Care Home: 89-91 Bessborough Road

Similar services:

• Townley Road, 2-3
• Foxley Lane (121a)
• Tudor Lodge
• Stacey Street Nursing Home
• Delrose House Ltd
• Clovelly House Residential Home Ltd
• Abbey Road [53]
• Cherry Tree House

What the care home does well The care home has a very warm welcoming atmosphere, and homely environment. The garden is attractive and well maintained. Feedback surveys from people using the service and others were positive about the service provided to people using the service. People using the service see the service as their home, and spoke of being satisfied and content with the care and support that they received, and that they felt listened to. Comments from people using the service included `I like my key worker`, `staff are helpful`, and when asked if they were happy living in the care home, comments included `Yes very happy`, `this is my home`, and I`m `happy here`. Staff are knowledgeable and understanding of the varied needs of people using the service. They were observed to interact with residents in a respectful, positive manner. Staff spoke of being kept well informed of issues to do with the home and the people living in the care home, and confirmed that staff teamwork was good within the care home. Staff support residents to take part in a variety of preferred activities, which include accessing community facilities. It is evident that people using the service are encouraged to make choices with regard to leisure pursuits. People using the service informed me of the varied leisure pursuits that they enjoyed and regularly participated in. A resident spoke positively of holidays that she/he had enjoyed. Residents` contact with relatives and others (as agreed by the residents) is fully supported and enabled by the care home. People using the service spoke positively of the contact that they had with family and friends. Comments included `I visit my (family members), and often stay with them`, and `I speak on the phone with my (relative)`. A resident spoke of attending his/her relative`s birthday party. The manager is experienced, and keen to continue to put into place systems to improve and develop the service for people living in the care home. It is evident that he works hard with his staff team to ensure that people using the service are supported to be empowered to lead as independent lives as they are able too. People using the service are consulted and included in all aspects of the service, and the care home is flexible with regard to meeting their needs. What has improved since the last inspection? Requirements and recommendations from the previous inspection have been met. This indicates that the service ensures that it meets regulations and also is keen to make improvements to the service that it provides to people living in the care home. The home has continued to work hard to develop and improve systems within the care home to encourage people using the service to be as fully involved in the service as they wish, to take control of their lives, and to ensure that residents feel confident to challenge the service that they receive. The home continues to make the care home more homely. Some areas of the environment of the home have been improved. This has included redecoration and refurbishment of some communal areas, and office. Residents spoke positively of the improvements made and of their involvement in changes to the environment. The format of some of the care plans have been improved to ensure that it is evident that they are individualised and focus on the individual strengths and personal preferences that residents, and that people using the service participate in the care plan`s development and review. Residents have been supported in being more involved in the process of recruitment and selection of new staff. So giving them the opportunity to have a view on who provides them with care and support. What the care home could do better: Following further review of the format and content (i.e. include agreed timescales for meeting individual goals) of the `new` care plans. These care plans should be implemented for each person using the service so that residents (and staff) can easily access comprehensive up to date information about their needs, wishes and lifestyle. The home could improve some aspects of recording of `in house` staff medication training, to ensure that there is recorded evidence that the home is confident that all staff who administer medication are competent in carrying out this role.Staff personnel files should be reviewed to ensure that it is evident that required staff personnel information is recorded, and so provide evidence that people using the service are protected by the home`s recruitment and selection procedures. The manager should complete the process of registering with the Commission for Social Care inspection. He should complete the Registered Managers Award (RMA), to ensure that it is evident that the manager has the qualifications to run the home. The manager should supply on an annual basis to residents and stakeholders (i.e. relatives, healthcare and social care professionals, and significant others) questionnaires about their views of the service, and to use this feedback when planning improvements to the home. CARE HOME ADULTS 18-65 89-91 Bessborough Road 89-91 Bessborough Road Harrow Middlesex HA1 3BD Lead Inspector Judith Brindle Key Unannounced Inspection 14th and 15th May 2008 08:40 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 89-91 Bessborough Road Address 89-91 Bessborough Road Harrow Middlesex HA1 3BD 020 8423 1116 020 8864 4191 allanclaudius@tiscali.co.uk 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) Support for Living (Harrow) Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 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. