Care Home: 65 Charlton Road

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 65 Charlton Road 65 Charlton Road Kenton Middlesex HA3 9HR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Judith Brindle     Date: 0 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: 65 Charlton Road 65 Charlton Road Kenton Middlesex HA3 9HR 02082042191 02082040020 general.enquiries@heritagecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Daphne Gayle Type of registration: Number of places registered: Heritage Care care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 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: Learning disability - Code LD Date of last inspection Brief description of the care home 65 Charlton Road is a care home providing personal care and accommodation for up to 7 people who have a learning disability. The people living at the home at the time of the inspection were all female, though the service is not gender-specific. The registered provider of services at the home is Heritage Care, a national not-for-profit organization operating since 1993. Paddington Churches Housing Association owns the building. The home is located within a residential area of Kenton, within the London Borough of Harrow. It is around ten minutes walk from shops, pubs, parks and bus links. The home has a driveway that can take about five vehicles, including the house Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 7 Brief description of the care home passenger vehicle. Parking restrictions do not apply on the road outside the home. The home was opened in 1998. It is a two-storey building that was purpose built for residential care. It blends in reasonably with surrounding homes. All the homes bedrooms are single, all fully-furnished with built-in sinks. The home has two bathrooms and two shower rooms, all of which have toilets. One further toilet is available on the ground floor. Access to the first floor is by stairs or a lift. The home has a kitchen/diner, a main lounge, and a small second lounge available for private use. The home has a reasonable-sized garden, much of which is paved for easier access. The service user guide, and range of fees, are available from the manager on request. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection took place throughout a day in January 2009. There was one vacancy at the time of the inspection. We were pleased to meet and talk to all the people living in the home. The registered manager was present during most of the inspection. A number of feedback surveys were supplied to the care home prior to the inspection. At the time of writing this report the Commission for Social Care Inspection had received two completed surveys from people using the service, and three from staff. Documentation inspected included, residents care plans, risk assessments, staff training records, and some policies and procedures. The inspection included a tour of Care Homes for Adults (18-65 years) Page 6 of 37 the premises. Observation was also significant tool used in the inspection process, due to the varied communication needs of the people using the service. Assessment as to whether the requirements, and the recommendations from the previous key inspection (11th and 12th January 2006) had been met, also took place during this key unannounced inspection. 29 National Minimum Standards for Adults, including Key Standards, were looked at during this inspection. Prior to this unannounced key inspection the registered manager supplied the Commission for Social Care Inspection (CSCI), with a completed Annual Quality Assurance Assessment (AQAA) document. This record includes required information from the registered manager (and/or owner) about the quality of the service provided by the care home, and of any planned improvements. This document had been completed comprehensively. Reference to some aspects of the AQAA is included in this report. We thank the people living in the care home, staff, and the manager for their significant assistance in the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: Some aspects of record keeping could be better. Though some improvements have Care Homes for Adults (18-65 years) Page 8 of 37 been noted there could be further development and improvement in some areas of record keeping. All records should be dated, the recording of the monthly review of the care plans, and of activities that residents take part in, could be better. It should be more evident that people using the service are fully involved in their care plans and have the opportunity to sign them. There should be development in ensuring that the care plans are working tools, so updated frequently,to ensure that the whole persons life needs are met, and their goals (short and long term goals) are fully addressed. People using the service should be given copies of their plan of care, and support. There could be improvement to the format of information relevant, and of interest to people using the service, such as the menu, to ensure that it is more accessible to those people who have difficulty in reading. It could be more evident that all staff (including night staff) participate in regular fire drills, to ensure that they know what to do in the event that there is a fire in the home. People using the service could have individual assessment of their financial needs to ensure that it is evident that they have the opportunity to have as much involvement, knowledge, understanding, and participation as they wish or are able to in the management of their monies. All concerns/complaints should be recorded in the complaints recording book (or other suitable document). This would ensure that it is evident that residents understand the complaints procedure, that they feel confident to communicate their concern/complaint, feel listened to, and that appropriate action in line with the complaints procedure is taken by staff. Some issues of health and safety with regard to fridge temperature monitoring and risk assessment of the use of portable fans, should be resolved. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service have the information needed to choose a home that will meet their needs. Prospective residents have their needs assessed, with their participation (and/or their family member/friend), 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 home has an accessible service user guide, and statement of purpose, which include information about the service provided to residents by the care home. A copy of the service user guide was seen in the residents care plan files of the two plans inspected by us. This service user guide is in written, and picture format. We were told that this information was up to date, and that this guide was given to prospective residents, and to others, such as the relatives of people planning to move into the care home. These documents should be dated. Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: There has been one new resident admitted to the care home since the previous key unannounced inspection that took place in January 2006. The Annual Quality Assurance Assessment (AQAA) told us that the home has a referral and admission policy. We were told about the process of a person moving into the home. The home receives a referral (generally from a Local Authority), which includes information about the persons needs. The prospective resident then has their needs comprehensively assessed by staff including the manager, and other management staff. We were told that this assessment of the persons needs involves full participation from the prospective resident. A completed initial assessment of a residents needs was available for us to look at. This was generally comprehensive, though there are areas of the assessment that possibly could be further developed. This includes the section (which includes information about the ethnic origin, and religion of the person) with regard to the persons equality and diversity needs, which should be broadened to include all the six strands of diversity (including gender identity, age, sexual orientation, race, belief or disability). This was discussed with the manager, who spoke of including this information in the initial assessment. We were told that the referral, and transition process, of a person moving into the home, is flexible in accordance to the needs of the prospective resident. The number and kind of visits to the care home are discussed and agreed with the person. A resident told us that she had visited the care home before moving in. This resident confirmed that it had been her choice to live in the home, and that she was happy living at 65 Charlton Road. It was evident that the people using the service receive a contract of terms and conditions (licence agreement) with the care home. This document could be developed into a more accessible format for people using the service, who might have difficulty reading. Care Homes for Adults (18-65 years) Page 12 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have an individual plan of their needs, which includes details of the care and support that they require from staff. These care plans could be further developed in some areas. 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. Two care plans were looked at. These care plans are based upon assessment of the residents needs. This assessment includes the persons health, behaviour/mental health, skills, abilities, emotional, social needs, and aspirations, as well as some guidance to ensure that these needs are met through staff care and support. We were told by the manager that these care plans are in the process of being further Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: developed to include more comprehensive information about the person using the service, for example with regard to their goals, and plans. The manager told us that there would be development in ensuring that the care plans are working tools, so updated frequently, to ensure that the whole persons life needs are met, and their goals (short and long term goals) are fully addressed, and reviewed. This should take place, and the residents should be given copies of their plan of care, and support. We were shown some recently developed Person Centred Plans (plans where the person using the service is central to, and takes a lead with regard to their care and other support needs). These plans are are in picture and written format. The manager told us that these documents would be further developed and be updated on a day to day basis, with residents when the persons needs change and/or are reviewed. Each resident should have a copy of their Person Centred Plan. It was evident that these care plans had been reviewed approximately every six months, with the resident, family member, and key workers from the home and from the day resource centre. The care plans told us that they had also been reviewed monthly but that this review process had stopped several months ago. It was not evident from the recorded information as to how much involvement the residents had had, with regard to the formation in their care plan and of its recorded review. People using the service should have the opportunity to sign their plan of care. This was discussed with the manager. The care plan information includes a comprehensive summary profile of each person using the service. People using the service spoke positively about the staff. Three residents told us the name of their key worker. They confirmed that their key worker actively provides one to one support, and assisted them with meeting their needs, including personal care needs, and shopping for personal items. People using the service should have the opportunity to