom was seen to be stained and should be cleaned or replaced. The condition of carpets in the home should be reviewed and they be cleaned or replaced if required. A toilet seat in a bathroom on the top unit was seen to be significantly stained with toilet cleaner and needs to be replaced, and a toilet cleaning brush and holder, which looked unclean, could be replaced. The tops of several taps were missing and should be replaced. The vinyl flooring surrounding the shower facility on the ground floor was ‘peeling’ away from the shower surround, and could ‘catch’ on a resident’s legs. So needs to be repaired. The paint work of some skirting boards was seen to be chipped and could be re-painted. The sitting rooms and bathrooms in both units could be more homely and attractive looking. There could be a clock in the sitting room upstairs. A missing drawer front of a cupboard in the upstairs sitting room should be repaired. A previous requirement that an extractor fan in the downstairs laundry is cleaned was judged to have been met at the time of this inspection, but the fan extractor fan in the upstairs laundry was seen to be clogged with dust. This could lead to the fan not working properly and could possibly cause a risk of fire. This was discussed with a member of staff who confirmed during the inspection that the fan had been cleaned and that the task to clean it would be listed on the cleaning rota. The sitting room located in the upstairs unit felt very warm. We were told by the manager that though all radiators have radiator protectors, several radiators in the care home do not have individual temperature controls that are accessible. All radiators in the home need to have a system in place where the temperatures of radiators can be adjusted if required. The temperatures of rooms should be monitored. This was discussed with the manager. The manager told us that since he has managed the home he has ensured that a number of maintenance issues have been carried out, was aware that further work in these areas was needed and had put forward requests for further 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 23 maintenance and redecoration of a number of areas of the home to be completed. A relative/advocate told us that the home could ‘react much faster to maintenance issues’. The organisation should review the system it has in place with regard to ensuring that 237 Kenton Road is always well maintained. There was some out of date information with regard to the previous Commission displayed in the upstairs sitting room. This should be removed. The home has an enclosed garden, which is well maintained. We were told that the garden is regularly used in the good weather by residents and that some people using the service observe staff gardening and/or participate in some aspects of this activity. We were told that a variety of garden furniture was accessible to people using the service. Two residents kindly showed us their bedroom; another two people gave us permission to see their rooms. These bedrooms were individually personalised, with items that included; music systems, photographs and attractive furniture, of the persons choice, and some residents had their own television. Residents told us (or indicated by gestures and sounds) that they were happy with their bedrooms. The laundry facilities are located away from food storage, and food preparation areas. Disposable gloves were seen to be accessible to staff and to others. The AQAA confirmed that the home has an infection control policy, and that staff had received infection control training. Care staff carry out cleaning duties in the home. Soap and paper towels were generally accessible with hand washing facilities in the home. A toilet facility in the upper unit of the home did not have any soap. We had to use the hand soap that was located in the kitchen. This was discussed with a staff member, who told us that due to a resident’s particular behaviour, soap was not left in that bathroom. Soap needs to be accessible with hand washing facilities. With regard to the infection control, the home should look at installing soap dispensers where soap can be accessed by people, and also minimise the risk of harm to people using the service. A referral to a psychologist might be of benefit to the resident whose behaviour at present prevents hand soap being accessible in that bathroom. A waste bin that is located in a ground floor bathroom had a lid that was missing which should be replaced to minimise the risk of any spread of infection. Records told us that the home had been awarded 3* (good) rating from an Environmental Health inspection that looked at food safety in the home. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. National Minimum Standards 32, 34, 35 and 36 were looked at. Staff in the home are trained, skilled and are in sufficient numbers to support the people using the service, and to support the smooth running of the service. People using the service are supported and protected by the care homes recruitment policy and procedure. EVIDENCE: The staff rotas for each unit/floor were available for inspection. These and staff told us that there were presently two staff on duty during the day, and a ‘wake night’ staff member at night, working on each floor. The manager confirmed that staffing numbers were flexible in accordance to the needs and changing needs of people using the service. The photographs of staff on duty were displayed downstairs, and in the upstairs unit were changed to the correct staff photographs, when this was pointed out by us. Staff meetings take place regularly, and records told us that they are well attended. Staff spoke of knowing the residents well, and of working as a team in the home. Staff follow a daily shift planner with regard to carrying out their duties. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 25 A staff member told us that their induction programme covered what they needed to know. The AQAA and records told us that the staff induction is linked to Skills for Care and meets National Minimum Standards for the service. The manager showed us the staff training programme. He told us that he had reviewed and updated the plan this year. We were told that staff attend several mandatory training days (including refresher training) each year. We were told that staff training included health and safety, infection control, 1st Aid, moving and handling, fire safety, safeguarding adults, medication and safe food handling training. A staff member spoke of there being sufficient training. Certificates of staff training were available for inspection. The manager told us that fire training had been completed by staff this year, and that most staff have achieved NVQ (National Vocational Qualification) level 2 or above care qualification. The AQAA told us that ‘the staff team have won the companys Top Team award four times. Staff told us that they enjoyed working in the home. Comments included, ‘I love my job’, and ‘I know the residents well’. They told us of how fond they were of the residents and of how much residents were missed when they moved on to other placements/homes. The home has a staff recruitment and selection procedure. Three staff personnel records were looked at. These confirmed that appropriate required checks including an enhanced Criminal Record Bureau check (a check to gain information as to whether a person has a criminal record) was carried out. The AQAA told us that people using the service can participate in the recruitment of staff by asking prospective staff questions when they visit the home. We were also told that staff can observe the interaction of prospective staff with residents during this time. Records, including the AQAA, and staff told us that staff receive regular 1-1 staff supervision. The manager spoke of being in the process of ensuring that all staff now receive an appraisal, which they hadn’t had in the past. He told us that he had recently carried out two staff appraisals. It was evident talking to people using the service, records, and from observation that residents know the staff team well, are confident to approach them, and to interact with them. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. National Minimum Standards 37, 39, and 42 were looked at. The management, and administration of the home is based on openness, and respect, has effective quality assurance systems, which ensures that a quality service is provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected. EVIDENCE: The registered manager has managed 237 Kenton Road for approximately one year. Prior to that he managed another care home within the organisation. He has significant experience of working with people who have a learning disability. The manager spoke of his role, and of the numerous systems, and records within the home that he has reviewed since taking on the role of 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 27 manager of 237 Kenton Road. The AQAA told us about the significant number of improvements to the service that have been made since the manager has run the home. The manager told us that he had ‘spent this first year restoring staff confidence, and morale, and ensuring service users lifestyles were maintained, and enhanced where possible’, and was presently working with two deputy managers to develop their roles and responsibilities. It was evident from the completed AQAA, looking at records, talking to staff, and from talking to the manager that the manager is motivated and competent in ensuring that people using the service are provided with a quality service. Where there are areas for improvement that emerge, the service recognises them, and works to put systems in place to manage and develop them. Staff told us that the running of the home had improved significantly since the manager has been managing 237 Kenton Road. They told us that the manager is approachable, listens to staff and has worked hard to improve the quality of the service provided to residents. One staff member told us that the manager was a ‘great’ manager. Staff told us that they felt involved in their staff team, and that the home was a much more pleasant working environment since the manager has been running 237 Kenton Road. Talking to staff, and looking at records (including the AQAA, care plans, health and safety checks, and staff training), confirmed that the home has systems in place to improve, and to monitor the quality of the service provided to people using the service. The manager told us that the organisation carries out an annual comprehensive audit of the service, and that this had recently been completed. The report of that visit was not available, but we looked at the 2008 annual quality assurance report. We also saw a recent record of a monthly audit of the home that was carried out by a representative of the organisation. The AQAA told