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 12 22nd May 2007 Date of last inspection Brief Description of the Service: 89-91 Bessborough Road is a care home for up to 12 adults who have enduring mental health problems and require medium to long-term support. The registered provider of the care home is Support for Living (Harrow), and is staffed by the Family Welfare Association. Paddington Churches Housing Association owns the premises. At the time of inspection there were no vacancies. The home is situated on a busy link road to Harrow that includes access to public bus services. It is a few minutes walk from Harrow town centre, which comprises of a variety of shops, banks, restaurants and other leisure facilities and amenities. Further bus and train transport links are located in Harrow. There is space for two cars to park on the forecourt, and there is unrestricted but regularly used parking on the road. The home is made up to two interlinked semi-detached properties that span three floors. Access is by stairs only. Bedrooms are situated on the 1st and 2nd floors. Each person using the service has his or her own single room. The ground floor has communal living and dining rooms, a conservatory, a laundry room, and office space. The home has an enclosed accessible maintained garden at the rear of the property. Documentation/information about the service provided by the care home is accessible to residents and visitors. Harrow Local Authority has a ‘block contract’ with regard to the placements in the care home. Fees at the time of inspection were £796.59. Information in regard to fees can be obtained by contacting the manager and or owner. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 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 unannounced key inspection took place throughout two days during May 2008. There were no vacancies at the time of the inspection. The manager was present during most of the inspection Talking with people using the service, staff, and observation were significant tools used in this inspection. Several residents kindly spoke of their experience of living in the care home. Feedback surveys received by the Commission for Social Care Inspection included 7 from residents, two from staff and one from a visitor/relative. These were positive about the service provided by the care home. Documentation inspected included, care plans of people using the service, risk assessments, staff training records, staff personnel files, and some policies and procedures. The inspection included a tour of the premises, with a person using the service. A resident kindly showed me her/his bedroom, and spoke of being ‘happy’ with their room. A particular focus of the inspection was looking at the care home’s understanding of safeguarding adults and of the systems in place to ensure that people using the service are protected and safe. Assessment as to whether the requirements and recommendations from the previous key inspection (22nd May 2008) had been met also took place during the inspection. 26 National Minimum Standards for Adults, including Key Standards, were inspected and assessed as to whether these have been met. Prior to this unannounced key inspection the manager supplied the Commission for Social Care Inspection (CSCI) with a very comprehensively completed Annual Quality Assurance Assessment (AQAA) document. The AQAA is a self- assessment of the service provided by the care home that is carried out by the owner and/or manager. It focuses on the quality of the service, and how well outcomes are being met by people using the service. It also includes information about plans for improvement, and it gives us some numerical information about the service. Reference to some aspects of this AQAA record will be documented in this report. Other information received by the Commission for Social Care Inspection about the service 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 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 6 home, these are called notifications and are a legal requirement. Also relevant information from other organisations, and what other people might have told us about the service. The inspector thanks the people living in the care home, staff, and the manager for their assistance in the inspection process. What the service does well: The care home has a very warm welcoming atmosphere, and homely environment. The garden is attractive and well maintained. Feedback surveys from people using the service and others were positive about the service provided to people using the service. People using the service see the service as their home, and spoke of being satisfied and content with the care and support that they received, and that they felt listened to. Comments from people using the service included ‘I like my key worker’, ‘staff are helpful’, and when asked if they were happy living in the care home, comments included ‘Yes very happy’, ‘this is my home’, and I’m ‘happy here’. Staff are knowledgeable and understanding of the varied needs of people using the service. They were observed to interact with residents in a respectful, positive manner. Staff spoke of being kept well informed of issues to do with the home and the people living in the care home, and confirmed that staff teamwork was good within the care home. Staff support residents to take part in a variety of preferred activities, which include accessing community facilities. It is evident that people using the service are encouraged to make choices with regard to leisure pursuits. People using the service informed me of the varied leisure pursuits that they enjoyed and regularly participated in. A resident spoke positively of holidays that she/he had enjoyed. Residents’ contact with relatives and others (as agreed by the residents) is fully supported and enabled by the care home. People using the service spoke positively of the contact that they had with family and friends. Comments included ‘I visit my (family members), and often stay with them’, and ‘I speak on the phone with my (relative)’. A resident spoke of attending his/her relative’s birthday party. The manager is experienced, and keen to continue to put into place systems to improve and develop the service for people living in the care home. It is evident that he works hard with his staff team to ensure that people using the service are supported to be empowered to lead as independent lives as they 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 7 are able too. People using the service are consulted and included in all aspects of the service, and the care home is flexible with regard to meeting their needs. What has improved since the last inspection? What they could do better: Following further review of the format and content (i.e. include agreed timescales for meeting individual goals) of the ‘new’ care plans. These care plans should be implemented for each person using the service so that residents (and staff) can easily access comprehensive up to date information about their needs, wishes and lifestyle. The home could improve some aspects of recording of ‘in house’ staff medication training, to ensure that there is recorded evidence that the home is confident that all staff who administer medication are competent in carrying out this role. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 8 Staff personnel files should be reviewed to ensure that it is evident that required staff personnel information is recorded, and so provide evidence that people using the service are protected by the home’s recruitment and selection procedures. The manager should complete the process of registering with the Commission for Social Care inspection. He should complete the Registered Managers Award (RMA), to ensure that it is evident that the manager has the qualifications to run the home. The manager should supply on an annual basis to residents and stakeholders (i.e. relatives, healthcare and social care professionals, and significant others) questionnaires about their views of the service, and to use this feedback when planning improvements to the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 9 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 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1 and 2 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective people using the service have the information that they need to make an informed choice about where to live, and they can feel confident that their needs will be assessed before moving into the care home. EVIDENCE: The care home has an accessible statement of purpose, and service user guide, which includes information about the service that the care home provides. This documentation is specific to the home, and resident group that they care for and support. A resident spoke of having received ‘some information’ about the home. Feedback surveys from residents told us that they had received enough information about the home prior to moving in, so that they could decide if it was the right place for them. There have been no new admissions to the care home since the previous key inspection. The home has an admission procedure. Information about the admission process was also recorded in the Annual Quality Assurance Assessment (AQAA) document. It told us that told us that the care home provides a thorough assessment programme for new residents so that they are 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 11 clear about the service provided by the care home, and can therefore make an informed choice about living in the home. The manager spoke of the process of admitting a resident to the care home. He told us that new residents are admitted following a comprehensive initial assessment, which is carried out by a competent staff member, with the full involvement of the prospective resident. Following discussion with the prospective resident, a series of planned visits (including overnight stays) to the care home, also take place. The prospective resident has a ‘settling in’ period of a six week stay in the care home prior to their placement being confirmed, (with their agreement) at a multi disciplinary review meeting. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 6, 7, 8 and 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service each have a plan of care, which includes a record of the assessed needs, changing needs and personal goals of each person. People using the service are supported and encouraged to make decisions and choices, and are supported to take risks as part of an independent lifestyle. EVIDENCE: All the people using the service have a plan of care. Staff sign when they have read each care plan. Three residents when asked confirmed that they had knowledge of their plan of care. The manager reported that the care plan format was in the process of being comprehensively reviewed to improve the content, and accessibility of the information recorded in them. He spoke of being in the process of implementing these care plans, with the full participation and involvement of the people using the service, and their key worker. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 13 Five care plans were looked at. It was evident that residents have participated in their plan of care, some of whom had signed their plan of care. The care plans inspected recorded a number of assessed needs of each resident. These needs included health social, mental health needs, communication, emotional, cultural, and religious needs of residents. Some aspects of the new care plans could be further developed, such as ensuring that timescales for meeting individual goals are included, and the recording of further aspects of equality and diversity needs, such as age, and sexuality needs. This was discussed with the manager, who spoke of including these in the new care plans. This is positive The care plans included clear guidance to be followed by the resident and staff to ensure that their identified and assessed needs are being met by the service. Staff and residents spoke of having regular key worker meetings, in which residents discussed their care plans and discussed various issues of their choice. Records and people using the service confirmed that the care plans are regularly reviewed with full participation from residents. These plans include risk assessments. These risk assessments included staff and resident guidance to minimise the identified risk to the person using the service. Risk assessments included, road safety, personal care, health, handling money, cleaning, and cooking. It was evident that the management of risk is positive in addressing safety issues while aiming for improved outcomes for people. Where there are limitations, the decisions have been made with the agreement of the person, and are recorded. The home has a list of the religious festivals celebrated by a variety of