Care Home: Booth Road 82

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What the care home does well The staff team works hard to support people using the service within a friendly and family-like atmosphere. Over time staff have got to know the specialised and complex needs of the residents and treat each person as an individual in their own right. As a result residents are pursuing a range of interests and activities, both inside and outside of the home, and are part of their local community. The home works closely with other agencies, especially the local community learning disabilities team, to meet the specialised needs of residents. For example one person has severe epilepsy and there is close liaison with the specialist nurse for epilepsy to ensure this person`s needs are met as far as possible. The home continues to develop a person-centred approach to support people, that builds on the residents` strengths and wishes, and encourages their independence as far as possible, including using advocates to safeguard and promote residents` best interests.Booth Road 82DS0000010411.V375168.R01.S.docVersion 5.2 What has improved since the last inspection? The home has met all requirements made during the previous key inspection as a result of this the quality outcome for people using the service has improved and the rating has been changed. Information given to people using the service has been reviewed and people using the service receive current information about the care and support provided. Risk assessments in regards to the environment have been drawn up and identified risks are managed appropriately. A gardener has been contracted and the grass is cut monthly, enabling people using the service accessing the outdoor space to relax or for parties. Issues around the missing sink in number 82, the leaking shower in number 82, the missing toilet in number 84, and missing tiles in the bathroom in number 84 have been addressed and people using the service have now access to safe and clean toilet facilities. This reduces the risk of cross infection and overall improves the overall ambience of the home. A new bath has been ordered and delivered for number 82, but the contractor did not order the correct size and a new bath is on order. Staff receive regular supervisions and appraisals. Regular monitoring visits by senior managers are undertaken, which improves the overall running of the home. Fire evacuations are undertaken regularly, to ensure people using the service are aware of the procedure and their responsibilities` in case of a fire. What the care home could do better: We have made seven requirements during this key inspection, which have an impact on people`s safety and quality outcomes. The risk assessment of the premises must justify the need for environmental restraints, and each resident`s risk assessment must document that these restraints have been agreed as appropriate by relevant parties, such as relatives and professionals. Written consent must be given by the person or relative owning the vehicle, before it can be used for other residents living in Booth Road. The manager must ensure that the new bath will be fitted at 82 Booth Road without delay and inform the Care Quality Commission (CQC) of the progress. The kitchen draws, cupboards in 82 and 84 Booth Road must be repaired or replaced ensuring peoples safety when using the kitchen. Staff training and development plans must be updated to reflect the actual training attended by staff.Booth Road 82DS0000010411.V375168.R01.S.docVersion 5.2 Key inspection report CARE HOME ADULTS 18-65 Booth Road 82 Colindale London NW9 5JY Lead Inspector Andreas Schwarz Key Unannounced Inspection 24th June 2009 09:00 Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Booth Road 82 Address Colindale London NW9 5JY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8200 8504 F/P 020 8200 8504 harpreet.ghatara@adepta.org.uk www.pentahact.org.uk PentHact Ltd trading as Adepta Manager post vacant Care Home 8 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Limited to 4 adults who have a learning disability (LD) and who may also have physical disabilities (PD) and have associated nursing needs. Specific Service User One specific service user who is currently resident in the home and is over 65 years of age can reside in this home. This condition will need to be reviewed when s/he vacates the home. Date of last inspection Brief Description of the Service: This home is owned and run by Adepta, previously known as PentaHact. It comprises two houses that are side by side and are joined by an open corridor. Numbers 82 and 84 Booth Road were previously registered as two homes but now operate as one home. On the ground floor of each house is a lounge, kitchen-diner, toilet and laundry room. On the first floor of each house there are walk in showers, an assisted bath with a toilet and four bedrooms. On the second floor there is an office shared by both houses, a storage room and a meeting room. There is a small parking area at the front of the home and a garden at the back. The home is situated close to Colindale station on the Northern line, a short walk to Collindale hospital and approximately a mile away from Edgware Hospital. It is close to the shops, restaurants and public transport facilities that are located along the Edgware Road. The stated aim of the home is to provide twenty four hour care and support for people with profound learning disabilities to enable them to live as independently as possible within the community. Placements at the home costs around £1,336 for each person per week. Booth Road makes available information about the service, including inspection reports, to the people who use the service and other stakeholders. Booth Road 82 DS0000010411.V375168.