us that ‘from time to time, questionnaires and surveys are sent to service users and their families for feedback about the service’ provided to people. There are up to date policies, and procedures in place to ensure that people using the service are safe. The home has a fire risk assessment. Records and the manager told us that appropriate fire checks and fire drills are carried out. The manager told us that an inspection the fire service concluded that the systems in place are satisfactory. A fire system check was carried out by a staff member during the inspection. We noted that doors in the home had door safety closure mechanisms in place. On the first floor, a wall bracket holding a fire extinguisher was seen to be loose. This needs repair as the fire extinguisher could be of risk of falling, and possibly causing an injury to someone. The manager told us that this would be repaired promptly. The manager and records told us that equipment in the home is regularly serviced/checked by appropriate persons. Records told us that fridge and freezer temperatures are monitored closely. The employers liability insurance is up to date. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 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 3 2 3 3 X 4 X 5 X 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 2 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 4 X X 3 X Version 5.3 Page 29 237 Kenton Road DS0000030898.V378571.R01.S.doc 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. 1. Standard YA24 Regulation 23(2) Requirement A significantly stained toilet seat located in a bathroom on the top unit needs to be replaced. Timescale for action 16/02/10 2 YA24 23(2) 3 YA24 13(4) 4 YA30 13(3) The vinyl flooring surrounding the shower facility on the ground floor is ‘peeling’ away from the shower surround, and could ‘catch’ on a resident’s legs. So needs to be repaired. All radiators in the home need to 16/02/10 have a system in place where the temperature of each radiator can be adjusted if required. A wall bracket (located on the 16/01/10 top floor) holding a fire extinguisher to the wall was seen to be loose. This needs repair as the fire extinguisher could be of risk of falling, and possibly causing an injury to someone. Soap needs to be accessible with 16/02/10 all hand washing facilities. With regard to the infection control. 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 30 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 YA1 Good Practice Recommendations The format of the service user guide could be further developed to improve its accessibility to people using the service (and to others), who are unable to see, and or have difficulty reading. There could be further development with regard to identifying and meeting people’s equality and diversity needs. It could be more evident in the care plans (and other records concerning the resident) that people using the service are involved in their care plans, and that the content had been explained to and/or read to the person using the service, who might be unable to read or have a visual impairment, and or have significant communication needs. The staff should sign that they had read the care plan and review documentation. Staff should ensure that they support residents to always dress appropriately in clothes that do not need repair. The home should continue to further develop the number and variety of leisure pursuits and other activities for people using the service. The format of the complaints procedure could be further developed (i.e. audio, DVD, or primarily in picture format) to ensure that it is more accessible to people using the service, particularly those who have a visual impairment or have difficulty in reading. The condition of the carpets in the home should be reviewed and cleaned or replaced if required. A toilet cleaning brush and holder located in the top floor unit, looked unclean, and should be replaced. The tops of several taps located in bathrooms were missing and should be replaced. The paint work of some skirting boards was seen to be chipped and could be re-painted. DS0000030898.V378571.R01.S.doc Version 5.3 Page 31 2. YA6 3. 4. 5. YA7 YA13 YA22 6 YA24 7 YA24 237 Kenton Road The sitting rooms and bathrooms in both units could be more homely and attractive looking. There could be a clock in the sitting room upstairs to ensure that residents (and staff) have access to knowing the time if they wish. A missing drawer front of a cupboard in the upstairs sitting room should be repaired. The temperature of the sitting room in the upstairs unit (and in other rooms) should be monitored. So that the temperature of all rooms are always at a comfortable temperature. The organisation should review the system it has in place with regard to ensuring that 237 Kenton Road is always well maintained. The home should look at installing soap dispensers, where soap can be accessed by people, and that also minimise the risk of harm to people whose behaviour might challenge the service. A referral to a psychologist might be of benefit to the resident whose behaviour at present prevents hand soap being accessible in a bathroom. A waste bin with a lid missing (located in a ground floor bathroom) should be replaced to minimise the risk of any spread of infection. 8 YA24 9 YA30 237 Kenton Road DS0000030898.V378571.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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