faiths. Staff told us that aspects of diversity needs are raised and discussed in community meetings and staff meetings. The AQAA document informed us that a resident whose first language is not English has access to an interpreter during meetings when his/her progress is reviewed. . Staff spoke of the ways that the care home supported people using the service to make choices, and of how staff listen to them, and respect residents views. Annual Quality Assurance Assessment (AQAA) informed me that the care home service is led as much as possible by people using the service. Residents who kindly spoke with me informed me of the choices that they made. A person using the service opened the front door to let me in and checked my ID badge. Residents were observed to make numerous choices during the inspection. It was clear from talking to residents, staff, and from observation that care staff had a good understanding of the resident’s needs of privacy and respect. I was informed by staff, and people using the service that routines are flexible, and that residents are listened too. The manager spoke of the ways that staff support residents to achieve what they want to do. A person using the service informed me of examples of how staff support him/her with cooking, administrating medication, and accompanying him/her to hospital appointments. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 14 Records, and residents confirmed that they had the opportunity to attend residents (community) meetings to communicate their views and wishes, and views of the service. A resident confirmed that he/she had recently attended a residents meeting, and that there was another meeting planned to take place during the second day of the inspection. Records and people using the service spoke of having participated in ‘away day’ meetings in which they have the opportunity to be fully involved in the care home. Feedback surveys from residents told us that people using the service were supported in making decisions and choices about their lives. These choices included when to get up, go to bed and what to wear. The manager reported that some residents have had access to an advocate, who has supported them with regard to recent reviews of their placements at the care home. The management of resident’s ‘monies’ was discussed with the manager. People using the service manage their own finances. They all have bank/building society accounts. Care plans confirmed that financial risk assessments are carried out , and that support with aspects of management of finances is provided to residents as and when needed. A resident kindly spoke about how she/he managed her finances with some support from staff. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 15 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): Standard 12,13,14,15, 16, and 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the care home have the opportunity to take part in a variety of preferred activities including those promoting personal development, and are supported (if they agree) to maintain contact with family/significant others. 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 cultural/religious needs. EVIDENCE: The care plans inspected confirmed that each resident has an activity programme, which includes community leisure pursuits, and every day living skills activities. It was evident from talking with residents, manager and staff that central to the home’s aims and objectives is the promotion of the individuals right to live an ordinary meaningful life. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 16 Staff spoke of the ways that they support residents, and of how people using the service support other residents to develop and maintain their skills. People using the service kindly informed me of the various activities that they participated in and enjoyed. These activities include being fully involved in the household duties in the care home. A person using the service kindly showed me various rotas that indicated the kind and number of domestic routines that residents carry out during the week. These include cleaning, cooking, and their own laundering duties. Residents were knowledgeable about the tasks that they were allocated to do during the inspection, and were positive about their involvement in them. A resident spoke of his/her involvement in the domestic routine of the home, and of taking responsibility for his/her own bedroom. Some residents attend an Asian day resource centre for a few days per week. Access to the community by people using the service was evident, residents; spoke of going out for meals, and shopping. During the inspection, residents went food shopping. They were observed to interact positively with each other planning what food to buy and checking their shopping lists. Other meaningful activities included attendance at various clubs, various employment activities. A resident spoke of working part time. Another person using the service spoke positively about having developed his/her computer skills, and that he/she particularly enjoyed making Christmas cards. The home has a computer accessible to residents. Other leisure pursuits included going out for meals, and to the pub. Residents have varied cultural and religious needs. These needs were recorded in care plans inspected. The manager spoke of the ways that religious festivals are acknowledged and supported by the home. Residents attend religious places of worship if they so wish. The manager spoke of residents attending places of worship with their family. During the inspection the residents fully participated in a variety of activities and leisure pursuits of their choice. All the residents have travel passes for free public transport travel in London, and some have Local Authority taxi cards. A resident spoke of some of the holidays that he/she had taken whilst living in the care home. It was evident from speaking to people using the service and to staff that residents are supported to maintain (if residents agree) important personal and family relationships, inside and outside the care home. People using the service spoke of the contact that they had with family and friends. Residents spoke of the varied contact that they