Care Home: Flat A 12 Hyde Close

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What the care home does well The home is clean, bright and tidy. The staff are trained and experienced to provide care that meets the needs of the people who use the service. There are good activities for the residents to be engaged. The home`s efforts to support the residents to access community based facilities are recommendable. What has improved since the last inspection? The home`s policies and procedures have been updated as required at the last inspection. A plan of the refurbishment of the home is put in place. The kitchen units have been changed and the kitchen has been upgraded. What the care home could do better: It is important for the home to ensure that the residents and their relatives or advocates are consulted about holiday money or other expenses. This will ensure that the residents money is spent for the residents and in their best interest. Also the home needs to have a robust system for the recording and disposal of medicines. A bathroom which is not in good working order needs to be done so that it is available and safe for the residents to use. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hyde Close 12A Hyde Close 12A High Barnet Hertfordshire EN5 5TJ     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: Teferi Degeneh     Date: 0 3 0 6 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 27 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 27 Information about the care home Name of care home: Address: Hyde Close 12A Hyde Close 12A High Barnet Hertfordshire EN5 5TJ 02084474041 02083648083 emma.thorpe@sense.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Sense, The National Deafblind and Rubella Association care home 5 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 5 5 The maximum number of service users who can be accommodated is: 5 The registered person may provide the following categories 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 Physical disability - Code PD Date of last inspection Brief description of the care home 12a Hyde Close is managed by Sense. It is a service for adults who have sensory impairments, mobility problems and severe or complex learning difficulties. The four flats in the building at Hyde Close which, although always managed separately, were originally under one registration but now, each flat has its own registration. This is the first inspection of 12a Hyde Close under its own registration. 12a Hyde Close accommodates 5 people in their own rooms and has a kitchen/lounge area and two bathrooms. Each person has his or her own single bedroom with a Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home washbasin. There is a large shared sensory garden area and a patio. The laundry facilities are shared between the flats. The staff team work two day shifts and at night, there is one waking night and one sleep-in staff member. Opposite the home on the same site, there is a specialised day service, which is separately managed. The residents have access to all these facilities and other community resources. The flat has its own eight seater minibus, which accommodates wheelchairs. The home is situated in High Barnet, in a pleasant residential area, close to shops, restaurants, pubs and other local amenities. The area is well served by public transport. The stated aims of the service are to provide support to the residents to achieve their optimum potential in social, emotional, developmental and educational activities, and enjoy a good quality of life. A copy of the inspection report can be available by requesting directly from the home or from the CQC website. The fees for the home range between £1461-£2115. Care Homes for Adults (18-65 years) Page 5 of 27 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: We arrived at the home at 07:45 am without giving a notice that we were visiting. Two care staff and two residents were at the home when we arrived. The manager, who is yet to be registered by the Care Quality Commission and, therefore, we referred to her as an acting manager in this report, came about thirty minutes after we arrived. The service manager was also briefly present when the inspection was taking place. The inspection activity undertaken included a tour of the building, the examination of the residents files including care records, the examination of health and safety records, the viewing of staff rotas and observation of people who use the service, care staff and the homes management. Two care staff were individually interviewed. Care Homes for Adults (18-65 years) Page 6 of 27 Before this inspection we had received the annual quality assurance assessment (AQAA) from the home and have included the information in our judgement of the quality of the services of the home. An AQAA is a self assessment which the home is required to complete and send to us yearly to tell us how they intend to improve the care they provide. We have also considered the last inspection report and all other information we have about the home when writing this inspection report. 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 27 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 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are confident that their admission to the home is based on the ability of the home meeting their assessed needs. Evidence: No new residents have been admitted since the last inspection. The home has a procedure for admitting residents. The acting manager confirmed that all prospective residents are visited at their homes and assessments are completed to check that their needs can be met and they are compatible with the existing residents. The acting manager said she is currently completing assessment for two residents. She said a decision to admit new residents will be made only if the facilities and services available at the home are suitable for their needs. Care Homes for Adults (18-65 years) Page 10 of 27 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. The people who use the service can be reassured that their care plans and risk assessments are updated and their needs met by the home. Evidence: The files of the three residents were checked. These all contained evidence of care plans and risk assessments. The care plans are detailed with information about how to meet the needs of the residents. The acting manager said the care plans are reviewed regularly with the involvement of the families and people from the social services. The AQAA states that each resident has a key worker who has a special interest in their day to day care. Risk assessments are also up-to-date and all care staff have signed to confirm that they have read and understood how to manage risks to the residents. The AQAA says: We recognise that SU [service users] have a right to be given the choice to take a degree of risks that will improve their confidence and independence. The home is introducing a person centred care planning. A person centred care planning is a plan which gives the whole picture of the needs, aspirations and goals of a resident. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: The acting manager confirmed that the home is working to improve the quality of the person centred care planning. Two residents who were at the home during the visit were observed in the lounge. Both residents have a physical disability and use a wheelchair to access communal areas. Discussions with the staff and observations showed that the residents were encouraged, wherever possible, to make decisions about what to eat, drink, and where to stay, for example, in the lounge or bedroom. Records in the files and conversations with the staff showed that the residents are supported to go out to the shops and cafes. Care Homes for Adults (18-65 years) Page 12 of 27 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. There are good opportunities for the residents to be active and engaged. However, the residents can be more reassured by the implementation of a robust system of managing their personal allowance. Evidence: Two of the residents were at the home and another resident was at a hospital when this inspection was carried out. From discussions with the acting manager and from the residents files it was evident that the residents are engaged both within and outside the home. During the inspection the staff went out with the residents to do some shopping. This seems to be a common practice and the residents enjoy going to the public houses, cooking sessions, art classes, and swimming. The home has its own wheelchair accessible minibus. Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: Discussions with the acting manager and the records indicated that holidays are arranged for the residents. The home is currently planning an additional holiday for a resident. The acting manager said the resident has sufficient money to cover expenses for themselves and two staff for the holiday. Even though this was a good idea, we expected the home to make such a decision with the residents families, social worker or advocates. The acting manager said she will contact the residents social worker and discuss with them the details of the planned additional holiday. Most of the residents regularly visit their families at home. The home has recently supported a resident to move to a care home nearer their family. The food provided at the home is of good standard and the menu is prepared in consultation with the people who use the service. The residents can choose what and when to eat. Packed lunches are provided when and if the residents choose. On the day of the inspection there were fresh vegetables, fruits and a variety of food items in the home. From discussions with the staff it was clear that the residents dietary needs are met. The staff were observed assisting residents with their meals. Care Homes for Adults (18-65 years) Page 14 of 27 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. The systems of the home and the staff are good to meet the health and personal care of the people who use the service. The recording of the receipt and disposal of medication is in need of an improvement. Evidence: Medicines are kept in the residents bedrooms. The acting manager said that medication administration is done by two persons which means that one member of staff witnesses when the other gives medicines to a resident. We checked the medication administration record sheets (MARS) and found out that all relevant boxes have been signed by the staff to confirm that the medicines have been administered. However, when we checked the medicines we could not work out how many of one of the tablets have been given as the recording system did not show how many tablets there were in the home. It is important for the home to improve the recordings of the receipt, administration and disposal of medicines. From discussions with the acting manager and the staff it was clear that the home is aware of some symptoms of ill health and the steps that need to be taken, for Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: example, by calling the ambulance service and enabling the residents to access health care services. The residents files contained evidence that the residents have their own general practitioners (GPs), and have access to a dentist and an optician. Letters in the files indicated that the residents have regular checks and appointments with a consultant psychiatrist. On the day of the inspection both residents looked comfortable and relaxed. Discussions showed that care staff are experienced and knowledgeable to ensure privacy, dignity and individual choice when assisting the residents with personal care. Care Homes for Adults (18-65 years) Page 16 of 27 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. The safety and wellbeing of the people who use the service are ensured by the homes good complaint management practices and adult safeguarding arrangements. Evidence: No complaints have been recorded since the last inspection. The acting manager said the staff are trained and experienced to notice and act on the concerns of the residents. She said that all concerns are taken by the home seriously. The home has a safeguarding policy and a copy of the local authoritys policy on the protection of adults from abuse. The two care staff who were interviewed were able to provide satisfactory explanation of what safeguarding is and how to ensure that the people who use the service are safeguarded. They also confirmed that they have attended training on safeguarding. The home has continuously reported to the Commission and the local authority whenever there has been an allegation of abuse or mismanagement of the service. Care Homes for Adults (18-65 years) Page 17 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good facilities for the residents to feel that