Care Home: Little Road, 2

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What the care home does well People who were at the home during the inspection appeared settled and comfortable. they interacted in a friendly manner with care workers. People that were spoken with expressed satisfaction with the quality the care they received. Health and safety records were up-to-date and indicated that safety in the how is monitored. The home was clean, hygienic and well maintained. The atmosphere was calm and homely. What has improved since the last inspection? Life Opportunities Trust has been working toward supplying important information to people in a way that is suitable for them, this was evident in the complaints procedure and the satisfaction survey for people who use the service. We were able to look at staff recruitment files, all of the information required was on file except identity verification, this was being held at Life Opportunities Trust Head Office. What the care home could do better: A schedule is in place for peoples` daily activities as day services are not available. The staff organize and participate in the activities. It is recommended that external activities or further education be sought for people and introduced, this would enable them to participate in the community outside of the home. if they would like to. The training records did not appear to be complete and did not evidence that all staff had received mandatory and refresher training in health and safety courses such as food hygiene. Key inspection report Care homes for adults (18-65 years) Name: Address: Little Road, 2 Little Road, 2 Hayes Middlesex UB3 3BT     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: Susan Woolnough-Singh     Date: 0 9 0 9 2 0 0 9 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) 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. 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: Little Road, 2 Little Road, 2 Hayes Middlesex UB3 3BT 02088489126 Telephone number: Fax number: Email address: Provider web address: littleroad@lot-uk.org.uk lifeopportunitiestrust.co.ukwww.lifeopportunitie str Life Opportunities Trust Name of registered provider(s): Name of registered manager (if applicable) Mrs Adela Man Type of registration: Number of places registered: care home 6 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: 6 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 2 Little Road is a residential home for six service users with learning disabilities. The home was registered in 1995. Shepherds Bush Housing Association owns the home and the care provider is Life Opportunities Trust. The home is a six bed roomed, semidetached house, located in Hayes and is within walking distance to the town centre, the main line station and public transport facilities. The home has six single bedrooms. Two are on the ground floor. The ground floor has a lounge/dining area, which is Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 6 Brief description of the care home comfortably furnished, for the service users. The kitchen, one small toilet, a shower room with a toilet and the utility/storage room are also on the ground floor. There is a bathroom with a toilet, and the office, on the first floor. The service users bedrooms are at least 14.1 square metres and are fitted with TV points and emergency call systems. There is a small rear garden, which is mostly lawn, with a patio area. Limited parking is available in the street. The staffing structure consists of a Registered Manager, a deputy, a senior, two full time and two part time day residential workers and one full time waking night staff. The staff provide support with personal care, practical tasks and leisure activities. There are two staff on duty at times when the majority of the service users are in the home, which includes the Deputy Manager. One staff is on a waking night duty, with an on call system in case of emergencies. 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: The first unannounced visit to Little Road was carried out on Sunday 9th August 2009. On this occasion we met with people who live in the home and had a tour of the home. We returned on two further dates to complete the inspection, on 20th August 2009 and finally on 9th September to meet with the Registered Manager. During the course of the inspection the homes policies, procedures and records were viewed. A tour of the building was undertaken and observations were made. We spoke with two people who live in the home. The requirements that were made at the last inspection and all key National Minimum Standards were assessed. The home had met statutory requirements made at the last inspection. 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 personal files of people were viewed at random and indicated that individual needs and aspirations were appropriately assessed prior to admission. Evidence: We looked at the care records of two people who use the service. One person had moved into the home since the last inspection. We were able to see from the records that care needs had been assessed. A placement review had also taken place. A copy of the Terms and Conditions of residence were available on file. Life Opportunities Trust policy on Admissions was in place. 