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 stars. This means the people who use this service experience good quality outcomes. This inspection is the annual key inspection and the aim is to look at how well the service is meeting the key National Minimum Standards for Younger Adults. The unannounced inspection consisted of one visit over seven hours. The inspection began in the morning and ended at teatime. The manager and deputy manager were interviewed and assisted with the inspection. A resident together with a member of staff showed us around the home. All eight people using the service were in the home at the time of the inspection. Most people using the service have significant communication difficulties, so throughout the inspection the way in which staff communicated with and supported residents was observed, as well as how residents got on with staff. We also interviewed staff to get their views and comments on the home. We did not receive staff and service users’ surveys in time to include in this report. The inspector would like to thank the residents, staff and management team at Booth Road for their assistance with the inspection. What the service does well: The staff team works hard to support people using the service within a friendly and family-like atmosphere. Over time staff have got to know the specialised and complex needs of the residents and treat each person as an individual in their own right. As a result residents are pursuing a range of interests and activities, both inside and outside of the home, and are part of their local community. The home works closely with other agencies, especially the local community learning disabilities team, to meet the specialised needs of residents. For example one person has severe epilepsy and there is close liaison with the specialist nurse for epilepsy to ensure this person’s needs are met as far as possible. The home continues to develop a person-centred approach to support people, that builds on the residents’ strengths and wishes, and encourages their independence as far as possible, including using advocates to safeguard and promote residents’ best interests. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: We have made seven requirements during this key inspection, which have an impact on people’s safety and quality outcomes. The risk assessment of the premises must justify the need for environmental restraints, and each resident’s risk assessment must document that these restraints have been agreed as appropriate by relevant parties, such as relatives and professionals. Written consent must be given by the person or relative owning the vehicle, before it can be used for other residents living in Booth Road. The manager must ensure that the new bath will be fitted at 82 Booth Road without delay and inform the Care Quality Commission (CQC) of the progress. The kitchen draws, cupboards in 82 and 84 Booth Road must be repaired or replaced ensuring peoples safety when using the kitchen. Staff training and development plans must be updated to reflect the actual training attended by staff. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 7 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at National Minimum Standards 1 and 2 during this inspection. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed information about the home is available so that people using the service and families know what they can expect from Booth Road, the Statement of Purpose and the Service User Guide has been updated. People moving into the home can be confident that their needs and wishes will be fully assessed and an appropriate plan for meeting these needs will be drawn up. As a result their needs are met EVIDENCE: The home has updated the statement of purpose and service users guide, a copy of the updated documents has been send to the CSCI in October 2008. Both documents are now compliant with National Minimum Standards. The home has addressed equality and diversity issues in the service user’s guide. The manager told us that the home is currently in process of updating and reviewing the care planning procedures and informed us that once completed the statement of purpose and service users guide will be included in the care planning folder. The home did not include the new contact details for the Care Quality Commission (CQC), which is recommended. One person using the Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 10 service told us that ‘she is very happy in Booth Road and gets on well with staff and in particular with her key worker’. The files for two of the people using the service were looked at and indicated that before they moved in a full assessment had been received from Social Services. A care plan had then been drawn up by the home showing how these needs were to be met. Most people have lived at the home for several years and indicated from observation that they were settled at Booth Road. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at National Minimum Standards 6, 7 and 9 during this inspection. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provided detailed information so that the needs of residents are met. The staff team at Booth Road is good at finding ways for residents to make as many decisions for themselves as possible. Residents are protected by risk assessments that are comprehensive and indicate clearly how risks to the safety of residents are reduced, whilst still promoting independence. However residents do not have the protection of risk assessments that take account of environmental restraints such as bedrails used in the home. EVIDENCE: We looked at two care plans and person centred plans in detail during this inspection. The care plans were chosen randomly and we assessed care plans Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 12 from 82 and 84 Booth Road. Staff told us that the home is currently in the process of up dating care plans. Both care plans assessed were detailed and provided information about the needs of people using the service and guidance how the needs are best met. Some people using the service are using wheel chairs and care plans provide pictorial guidance in how to position people safely and comfortably in the wheel chair, this is good practice. It was evident that care plans have been