Care Home: Perryn Road 23

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What the care home does well Prospective residents are fully assessed and given the opportunity to visit the home prior to admission, to ensure the home is right to meet their needs. There is also a settling in period to give new residents the opportunity of getting to know their fellow residents plus the staff, and be sure this is the right home for them. The service user plan documentation is clear and comprehensive, providing a good picture of the resident and their needs and how these are to be met. Risk assessments are in place for all identified risks, to show how these are best managed for each person. Residents are encouraged to make individual choices about what they do and do not wish to do and to maintain their independence to the best level they can. There are individual activities programmes to meet persons interests, abilities and needs. The home has an open visiting policy and visiting is encouraged. Staff care for residents in a friendly, dignified and professional manner, promoting good relationships between residents and staff. The food provision at the home is good and varied, and residents choices are ascertained and respected. The heathcare needs of the residents are identified and met, to maintain their well-being to the optimum level. Staff were seen to communicate effectively with residents and there was a good atmosphere in the home. Overall medications are being well managed and the one shortfall identified should be easy to address. Clear procedures are in place for the management of complaints and safeguarding adults issues, and these are adhered to, thus protecting the residents. There is a redecoration and refurbishment plan for the home, and evidence that this is being progressed, with work having already been carried out in several areas. Infection control procedures are in place and are being adhered to. The home is being appropriately staffed to meet the needs of the residents. Staff vetting and recruitment procedures are robust, thus safeguarding residents. Although the home is currently without a manager, action had been taken promptly to recruit a new manager and in the interim period the Deputy Manager, supported by the Regional Director, was ensuring the home was being effectively managed. Systems are in place for quality assurance and residents are actively encouraged to give their input about various aspects of the home. Health and safety is being well managed at the home. What has improved since the last inspection? Several areas of redecoration and refurbishment were identified at the last inspection and action has been taken to address these. Staff now receive training to provide them with the skills and knowledge to care for residents effectively. What the care home could do better: Ensure that all medications to include prescribed creams are administered in accordance with the prescribers instructions. Although the home has a redecoration and refurbishment programme, timescales for competion need to be included to ensure the programme is completed in a timely fashion. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Perryn Road, 23 Perryn Road, 23 Acton London W3 7LS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Clare Henderson-Roe     Date: 2 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.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: Perryn Road, 23 Perryn Road, 23 Acton London W3 7LS 02087498273 02087405999 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care Management Group Ltd (trading as CMG Homes Ltd) Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 8 The maximum number of service users who can be accommodated is: 8 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 23 Perryn Road is home to a maximum of eight adults with learning disabilities. Some of the service users have additional mental health needs. The service is managed by the Care Management Group. The home is a detached property in a residential area close to Acton High Street, which provides good shopping and public transport facilities. The property has an enclosed rear garden and off street parking for two cars. Care Homes for Adults (18-65 years) Page 4 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: This was an unannounced inspection carried out as part of the regulatory process. A total of 5 hours was spent on the inspection process, which included a tour of the home and viewing records to include medication management, service user plan documentation, training records, quality assurance documentation, staff employment records and maintenance and servicing records. The Annual Quality Assurance Assessment (AQAA) sent to the home prior to the inspection was also viewed as part of the inspection process. We spoke with 5 residents and 3 staff. No visitors were present at the time of inspection. Care Homes for Adults (18-65 years) Page 5 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Adults (18-65 years) Page 6 of 25 printed copies from enquiries@csci.gsi.gov.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. Prospective residents are fully assessed prior to admission, thus ensuring that they are placed in a home that best meets their needs. Evidence: Since the last inspection the home has had one admission who transferred from another CMG Home. CMG have a comprehensive pre-admission assessment document and this is completed for all prospective residents, so that they gain a good picture of the person and their needs and can then plan to admit them to the most appropriate CMG home for the individual. A copy of the Social Services assessment plus any other reports from health and social care professionals are also obtained. 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. Documentation in the service user plans is comprehensive and up to date, providing staff with a clear picture of each resident, their needs and how these are to be met. Residents are actively encouraged and supported to maintain as much independence as they are able, and their wishes are respected. Risk assessments are in place for all identified areas of risk, thus minimising the risk to each resident whilst respecting their right to independence. Evidence: We viewed the care plan and related documentation for one resident, plus areas of documentation were also viewed for other residents. This had been well completed and was up to date. The information was personalised, comprehensive and provided a clear picture of the persons needs and how these are to be met. There was evidence of monthly reviews of the care plan documentation plus the key worker completes a detailed monthly report covering all aspects of each residents activities of daily living. Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: The people living at the home are encouraged to make choices about their own daily lives, and are encouraged to be as independent as they are able to be. Regular resident meetings take place, and these are minuted. The minutes evidenced that each resident is asked for their views on the topic being discussed so that they can state their preferences and action can then be taken to meet their wishes. Risk assessments were seen in place for all areas of identified risk. These are comprehensive and there is evidence that they are reviewed regularly, with new assessments being drawn up to address the risk posed by any changes in a residents condition or abilities. 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. Each resident has their own activity plan to include work, social and leisure activities, thus ensuring their needs are individually planned for. The home has an open visiting policy and visiting is encouraged, thus maintaining good links with family, friends and the community. Staff care for residents in a friendly, caring and professional manner, maximising each persons independence. The food provision at the home provides variety and choice to meet each persons dietary needs, to include cultural preferences. Evidence: Each resident has a weekly programme that identifies their routine for each day. This includes attendance at day centres, supported work, work experience plus social and leisure activities. These activities provide good links with the local community. In addition work has been done to promote links with other social networks in the community. Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: Each residents activity programme is individualised and plans morning, afternoon and evening activities. Residents also have the opportunity to go on holiday and discuss where they would like to go. The home has an open visiting policy and visiting is encouraged. Residents can meet with visitors in one of the communal rooms or in the privacy of their own bedroom, whatever their preference is. Maintaining contact with family and friends is a very important part of life for the residents, and staff do what they are able to facilitate and encourage this. Each resident has their own bedroom and staff respect this and knock before entering the room. Deprivation of Liberty risk assessments have been carried out and from these care is being taken to ensure residents have a key to their bedroom door and also to the front door, should they wish to go out. There was good interaction noted between staff and residents and a very homely and friendly atmosphere throughout. The kitchen has been refurbished and was clean and tidy. A list of residents food preferences is recorded for each person and the weekly menu is drawn up to reflect this. Residents are weighed each month, and where there is a marked change action is taken to refer them to the dietician via the GP. The residents are involved in the weekly shopping trips and the acting manager said that residents often choose which shop they would like to buy particular items from. The main meal is in the evening and this is seen as a social occasion for residents and staff. There was evidence that care is given to meeting cultural preferences also. 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. The wishes and preferences of each resident are recorded and respected by staff, thus promoting choice and independence and treating people with dignity and respect. The healthcare needs of each resident are identified and met, to keep them at an optimum level of health. Medication management in the home is good, thus ensuring the residents medication needs are met. The one shortfall should be easy to address. Evidence: Each resident has a key worker with whom they have a good relationship. There is a Listen to Me workbook that is completed with and for each resident and this is thorough and gives a good picture of each residents likes, dislikes, interests and life history. All the information for resident provides those caring for them with up to date information about their wishes and preferences, and these are respected. Residents looked content and expressed the fact they are being well cared for, and they were well groomed and dressed to reflect individuality. All the residents are registered with a GP and their records also include a health action plan, which has details of their healthcare needs and how these are met. Each resident Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: is involved in the review of their records to include healthcare information. Comment received from healthcare professionals included the fact that residents are encouraged to, where they are able, attend the GP surgery, which enables full medical care to be given and promotes independence. There was evidence of recent input from healthcare professionals to include GP, dentist, optical, mental health team and diabetic care nurse. Medications are securely stored in the staff office, in a purpose built metal cabinet. A list of staff names and initials was available for ease of identifying each person administering the medication. All staff administering medications have undertaken medication competency training. We viewed the medication administration records (MAR) for 5 residents. Receipts of medications to include those received mid-cycle had been recorded. Administration records were complete apart from one instance where a particular medication had been refused, and the importance of using the appropriate code to identify this rather than leaving a gap in signing was discussed with the deputy manager. The majority of tablets are supplied in 28 day monitored dosage system blister packs, so stock control is easy to monitor. For those items supplied in boxes the date of opening is written on to aid with stock monitoring. The home has several books for the management of medications, to include a British National Formulary dated March 2008. The deputy manager explained that any monitoring for people with diabetes is carried out at the GP surgery, following discussion with the GP and community nurses. Overall medications are being well managed at the home, and the shortfall noted should be easy to address. 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. There are clear procedures in place for the management of complaints and safeguarding adults, and these are adhered to, thus safeguarding residents. Evidence: The home has a clear complaints procedure, written in a user-friendly format. Residents are encouraged to raise any concerns they may have so that these can be promptly addressed. There have been no complaints received in the last 12 months. The home has a safeguarding adults procedure and also follows the Ealing safeguarding documentation. Staff receive training and updates in safeguarding adults procedures. There has been one safeguarding incident raised and this has been appropriately reported and investigated. Clear procedures are in place for the management of residents personal finances. Residents monies are checked at each hand over and clear records are maintained. There are clear records of income and expenditure available. Each resident has a bank account or have family members who are their appointees. 