Care Home: Haroldstone Home

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What the care home does well The service is well run with good structures and systems in place. Service users health, emotional and behavioral needs are well met at the home. What has improved since the last inspection? The home has built upon its successes with further development of the service it provides.Social activities have been expanded. What the care home could do better: Two requirements and five recommendations were made as a result of this inspection. We have required that staff training and supervision are improved. We have recommended that medications stocks are audited, that a service user`s financial arrangements are regularized, that staff training is better planned and information regarding an alleged allergy is confirmed and information regarding another allergy is made more prominent. Key inspection report Care homes for adults (18-65 years) Name: Address: Haroldstone Home 8 Harold Road Leytonstone London E11 4QY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Anne Chamberlain     Date: 2 1 0 4 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 25 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 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 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Haroldstone Home 8 Harold Road Leytonstone London E11 4QY 02082577094 TBC khanozgur@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Clearwater Care (Hackney) Ltd Name of registered manager (if applicable) Ozgur Khan Type of registration: Number of places registered: care home 5 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: 5 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 Date of last inspection Brief description of the care home Haroldstone Home is a Care Home providing accommodation and personal care for up to five people with a learning disability. The service is provided by Clearwater Care (Hackney) Ltd, a private limited company who has other care homes in other areas. The company provide line management support, human resource support and training for the homes staff and manager. The home is located in Leytonstone, close to shops, pubs, the post office, library and other amenities. It is also within a few minutes walking distance of Leytonstone underground station and is serviced by regular bus Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 5 Brief description of the care home services. Haroldstone home is a small family sized house, which is modern and has been recently refurbished and decorated throughout. It has 5 bedrooms all with ensuite toilet and hand washbasin. Separate bathroom and toilet facilities are provided. Residents bedrooms are comfortable and well maintained and reflect the residents own personal choices of decoration and personal items. All the homes bedrooms are single. The home has a garden to the rear. The home is not suitable for the use of wheelchairs. Information about the service provided is made available to current and potential residents in the homes, including reports by the Commission. The current cost of the service is from £1400 per week to £1700 per week, depending on the persons assessed need. Care Homes for Adults (18-65 years) Page 5 of 25 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: In order to undertake this key inspection, we viewed the Annual Quality Assurance Assessment which the provider had completed. The gave us useful information. We also undertook an unannounced inspection of the home. We viewed two service user case records and two staff personnel files as well as key documentation and records. We viewed the arrangements for the administration of medication and made a tour of the home. Care Homes for Adults (18-65 years) Page 6 of 25 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 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 7 of 25 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 8 of 25 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 home undertakes a quality assessment on prospective service users before a placement is offered. Evidence: We viewed the evidence of pre admission assessment on the files of two service users. Thorough assessments had been carried out with the service users before they came to live at the home. They also had the opportunity to visit the home and meet the other residents and staff. Care Homes for Adults (18-65 years) Page 9 of 25 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 home writes good service user plans, encourages services user to take decisions for themselves and measures risks carefully. Evidence: We viewed service user plans in two service user case files. These were divided into sections and they were well completed and reflected service users individual needs. The manager stated that service users have choices in their everyday lives. She gave examples of decisions including going for a walk, buying a mobile phone and choosing clothes and meals. One service user has favorite clothes he likes to wear. Two of the service users are non verbal and staff use signs pictures and symbols to assist communication with them. We saw one service users symbol cards and communication book. We noted appropriate risk assessments on files. The risks were graded for severity and likelihood, and related to a range of topics relevant to the individual. Care Homes for Adults (18-65 years) Page 10 of 25 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. Service users have a variety of opportunities to access the community. Relationships with family and friends are encouraged and supported, meals are varied and wholesome and mealtimes are pleasant. Evidence: Service users at the home make good use of two educational establishments locally, taking courses and recreational activities. They also enjoy swimming, Gateway disco nights and picnic walks. Everyone attends the Popcorn Club on Tuesdays which is a cinema activity. One service user plays pool in a local pub and other service users go along to watch him. He also goes to the local shop independently and enjoys gardening. Family contact is supported. One