had with family members and friends. The care home has an accessible pay phone for residents use. People using the service went in and out of the home without restriction. Residents were knowledgeable of ‘healthy eating’, and spoke of choosing their meals on a weekly basis, and showed me the menu. It included varied and 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 17 wholesome meals, with vegetarian options, and various meals that meet cultural needs. People using the service reported that they enjoyed the meals and that they took turns to buy the ingredients and to cook the meals. A resident said that he/she was planning to cook shepherds pie for the evening meal. Another resident told me that he/she had the ingredients including spices for cooking his/her preferred cultural meals. One resident showed me the vegetarian meal that she had started to cook. A person using the service spoke of ‘staff helping him/her to cook some meals. A variety of fresh, frozen, tinned and dried foods were accessible in the care home during the inspection. Food stored in the fridge was dated and covered. Fresh fruit was available. Residents were seen to help themselves to food and made snacks as and when they wished. Residents told me that they enjoy the occasional take away meal and/or lunch out. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18,19, and 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service have their personal care and healthcare needs met. Systems are in place to ensure that medication is stored and administered safely to people using the service. EVIDENCE: Residents have access to healthcare services. Treatment and care provided to residents from the GP, dentist, optician, and chiropodist is recorded. Records confirmed that residents receive additional specialist support from other health care professionals, as and when needed by them. . Attendance at specialist clinics and hospital clinics were also documented. A resident spoke of regularly having appointments with a psychologist. Staff spoke of the close liaison that the home has with health and social care professionals, and of respecting and understanding the rights of residents in the area of healthcare and medication. Two residents spoke of regularly seeing a ‘doctor’. A resident reported that he/she going to attend a hospital appointment during the inspection. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 19 People using the service, staff and records confirmed that they have their mental health needs monitored closely, and that changing healthcare needs are responded to appropriately by the staff team, to ensure that all physical and emotional health needs are met by the care home. A staff member spoke of the care home’s plan to ensure that each person using the service has an annual physical check up. This is positive. A resident spoke of meeting his/her social worker for lunch during the inspection. It was clear that staff respected the privacy of residents during the inspection. Care plans inspected include information about individuals health and personal care needs. The care home has a medication policy/procedure. This was accessible in the home. Medication is stored securely. The home uses the monitored dosage system in which the pharmacist provides individual dosages of medication to the home for people using the service. A staff member spoke of their role with regard to the management of medication within the care home. He spoke of the various levels of involvement and support from staff that residents had with regard to their medication. A person using the service spoke knowledgeably about his/her medication, and reported that he/she required some assistance from staff in the administration of their medication. This person knew what medication they were prescribed and what the medication was for. Care plans included individual resident medication assessments, and medication profiles. The home has a comprehensive system/programme (including risk assessment) of supporting residents to self medicate. Medication was observed to be administered to some people using the service and this was judged to have been administered safely. Records confirmed that the home generally records very comprehensively when medication is administered, or refused to a resident. But one randomly inspected medication administration record sheet had two gaps in recording. This was checked during the inspection, and was confirmed that the medication had been given, as required. A staff member spoke of speaking to the staff member concerned about the importance of ensuring that medication is signed for, and confirmed that recording of medication would continue to be monitored closely. A staff member spoke of the medication training that all staff receive, including training from a pharmacist and ‘in house’ training, which includes several weeks of new staff ‘shadowing’ and observing more senior staff administering medication to people using the service. Then ‘spot checks’ being carried out by senior staff to monitor care staff administering medication. A staff member confirmed that they would develop a check list/assessment record of the ‘in house’ staff medication training, to ensure that there was a record of this, and that it could be also a tool for ongoing monitoring with regard to the competency of staff in the safety and administration of medication to people using the service. This is recommended. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and handled objectively. People using the service are protected from abuse, neglect and self-harm. EVIDENCE: It was evident from observation, and from talking with residents that the care home has an open culture that enables residents to express their views and concerns in a safe and understanding environment. A resident confirmed that he/she felt safe in the home. The home has a recently reviewed the complaints procedure. The manager spoke of plans to inform residents of this up to date policy. The complaints procedure includes timescales for the manager to respond to complaints. A person using the service was fully aware of the complaints procedure, and spoke of having received a copy of it. She/he spoke of talking to his/her key worker if he/she had a ‘concern’. Staff spoke of how people using the service are supported in communicating their ‘concerns’/complaints. The complaints recording book recorded that staff should ‘encourage residents to complain about things that they are unhappy about’. There was evidence that appropriate action had been taken by the manager in response to some complaints/’concerns’ that had been recorded by people using the service. Feedback surveys confirmed that residents and a relative knew how to communicate a concern and/or complaint. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 21 The Annual Quality Assurance Assessment (AQAA) document supplied to the Commission recorded that relatives are aware of the complaints policy, and that the manager recognises the importance of learning from ‘critical comments’. The manager informed us that reviewing all areas of ‘concerns’, complaints and protection procedures is included in plans for improvement of the service. The home has a protection of vulnerable adults policy, and a whistle blowing policy. The manager reported that he would access the up to date local authority safeguarding guidance. During this inspection there was a particular focus on the systems in place and the understanding by people using the service, staff and others with regard to the issue of Safeguarding Adults (ensuring people using the service are safe, and protected from abuse and/or self harm). Particular questions were put to people using the service, staff and the manager about safeguarding (protection of vulnerable adults). It was evident from these that residents and staff had a good understanding of what safeguarding means, and of the reporting (and recording) procedures when responding to a suspicion or allegation of abuse. I was informed that protection of vulnerable adults training for all staff including agency staff was carried out in January 2008. The manager spoke of his plans to access safeguarding adults training (particularly for managers) from the Local Authority. There are robust financial systems in place with regard to the management of resident’s monies. (see Standard 7). Systems are in place to ensure that accidents and incidents are reported and recorded appropriately. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 26 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, homely, and comfortable. The premises are suitable for the care home’s stated purpose in meeting the needs of the people who live there. EVIDENCE: The care home is located close to a variety of local shops and amenities. Harrow is within a few minutes walk from the home. Public transport facilities include train, and bus services are easily accessible. The inspection included a tour of the premises, accompanied by a person using the service. It was evident that this person was proud of the home, and was fully aware of what was going on in the home, including issues to do with the premises. He/she spoke of enjoying living in the home. The home is well maintained, and the environment promotes the privacy, dignity and autonomy of residents. The manager reported that the home continues to work with the 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 23 people using the service to make the care home more personalised, and homely. Several areas of the care home have been redecorated since the previous key inspection, which has led to the environment seeming to be more bright and clean. These include improvements to a sitting room, and the office. New furnishings were evident. These included a large television, a new rug and cushions in a sitting room. A resident spoke of having been involved in choosing furnishings and fittings. A smoking/seating area has been built in the garden. Residents told me that the home is stopping all smoking within the house (there is presently a smoking suiting/lounge are in the home) from the 1st July 2008. Some residents spoke positively of this, and were aware of the reasons for this planned change. The garden is well maintained and is easily accessible. Residents spoke of spending time in the garden and of having had barbeques there. All the residents have their own bedroom. A person using the service kindly showed me their bedroom. Comments from him/her and other residents included ‘ I like my room’, ‘I am happy with my bedroom, I have lots of things’. The resident’s bedroom was individually personalised, and included a variety of items including pictures, and photographs. The resident told me that she/he had recently bought a new armchair for their bedroom. The home is warm, clean and odour free. The laundry facilities are located away from food storage and food preparation areas. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 and 35 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are supervised, and receive appropriate training to ensure that they are competent, and skilled to enable them to carry out their roles and responsibilities to ensure that the needs of people using the service are met. People using the service are supported and protected by the care home’s recruitment policy and procedures. EVIDENCE: The staff rota and staff confirmed that there was generally two staff members on duty during the day, and a ‘sleep in’ staff member at night. Care staff confirmed that they felt that there were sufficient staff on duty. The manager reported that there were two vacancies for mental health worker posts, which were currently being filled by agency staff that were well known to the residents. An agency staff member spoke of knowing the people using the service well, and of having worked in the home for sometime. Staff spoke of being supported by the ‘on call’ staffing system. It was evident that the staffing structure is based around delivering outcomes for residents. People have confidence in the staff that care for them. People using the 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 25 service were positive about the staff. comments included ‘ the staff listen to me’, ‘the staff are nice’, ‘and I like my key worker’. The Annual Quality Assurance Assessment (AQAA) recorded that there is always sufficient staff on any given shift, and that there was not a big staff turnover. Some of the care staff spoken