participate in planned informal regular one to one key worker meetings, to enable and support them to plan, and review their goals, and to lead purposeful, and fulfilling lives as independently as possible. This was discussed with the manager. Staff who spoke to us had knowledge, and understanding of their key worker role. Staff surveys told us that we try to work in a person centred way. AQAA told us that there were plans to purchase, and install sensory equipment for one service user in her bedroom, as a form of stimulation for her. This should be put in place. The care plans that were looked at included some evidence of risk assessment, which covered a range of possible risks (including behaviour, risk of seizures, and road safety) to the persons safety. These included guidance to minimise these risks and to support the person using the service to lead a quality life as independently as they are able to. The manager spoke of further developing each persons risk assessment. Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: Residents spoke to us about the choices that they made. Examples of these included deciding when to go to bed, and when to get up in the morning. A resident commented that she had a lie in at weekends. Other decisions that residents spoke of making included; choosing their own clothes, meals, holidays, and bedroom furnishings. Staff were seen to offer residents a number of choices during the inspection, and they respected the decisions made by the residents. The feedback surveys from people using the service told us that they make decisions about what they want to do each day. We were told by the manager that all the people using the service have support with the management of their finances. The manager told us that Heritage Care is a corporate appointee with regard to managing most (a resident has support from a relative) residents monies. We were told that residents receive their benefit allowances in to a central bank account (which manages each persons finances separately). The manager told us that when a resident needs money she requests this from Heritage Care, and a cheque is sent to the home, which is cashed at a bank. Residents have some cash kept in the home. We were told that monthly statements of residents financial accounts are supplied to the home. Two of these statements and other financial records of incoming cash, and expenditure were looked at. Appropriate records are kept of the incoming finances and of all expenditure. It was not clear from the residents individual monthly finance statements, as to whether residents receive their entitled interest on their personal account. Residents need to have have an individual financial risk assessment/assessment recorded in their care plan, and they should have the opportunity to have individual bank/building society accounts. This would ensure that it is evident that people using the service have the opportunity to have as much involvement, knowledge, understanding, and participation as they wish, or are able to in the management of their monies. This was discussed with the manager. Care Homes for Adults (18-65 years) Page 15 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle, and are supported to develop their life skills. The recording of activities that residents participate in, could be better. 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, and meet the needs of people using the service. The menu information could be more accessible to residents. Evidence: People using the service told us of the activities that they participate in, and of those that they enjoyed. These activities include taking part in a variety of educational programmes, and leisure pursuits that take place at the resource centres, which they Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: attend. We were told that people using the service choose to attend these resource/activity centres several days during each week. Residents spoke of enjoying meeting friends, and others at these centres. People using the service spoke of the activities that they enjoyed doing. These included shopping for clothes, going to the local hairdresser, buying their toiletries, cooking, watching soaps on television, and listening to music. A resident told us of the holiday that she had enjoyed that had taken place in 2008. Another resident spoke about a holiday that she had recently had in Spain. Residents told us that they had enjoyed the Christmas, and New Year festivities, and had received a number of gifts that they had liked, and had also attended a New Year party. We were told that the manager had put forward (to the organisation) plans to ensure that people using the service have access to their own computer. This is positive. Staff told us that activities, and leisure pursuits are flexible, and chosen by the people using the service, and that residents participate in the community, by accessing a variety of amenities, and facilities. A resident spoke of attending various clubs, including a lunch club. We were told that people using the service had recently been to a pantomime. A comment from staff feedback form told us that people using the service do lots of activities. The care home has a passenger vehicle. AQAA told us that the home had plans in the next twelve months to purchase an up to date adapted minibus. A resident was seen to take part in daily living activities, including being supported by staff in making her own cup of coffee as well as making some drinks for others. Staff told us that some residents assist staff with the food shopping for the home, and are fully involved in the laundering of their clothes. AQAA told us that residents could have more opportunity to be involved in daily living activities including general household duties. Though people told us about the activities that they participated in, this was not