Care Home: Chadwin Road (81-83)

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What the care home does well We found that the service supported residents to achieve fulfilment and as much independence as possible. Residents spoke very positively about the care that they received and about their interactions with staff. Residents were encouraged to participate in community activities as well as engaging in household duties. External friendships and relationships were supported, with staff recognising the importance of these contacts for the residents. What has improved since the last inspection? Seven requirements and two recommendations were issued in the previous inspection report; these have all been deleted as they were evidenced to have been met at this inspection visit. The Statement of Purpose and Service Users Guide had been updated and the risk assessments were now more comprehensive. Clear improvements to the environment had been achieved and the management of the medication and first aid equipment was safe. Staff benefited from programmes of training to meet their own needs (for example, Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 more experienced staff were accessing a higher level of qualification) as well as training that reflected the needs of the residents. Hazardous items were safely stored. What the care home could do better: We have issued one requirement and one recommendation. The service needs to address some identified issues in regard to planning and meeting health care needs, and we have suggested improved recording of residents’ life stories. Key inspection report CARE HOME ADULTS 18-65 Chadwin Road (81-83) 81-83 Chadwin Road Plaistow London E13 8ND Lead Inspector Sarah Greaves Key Unannounced Inspection 10 and 11th August 2009 11:00 th Chadwin Road (81-83) DS0000058206.V376997.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. Chadwin Road (81-83) DS0000058206.V376997.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 Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chadwin Road (81-83) Address 81-83 Chadwin Road Plaistow London E13 8ND 0207 474 8378 0207 474 8378 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) Consensa Care Limited Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places Chadwin Road (81-83) DS0000058206.V376997.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: 7 5th August 2008 Date of last inspection Brief Description of the Service: 81-83 Chadwin Road is one of a group of homes owned and managed by Consensa Care Limited and situated in a residential street off the A13 in the London Borough of Newham. It provides twenty-four hour support for seven people with severe or enduring mental illness who have high care support needs. Care staff support and facilitate individual service users in tasks associated with daily living, both within the house and in the community. Placements are permanent; however the aim is to encourage service users towards independent living. The service is not registered to provide a service for service users with organic brain disease, learning difficulties or dementia. The service also cannot cater for people with a history of serious risk to themselves or others or who require high levels of nursing care. There were three residents living at the care home at the time of this inspection, although prospective residents were in the process of moving in. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service has been assessed as two star –good service. This unannounced key inspection was conducted over two days. We gathered information by speaking to the residents, the staff and the manager. We checked the storage and administration of medication, toured the premises and read two out of the three available care plans. We looked at staff files (for training, recruitment, supervision and appraisal) and checked documents held within the care home (for example, residents’ finances, health and safety checks conducted by staff and by external competent persons, and policies and procedures). What the service does well: What has improved since the last inspection? Seven requirements and two recommendations were issued in the previous inspection report; these have all been deleted as they were evidenced to have been met at this inspection visit. The Statement of Purpose and Service Users Guide had been updated and the risk assessments were now more comprehensive. Clear improvements to the environment had been achieved and the management of the medication and first aid equipment was safe. Staff benefited from programmes of training to meet their own needs (for example, Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 6 more experienced staff were accessing a higher level of qualification) as well as training that reflected the needs of the residents. Hazardous items were safely stored. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 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. Prospective residents are assured that their holistic needs will be identified before moving in, and they will have the chance to view the service before deciding to move in. EVIDENCE: At the time of this inspection there were three residents living at the care home and two people were due to move in; the service can accommodate a total of seven residents. We looked at the admission process for one of the current residents; it was noted that the needs of the resident had been fully assessed by health and social care professionals, and the service had conducted its own pre-admission assessment. On the second day of the inspection we observed a prospective resident come along to the service to meet other residents and staff, and to have a look around (including a viewing of the proposed allocated bedroom). Senior staff were also attending ward meetings for prospective residents that were due to be discharged from hospital to Chadwin Road. The attendance at these meetings spanned over several weeks, enabling the service to gather as much relevant information as possible from the multi-disciplinary hospital team (as Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 9 well as the usual process of talking to the resident and where applicable, his/her supporters). Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 10 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): 6,7 and 9 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. Although some small issues need to be addressed, the service demonstrated that residents are supported by care plans (inclusive of risk assessments) that promote good, individualised care and appropriate levels of independence. EVIDENCE: We read two care plans during this inspection; the following observations were made: Key workers need to consistently use their full name when signing care plans, as they are professional documents. The weight monitoring sheet would very much benefit from also having details regarding a person’s height and the recommended weight that they should be in accordance to their Body Mass Index (BMI). It was advised that staff should seek the support of community staff for this task such as practice nurses, as an incorrect BMI would be identified if any resident was not entirely sure of their exact height. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 11 There was a reference in one of the care plans to an uncommon medical condition; it was advised that there should be a brief explanation within the care plan as to the meaning of the medical terminology as we would not ordinarily expect new staff to be familiar with the condition. Staff should be careful about using correct wording; for example, a resident was described as smoking ‘sticks’ but upon discussion with the manager it emerged that this meant cigarettes. This is acknowledged to be a minor issue but we were concerned that this practice might lead to incorrect conclusions being drawn by an external professional (such as a community psychiatric nurse) reading the care plan. We would recommend that a care plan is established for a resident that needs to have their blood pressure checked every day; although there were no concerns regarding staff compliance with this task but it would be useful to have clear guidelines written up. However, the care plans were otherwise well written and up-to-date, with clearly presented and relevant risk assessments. There was a noticeable improvement in the quality of these documents since the last key inspection. We have recommended that the service consider the use of a bibliographical tool to record significant events in a resident’s life, taking into account that some people have experienced a lot of changes which they might not be in a position to describe in later life. At the time of this inspection there were only three residents, hence it was not possible to effectively conduct forums such as residents’ meetings. However, we were able to observe how people made their own choices about their daily routines and longer-term issues. For example, residents were observed to prepare snacks and beverages at times to suit themselves and one resident stated that they maintained friendships within the wider community. Information was provided regarding independent advocacy services that residents could access. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 12 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: 12, 13, 15, 16 and 17 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 are assured that they will be supported to pursue fulfilling activities. The food service was of a good quality. EVIDENCE: Through speaking to residents and staff, and via looking at the care plans, we found that the service supported people to avail of fulfilling activities in the community and at home. Residents informed us that they attended the gym, undertook voluntary work, attended church and social activities arranged by their parish, and went to adult education classes. We observed that residents were participating in activities within the care home, such as one-to-one structured discussions with their key workers, household chores and cooking. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 13 The service encouraged residents to maintain their links within the local community, including relationships with relatives and friends. We spoke to staff regarding how they might respond if there were any potential issues of concern; for example, if a resident might be at risk because of a friendship with a person in the community. We were satisfied that staff would respond in a professional and sensitive manner in order to safeguard the resident, whilst acknowledging a person’s right to make choices. There were no issues of concern regarding the food service. Residents were encouraged to participate in menu planning and food preparation. We noted that there was fresh fruit and healthy snacks available. Residents stated that they were happy with the quality of the food. We have suggested the trial of the use of de-caffeinated coffee and tea for any residents that the service might have concerns with in regard to late night caffeine causing insomnia. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 14 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): 18, 19 and 20 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 are provided with suitable care for their personal care and medication needs although some improvements are needed to the health care planning and documentation. EVIDENCE: The care plans evidenced that residents were supported to meet their personal care needs; for example, if prompting was needed to take showers or purchase new clothes. We have already identified some issues regarding how the service could improve upon the provision of health care (as recorded within ‘Individual Needs and Choices’). A requirement was issued in the previous inspection report regarding the safe management of medication. It was noted at this inspection that he service had Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 15 achieved notable improvements and now presented a comprehensively managed approach to the storage, administration and disposal of prescribed medications. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 16 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): 22 and 23 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 are assured that systems are in place to ensure that they will be listened to and protected from abuse, although the service must make sure that all staff promptly receive their safeguarding refresher training. EVIDENCE: We checked the service’s complaints procedure; it was clearly written and a copy was provided to each resident. We looked at the service’s complaints log and no issues of concern were identified. The service produced an appropriately written Safeguarding Adults policy and procedure. We spoke to staff regarding their understanding of the policy (inclusive of whistle-blowing) and found that they were confident in their correct understanding of relevant issues. It was noted that a few staff needed their refresher training, which the manager stated that she would address as a priority. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 17 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): 24 and 30 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 were provided with a homely and clean environment. EVIDENCE: The service occupies an ordinary domestic property (two houses that have been joined into one premise) on a residential street. A number of issues were raised in the previous key inspection report in regard to the condition of the house and requirements were given for improvement. It was noted at this inspection that a considerable level of improvement had been achieved in order to provide the residents with a comfortable, safe and hygienic home. We were permitted by a couple of the residents to view their bedrooms and noted that people were encouraged to personalise their own private space. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 18 The manager identified that there were on-going environmental improvements that had been agreed with the provider and were scheduled at dates after the inspection. We found that the care home was clean and free from any offensive odours. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 19 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): 32,34, 35 and 36 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. The service needs to demonstrate some improvements with staff training and supervision in order to evidence that residents fully benefited from well trained and supervised staff; however, it is felt that on-going progress was been made at the time of this inspection. EVIDENCE: We noted that some of the staff needed to refresh specific mandatory training, although there was good evidence of staff receiving specific training to address the needs of people with mental health care needs. We have acknowledged that some staff were unable to attend an arranged medication training session due to a day of extreme weather conditions earlier this year and will be booked onto the next available opportunity. Staff recruitment was thorough and safe; we checked a random sample of the staff files during this inspection. The organisation enabled residents to participate in the recruitment process. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 20 There were no issues of concern in regard to staff accessing National Vocational Qualifications (NVQ) in Care at either level 2 and/or 3. It was noted that a delay with NVQ training problem beyond the control of the staff had arisen under the management of the former registered manager; however staff were now busily engaged in acquiring their qualifications and spoke to us about their progress. It was noted that the new manager had commenced a supervision and appraisal programme but it was acknowledged that this had fallen short of the expected level of supervision within a twelve month period (appraisals were done). It is noted that the manager worked with staff on improving other aspects of care since she started at the service a few months ago, such as care planning and risk assessments, and direct work with the residents. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 21 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): 37, 39 and 42 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 benefited from a management approach that sought their opinions and promoted their safety and welfare. EVIDENCE: The manager was relatively new at Chadwin Road, having previously worked at another care home owned by the service provider. We were informed that the manager was undertaking a management qualification and would be applying for registered manager status with the Care Quality Commission. We were pleased with the ideas expressed by the manager in regard to the improvements that she had already achieved and her views for on-going development of the service. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 22 We read a selected sample of the Regulation 26 visits reports (unannounced monthly quality monitoring of the service by the provider). These reports were very through and open; it was noted that issues for improvement were clearly recorded and then checked upon at the next visit. The service had identified its aim to improve since the last key inspection and these reports demonstrated some of the measures that had been implemented. The residents that we spoke to during the inspection conveyed that they felt that staff consulted them and listened to their views about the service. There were no issues of concern in regard to the service’s management of residents’ finances; in fact it was a very thorough approach which had been devised to try to ensure that no irregularities occurred. We checked a sample of the health and safety records and practices within the premises; all records were up-to-date and appropriately maintained. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 23 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 X 2 3 3 X 4 3 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 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X Version 5.2 Page 24 Chadwin Road (81-83) DS0000058206.V376997.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 YA19 Regulation 15 Requirement The registered person must ensure that the health care issues within this report are addressed. Timescale for action 31/10/09 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 The use of recorded information about a resident’s life is recommended, if they wish to participate. Chadwin Road (81-83) DS0000058206.V376997.R01.S.doc Version 5.2 Page 25 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.london@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. 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. 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