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 care plans that were drawn up in relation to individual people were viewed and found to be satisfactory. people have choice in their day to day living and are supported in activities to enable them to participate in an independent lifestyle. Evidence: Two care plans were examined within individual peoples files. It was reflected that separate health care, personal and social needs were assessed and actions and goals had been put into place within care plan formats. The care plans highlighted areas where communication and self kelp skills are to be encouraged. We were able to see that peoples care had been reviewed in detail with the placing Local Authority. The reviews contained up dated information on social care and health care. The care plans and daily schedules reflected peoples routines and preferences. People, depending on their capacity to do so, are able to make decisions regarding their daily Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: living routines such as activities, meals, personal purchases and what they wear each day. People have their own financial arrangements but receive support from care staff when accessing state benefits and/or making chosen purchases. Personal interests and choices were also reflected in individual bedrooms. Risk assessments relating to activities identified within care plans had been carried out. These mainly included community activities and individual areas of risk pertaining to peoples, abilities and behaviour pattern. Care Homes for Adults (18-65 years) Page 11 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. The people who use the service are supported in taking part in activities of their choice within the community and are encouraged to maintain contact with relatives. Varied and nutritional meals are being provided. Evidence: Our first visit to the home was unannounced and took place on a Sunday afternoon, we met people who live home and talked with two people who gave a tour of the building. People spoke in general terms regarding the home and appeared settled. One person was able to show certificates in relation to his/her activities. People regularly evening clubs, people do not attend Day Centres and this was identified as a barrier to improvement by the Registered Manager. An Activities Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: Programme was on display and indicated that a daily schedule is available and this includes local outings such as shopping and walks in the park, house keeping tasks and some indoor activities, mainly board games. People who live in the home have a residents meeting on Sundays. We looked at the minutes of the last meeting and saw that activities, holidays and menus were the main topics on the agenda. An open visiting policy is in place and contact between people and their respective relatives, advocates and/or friends is encouraged and facilitated. People who use the service participate in housekeeping tasks such as setting the table, drying dishes, bringing down laundry and with supervision, tidying their bedrooms. The home does not employ a cook but meals are prepared by care staff. The menus were viewed and varied and wholesome choices were reflected. These contained mainly traditional British dishes, some pasta dishes and curries. A packed lunch or a light lunch is available during week days. We were able to see good reference to individuals food preferences in the minutes of the residents meetings. Care Homes for Adults (18-65 years) Page 13 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. People who use the service receive appropriate personal support and their health care needs are being met satisfactorily. Life Opportunities Trust policy and procedures on the safe administration of medication are in place. Evidence: We looked at the care records of two people who live in the home. It was reflected that access to General Practitioners, Dentists and Chiropodist, Psychiatrist, and gender related health checks were arranged as required, and people were accompanied to hospital appointments. We were able to see that peoples health needs were recorded on a Health Action Plan dated Janayary 2009. The care plan for each person set out guidance and support needed in maintaining good personal care and hygiene. Life Opportunities Trust policy and procedures on medication are in place. We examined the medication administration records for two people and looked at the storage of medication. Medicines were safely stored and administered and medication administration sheets were accurately recorded. People who use the service do not Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: administer their own medication. The (AQAA) informed us that staff have received training in the safe administration of medication and that there are plans for refresher training. We were also infornmed that there is monitoring system in place whereby the safe administration of medication can be audited by the Manager. Care Homes for Adults (18-65 years) Page 15 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. The complaints procedure is satisfactory and accessible to people and their relatives. Safeguard are in place for vulnerable adults, however all staff should receive the additional training in Adult Protection. Evidence: The complaints procedure was clearly detailed, written and illustrated in a format suitable to meeting the needs of people and accessible to relatives. The leaflet available for people on making a complaint is of a good standard and provides pictures, photographs of Senior Managers and is written in clear language. One complaint had been received since the last inspection. We discussed this with the Registered Manager and looked at related correspondence. The complaint was not regarding the quality of care in the home The complaint had been referred to the correct external professionals for a review. Policies and procedures relating to the Safeguarding of vulnerable Adults are in place, and Whistle blowing for care staff. The (AQAA) informed us that staff had completed Topss England/Skills for care induction training which includes material on protecting vulnerable adults from abuse. The (AQAA) informed us that all staff had attended Safeguarding training and yearly Care Homes for Adults (18-65 years) Page 16 of 25 Evidence: refresher training in this is planned. We sampled the training records of a new member of staff. Inspection training had taken place; Safeguarding training had not taken place and did not feature on the training spreadsheet for this person. Please refer to Outcome Area 7 - Staffing. We looked at the financial records of one person and tracked the process of financial management from an allowance being paid to how money spent is recorded. We looked at safeguards in place to ensure protection and correct management by staff where this