they live in a safe and comfortable home. Evidence: At the last inspection the home was required to ensure that a clear refurbishment plan is produced, including timescales and lines of responsibility. The home was also asked to to ensure that the kitchen units are replaced. From observations and the documents which were made available for the inspection, it was evident that the home has a clear plan to undertake a refurbishment. The home has also replaced the kitchen units. However, it was noted that one of the bathrooms was out of use and has been locked by the acting manager so that the risk to the residents and the staff is controlled. The acting manager said she has reported this problem to the people who manage the building and is waiting for them to sort out the problem. All the other parts of the home were clean, tidy, bright and free from bad smells. The bedrooms were personilised and have sensory stimulation such as aromatherapy and hanging mobiles. Furniture that meets the needs of each resident is provided. For example, a resident has a special sensory massage chair and the other person has music equipment. The acting manager said the home is in the process of getting a Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: resident a new wardrobe. Care Homes for Adults (18-65 years) Page 19 of 27 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. The residents are reassured that they are supported by staff team who are vetted, experienced and knowledgeable to provide care that meets their needs. Evidence: The staff rota showed that there are two care staff and the acting manager or the deputy manager during the day and evening shifts. There is also a sleep-in staff at night. A waking night staff is available to provide supports for the residents in this and another flat in the building. As mentioned earlier there are two residents living at the home at the moment. Two care staff were observed and interviewed individually. Both are experienced and have worked at the home for a number of years. They were able to demonstrate their good knowledge, experience and skills of supporting the people who use the service sensitively by ensuring respect, dignity and choice. From the interview and files it was possible to confirm that the staff have attended a range of training programmes including safeguarding adults from abuse, first aid, moving and handling, infection control, food hygiene, medication and health and safety. They have also achieved a national vocational qualification (NVQ) in care at level 2 or 3. The staff spoken to confirmed that they receive regular supervision and they work well with the team. The Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: home has a training plan which we were able to check. We confirmed in the staff files that they have satisfactory certificates from the criminal record bureau (CRB) and two written references. The company has a recruitment process and no new staff are employed without providing satisfactory CRB certificates and written references. There is a policy on equal opportunity. Care Homes for Adults (18-65 years) Page 21 of 27 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. The home is managed well by a committed manager who is supported by senior people in the organisation. Evidence: The manager is yet to be registered by the Care Quality Commission and, therefore, we referred to her in this report as an acting manager. She has a long experience of working with the people who use the service at a care home and a day centre. She said she has worked as a deputy manager before taking up the managers post. The staff we spoke to told us that he manager is good and she supports them well. The manager is currently studying to achieve an NVQ level 4 qualification. During this inspection we found the acting manager to be cooperative and forward looking with a lot of ideas to improve the service. We noticed that she works closely with the other managers of the company that owns this home. We stated above that the home helps the residents with the management of their personal allowance. We checked the financial records, receipts and the cash tins of the Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: two residents currently living at the home. All these were in order. However, we advised that the home must ensure that the residents relatives or advocates are consulted regarding expenses for extra holidays or some items costing a certain amount of money. This amount needs to be discussed and decided in a review meeting where all relevant people are present. There is a robust quality assurance system. This includes a monthly health and safety audit undertaken by the acting manager and the service manger; a regular visit by quality team from the head office; and a fortnightly visit by the service manager to review the services. The manager said the home is developing formal feedback surveys to be given to all the stakeholders. As stated earlier the home is accessible to people with a physical disability. There are systems in place to ensure that risks to the health and safety of the residents are removed and managed. Records showed that the gas boilers and fire extinguishers were last serviced on 8th August 2008 and 7th April 2009 respectively. Fire alarms and the water are tested and recorded regularly. The staff have attended training on health and safety, fire safety, first aid and manual handling. Care Homes for Adults (18-65 years) Page 23 of 27 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 24 of 27 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 13 20 There must be a robust and transparent system for the management of residents money. This will ensure that all expenses made for the residents are in the best interest of the residents. It also ensures that the residents or representatives are involved in the decision making. 15/07/2009 2 19 13 Clear records of the receipt, administration and disposal of medication must be kept. In this way it will be possible to know the amount of tablets received, administered, disposed of or remaining at the home. 30/06/2009 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. Care Homes for Adults (18-65 years) Page 25 of 27 No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 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). 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. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!