Care Home: Dimensions 54 Beechcroft Gardens

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Annual service review Name of Service: Dimensions 54 Beechcroft Gardens The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection We do an annual service review when there has been no key inspection of the service in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection or annual service review.   Has this annual service review changed our opinion of the service?   No You should read the last key inspection report for this service to get a full picture of how well outcomes for the people using the service are being met. The date by which we will do a key inspection: Name of inspector: Judith Brindle Date of this annual service review: 1 2 1 1 2 0 0 9 Annual Service Review Page 1 of 8 Information about the service Address of service: 54 Beechcroft Gardens Wembley Middlesex HA9 8EP 02089048258 02083438876 sotalabi@adepta.org.uk www.pentahact.org.uk Dimensions (ADP) Limited Telephone number: Fax number: Email address: Provider web address:   Name of registered provider(s): Conditions of registration: Category(ies) : learning disability Conditions of registration: Number of places (if applicable): Under 65 Over 65 3 0 The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Have there been any changes in the ownership, management or the No service’s registration details in the last 12 months? If yes, what have they been: Date of last key inspection: Date of last annual service review (if applicable): Brief description of the service 54 Beechcroft Gardens is a is a registered care home providing personal care, and accommodation for up to 3 adults who have a learning disability. The care home is a detached 3-bedroom bungalow located in Wembley Park, close to a variety of shops, health, social and leisure services, and other amenities. Bus and train public transport facilities are in close proximity to the home. There is parking for two to three cars on the forecourt of the care home. A well maintained enclosed garden is located at the rear of the property. The local health authority owns the property and Dimensions (ADP) Limited provide Annual Service Review Page 2 of 8 the care and support for the people using the service. Documentation/information about the care home is accessible to residents and to visitors. Fees, including additional charges vary according to the individual needs of residents. The fee contribution paid by the residents is documented in their contract/statement of terms and conditions. Information about the range of fees is available from the home. Annual Service Review Page 3 of 8 Service update since the last key inspection or annual service review: What did we do for this annual service review? We looked at all the information that we have received, or asked for, since the last key inspection that took place on the 20/11/07, and the annual service review that we carried out on the 12/11/08. This included; looking at the annual quality assurance assessment (AQAA) that was supplied to us by the service prior to this annual service review. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We also looked at feedback surveys that were returned to us. Two had been completed by people using the service, four by health care professionals, and two by staff. We looked at how the service has managed any complaints, and what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. We also spoke with the registered manager prior to this review. The previous key inspection report and relevant information from other organisations was also considered. Since the previous annual service review, and key inspection the name of the registered provider has changed from Pentahact (trading as Adepta) to Dimensions(ADP) Limited. There was one requirement from the previous inspection, which the registered manager told us at the time of the previous annual service review had been met by the service. We thank all those who provided us with feedback about the service during this annual service review 54 Beechcroft Gardens. What has this told us about the service? The AQAA (Annual Quality Assurance Assessment) document had been completed comprehensively by the registered manager, and gave us all the essential information about the service that was asked for. The AQAA included examples to demonstrate how positive outcomes are supported, and enabled for the people using the service. Key points within the AQAA included reference to listening to, and supporting people using the service to make decisions about their lives. The AQAA told us that regular resident meetings take place, so they (people using the service) can share their views with staff and promote ownership of what goes on in their own home, and we were also told that residents participate in the development and review of their care plans. We were informed of developments that had been made to the service as a result of listening to people using the service. These include; the home having made significant changes especially around the way the individuals are supported, such as matching staff to meet the individual needs of people using the service. We were told by the home that people we support are actively involved in the recruitment and selection process, and are supported to sit on the interview panel, and ask their questions. With regard to the environment we were told of other changes that had been made following review of the needs and changing needs of people using the service. These include the home having carried out some major refurbishment work in the utility room and bathroom to meet the care assessment needs of the people using the service, and we were told that the home has purchased new furniture for their (residents) individual bedrooms, changed the T.V, carpet and dining table in the lounge and have replaced the fridge and the washing machine. Annual Service Review Page 4 of 8 We were told that the home has an Equal Opportunitys policy/procedure, and staff receive training with regard to gaining knowledge and understanding of the equality and diversity needs of people using the service. Also information from the AQAA told us that the home recognises the peoples individuality by maintaining holistic care and respecting their (people using the service) race and culture and that this is reflected in their choice of clothing, preferences of activities, and choice of favourite food. We were informed that staff practice does not discriminate against the people we support, and the home is open and non judgemental in their approach to service delivery. We were also told that peoples religious needs are respected, and that two people using the service regularly attend church services. We were told from previous inspection, and the AQAA that the home has a referral and assessment policy which tells us that prospective residents receive an initial assessment, and risk assessment of their needs (with their, other agencies full involvement) before they move into the home, and are supported and encouraged to visit the care home before moving in. A quote from the AQAA informed us that: during the assessment process we take into consideration the total needs of the person, i.e socially, physically, emotionally, mentally, financially, psychologically. AQAA told us that the home has an up to date statement of purpose and service user guide. The AQAA, and previous inspection told us that residents each have a care plan, which is person centred (where the person takes the lead and is central to their plan of care). Extracts from the AQAA informed us that the health needs of people using the service are