Care Home: Colham Road, 3

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What the care home does well Good quality assessments are undertaken before prospective residents are accepted to move into the care home. High levels of needs amongst the residents are met by high levels of skilled care provision. All the residents have multiple and complex care needs. Three places at the home are used for respite care that is often provided on a rotating basis. detail and individualized care plans exist for all residents, including those on respite. The care plans are in picture format. Risk assessments are undertaken for all residents. Health Action Plans and Hospital Books exist. Most residents attend day centres and a range of activities, outings and a holiday are provided. The home has several vehicles to take residents out in. Complaints are always taken seriously and fully investigated. Residents are well protected from abuse. Most of the building is well maintained, equipped and furnished. The permanent staff group are very well trained. Health and safety are taken seriously. What has improved since the last inspection? Additional documents have been created in picture format for the benefit of residents. The home`s kitchenettes have been refurbished. Decoration and replacement of soft furnishing have taken place. Most long-stay bedrooms have had wash-hand basins installed. Two new vehicles have been purchased. A new television and a new washing machine have been obtained. What the care home could do better: One of the respite care beds has been occupied for nine months by someone awaiting a permanent home elsewhere. The home does not have a recent assessment for this person nor an up to date care plan as no review of her care needs appears to have been done for over two years. Not all care plans within the home are dated hence it is difficult in some instances to determine which care plan is current. Not all residents are weighed regularly as a means of monitoring their health. The home`s bathrooms are in need of refurbishment, there is a lack of dedicated storage for mobility equipment, and the respite care bedrooms are undersized and lacking wash-hand basins or adjacent bathing facilities. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Colham Road, 3 Colham Road, 3 Hillingdon Middlesex UB8 3UR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Robert Bond     Date: 0 7 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Colham Road, 3 Colham Road, 3 Hillingdon Middlesex UB8 3UR 01895271245 01895236588 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: London Borough of Hillingdon care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 13 The registered person may provide the following category of service only: Care Home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 3 Colham Road is managed by the London Borough of Hillingdon and owned by the Health Authority. It provides residential care for ten permanent and three respite care service users. The residents have profound multiple learning, sensory and physical disabilities. All are non-verbal and three require PEG (pecutaneous endoscopic gastronomy) feeding. The home was purpose built in 1987 and is set on one floor, divided into four units: North, South, East and West Lodges. Each lodge is designed for three or four residents and leads out to an attractive central courtyard, laid out with Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 13 Brief description of the care home paved sitting areas and fringed with shrubs and trees. Each lodge is self - contained with a lounge, kitchen/diner, bathroom with toilet facilities and single bedrooms for each resident. All the bedrooms are attractively decorated with individual colour schemes and furnishings. Seven of the bedrooms do not meet the National Minimum Standard of 12 square meters for residents needing to use a wheelchair within their bedroom. All but two residents attend day centres, for which The London Borough of Hillingdon provides a special minibus. Residents attend medical appointments and use the homes specially adapted transport for this. The home is set in its own large grounds near Hillingdon Hospital and is about three miles from central Uxbridge. The home has ample parking facilities and is easily accessed by public transport. The staff team consists of one Manager, five full-time team leaders, seventeen care workers, five night workers, one domestic, one full time administrative officer and one part time handy person. 3 Colham Road is currently regularly using a large number of agency staff to support the permanent staff team. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key unannounced inspection that considered the outcomes for residents for the key National Minimum Standards (NMS) for care homes for younger adults as published by the Department of Health. The previous key inspection took place on 15th August 2007 but an Annual Service Review was undertaken on 14th January 2009. In advance of the inspection, we sent the home an Annual Quality assurance Assessment (AQAA) that was returned to us on 10th June 2009. We also sent questionnaire surveys to staff and to residents, and had 9 responses from residents with the help of staff. We spent most of one day visiting the premises during which time we toured the building, met staff and residents, interviewed two Team Leaders, and examined a range of documents. Care Homes for Adults (18-65 years) Page 6 of 26 Equality and diversity issues were considered throughout the inspection. What the care home does well: What has improved since the last inspection? 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 set out 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. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New and existing long-term residents have been admitted on a planned basis following thorough needs assessments, but the home does not have a current assessment for a respite care user who has become a long-term resident by default. Evidence: We examined three residents care files in order to consider the assessment information contained on the files. One resident had lived in the care home for several years, one resident had only recently moved in, and the third resident was receiving extended respite care. The recent long term admission had been undertaken following receipt by the home of a FACE assessment that had been completed one month before the resident had moved in. A initial care plan (undated) had been based on this assessment. A search of the care file for the resident who had received weekend respite care for several years prior to spending continuous 9 months at Colham Road produced only as assessment dated 2005. This residents needs had changed dramatically in that she Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: now needed long term residential care that was being provided temporarily at Colham Road pending a more suitable placement being found elsewhere. The phrase quoted to us was bed-blocking in that one of the respite places at Colham Road had not been available since November 2008. The Team Leader told us that the residents social worker had she thought completed a new assessment, but a copy of this document, and a revised care plan based upon that assessment, could not be located for our inspection. Care Homes for Adults (18-65 years) Page 11 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are kept under review, and picture format plans are also available, but in one case an up to date care plan could not be located for inspection. The increased use of picture format documents is commended and it should aid the involvement of residents in decision making. Risk assessment documentation was found to be reasonably current. Evidence: We examined three residents care files, as described above in the choice of home section of this report, with particular emphasis upon their care plans. The file of the long term resident who had lived at Colham Road for some years contained a good detailed care plan dated January 2009 that had been signed by the Team Leader. Daily routines, and the residents likes and dislikes were recorded, which is good, and for the benefit of staff whose first language is not English, a photograph record of what to do had been produced, which is commended. Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: The file of the long term resident who had recently moved in contained a number of blank spaces, but further investigation demonstrated that this was because hand written documents such as a revised care plan were with the admin assistant awaiting typing up. Thus we discovered that the initial undated care plan had been reviewed on 08/01/09, and the revised version was signed by the manager. The care plan of the respite care resident who is at the time of writing a semipermanent resident was neither dated nor signed by anyone. A review of this resident had taken place at her day centre in 2007 but we could not find any evidence of subsequent reviews and changes to her care plan for Colham Road despite her change of circumstances. Picture format care plans are displayed in residents bedrooms. The homes AQAA reports that they have completed 10 photo care plans for permanent residents, and 9 for respite service users. Other picture format documents to aid the involvement of residents in decision making are a photo food menu, complaints procedure, and record of resident meetings. We considered the risk assessments on the three care files examined. The AQAA reports that these documents are also being created in picture format. The established long term resident had a Moving and Handling risk assessment completed on 24/07/08. Whereas this had not been reviewed one year later, a risk assessment in a new format had been undertaken on 27/01/09. A risk assessment had been undertaken on the new long term resident at the time of her moving in, and a fairly recent risk assessment had been completed on the semi-permanent respite resident. Care Homes for Adults (18-65 years) Page 13 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to take part to a satisfactory extent in a range of appropriate leisure activities in the home, and in the wider community. Most long-term residents maintain links with their families. Residents rights are well recognised. An appropriate diet is provided and good records are kept of food and drink consumed. Evidence: Three day centres are accessed by residents, with attendence being for 2, 3 or 4 days of the week. Two residents choose to no longer attend a day centre, having retired. For those not attending a day centre on a particular day, the home arranges activities on a communal and one to one basis. Each resident has an activity plan. Last year some residents were taken to Euro-Disney and photos of the trip are displayed in the main communal area. The home has several vehicles in which to take residents out. Feedback from residents Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: in the form of questionnaires completed by link workers included comments about going out to lunch, and for walks in the community, and one said the home helps me to go and see my parents on a regular basis. One resident, via their link worker, made a plea for new and exciting activities. Food is prepared in the home but three residents are PEG fed. Care Homes for Adults (18-65 years) Page 15 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive excellent personal support in the way they prefer and require. Residents physical and emotional health needs are being met but the weight of every resident is not being monitored. Residents are well protected by the homes policies and procedures for dealing with medicines. Evidence: The care plans we examined contained detailed instructions for the support staff to follow concerning how personal care tasks should be undertaken in ways that the residents prefer. These instructions are supplemented by the use of photographs, which is commended. Long-term residents have Health Action Plans and Hospital Books to be taken to hospital with them when a hospital admission proves to be necessary. The book provides hospital staff with all the information that they would need to know about the resident. The use of this process is commended. We checked the records of residents weights and