clear from records. Daily records (logs) that were looked at generally recorded details of how each persons personal support, and dietary needs had been met, and whether they had watched television. Activities that residents participate in could be better recorded, to ensure that it is evident that people using the service have the opportunity to take part in a variety of activities of their choice. AQAA told us that the care home supports and encourages service users to maintain their independence. The visitors book confirmed that there are visitors to the care home. It was evident that the home supports residents to develop, and to actively maintain relationships (if they wish) with family and friends. We were informed by staff, and residents that people using the service have varied contact with relatives and/or significant others. A Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: person using the service told us that she regularly visited a relative at weekends. We were shown the five week rolling menu. This included a record of varied, and wholesome meals. We were told from the AQAA that this menu had recently been reviewed with people using the service to ensure that their choices, and preferences with regard to meals were reflected in it. The manager told us that the menu is flexible to ensure that people using the service can choose what they wish to eat upon a daily basis. Some information with regards to meals eaten by residents could be better recorded, so that it is easily accessible when needed. The manager spoke of recording some of this information onto the menu. The menu was in a file in the kitchen, in written format. The menu information could be in a more accessible format for people using the service, particularly for those residents that have difficulty in reading. The manager told us that the home had plans to display the meals of the day in photographic format to inform people about the meals they had to look forward to on a daily basis. People using the service spoke of enjoying the lunch that they had during the inspection. Other residents told us that they had chosen what to eat for breakfast. The kitchen included storage of a variety of fresh, frozen, dried, and canned food items. Staff told us that residents had a choice of snacks, which could be provided when they wished. Care Homes for Adults (18-65 years) Page 18 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 practise. 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, and from general observation, and from looking at records that staff have knowledge, and understanding of the importance of ensuring that the residents have their health care needs assessed, and met. The care plans that were looked at, included up to date Health Action Plans of each person. Treatment, and care for residents from health care professionals including the GP, dentist, chiropodist, psychiatrist, and optician, were recorded. It was evident that the recording of health care appointments/contact had improved. Attendance at specialist clinics, and hospitals appointments were also documented. We were told that advice Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: was sought as, and when required from health care professionals, and that referrals were made in accordance to residents needs, and their changing needs. A resident told us that she had visited the GP. 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. The medication storage, and administration systems were inspected. Medication administration records were up to date, but on one day there were gaps in recording for one person. Checking of the medication for that day told us that this medication had been very likely administered to the person. The manager said that she would look into this issue. We were told that a pharmacist regularly inspects the medication storage, and administration systems in the care home. Since the last key inspection in January 2006 there have been a number of medication errors in the care home. The last notified medication error was in February 2008. These had all been responded to appropriately at the time of each incident, and systems have been reviewed, and put in place to minimise the risk of any future occurrence of a medication error. In the AQAA the manager told us that good medication control systems are in place i.e. medication checks at all hand overs, with two staff checking and signing to ensure medication is correctly administered to people using the service, and that a medication assessed staff is always on duty. There is recorded guidance for administrating medication to residents. We were told that all staff receive comprehensive medication training when they start their job. The manager told us that she ensures that prior to staff administering medication to people using the service they receive training, and assessment to ensure that they are competent to carry out the task in the care home. This includes staff spending a period of shadowing more experienced staff when they administer medication to people living in the home. We were shown the format of a medication assessment that staff receive when they receive external medication training. The manager spoke of having carried out recorded assessment of the in house medication training that new staff receive, and that she would continue to do this. This is positive, as it will show that staff who administer medication to people living in 65 Charlton Road, have a good understanding of each residents particular medication needs. These needs include staff understanding what medication residents are prescribed, and knowing what it is for, and whether there are any contra-indications in taking a particular medication, which staff should be aware of. Regular refresher in house medication training/assessment was discussed with the manager. Care Homes for Adults (18-65 