Care Home: Hawthorn House

What the care home does well The home provides a very pleasant homely environment. The home is modernised and fitted to a high standard. The home is well managed and run by the Registered Manager and staff who have a sound understanding of the needs of people with mental health issues. There are good systems in place to ensure that residents` viewd inform the running of the home. What has improved since the last inspection? This was the home`s first inspection. What the care home could do better: Staffing levels should be reviewed to ensure that their are always sufficient staff to meet people`s needs. Key inspection report Care homes for adults (18-65 years) Name: Address: Hawthorn House 15 Linley Road London London N17 6RP     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: Margaret Flaws     Date: 2 0 0 5 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 26 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 26 Information about the care home Name of care home: Address: Hawthorn House 15 Linley Road London London N17 6RP 02088048101 02083662638 tim@conniferscare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Connifers Care Limited Name of registered manager (if applicable) Mr Louise Jean-Claude Nombreuse Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of sevice 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 folloowing category of care: Mental Disorder excluding learning disabilities or Dementia - Code MD Date of last inspection Brief description of the care home Connifers Care took over the former St Margarets Lodge in September 2009. The service previously had three places for residents. Over the winter 2009, the home was gutted and fully refurbished as Hawthorn House. The number of places was increased to five by a major variation in February 2010. Some of the previous residents remain at the home. They stayed at another of the providers home during the refurbishment. The home provides care and support to people with mental health issues. Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 5 Brief description of the care home The home is an ordinary terraced house, adapted to contain five bedrooms, some ensuite, a large conservatory and garden. It is furnished and refurbished to a good standard. This is the homes first inspection as Hawthorn House. 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 inspection took place over one day and was completed by Inspector Margaret Flaws. The Registered Manager assisted throughout the inspection and we spoke to and observed two staff and four residents. We also spoke to the Human Resources Director. We looked at care, staff and general home records and toured the building and grounds. Care Homes for Adults (18-65 years) Page 6 of 26 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 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 8 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed prior to them coming to live in the home and their changing needs fully assessed so that they can be confident the home can support them. Evidence: Connifers Care took over the former St Margarets Lodge in September 2009. The service previously had three places for residents. Over the winter 2009, the home was gutted and fully refurbished as Hawthorn House. The number of places was increased to five by a major variation in February 2010. Some of the previous residents remain at the home. They stayed at another of the providers home during the refurbishment. The home provides care and support to people with mental health issues. This is the homes first inspection as Hawthorn House. There were four residents living in the home. We checked the files for three residents. They all had comprehensive assessments of their needs completed prior to moving into the home. The assessments had been completed by placing authorities and by Care Homes for Adults (18-65 years) Page 9 of 26 Evidence: staff from Hawthorn House. Peoples needs were also regularly reassessed and care plan adapted. Care Homes for Adults (18-65 years) Page 10 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. Peoples needs are assessed and their care planned. Their rights and wishes are respected and encouraged. Evidence: We checked the files and care plans for three residents. Detailed care plans were in place for each person, based on a thorough assessment of their needs. Peoples likes and dislikes were extensively explored and recorded. In most cases, these were written out by the residents themselves. The home has a key working system and each key worker had taken responsibility for sitting with each resident regularly and discussing their progress and needs. They then updated their files. There were also detailed risk assessments in place and these reflected how the home balanced the residents mental health needs with their wishes and goals. The residents told us that they were able to spend the days as they wished, in line Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: with their interests. Throughout the inspection, the four residents were at home, watching music DVDs, spending time in their rooms or in the garden and talking to the staff. Residents told us the staff treated them respectfully and with kindness. Care Homes for Adults (18-65 years) Page 12 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 free to choose their lifestyles and spend their time how they wish. They are supported to be active in the community and with their families. Their rights are respected and they are provided with a good and nutritious diet. Evidence: We observed the residents enjoying being at home during the inspection. They all pursued their own specific interests. For example, one resident who liked music, watched a DVD of a concert by one of her favourite singers. Another resident spent time in the garden, enjoying the sunshine and chatting to staff. There was a relaxed and homely atmosphere throughout the inspection. Peoples interests were recorded on file and their activities scheduled. These include dancing, going to a disco, painting, reading comics, music therapy, watching opera, going for local walks, assisting with shopping and maintaining the home, and pottery. Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: Some residents had more contact with their families than others but all their family contact was recorded and it was clear from the notes and from what people told that families and friend regularly came to visit. One resident also went to stay regularly with family. The kitchen was an ordinary domestic kitchen. There was a plentiful supply of fresh food, including meat, fish, fruit and vegetables. On the day of the inspection, residents had lamb chops for lunch. There were alternative meals available on a flexible menu and staff told us that they were able to easily meet peoples individual needs. Residents told us that they were happy with the food. The kitchen was clean and hygienic and staff had been trained in infection control and food hygiene. Care Homes for Adults (18-65 years) Page 14 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 healthcare and personal support needs are met by the home. There are good policies and procedures in place to protect residents who need to take medication. Evidence: We saw three residents health care files. There were detailed healthcare assessments on file, iincluding mental health assessments and care plans. Residents physical health had been regularly assessed and monitored. Residents with ongoing health conditions attended regular appointments and health professionals visited as needed. Residents had monthly physical check ups, with their weight, blood pressure and temperatures monitored. Staff showed us the medication procedures and storage arrangements. There is a large walk in medication cupboard in the office. This is kept cool. There were sound procedures in place, with