met, and they have access to care and treatment from a variety of health care services. We were informed that the home recognises the importance of people using the service having a health action plan, and regular health checks. We were told that the incontinence nurse, and the physiotherapist have been involved in assessment review for one individual who needed a bathroom aid, toilet grab rail, commode. Health and social care professionals told us that the homes assessment arrangements always ensure accurate information is gathered and that the right service is planned for people, peoples health needs are properly monitored, reviewed and met by the service, and that staff usually have the right skills and experience to support peoples health and social needs. Comments from surveys from health care professionals told us that staff are very friendly and co-operative, always willing to assist, and they are very thorough in all aspects of medication, and staff follow all their procedures correctly. We were told from previous inspection that people using the service are supported to take part in the activities, and leisure pursuits of their choice, and they are fully involved in making decisions with regard to these. Activities that we were told about include; two people using the service have been on holidays of their choice, and an annual BBQ party had taken place. We were told that the home has promoted more social interaction between services by exchanging visits, and that residents are all empowered to be involved in various activities of their choice within the local community; i.e they all exercised their civil right to vote, attend the local town hall for events such as musical shows, pantomimes, tea dance, been to the Stadium to watch lives shows and many other events. We were told from the AQAA that the home promotes and encourages social skills, and relationships of the people (they) support within the larger community, and the home respects peoples right to choose their friends, integrate in the community and that visits to each others homes are Annual Service Review Page 5 of 8 encouraged. A quote from a staff member told us that the home does well in supporting people using the service on their holidays, day centre, activities, and outings in the community. A comment from a health care professional told us that Beechcroft staff give their clients the opportunity to choose what activities they would like to do. We were informed from previous inspection that a variety of nutritious meals, that meet the cultural and religious needs of people using the service are provided to them. Feedback from people using the service told us that they like the meals in the home. Feedback from surveys that we received from people using the service (who had some help from staff to complete them) told us that they were asked if they wanted to move into the home, they received enough information about the home before they moved in, the home is fresh and clean, they can do what they want to do during the day, and they know who to speak to if they are unhappy, staff treat them well, and listen to what they say. Previous inspection and the AQAA told us that the home has a complaints procedure, and people using the service were listened to, and understood how to communicate any concerns that they may have. We were informed by the AQAA that there had been one complaint within the last twelve months, and the home ensures appropriate measures are put in place to protect the people that they support from abuse. We were also told that the home ensures complaints are logged appropriately, and the home informs all the necessary agencies, and complaints are responded to within 28 days. The AQAA told us that staff are aware of the whistle blowing policy and the complaint procedures and understand how to respond to an allegation, and staff had received safeguarding adults and deprivation of liberty safeguards training. Feedback via surveys from people using the service told us that they know who to speak to if they are unhappy. AQAA and previous inspection told us that the home is clean, homely, safe and suited for its stated purpose. We were told that the home has a planned maintenance and renewal programme for both internal and external decoration, and we were informed of the areas of maintenance and refurbishment that had taken place. AQAA told us that the home caries out appropriate recruitment and selection procedures to ensure that people using the service are protected. A staff member confirmed this. AQAA told us that staff receive appropriate induction and training to ensure that they have the knowledge and skills to carry out their roles and responsibilities, and received supervision and appraisal. We were told that all staff have completed NVQ (National Vocational Qualifications) level 2 or 3 in health and social care, and are key workers for people using the service. Feedback from a staff survey told us that they were always given up to date information about the needs of the people that they support and care for, their induction covered everything that they needed to know to do the job, they received regular supervision, and there are sometimes enough staff to meet the individual needs of people. The manager could look into the staffing levels in the home. A comment from a staff member told us that communication within the staff team is very good, and that staff are well supported. We were told that the manager is so good and organised. Annual Service Review Page 6 of 8 With regard to Quality Assurance, we were told that the home carries out a yearly service audit, and the result of this audit reflects positive outcomes for people using the service, and that there is positive feedback about the service, from the people that use the service, including families/advocates/friends, and stakeholders. The AQAA told us a monthly proprietors inspection is carried out by the Area Manager, and a yearly financial audit of the service is also completed. We were told from the AQAA that the home has up to date policies, and procedures in place. The AQAA and previous inspection told us that the home has systems in place to ensure that required safety checks are carried out in the home, and appropriate monitoring of the service takes place. A quote from the AQAA told us we have a responsible Health and Safety Person who raises health and safety issues and there are records of accidents and incidents, and a disaster management plan in place, and Swine flu contingency plan, which all staff are aware of as discussed in staff meetings. The manager is registered with us and has a significant number of years experience working in social care with people who have a learning disability, and is well qualified and competent to manage the care home. What are we going to do as a result of this annual service review? It is evident from the information received about the care home since the key unannounced inspection (20/11/07 ) that our judgement is that the home is still providing a good service to people using the service. However we can inspect the service at any time if we have concerns about the quality of the service or the safety of the people using the service. Annual Service Review Page 7 of 8 Reader Information Document Purpose: Author: Audience: Further copies from: Annual service review CQC General Public 0870 240 7535 (national contact centre) Our duty to regulate social care services is set out in the Care Standards Act 2000. The content of which can be found on our website. Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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