is needed. Transactions are recorded and a Service Manager audits peoples financial records on a regular basis. Care Homes for Adults (18-65 years) Page 17 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 is well maintained and the atmosphere is calm and homely. Evidence: We were shown around Little Road by two people who are resident in the home. We were able to see that peoples bedrooms are personalized and that there are adequate facilities such as a shower room on the ground floor and a bathroom on the first floor. The communal areas within the home are comfortably furnished, adequately spacious and suitable for shared and/or individual activity. The garden was tidily kept and accessible to people. Care Homes for Adults (18-65 years) Page 18 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. People are supported by qualified and competent staff. Recruitment policy and practice meets the required standard with the aim of safeguarding adults. Evidence: A total of nine care staff members are employed at the home, including the Registered Manager and night staff. It was reflected on the rota that two care workers covered duty on each shift during waking hours and one care worker covered waking duty at night. On examination of the staff duty rota we were able to see that nineteen day shifts were covered by L.O.T Bank Staff. Staff at the home have designated areas of responsibility these include the cleaning rota, fire safety and health and safety, shopping for provisions, medication and activities. We looked at the personnel file of one member of staff. The required documentation was on file apart from documentary evidence of identity, we were informed that this would be forwarded and was held at Head Office. The file contained a Criminal Records Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: Bureau check reference number, application form and two written references. The member of staff had received a In-House induction which took place over a period of three days. We did not see evidence of the Skills for Care Training which incorporates the five core values. The (AQAA) informed us that the Registered Manager has completed the NVQ Level 4 in Health and Social Care and the Manager and a Senior Support Worker have completed Leadership and Assertiveness training. One Senior Care Worker has started the NVQ A1 Assessors course. The Registered Manager has completed NVQ level 4 in health and social care. The (AQAA) informed us that eight staff had achieved National Vocational Qualification in levels 2 and/or 3. It was indicated in the 2009 training spreadsheet that during this period training included Food Hygiene, Fire safety, First Aid and Protection of Vulnerable Adults. However, it was not clear from the records that all staff had attended the required training in Safeguarding Vulnerable Adults and mandatory health and safety based courses. Care Homes for Adults (18-65 years) Page 20 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 organized and well run. Systems for undertaking effective quality assurance are in place. The records were indicative of the health and safety of residents being protected. Evidence: A new Registered Manager has been appointed since the last inspection. The new Registered Manager has fifteen years experience with Life Opportunities Trust. She has undertaken NVQ to level 4 and is an NVQ Assessor. The Registered Manager had completed and returned the Annual Quality Assurance Assessment. We could see from this document, which has been completed in a clear and precise manner, that strengths, and areas for improvement had been identified. Working towards a service user centered service and continuing to encourage people to express their wishes are stated plans for improvement. Barriers to improvement are identified as changes and shortages (due to sick leave) in the staff team and a Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: reduction in external support services such as a reduced day service and dietitian services. We looked at two sets of surveys with regard to quality assurance and service user consultation. The survey for people who use the service is presented in way which is suitable, pictures are used of different activities in conjunction with plain English. These covered all aspects of life in the home. We were informed that the surveys had not been completed yet but were due to go out. We were ale to see the analysis of stakeholder and relative surveys, this had been collated by LOT Head Office. The document indicted a positive response with regard to the satisfaction with the service. We were able to see the London Borough of Hillingdon contract monitoring report for October 2008. This had one recommendation with regard to a referral, overall the report was satisfactory. We looked at a sample of fire records and health and safety records. The Fire and Emergency Planning Authority last inspected in October 2008. A fire evacuation procedure is in place and the last fire drill with an evacuation took place in August 2009. A premises fire risk assessment had been completed and was dated July 2008. The fire alarm system is tested weekly. Records seen indicated that a Legionella Assessment took place in May 2009, a Gas Safety Certificate was issued in May 2008. The fire alarm system was serviced in March 2009. Care Homes for Adults (18-65 years) Page 22 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 23 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 18 The Registered Manager and 01/02/2010 Registered Provider must ensure that all staff have received mandatory training and refresher training. Staff must receive mandatory training in working safely with people and this must be recorded. 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 12 We recommend that the Registered Manager and staff team, where it is the persons prference, look at activities and day placements external to the home. 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. Care Homes for Adults (18-65 years) Page 25 of 25 - 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!