found that the recording system had Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: been improved in that weight gain or weight loss had been recorded on a monthly basis. However one file examined stated that the resident refused to be weighed as she was afraid to be hoisted. A requirement has therefore been made. We checked the medication storage and administration records in one unit of the home. No errors or omissions were noted, the medication was neatly maintained, and appropriate records of the return to the pharmacist of unused medication had been kept. Care Homes for Adults (18-65 years) Page 17 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Relatives of residents can be assured that their views are listened to and acted upon where necessary. Residents are well protected from abuse, neglect and self-harm in terms of the training that staff have received. Evidence: The AQAA reports that three complaints had been received by the home during the last 12 months. We examined the complaints file and found that complaints had been appropriately investigated and responded to. We saw records that demonstrated that all existing staff had received training in Safeguarding Vulnerable Adults. Care Homes for Adults (18-65 years) Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely and comfortable environment but one that will not be sufficiently safe until washing facilities in the respite care unit, and in those long stay bedooms without wash hand basins, have been improved. Resideents live in a home that is sufficiently clean and hygenic, with the possible exception of some bathrooms. Evidence: Since our previous inspection, the homes kitchenette units have been refurbished, some communal furniture has been replaced, and wash hand basins have been installed in most, but not all bedrooms. Hand washing facilities are still lacking in the respite care part of the building in particular, and the bedrooms are undersized. This unit is yet to be renovated, with the planned installation of shared bathrooms. The bathrooms in the other units are also still in need of refurbishment. Examples were seen of damaged bath housings, damaged plaster, and a obsolete ceiling mounted hoisting system. The home was seen to be clean, tidy and hygenic overall. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are well supported by staff who are competent and in the case of the permanent staff, very well qualified. There is still a substantial reliance on temporary agency staff. We consider residents to be well supported and protected by the homes recruitment policy and practices. Evidence: The Team Leader reported that recent recruitment drives have led to the employment of additional permanent staff. Although some agency staff are still employed, their number has been reduced, and most of those used are well established in the home. We examined the staff rota and determined that of the 8 support staff needed each day, permanent staff were used to cover between 4 and 7 of the shifts according to which day it was. The reliance on agency staff however remains a concern. Only 2 out of 5 Team Leaders are permanent post holders. A residents relative contacted us two months ago to express her misgivings about the high use of temporary staff. We also received an anonymous complaint in April 2009 from a member of staff that mentioned amongst other matters the reliance on agency staff and the fact that the homes manager had been promoted away from the home. The Team Leader told us that all the permanent support staff held NVQ2 awards. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: As the homes Acting Manager was not present, we were unable to check any staff recruitment files or supervision records but we examined the training records that demonstrated that mandatory training was up to date. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the two years since our last inspection, improvements have been made, and standards maintained by the management of the home. Evidence: As reported above, the previous Registered Manager of the home has been promoted elsewhere within the organisation. The home is currently being managed part-time by a manager from another home. She was on leave the day of this unannounced inspection but we spoke to her subsequently by telephone. During the day of our inspection we were informed by Hillingdons Team Manager that the vacant manager post for 3 Colham Road was about to be advertised. Customer surveys are sent out to residents relatives every six months. The results are summarised by Head Office and made available to the manager. We checked fridge and freezer temperature records, water temperature records, and the contents of two first aid boxes. Care Homes for Adults (18-65 years) Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 Written assessments of need 01/10/2009 have to be kept under review and revised at any time when it is necessary to do so having regard to any change of circumstances. Otherwise the residents care plan may not be up to date, and residents needs may not be fully met. 2 6 15 Residents care plans must be kept under review. Otherwise residents care needs may not be fully met. 01/10/2009 3 19 12 Ways must be found to monitor the weight of all residents. Otherwise a potential health issue may develop unnoticed. 01/10/2009 Care Homes for Adults (18-65 years) Page 24 of 26 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 24 23 All bedrooms must have 01/05/2010 adequate facilities for residents to wash. THIS IS A RESTATEMENT OF PREVIOUS REQUIREMENTS. Otherwise residents hygiene may not be maintained. 5 27 23 The homes bathrooms must 01/05/2010 be refurbished. Otherwise standards of hygiene cleanliness and safety may not be met. 6 33 18 Further efforts must be made to increase the proportion of support and management staff who are permanent. Otherwise the support needs of residents may not be fully met. 01/11/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Residents care plans should always be dated in order to assist with their identification. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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