to had worked for several years in the care home, and spoke positively of the atmosphere in the home, and confirmed that they enjoyed their jobs as care workers. It was evident that staff communicate positively amongst themselves, and with residents. A staff communication book recorded a number of entries from staff. We (Commission for Social Care Inspection) were informed from records and staff that staff, and also resident meetings take place very regularly. Both meetings took place during the two days of the inspection. Four staff personnel files were inspected. Though this documentation generally included evidence that required and appropriate recruitment procedures had been carried out, it was not easy to access this information from these files, due to way that the records were filed. It was not evident that two enhanced Criminal Record Bureau checks (a check to ascertain whether a prospective staff member has a criminal record), and two references for one staff member had been carried out. The manager informed us that the human resources staff of the organisation manage the personnel aspect of the recruitment of staff. The manager reported that the original personnel information was stored at the human resource offices. Following the inspection he supplied the Commission for Social Care inspection with confirmation that required staff recruitment and selection processes had been carried out. He provided the Commission with requested information (including the Criminal Record Bureau check numbers) with regard to these checks. The staff personnel files in the care home should be reviewed to ensure that it is evident that required staff personnel information is available for inspection, and also provide evidence that people using the service are protected by the home’s recruitment and selection procedures. The manager spoke of how the care home has supported people using the service to be more involved in the process of staff recruitment and selection. Residents had contributed three questions to be included in staff interviews. He spoke of plans for supporting people using the service to be as fully involved as possible in the recruitment and selection of new staff. This is positive. Staff spoke of receiving the support and supervision that they need to carry out their jobs, and confirmed that they received one to one staff supervision. A staff member spoke of having supervision regularly and whenever she/he ‘needs’ support. She/he spoke of having staff supervision ‘every other month’. Records confirmed that staff 1-1 supervision is carried out. The manager spoke of the ongoing informal supervision of staff, which constantly takes place in the care home. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 26 Staff receive annual appraisals. A staff member had plans to have an appraisal during the inspection. The Annual Quality Assurance Assessment (AQAA) recorded that there is always sufficient staff on any given shift, and that there was not a big staff turnover. Some of the care staff spoken to had worked for several years in the care home, and spoke positively of the atmosphere in the home, and confirmed that they enjoyed their jobs as care workers. It was evident that staff communicate positively amongst themselves, and with residents. A staff communication book recorded a number of entries from staff. Staff spoke of having received a comprehensive induction programme, which meet the Skills for Care induction standards. Two out of five staff have an National Vocational Qualification (NVQ) level 2 or 3 in care. The manager informed us that a new member of staff would be commencing an NVQ level 3 care course. Two staff each have a psychology degree. The care home has an up to date staff training plan, and records confirmed that staff receive varied and appropriate training to ensure that they are competent and confident to carry out their particular roles and responsibilities. Staff spoke of the varied training that they had received. This included statutory training such as food and hygiene training, medication training, manual handling training and health and safety training. A staff member spoke of having recently received 1st Aid training, and also safeguarding adults training.. AQAA documentation informed us that both statutory and specialist training for staff would take place over the next twelve months. This is positive. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 and 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Health and safety and welfare of people using the service is promoted and protected by a competent manager who is keen to achieve positive outcomes for residents and staff. Arrangements are in place to ensure that effective quality assurance and quality monitoring systems are in place to monitor and improve the quality of the service provided to people by the care home. EVIDENCE: The manager has the required experience, to run the care home and meet its stated aims and objectives. For several years he managed another care home within the organisation prior to managing this home. The manager has commenced the process of registering with the Commission for Social Care 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 28 inspection. This is positive, as this has been a need since the manager began managing this care home, over two years ago. He is in the process of completing the Registered Managers Award (RMA) qualification. This course was commenced a significant time ago, and effort should be made by him to complete it. He has had several years experience in a management role in supporting and caring for adults with mental health needs. Records, staff and residents confirmed that there are clear lines of accountability within the care home. The residents spoke positively of the manager and of the staff team. We (CSCI) were informed that in 2007 the home had recruited a deputy manager but that the person had not taken up the post. The manager reported that following consultation with senior management that it had been agreed that an agency deputy manager would be recruited shortly, with the long term plan of a deputy being permanently recruited. This is positive and highly recommended to ensure that the manager has the