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. There is evidence of redecoration and refurbishment taking place, to improve the standard of the environment and provide a homely, safe and clean place for residents to live in. Infection control procedures are in place and are adhered to, thus minimising infection risks. Evidence: There has been an ongoing programme of redecoration and refurbishment. The home does have a listed programme, however timescales for completion need to be added to this in order to evidence that work is being completed in a timely manner. At the time of inspection the decorator for CMG was present in the home and explained that he would be working in the home over the next few months in order to complete the redecoration work, and thereafter the carpets that have not already been replaced, to include the main corridors and stairs, would be done. The environmental requirements from the last inspection were discussed and a tour of the home carried out. The requirements had been addressed. The dining room door is no longer being propped open. The deputy manager confirmed that the wire in use on one window frame had been removed and all bedrooms have working locks. The ground floor shower room and the kitchen have been fully refurbished. Care Homes for Adults (18-65 years) Page 17 of 25 Evidence: We viewed 2 bedrooms and these were homely and personalised. The AQAA states that bedrooms are being refurbished in line with the needs and wishes of the residents, and that the residents have been involved in the drawing up of the refurbishment plan. The home has a communal sitting room and a communal dining room. Both these rooms are appropriately furnished and are homely in appearance. The home has a small laundry room with a washing machine and tumble dryer. The deputy manager confirmed that the machines meet the needs of the residents. Infection control procedures are in place and there were no issues identified at the time of inspection. 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. The home is staffed with appropriately trained staff in such numbers as to ensure that the needs of the residents are understood and met. Systems for vetting and recruitment are in place and are adhered to, thus protecting residents. There is an ongoing programme of training to provide staff with up to date skills and knowledge to enable them to care for the residents effectively. Evidence: The staff records contain clear job descriptions and also there is evidence of staff induction training which is in line with the Skills for Care common induction standards. The majority of staff are trained to NVQ level 2 or 3 in care. The home has a stable staff team who work well with the residents, and staffing levels are calculated in accordance with resident dependencies. We viewed 2 sets of staff employment records. In one instance the home was awaiting a copy of the application form and health questionnaire to be sent from head office, however all documentation is verified by head office before people are employed at the home. The deputy manager has since confirmed that these documents have now been received by the home. The records contain the information required under Schedule 2 of the Care Homes Regulations 2001. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: The deputy manager confirmed that the monthly training programme is ongoing. Staff training needs are identified with the deputy manager, who is also the Training Champion for the home, and staff are put forward to attend training to meet there objectives. Clear training matrices are on display in the office, and action is taken to ensure health & safety training and updates are undertaken in line with current legislation and good practice recommendations. 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 between managers, however the home is being effectively managed in the interim to ensure the well-being and safety of residents, staff and visitors. Systems are in place for quality assurance, providing an ongoing process of practice review within the home. There are good systems in place for the management of health & safety, thus safeguarding residents, visitors and staff. Evidence: The last manager had recently left the home and the deputy manager was in charge of the home and has the experience to run it effectively. The Regional Director visited the home during the inspection and explained that the company is actively recruiting a new manager and they hope to be able to appoint in the near future. The Regional Director provides support for the deputy manager and the staff at the home. CMG have a system in place for quality assurance. This includes regular audits to include the environment, medications, food safety and the care planning documentation. Any shortfalls identified are addressed in a timely manner. Regulation Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: 26 unannounced visits are carried out on behalf of the registered provider and reports from these visits are available. An annual questionnaire is sent out to residents, relatives and staff, and the results of these were available to view. Residents meetings take place regularly and each resident is encouraged to have their individual say and make suggestions about what they would like to do, for example, for the Christmas party. Clear minutes are kept of each meeting. We sampled the servicing and maintenance records and those viewed were up to date. The fire risk assessment was last reviewed in September 2008. Fire drills are carried out and recorded, however the actual timing of the drills was not recorded. We discussed ensuring that the time was recorded so that there is evidence that all staff are involved in fire drills a minimum of 6 monthly. The training matrix shows what training each member of staff needs to undertake to keep up to date with health & safety training topics. Risk assessments are in place for all aspects of risk identified. During the tour of the home no health & safety issues were identified, and overall health & safety is being well managed at the home. 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 20 13 Correct codings must be used to identify the reason for omitting a medication. To provide evidence of the reason a medication has been omitted. 01/03/2009 2 24 23 That the redecoration and refurbishment plan contain timescales for completion. To ensure that all work is carried out in a timely manner. 01/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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