years) Page 20 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service, have access to an effective, robust complaints procedure, and are protected from abuse, and have their rights protected. It could be more evident that residents are fully supported to express any concerns that they may have, which are listened to, and acted upon. Evidence: The care home has a complaints procedure, a summary of which is recorded in the service user guide. The complaints procedure includes timescales, with regard to responding to a complaint. AQAA told us that all service users have been given copies of the complaints procedure and that a copy is displayed in the kitchen. Comments, suggestions, and concerns feedback forms were seen to be located in the kitchen. The format of these could be more accessible to people using the service. We were also told that the issue of (the) complaints procedure is always discussed in service users meetings and that key workers, and other staff will support service users if they wish to make a complaint. The home has a complaints record book. The last recorded complaint was dated the 26/12/07. We discussed with the manager the issue of ensuring that it is evident that all residents concerns and complaints are listened to. The manager told us that some Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: residents readily communicate any issues/concerns that they may have about the service, and that appropriate action in response to these is always taken, and recorded in residents daily logs. All concerns/complaints should be recorded in the complaints recording book (or other suitable complaints record book). This would ensure that it is evident that residents understand the complaints procedure, that they feel confident to communicate their concern/complaint, will be listened to, and that appropriate action to resolve the issue, in line with the complaints procedure is taken by staff. From talking to staff, and the manager it is evident that the service recognises the value and importance that complaints/concerns bear in driving the service forward, and in protecting individuals, but there could be better recording of them. AQAA told us that the service could do better in ensuring that complaints are dealt with within 28 days. The home has clear and robust policies and procedures with regard to the protection of people using the service. A staff member who spoke with us, and information from staff surveys told us that staff had an awareness, and understanding of the reporting, and recording procedures with regard to responding to concerns or complaints, or of any suspicion or allegation of abuse. Staff, and records told us that staff had received training in safeguarding adults, and we were told that that safeguarding adults training is included in the staff induction programme, and in the National Vocational Qualifications (NVQ) in care that most staff have achieved or are in the process of completing. It has been evident from previous inspection and records that the care home has continued (as required) to inform the Commission for Social Care Inspection (CSCI) of notifiable events, and of the action taken by the service in response to incidents, but during the inspection we were told of an accident that a resident had had in December 2008. Records confirmed that appropriate action had been taken in response to this accident, but it was not evident that the Commission for Social Care Inspection had been informed. The manager told us that she was away at the time of the incident, and would discuss the reporting procedures with staff. The manager needs to ensure that all staff understand the reporting procedures with regard to notifying the CSCI of accidents and/or incidents. We need to be told of notifications that we are legally required to be informed of. Following the inspection the manager supplied us with the details of this accident. AQAA told us that the home has policies with regard to counter bullying, dealing with violence and aggression, equal opportunities, diversity, and anti-oppressive practise, and whistle blowing. We were told that all staff are aware of the whistle blowing policy, and that any suspicion of abuse would be taken seriously, recorded, acted upon and reported to the relevant authority including CSCI. AQAA told us that all accidents and incidents are recorded in the relevant book. We saw that accidents were Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: recorded. Care Homes for Adults (18-65 years) Page 23 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The layout of the home enables residents to live in a safe, well maintained, and comfortable environment, which supports and encourages their independence. Residents bedrooms, meet their individual needs, and are individually personalised. Evidence: The care home is purpose built, and is located in a residential area, close to a variety of amenities, including public train and bus transport facilities of Kenton. A person using the service spoke of accessing local shops with staff, to buy herself personal items. The inspection included a tour of the premises. The care home is accessible to people who use wheelchairs. It is generally well maintained, clean and airy. Feedback surveys from a people using the service confirmed that they thought that the home was fresh and clean. The living environment is homely, with furnishings of quality. Houseplants, ornaments, photographs, pictures, and a large television are located in the communal sitting room. There is also a quiet room, which residents, and others can access if they wish. The Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: sitting room is fairly small, but two residents who use wheelchairs were seen to manoeuvre their wheelchairs to the area in the room that they wished to reach. We were told that wheelchair access