reviewed regularly and people using the service, key workers and significant others such as family and health care professionals are involved in the review process. One of the care plans we viewed has changed into the new person centred format, the manager informed us that all the care plans will be in this format in the near future. People likes, dislikes and choices are recorded helping staff to meet the needs of people using the service. One of the care plans we have viewed makes reference to the person’s religious beliefs. We could however find no records in regards to dietary requirements due to the person’s religious beliefs. Staff was aware of the persons dietary needs. We asked the home to make clearer reference to cultural and dietary needs in peoples care plans. We viewed additional care folders, which included historical information and records of visits to GP, dentist, optician, etc. All people using the service have an allocated key worker; one person told us that she is very happy with her key worker and interactions observed confirmed this. Two of the people using the service were able to verbally confirm that they enjoyed living at the home. The remaining residents were able to show by their behaviour and interaction with staff that they are very settled at Booth Road. Throughout the inspection residents were observed in their daily routines and their contact with staff. Residents were clearly relaxed with staff and looked for them where necessary for support and guidance. The home is managing people’s finances, we checked financial records for two people using the service, both records were of good standard and peoples finances were spend appropriately. People using the service have changed their bank account to a new bank. Staff told us that in the interim it was difficult to access people’s finances and explained that this made it difficult to access activities. This has been resolved and new activities have been looked at and discussed with people using the service. We noted that in one account substantial amounts have been withdrawn of service users’ account. Records did not show what the money was used for and the manager was not able to give an explanation. The withdrawals were done prior to his employment. We asked the home to forward information of the withdrawals to the Care Quality Commission (CQC). Staff told us that they support people using the service to make choices, by listening and observing them. Advocates are involved and can be accessed if required. In one instance and advocate is supporting a person in finding employment. The manager told us that social services have not undertaken Deprivation of Liberty and Mental Capacity Assessments. We discussed this with the manager and suggested to contact social services and ask to undertake the assessments. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 13 We looked at a number of risk assessments relating to the individuals in care plans assessed during this inspection. Risk assessments are detailed and provide clear guidance how risks can be minimised by following procedures. Risk assessments viewed include lone working, using a mower, using a hoist, choking, personal care, attending day centres, using a car, etc. All risk assessments have been reviewed in January 2009. Staff told us that one of the people using the service is swallowing objects. As a result there is some use of environmental restraints in the home, such as stair-gates and high-level door handles. One of the people using the service gave us permission to view his room. We noted that the home is using bedrails, this has not been risk assessed. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: We looked at National Minimum Standards 12, 13, 15,16 and 17 during this inspection. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is good at enabling residents to get out and about so that they lead as ordinary a life as possible. Residents are getting a better quality of life because of the good links with the local community and the range of leisure activities available. Staff supports residents to keep in close contact with friends and family, as well as respecting their rights and encouraging them to act responsibly. Residents enjoy their meals and benefit from being offered a healthy diet. EVIDENCE: Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 15 People using the service access day centres on different days during the week. One person told us that staff is helping her to find employment. Staff told us that this is done together with the day centre. The person is trying out different jobs such as gardening, sandwich making, collecting and delivering mail, etc. Each of the people using the service has a weekly programme of activities. These include activities in the home to encourage people to be involved in ordinary domestic tasks such as cleaning and emptying the dishwasher, as well as helping with getting the shopping for the home. Staff play games with residents and make use of sensory materials to stimulate residents. Most of the residents enjoy music and participate in the regular sessions held in the home by a music therapist. The manager told us that due to the financial situation some residents recently lacked on a wider range of activities. People’s finances have now been resolved and the activity coordinator informed us that she is looking into more activities available to people using the service. Residents and staff confirmed that people using the service go and access the community, go to parks, do personal shopping, etc. Family is involved in peoples care and staff told us that one person is regularly visiting a family member for overnight stays. People have been on holidays nationally and internationally. One of the people living in Booth Road has their own car; the manager told us that other service users can use the car together with the owner. This has been agreed by the family, we could find no records of this. Staff confirmed that residents are having regular contact with their families. Residents