necessary support to carry out the numerous managerial duties need to ensure that a quality service continues to be provided to people using the service. The manager completed the Annual Quality Assurance Assessment, documentation very comprehensively and spoke of this being a useful tool with regard to assessing the service and for developing plans to continue to improve the service provided to people. The AQAA contained clear and relevant information, and let us know about changes the home has made and where they still need to make improvements. The manager spoke of the robust processes of self-monitoring and reviewing systems within the care home to ensure that the people using the service are provided with a quality service. This includes the completion of a Service Development Plan, which assesses aspects of the service, and from this information an action plan to develop and improve the service is completed. AQAA information informed us that all policies and procedures have been recently reviewed. A representative of the owner carries out monthly unannounced visits to the care home to monitor the quality of the service. Records of this were available for inspection. ‘Away days’ for staff and residents to examine the service provided to people using the service take place regularly. Prior to this inspection the manager had supplied the residents and others with the Commission feedback surveys. He spoke of plans to shortly supply residents and others with feedback forms (developed by the care home) to gain their views of the care and support provided by the home. This is recommended. Feedback is also gathered from various meetings. Minutes of residents and of staff meetings were available for inspection. A resident kindly informed me of the community meetings, and said that they took place ‘every Thursday’, and that these meetings are ‘important’ and ‘everyone attends’ them. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 29 The home has a health and safety policy. Annual Quality Assurance Assessment (AQAA) information confirmed that the manager has an understanding of the importance of promoting and protecting the health, safety and welfare of people using the service, and included information that confirmed all policies and procedures had been recently reviewed. The manager, and records confirmed that health and safety practices were closely monitored. Records and staff confirmed that staff have knowledge and understanding of health and safety issues. Residents were also aware of health and safety practices. A resident spoke of some areas of kitchen safety, including not leaving ‘pans on the cooker’. The home last had an inspection by the Environmental Health Department in late 2006, this resulted in a four star rating. Records confirmed that required safety checks of the gas and the electrical systems had been carried out. The home has a comprehensive fire risk assessment. Fire safety guidance is displayed in the home. Required fire safety checks are carried out and regular fire drills take place. The recording of details of those residents who refuse to respond and participate in some of these drills could be better recorded to ensure that it is clear that that staff (and others) are aware of who might refuse to leave their room in the event of a fire, and of the action that they should take depending on the agreed guidance. The manager reported that this individual guidance information was recorded in the fire risk assessment. The employer’s liability insurance is displayed and up to date. 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 30 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 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 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 X 3 X 3 X X 3 X 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 31 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA6 Good Practice Recommendations Following further review of the format and content (i.e. include agreed timescales for meeting individual goals) of the ‘new’ care plans. These should then be implemented for each person using the service, so residents (and staff) can easily understand and access information from these care plans. Staff should develop a check list/assessment record of the ‘in house’ staff medication training, to ensure that there is a record of the process of assessment that ensures that staff are confident and competent to administer medication to people using the service. The manager should obtain the up to date local authority safeguarding adult’s procedure, to ensure that he has knowledge and understanding of the roles and responsibilities of the agencies involved in the protection of adults from abuse. Staff personnel files should be reviewed to ensure that it is evident that required staff personnel information is DS0000017519.V364012.R01.S.doc Version 5.2 Page 32 2 YA20 3 YA23 4 YA34 89-91 Bessborough Road 5 YA37 recorded, and available for inspection, so provide evidence that people using the service are protected by the home’s recruitment and selection procedures. The manager should complete the process of registering with the Commission for Social Care inspection. The manager should complete the Registered Managers Award (RMA) qualification. To ensure that it is evident the manager has the qualifications for effective day-to-day running of the home. The home should recruit a deputy manager to ensure that the manager is provided with support in ensuring that all management duties are carried out for effective running of the care home. The manager should supply on an annual basis to residents and stakeholders (i.e. relatives, healthcare and social care professionals, and significant others) questionnaires about their views of the service. The recording of details of those residents who refuse to respond and participate in some of these drills could be better recorded in the fire drill record. This would ensure that all staff and others are aware of the action that they should take and of the guidance recorded in the fire risk assessment. 6 YA37 7 YA39 8 YA42 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 89-91 Bessborough Road DS0000017519.V364012.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!