to this room, and to other rooms has improved since quality non slip laminate flooring had replaced the carpets. We were told that communal areas had been fairly recently redecorated. The home has an enclosed garden, which was generally well maintained. We were told that the garden is regularly used in the good weather by residents, and that barbeques are held in the garden. A variety of garden furniture was seen to be accessible to people using the service. The home has a passenger lift, and accessible five shower/bathrooms and toilets. Some of the kitchen units are a little shabby in some areas, and a cupboard door to a small unit is missing. The manager told us that these maintenance issues had been reported, and that efforts had been made to repair this cupboard door, and that she planned to have this fixed soon. The manager spoke of having requested that the kitchen units be replaced. This is recommended to improve the attractiveness of the kitchen. Two people using the service kindly showed us their bedrooms. These bedrooms were individually personalised, with items (including their own television) of the persons choice. A resident confirmed that she had chosen her television. Both residents (and other people using the service) spoke of being happy with their bedroom. AQAA told us that there were plans to decorate service users bedrooms where appropriate, and to replace furniture in service users bedrooms as necessary. 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. We were told that people using the service are supported to be as fully involved (as they are able to be) in the laundering of their clothes. AQAA confirmed that staff had received infection control training. Care staff carry out the cleaning duties in the home. Care Homes for Adults (18-65 years) Page 25 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled, and are in sufficient numbers to support the people using the service, and the smooth running of the service. There could be review of the possible need for deputy manager/assistant manager support in the home. People using the service are supported and protected by the care homes recruitment policy and procedure. Evidence: The staff rota was available for inspection. It was evident from this record that there were generally three staff on duty during the day (there were two care staff and the manager on duty on the day of the inspection), and that there is one member of staff on wake night duty. We were told that there were sufficient staff on duty at all times to ensure that the varied needs of people using the service are met. The manager spoke of examples of the flexibility of the numbers of staff on duty. We were told that due to residents wishing to attend a recent social event, four staff were on duty during that time to ensure that the residents could participate in the event. AQAA told us that there is an adequate rota system in place to meet service users needs. It was noted that a resident asked a staff member, which staff were on duty in the afternoon. The staff member informed the resident of who would be on duty. The possibility of having Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: this information in a more accessible format (i.e. photographs of staff members on duty, displayed) than the written staff rota was discussed with the manager. She spoke of plans to put this in place. The manager spoke of there being plans (when the resident vacancy was filled) to employ a deputy manager. Until then the home should look at there being put in place further management staff such as an assistant manager/senior support worker to ensure that the manager is supported with the numerous managerial tasks that need to be carried out in the home, including keeping up to date with record keeping. Staff spoke of their role as key worker to residents. This includes supporting residents to lead a quality life as independently as they are able to, and participating with residents in the review of their personal plan of support. 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 their duties. It was noted that there were several areas of this record that had not been completed, so it was not evident that staff had carried out their planned tasks. Staff feedback surveys, and records, told us that staff had received a staff induction when they started working in the home. A staff member told us that the induction programme was very useful. Staff feedback confirmed that this ensured that they felt knowledgeable, and competent in carrying out their role and responsibilities. AQAA told us that the staff induction meets National Minimum Standards for the service. There is a staff training plan, and we were told that staff attend several training days each year. A staff member spoke of there being lots of training. We were told from the AQAA that an aim for the home was to ensure that staff receive training in communicating with people using the service in an appropriate form of sign language that meets some residents needs. This is positive. Some of this training is E learning (via computer training programmes). Staff training records, and certificates of training were available for inspection. Staff training in 2007 and 2008 included health and safety, 1st Aid, moving and handling, safeguarding adults, medication, and safe food handling training. Specialist training areas included Person Centred Planning training, and National Vocational Qualification (NVQ) level 2 and/or 3 in health and care. AQAA told us that seven out of nine permanent staff have achieved NVQ level 2 or above, and that there were other staff in the process of gaining this qualification. The home has a staff recruitment and selection procedure. Three staff personnel records (including a recently employed member of staff) were looked at. These records included required information, such as