have got to know each other well over the past few years and are relaxed in each other’s company. As a result residents have felt more settled at Booth Road. Staff told us that people using the service go to discos and a summer barbeque is arranged for July 2009. One person told us that she is maintaining a relationship in the day centre. Observation throughout the inspection indicated that staff treat residents with respect and are patient when encouraging residents to do something. Where residents are able to, they help with domestic tasks in the home, such as cleaning and tidying up. We viewed the homes menu, which is varied, healthy and nutritious. The home is currently in the process of introducing a pictorial menu; this should help people using the service to make clearer choices of what they want to eat. We observed lunch, which was nicely presented. One person told us that the food in the home is tasty and cultural meals such as Asian, African and European dishes are provided. Some of the people living in the home require assistance with eating, clear guidelines are in place. Food is pureed individually; we discussed with the manager how pureed food could be presented more appetising. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at National Minimum Standards 18, 19 and 20 during this inspection. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff is good at meeting the physical and emotional health needs of residents. As a result residents feel more at home and relaxed at Booth Road. The residents are protected by effective arrangements regarding medication in the home. EVIDENCE: Both of the care plan assessed during this key inspection had detailed personal care guidelines in place. Staff informed us that the guidelines are reviewed during care plan meetings. We found in two guidelines updates, which have been recorded. A number of people using the service use wheel chairs and hoists, records show that these are regularly serviced to ensure people using Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 17 the service are supported with safe equipment. Bathrooms can be locked from the inside to ensure people using the service are supported in privacy. People using the service where dressed appropriately and one person told us that staff help her choosing clothes in the morning and regular shopping trips to purchase new clothing are arranged by the home. The manager told us that he recently undertook interviews for new staff, but unfortunately did not receive any Caucasian applicants. The home has access to Barnet Learning Disability Team (BLDT); this service provides access to a wide range of health care professionals, such as psychiatrist, Speech and Language Therapist, psychologist, etc. The manager told us that the home is accessing these services as and when needed. We viewed a range of assessments undertaken by different health care professionals; this enables staff in the home to fully meet the needs of people using the service. The home has a key worker system and two people told us the names of their key worker and confirmed of meeting the worker regularly to discuss progress. People using the service are registered with a local GP, medication is reviewed regularly and changes of medication are recorded in peoples care plans. People using the service told us that staff accompanies them to see the doctor and visits are clearly recorded in care plans. Weight, bowel movements, etc is monitored and well documented. Staff told us that they contact the GP in case records show changes, which could be of concern. Regular dentist, optician visits are arranged with the consent of people using the service. District nurses come in weekly to monitor progress with residents and provided essential input. Staff spoken to demonstrated good knowledge of people’s complex health care needs. The home has clear guidance for the administration of medication in place. Staff have received medication training and records of staff competent in the administration of medication is in place. None of the people at Booth Road self administer medication. Medication is safely stored and the key is with the shift leader. All people using the service have individual medication protocols. The deputy manager is responsible for ordering and disposal of medication. She showed us guidance, which can be used by other staff in her absence. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at National Minimum Standards 22 and 24 during this inspection. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and relatives can be confident in the complaints procedures in the home that make sure their concerns are responded to. The residents benefit from a safeguarding adults procedures that make sure that they are safe and secure whilst at Booth Road. EVIDENCE: The home has a complaint procedure in written format in place. The manager told us that he has done work on this procedure and added pictures and symbols. This work is not complete and a completed user friendly complaints procedure should be forwarded to the CQC. The home did not receive any complaints since the last key inspection. Records from previous complaints demonstrate that the procedures are followed and complaints are thoroughly investigated. One person told us that she knows how to complain and explained that she would talk to the manager or her key worker. The home has an adult protection procedure in place; staff demonstrated good knowledge of procedures and responsibilities when adult abuse allegations are made. Deprivation of Liberty has been discussed with the manager and recommendations have been made in Standard 7. One allegation of financial Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 19 maladministration by the home had been investigated in 2008 under the procedures for safeguarding adults. This had been taken seriously both by the home and Adepta/Dimensions and a full investigation made, including an independent audit of the finance arrangements in place at Booth Road. As a result improvements have been made in relation to residents’ monies so that they each have their own bank account. Finances for each resident are checked daily by staff. At the time of the inspection satisfactory procedures were in place in relation to residents’ finances. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at National Minimum Standards 24, 25, 26, 27 and 30 during this inspection People using the service experience adequate 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 life in a comfortable and clean home which requires some up dating to improve the outcomes for residents.. EVIDENCE: Booth Road consists of two adjoining houses sharing corridors at ground and first floor level. Each person has their own bedroom that they have personalised to make more homely. Two residents invited us to view their rooms, which were clean and nicely decorated. We noted that one of the rooms had scratches on the paint work due to the person using a wheel chair. We informed that manager that the home is required to re-paint this room. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 21 Following a tour of the building it was evident that requirements in regards to the décor and repairs have been actioned. The wash hand basin in the downstairs toilet at 82 Booth Road had been replaced. This allows people using the service to maintain their hygiene. Since 4/8/08 the bath at 82 Booth Road has not been usable since it had leaked into the area beneath on the ground floor. The manager informed us that a new bath has been ordered and has been delivered. Unfortunately the contractors did not order the correct model and the new bath could therefore not been fitted. The manager told us that a new bath is on order and should be fitted within the next four weeks. The manager is required to update the CQC of the process and inform us once the bathtub has been fitted. At 82 Booth Road the flooring in the bathroom is worn and badly discoloured following a leak. The manager told us that new flooring will be fitted during the installation of the new bath. The leaking shower upstairs at 84 Booth Rd has been repaired and is now usable for people using the service. The broken bathroom and toilet at 84 Booth Road has been repaired and the missing tiles have been replaced. The shower room and the tiling at 84 Booth Road has been repaired making the shower usable for people using the service. The flooring in the bathroom at 84 Booth Road is showing signs of wear and it is recommended that new flooring is fitted. Kitchen units at both 82 & 84 Booth Road are showing signs of age, although usable. Door handles of draws and cupboards are broken. This can make it difficult for people using the service to use the kitchen independently and nails could lead to people being injured. We previously recommended that these units are renewed. Staff and management raised concern regarding the kitchens. The home must replace the broken kitchen cupboards in 82 and 84 Booth Road ensuring people using the service are able to use the kitchen safely and independently. The garden has been cleaned and people using the service were observed making use of the extra outdoor space. The home was found to be clean during the inspection. The utility room is separate and a washing machine and clothes dryer is provided and in working order. Harmful cleaning materials are stored in a lockable cabinet. People using the service told us that they help staff in domestic tasks; one person in particular enjoys hovering. Staff told us that they encourage people using the service to take part in the cleaning and up keep of the home. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at National Minimum Standards 32, 34, 35 and 36 during this inspection. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The committed, competent and experienced team of staff work hard to meet the needs of residents. People using the service are protected by the home’s rigorous recruitment procedures for new staff. Residents have an improved quality of life because staff have the training and support they need to provide a good standard of care. Staff do have the benefit of formal supervision meetings at the required frequency. EVIDENCE: Staff spoken to demonstrated good understanding of needs of the people using the service and the help they require to meet their complex needs. Staff spoken to have been working in Booth Road for a number of years. One member of staff told us that she has received abuse training, medication and specialist training to meet individual needs such as peg feeding, diabetes, Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 23 epilepsy. Six out of nine permanent staff have their NVQ Level 2 or above. The manager told us that all other staff will do this qualification once places become available. We observed staff interacting with residents during this inspection and noted the strong relationships and the knowledge staff demonstrates in supporting them. The home does not employ staff under the age of 18. The previous staffing ratio of 4 Early, 4 Late and 2 night staff remains unchanged. The manager told us that he is planning to introduce a middle shift enabling the home to provide a wider range of activities. New staff were interviewed and confirmed the appropriate checks had been made, including obtaining written references and satisfactory CRB (Criminal Records Bureau) disclosures before they started working at the home. Adepta has comprehensive and robust procedures in relation to the appointment of new staff. During the most recent interviews, which were held at the home a more able resident took part in the recruitment panel. Staff recruitment records are stored centrally and have been assessed by the Commission for Social Care Inspection Providers Relationship Manager as good. One member of staff told us that she is very happy with the training provided by Dimensions. “They help my development”. New staff confirmed of having received a detailed induction and records have been viewed during this inspection. All staff have a training and development plan. The plans viewed were out of date and we told the manager that these must be updated. Staff can access a wide range of training, which is available centrally. Staff told us if they have specific training needs, external training providers can be approached. In January the whole team had a staff development day, which was very successful and helped the team to bond and gain new skills. Staff said they felt well supported at Booth Road. Staff said they found the manager approachable and supportive. Records showed staff attend a variety of training courses and have supervision meetings with a senior member of staff to improve their care practice. We assessed two staffing records, which showed us that staff have received a minimum of six supervisions per year. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at National Minimum Standards 37, 39 and 39 during this inspection. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from being well supported at Booth Road. Residents benefit from living in a home where there are procedures in place to get the views of all key parties about how the home is running. The home has good procedures in place in relation to health and safety that help to ensure residents are protected at all times. EVIDENCE: Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 25 A new manager started at the End of March 2009, staff told us that the manager and deputy manager are very supportive and approachable. The manager has all relevant qualification in Care and Management to run a registered care home. He informed us that his registration with the Care Quality Commission is in the process, but not send in. The manager can access specific training relating to his role. The necessary insurance certificate is displayed in the office. People using the service told us that they like the new manager and deputy manager. Since starting at Booth Road the manager has introduced a number of changes, i.e. filing of records, reviewing and updating the care planning system, etc. Staff spoken to showed support and enthusiasm about these changes. One staff member said. “This helps us to look after the residents better”. The senior management team is visiting the home monthly to monitor and audit the service and outcomes for people using the service. Regular tenants meetings allow people using the service to contribute to the home and make changes about the care provided. These meetings are monthly and analysed annually. Staff told us that they have regular team meetings, which are open and engaging. Dimensions have a robust quality assurance procedure in place and the manager has arranged a meeting with the operation manager to discuss the annual development plan. The home has a gardening contract, which ensures that the garden is well maintained. Fire checks and drills are up to date and Health and Safety certificates are in order. Since changing to Dimensions new contractors provide the maintenance of equipment, alarms, gas and electrical wiring. Staff told us that at times it is difficult to find out of these changes. “The communication is poor”. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 26 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 2 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 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 Version 5.2 Page 27 Booth Road 82 DS0000010411.V375168.R01.S.doc NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13 Requirement The registered persons must ensure that the risk assessment of the premises justifies the need for environmental restraints such as bed rails at Booth Road so that the interests of each resident are safeguarded. The registered persons must ensure that each resident’s risk assessment documents that any environmental restraints at Booth Road have been agreed as appropriate by relevant parties, such as relatives and professionals so that the interests of each resident are safeguarded. The registered persons must ensure that written authorisation must be given by the person or their agent if other people are allowed to use the car so that the interest of the owner is safeguarded. The registered persons must DS0000010411.V375168.R01.S.doc Timescale for action 01/08/09 2. YA9 13 01/08/09 3. YA13 16 01/08/09 4. YA27 13 01/08/09 Version 5.2 Page 28 Booth Road 82 ensure that the bath at 82 Booth Rd is fitted once the correct tub is delivered from the manufacturer so that the healthcare needs of residents at 82 are fully met. The registered person must inform the CQC of progress of the repair. 5. YA27 23 The registered person must ensure that new flooring is fitted in the bathroom at 82 Booth Road once the new bathtub is fitted so that residents have an attractive environment when using this room. The registered person must ensure that the broken kitchen cupboards, doors and draws are repaired at 82 and 84 Booth Road so that people using the service are able to use their kitchen safely and independently. The registered person must ensure that all training and development plans are updated to provide people using the service and relatives with up to date information about the skills and knowledge staff have. 01/08/09 6. YA28 23 01/10/09 7. YA35 13 01/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 29 No. 1. Refer to Standard YA1 Good Practice Recommendations It is recommended to include the new Care Quality Commissions (CQC) contact details in the service users’ guide. The home should provide clearer documentation in how to meet people’s dietary needs due to cultural and religious requirements. The manager should contact social services and ask for Deprivation of Liberty and Metal Capacity assessments to be undertaken. The manager could look into ways of presenting pureed food more appetising. The provider Dimensions should communicate more clearly when new contractors are appointed. 2. YA6 3. YA7 4. 5. YA17 YA42 Booth Road 82 DS0000010411.V375168.R01.S.doc Version 5.2 Page 30 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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