service user goes to his fathers home twice a week and on the day of the inspection his father and niece were collecting him to go back with them. His father also joins him for Sunday lunch each week. Another service users Mother comes every week and another service user goes home every Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: other weekend or more often. All the service users can use public transport, one independently and the others with escorts. We were able to observe the service users during the course of the inspection and they appeared to be a compatible group, interacting well with staff and each other. We felt that they are encouraged to be increasingly independent. The manager stated that one service user was not able to sit at the table and eat with cutlery when he arrived, but is now doing so. We observed this. Another service user needed two to one support on public transport when he came, but is now able to travel with one escort. The service users went on a holiday together to Blackpool which was a big success and an outing to Leyton Orient was also organized a while ago. One service user enjoys his play station games and staff assist him to acquire new games. The home has a good choice of TV channels including music and media which the service users enjoy. We noted an activity chart in the file of a service user who enjoys doing puzzles indoors with staff. The service users are a culturally diverse group and so are the staff, which is reflective of the local area. We noted one service user who is Chinese enjoying some Chinese music. The home has a karaoke machine which is popular. The manager stated that a good variety of meals are cooked at the home as the service users enjoy a wide choice of foods. She said that the four weekly menu plan kept in the kitchen is created by service users. There is always an alternative if a service user does not want a dish. One service user told us that he likes the things on the menu and his favorite is sausages. Service users who are non verbal are assisted to make choices with pictures. One service user likes to help with cooking. The manager said that once a month there is a take out choice and individuals choose their own dinner. Care Homes for Adults (18-65 years) Page 12 of 25 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 personal support and health care needs of the service users are well met. The arrangements for the administration of medication are sound. Evidence: The service users have varying support needs with personal care which are documented in their service user plans. We noted favorably that one service user has a personal hygiene rota which is completed and signed by staff. We saw a range of evidence to indicate that the health needs of service users are met. One service user has epilepsy and he has a risk assessment for this and a chart to record seizures. There was a record of a recent visit to a GP and a visit by the chiropodist who comes monthly. Weight charts are kept. A psychiatrist had been consulted for one service user and had prescribed a medication which has helped him with his behavior. One service user has speech and language input. We noted that one service user was said to be resistant to seeing a dentist. We asked the manager if he had seen a dentist since being at the home and she was not sure. She agreed to look into this matter. Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: We also noted that a service user was said to be allergic to nuts. However a staff member said that she felt that this was not definite but his mother had said he was because she was being cautious. We recommend that the manager takes steps to find out whether this young man has an allergy to nuts or not and ensure that his records show the actual situation. Another service user had statements made about his personal history in his assessment material, about which the manager stated she had no further information. We asked her to verify the information or remove it from the record. We viewed the arrangements for the administration of medication. The home has a medication policy. The medications are kept in an appropriate locked cabinet in a small room. There is a thermometer and a daily record is kept of the temperature in the room. The manager stated that all the staff administer medication and they have all had training to do this. There was a specimen signature list for staff. The Medication Administration (MAR) Records are kept in a folder. Each resident has a section with their photograph at the front. The MAR charts were well completed with no gaps. We attempted to balance the stocks of medications and although the staff count them regularly and record the amounts, it is not possible to check if the stocks of medications are correct because no balances are brought forward. We explained this to the manager and she said she understood and would devise a system which allowed for stock balance checks. We noted that on the MAR chart of one service user it stated that he is allergic to penicillin, but the medication sheet in his file did not state this fact. Allergic reactions to penicillin can be very serious and we recommend that the manager ensure any record relevant to medications states clearly this allergy to penicillin. Medications received into the home and disposed of to the pharmacist are recorded in a book, which was viewed. Care Homes for Adults (18-65 years) Page 14 of 25 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. Complaints are taken seriously and service users are protected and safeguarded. Evidence: We viewed the complaints policy which had time scales. We also observed a user friendly booklet entitled How to Complain, this was displayed on the wall downstairs. We viewed the records of complaints which was quite satisfactory. The home has a safeguarding policy of their own and they also have a London Borough of Waltham Forest policy. The homes policy is not clear that it must be followed in conjunction with the Waltham Forest policy. However the manager stated it is due to be amended and we recommend that when this is done this issue is clarified. The manager is clear that safeguarding must in the first instance be referred to social services and follows this practice. One service user who has been at the home since May 2009 does not have access to his own monies. His benefits are paid to his family who have had no contact with him since he has been at the home. The home are loaning monies to the service user. We understand from the manager that the service users social worker is trying to sort this matter out. We recommend that all steps are taken to remedy this situation urgently. Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: Care Homes for Adults (18-65 years) Page 16 of 25 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. The home environment is clean, well decorated and feels homely. Bedrooms are personalized and communal areas are comfortable and welcoming. Evidence: We viewed the environment of the home including the garden. The maintenance and decor are of a good standard. The bedrooms are en suite. A service user showed us his bedroom which he said he was very happy with. It was personalized and pleasant. We were pleased to see the service users art work displayed on the walls of the home. A service user showed me our garden which he was obviously proud of. The home has a pleasant common area which is comprised on kitchen/diner and sitting room where residents enjoy spending time with each other and staff. The home has an industrial capacity washing machine, which can wash at a high temperature. It is housed in a laundry room. The home was clean and hygienic and the manager stated that there are no infection control issues. Care Homes for Adults (18-65 years) Page 17 of 25 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 home has well qualified staff and recruitment practice is sound. Staff training and supervision needs to be improved. Evidence: A good proportion of the staff at the home have gained relevant NVQ qualifications. We viewed two staff personnel files. They evidence robust recruitment practice with an application form, job description references and Criminal Records Disclosure (CRB) and POVA check. We also favorably noted a thorough induction process which was signed off at intervals. We viewed the staff training records. There was evidence that staff undertake relevant training. However not all staff had refreshed the core basics to include: health and safety, infection control, food hygiene, first aid, safeguarding and medication, within the last two years. We require that they do this. The manager had a training plan completed for 2009 but the planner for 2010 had no entries. We recommend that the manager uses her training planner and this will provide further evidence of training for inspection. Care Homes for Adults (18-65 years) Page 18 of 25 Evidence: The manager stated that as well as supervising staff herself the deputy manager supervises staff. We viewed the evidence of staff supervision. The home could not evidence supervision at the frequency of six times per year and we are making a requirement that staff receive formal supervision at this frequency, and that it is appropriately recorded. Care Homes for Adults (18-65 years) Page 19 of 25 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 well run. Quality assurance is undertaken and working practices are safe. Evidence: We viewed the evidence of quality assurance in the home. Regulation 26 visits are carried out, the most recent being the month before the inspection. The home has a business plan and a meaningful audit had been carried out for 2009/10. We were told that surveys had been sent out in January 2010 but had not been returned. There was however evidence of surveys being returned in 2009. We viewed the health and safety records for the home. Control of Substances Hazardous to Health (COSHH) products are kept in a locked cupboard. Portable Appliance Testing (PAT) testing had been undertaken in October 2009, electrical circuits had been checked in October 2007 and a gas safety test was undertaken in 2009.The fire blanket and extinguisher had been checked in January 2010. The alarm system was checked in February 2010 and the emergency lighting in February 2010. The last fire drill was undertaken in March and the manager stated that these are repeated at three monthly intervals. Care Homes for Adults (18-65 years) Page 20 of 25 Evidence: The manager of the home has a registered managers award and NVQ 4. Our view is that she runs the home very competently. Care Homes for Adults (18-65 years) Page 21 of 25 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 22 of 25 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 35 The manager must ensure 01/09/2010 that staff refresh the core basics of training to include: health and safety,infection control, food hygiene, safeguarding,medication and first aid To ensure staff are trained for the work they perform. 2 36 Staff must receive formal supervision six times per year and this must be appropriately recorded. To ensure they are properly supervised. 01/09/2010 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 2 19 20 We recommend that the manager takes steps to find out whether or not the service user is allergic to nuts. We recommend that the manager ensure that every record Page 23 of 25 Care Homes for Adults (18-65 years) 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 relevant to medication states that the identified service user is allergic to penicillin. 3 4 20 23 We recommend the manager devise a system for balancing the stock levels of medication. All steps must be taken to regularize the financial situation of the service user who does not have access to his own monies. We recommend that the homes safeguarding policy is amended to make it clear that it should be followed in conjunction with the Waltham Forest safeguarding policy. We recommend that the manager keeps her training planner up to date to provide further evidence for inspection. 5 23 6 35 Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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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