information about side effects, medication risk assessments completed,good procedures and recording for the receipt and return of medicines, and for stock control. The medication administration records we saw Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: were in good order and there were no gaps or errors in the chart. Staff who give medication are trained to do so and we saw their training records. The staff we spoke to had a good understanding of safe medication administration and handling. The home is in the process of changing over its pharmacy supplier. Care Homes for Adults (18-65 years) Page 16 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. Residents are protected by the homes complaints and safeguarding policies and procedures. Evidence: The home has a sound complaints policy and procedure in place and displayed for residents to use. Residents we spoke to told us that they knew how to express their concerns or make a complaint if they needed to. Staff were aware of the policy and could describe how they supported residents if they were unhappy with the service. Staff were observed during the inspection working sensitively with a resident who was expressing concern. We saw the complaints records and discussed them with the Registered Manager. There were no complaints received. The home also has an up to date copy of the local authoritys safeguarding policy and procedure. Staff have been trained in safeguarding adults and were able to describe how they would safeguard residents appropriately. Care Homes for Adults (18-65 years) Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with a comfortable, homely and safe environment to live in. Evidence: The home has been refurbished since its purchase by Connifers Care Ltd. The communal areas are welcoming and nicely fitted out. The new conservatory opens out into a large garden living space. During the inspection, residents spent time in the garden, in the conservatory and in the kitchen. The kitchen area also opens out onto the garden and sits alongside the conservatory. The garden area has a chairs and umbrellas for the summer. Long term residents told us that they liked the changes to the physical environment and were seen clearly enjoying the space. The Registered Manager showed us one bedroom on the ground floor. This room had good access and was furnished and fitted in a style appropriate to a small home in a domestic residence. There are toilet facilities on the ground and first floors, and a bathroom. Some rooms have an ensuite shower and toilets, others have a handbasin and toilet. The home has a clear policy and procedure for infection control and staff are aware of Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: how to follow good infection control and hygiene practice. 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 can be confident that staff are safely recruited, trained and supervised to meet their needs. Evidence: We checked the records of two newly appointed staff. All preemployment checks had been completed, including obtaining two written references, Criminal Records Bureau and POVA checks and checking right to work in the UK. The two staff on duty told us that they had had a thorough induction prior to starting work. One staff member was new and shadowing another on duty, in line with the procedure for new staff with POVA First checks. Staff inductions were comprehensively documented an learning goals checked and followed up in supervisions, as detailed in supervision notes. Supervisions were held at least two monthly and in many cases, monthly. Notes of discussions related to practice and professional development were excellent and demonstrated that the Registered Manager used supervision with staff as a venue to improve working life and practice in the home. We saw the training records and discussed staff training with the manager. Staff have either a minumum of NVQ2 qualifications but most have NVQ3 or equivalent qualifications. We saw evidence that staff were working towards further qualifications. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: We saw staff training certificates on file for a range of training, including core areas for social care training and service specific training (meeting peoples mental health needs, care planning, challenging behaviour and equality and diversity. We saw the rota for the home and discussed the staffing levels with the Registered Manager and HR Director. There were two people on each shift and the manager in the weekdays. There is one staff member on duty at night. The home still has one vacancy. A requirement is given that the home reviews its staffing level to ensure that there are always sufficient staff on duty to meet peoples needs. Many staff currently work part time while studying. The HR Director told us that staff worked according to Home Office guidelines for people working on student visas. Staff confirmed this when we spoke to them. 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. The home is well managed, is safe and run in the residents interests. Evidence: The Registered Manager remained in the home since it was owned by the previous owner. He knows the residents well and has had a long career working with people with mental health issues. He holds a Registered Managers Award. Residents told us they felt safe and confident with his management. The office space was very systematically organised and the staff were aware of the management systems they needed to follow and where to record things. Staff also gave good feedback about the managers style. They said that he was supportive and had clear expectations of them. The home has a sound system in place for gathering residents views. There are regular residents meetings, run by the residents, which are document and actions taken in response to issues raised. The Registered Manager told us that the residents have a residents council, with a formal chair who acts as a liaison person with him. The home has a formal quality assurance system in place ready to be used in its first Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: year of operation. Residents appeared confident and comfortable expressing their views to staff and to the managers and clearly expected to be taken seriously. The most recent quality assurance check was in April 2010 and checks were made against all National Minumum Standards and actions for improvement were recorded and taken forward, for example, into staff supervision or into management meetings. Connifers Care also has regular management and quality assurance meetings and we saw detailed minutes for these. We discussed residents finances with the Registered Manager. Two residents hold their own accounts, with support from their relatives. Where the home holds some personal money for the residents, we saw good records, audit trails, and safe keeping. Peoples capacity in relation to finance has been assessed and documented in their care plans and with their placing authorities. We saw the health and safety certificates for the home and for the building. These were all completed, in order and up to date, following major building work over the winter. Fire records were in good order and there were documented fire drills and equipment checks. Care Homes for Adults (18-65 years) Page 23 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 24 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 32 18 The Registered Person must 15/09/2010 review staffing levels to ensure that there are always sufficient staff on duty to meet peoples needs There should always be sufficient staff on duty to meet peoples needs. 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 Care Homes for Adults (18-65 years) Page 25 of 26 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. © 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. 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