confirmation that an enhanced Criminal Records Bureau (CRB) check (a check to gain information as to whether a person has a criminal record) had been carried out. Following the inspection, we were supplied with Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: confirmation that a staff member whose CRB record was not accessible during the inspection had had this check carried out. Staff job descriptions were seen. We were told by AQAA and the manager that people using the service participate in the staff recruitment process. This includes residents having the opportunity to meet prospective staff and to ask them questions during the process of being interviewed. The manager spoke of the residents enjoying their participation in this, and of the significant value that this had, with regard to the process of recruitment and selection of staff. The home relies on the use of some bank and agency staff. An agency staff member told us that she had worked in the home for several shifts and knew the residents well. Records, and staff told us that staff generally receive regular 1-1 staff supervision (approximately 2 monthly) and annual appraisal, to ensure that staff are supported in their role, and have the opportunity to develop and achieve goals in regard to carrying out their duties in caring and supporting people using the service. Staff feedback surveys told us that the manager meets with staff to give them support, and to discuss how they are working. The manager told us that she ensures that staff receive supervision. It was evident from talking to people using the service, records, and from observation that residents know the staff team well, including knowing the names of staff. A resident confirmed that she liked the staff and that they are approachable. Care Homes for Adults (18-65 years) Page 28 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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, but there are some areas of health and safety that need to be reviewed,and acted upon. Evidence: The manager has managed the care home for several years. She told us that she has many years experience of care and management within similar homes, working with people who have learning disabilities. The manager told us that she is currently completing NVQ level 4 /RMA (Registered Managers Award) in care and that she would achieve the qualification this year. It was noted that she has been in the process of finishing this course for sometime. Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: It was evident from the completed AQAA, and from talking to the manager that she 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. The AQAA information, told us that the manager is aware of improvements that could be made to the service including improving some areas of recording. Other areas that could improve include; aspects of communication, improving the format of some documentation, empowering people using the service to take more assessed risks with regard to participating in domestic affairs, and of generally it being more evident that residents are fully involved in taking a lead (where they are able to) in their plan of care, and support. Staff told us that the manager is approachable. The home has an up to date quality assurance policy/procedure. Talking to staff, and looking at records, 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 people using the service have the opportunity to participate in monthly residents meetings. Two residents spoke positively of these get-togethers. Records told us that these meetings are well attended. There are policies, and procedures in place to ensure that people using the service are safeguarded. We were shown up to date comprehensive quality assurance/annual development plans with regard to monitoring the quality of the service provided to people using the service. The manager spoke of receiving on-going feedback about the service from residents and/or their relatives or significant others. She spoke of plans to supply feedback questionnaires to stakeholders. Records confirmed that regular unannounced visits to the home by a representative of the organisation to review the quality of the service, take place. The home has a health and safety policy. AQAA told us that the health and safety and welfare of service users are promoted and protected at all times by constant monitoring of the service, and reporting any problems to the relevant people. There are specialist door opening devices located on several doors in the care home. Records told us that hoist equipment is regularly serviced, and electrical checks carried out as required to ensure the safety of people using the service. One health and safety issue noted during the inspection was the recorded fridge temperatures. These records included several recordings of the fridge temperatures being of 10 Celsius or above (it should be below 8oc). The manager told us that the fridge was quite new, but she would ensure that the temperature of it was looked into promptly. She needs to ensure that all staff know what the safe temperature of the Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: fridge needs to be, and know who to report unsafe temperature recordings to. So that residents and others are kept safe from possible food related illnesses. It should be assessed as to whether staff require further food safety training. The manager told us that requirements from an inspection by the Local Authority Environmental Health Department had been met by the home. There are a number of portable cooling fans located in residents bedrooms. There should be risk assessment with regard to their use to ensure that there is minimal risk (such as them being left on, a trip hazard etc) to people using the service and to others. This was discussed with the manager. The home has a fire risk assessment. Records and the manager told us that appropriate fire checks are carried out. Fire drills take place. There were three fire drills in 2008. The fire drill records should include the names of all the people participating in the drills. This would ensure that it is evident that all staff are involved in fire drills in the home on a regular basis, and as required, so that they are knowledgeable in how to respond if there is a fire in the home. The times of the fire drills should vary, and it needs to be evident that night staff (and other staff) have the opportunity to attend fire drills on a regular basis. The manager and records told us that equipment in the home is regularly serviced/checked by appropriate persons. The manager said that there were plans to purchase a new hoist that was more suitable for meeting the moving and handling needs of people using the service. This should take place. The employers liability insurance is up to date. Care Homes for Adults (18-65 years) Page 31 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 14 People using the service 01/04/2009 need to have an individual financial assessment and/or risk assessment, with full involvement (as far as they are able to) of their finances. To ensure that it is evident that people using the service have the opportunity to have as much involvement, knowledge, understanding and participation as they wish (or are able to) in the management of their finances. The manager needs to ensure that all staff understand the reporting procedures with regard to notifying the CSCI of accidents and/or incidents. So that it is evident that the CSCI is told about notifications that we are 01/03/2009 2 23 37 Care Homes for Adults (18-65 years) Page 33 of 37 legally required to be informed of. 3 42 13 The manager needs to ensure that all staff know what the safe temperature of the fridge needs to be, and know who to report possible unsafe temperature recordings to. So that residents and others are kept safe from possible food related illnesses. 01/03/2009 4 42 13 It needs to be evident that 01/04/2009 night staff, and other staff have the opportunity to attend fire drills on a regular basis. To ensure that it is evident that all staff know what to do if there is a fire in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The equality and diversity needs of prospective residents could be broadened to include as well as ethnic origin, and religion (which is presently recorded), all other areas of equality and diversity (gender identity, age, sexual orientation, disability) needs. The contract/terms and conditions between the home and the person using the service document could be developed into a more accessible format for the people using the service, who cannot read or have difficulty reading. There should be development in ensuring that the care plans are working tools so updated frequently, to ensure that the whole persons life needs are met, and their goals (short and long term goals) are fully addressed. People using the service should be given copies of their plan of care, and support. People using the service should have the 2 5 3 6 Care Homes for Adults (18-65 years) Page 34 of 37 opportunity to sign their plan of care. 4 6 Residents should have the opportunity to review their plan of care with staff (key worker) on a monthly basis or more often if their needs change People using the service should have the opportunity to have to have individual bank/building society accounts. To ensure that it is evident that people using the service have the opportunity to have as much involvement, knowledge, understanding and participation as they wish or are able to in the management of their monies. It should be evident that people using the service receive their entitled interest payments with regard to the money that they have in the bank. 6 14 Activities that residents participate in, could be better recorded, to ensure that it is evident that people using the service have the opportunity to take part in a variety of activities of their choice. Some information with regards to meals eaten by residents could be better recorded, so that this information is easily accessible when needed, for example when assessing as to whether the nutritional needs of people using the service are being met by the service. The menu information could be in a better format (i.e. photographic or picture format) so that it is more accessible to people using the service, who might have difficulty in reading. Regular refresher in house medication training/assessment should be carried out and documented. All concerns/complaints should be recorded in the complaints recording book, to ensure that it is evident that residents; understand the complaints procedure, feel confident to communicate their concern/complaint, feel they will be listened to, and that appropriate action in line with the complaints procedure would be taken by staff. The kitchen units could be replaced to improve the attractiveness of the room. The missing cupboard door in the kitchen should be replaced. The staff rota could be in a more accessible format for people using the service, so that they know who is on duty. The home should look at there being put in place, further management staff such as an assistant manager/senior support worker to ensure that the manager is supported with the numerous managerial tasks that need to be carried out in the home, including keeping up to date with 5 7 7 17 8 17 9 10 20 22 11 24 12 13 33 33 Care Homes for Adults (18-65 years) Page 35 of 37 record keeping. 14 42 There should be a risk assessment with regard to the use of cooling fans to ensure that there is minimal risk (such as them being left on, a trip hazard etc) to people using the service and to others. Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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