Care Home: SEVA Care Home

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What the care home does well Provides good information to help potential residents decide whether to use the service. Ensures residents have access to healthcare professionals and get medical treatment when they need it. Provides a clean, homely environment where Hindu Gujarati residents` religious, cultural and dietary needs are met. Makes relatives welcome when they visit. Provides good quality home cooked food. Installs adaptations or obtains specialist equipment where necessary to meet residents` mobility needs. What has improved since the last inspection? The home has responded well to the requirements made in the last CQC inspection report. There are more staff on duty in the afternoon. Staff records are better organised. Staff have attended English language training to enable them to access training relevant to their jobs. The manager now has regular professional supervision. Carpets have been replaced with solid flooring in some parts of the home, which better suits residents` needs. What the care home could do better: Review risk assessments more regularly to take account of any changes in need. Improve medication practice to ensure that all residents receive their medication safely. The manager could further improve her Gujarati language skills so that she is able to communicate with residents in their first language. Key inspection report Care homes for older people Name: Address: SEVA Care Home 33 Radnor Avenue Harrow Middlesex HA1 1SB     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: Simon Smith     Date: 2 5 1 1 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 Older People 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 Older People 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 Older People Page 3 of 26 Information about the care home Name of care home: Address: SEVA Care Home 33 Radnor Avenue Harrow Middlesex HA1 1SB 02088611885 02088611885 info@sevacarehome.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Akshay Chandrakant Barot care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 6 The maximum number who can be accommodated is: six The Registered Person may provide the following categories of service only: Care home only -Code PC The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: OP--Older People Dementia _DE (E) DE-Dementia The maximum number that can be accommodated is : six Date of last inspection Care Homes for Older People 0 9 1 2 2 0 0 8 0 0 Over 65 6 6 Page 4 of 26 Brief description of the care home Seva Care Home is registered to provide personal care and accommodation for up to six older people who may have dementia. The home specialises in providing a service to the Hindu Gujarati community but welcomes people from any background. All food provided by the home is vegetarian. The home is owned and run by an independent care service provider. Residents accommodation is situated on the ground, first and second storeys. Four bedrooms are for single occupancy and one is a shared room. One bedroom has en-suite toilet and shower facilities. The home has off-street parking at the front of the building. At the rear there is good-sized, well-maintained garden. There are ramps and grab rails at the front and rear entrances. The range of fees at the time of the inspection was #350 per week for the shared room to #464 per week. The Service User Guide is available on request, including a Gujarati version. Care Homes for Older People 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. We used information from a range of sources when making this judgement about the home. This included visiting the home unannounced on 25th November 2009 and meeting the manager, staff, people who live at the home and a visiting relative. We also spoke to two healthcare professionals who have regular contact with the home. We checked some written records including residents files, staff files and health and safety checks. We also took into account any information the home had sent us since the last inspection. This included notifications of any accidents, incidents, complaints or safeguarding alerts. The manager filled in a Quality Assurance Assessment (AQAA) which gave us information about the home in the last year. Care Homes for Older People Page 6 of 26 We spoke to a visiting relative during the inspection. The relative said they were happy with the care their family member had received since moving to the home and said that the manager and staff are good. We spoke to two healthcare professionals who have regular contact with the home. The professionals gave positive feedback about the care provided to residents. One healthcare professional said, They do very well for Asian elders. They liaise well with us and the other said, Im very happy with the home and the care they provide. Everything is appropriate to the clients needs. Care Homes for Older People Page 7 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. Care Homes for Older People Page 8 of 26 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Potential residents have access to good information to help them decide whether to use the service. New residents needs are assessed before they move into the home. Residents rights are set out in a written agreement. Evidence: The owner has produced a Statement of Purpose and service user guide for the home. These documents explain the service the home provides and set out residents rights and responsibilities. The Statement of Purpose and service user guide need to be updated to reflect the change in the homes regulator from the CSCI to the Care Quality Commission (CQC). We found that all residents have an assessment carried out by their placing authority Care Homes for Older People Page 11 of 26 Evidence: before they move into the home. The manager said that any residents admitted in the future will also have an assessment carried out by the home as this was recommended in the last CQC inspection report. The home has been registered to accept people with dementia since the last inspection. The manager and some staff have attended dementia training. The manager said that the staff who were unable to attend will do this training in January 2010. The manager said that she plans to develop her knowledge about dementia care through further training in the future. Four people were living at the home at the time of inspection. One resident admitted to the home from hospital has recuperated well and plans to return to his family in the near future. The home does not admit residents for intermediate care. All current residents are funded by local authorities. The manager said that all residents have an allocated care manager at their placing authority and that care managers undertake regular reviews of their clients. We found that residents are issued a contract which sets out the terms and conditions of their residency. The contract confirms that residents are able to move in initially on a trial basis for six weeks. Care Homes for Older People Page 12 of 26 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Care plans contain good information about residents needs and their preferences in terms of how their care is delivered. Residents have access to health care professionals and get medical treatment when they need it. Medication practice needs to improve to ensure that all residents receive their medication safely. Staff treat residents with dignity and respect. Evidence: Each resident has a written care plan. We checked three of these and found that they contained good information about residents needs and their preferences in terms of how their care is delivered. We also found that care plans are regularly reviewed and that they contained details of any healthcare appointments and medical treatment. Care plans contained Waterlow assessments (which assess the risk of developing Care Homes for Older People Page 13 of 26 Evidence: pressure ulcers) and moving and handling assessments. The moving and handling assessments we saw had last been reviewed in November 2008. It is good practice to review these assessments at least once a year in case residents needs have changed. Care plans contained evidence that the home carries out risk assessments to identity and minimise any risks to residents in their daily lives, such as moving around the home, falls and using the kitchen. We found that some risk assessments were dated November 2007 and therefore needed review to take account of any changes in need since they were carried out. The home has had regular input from a community matron, which the manager said has realised benefits for residents in identifying healthcare needs and obtaining appropriate treatment. For example the community matron identified that one resident had problems swallowing and arranged input from a speech and language therapist and a dietician. The manager said the home also has good access to general practitioners who are willing to visit residents at home. The home has secure lockable storage for medication. All residents who take medication have support from staff to do this. We checked medication records for three residents. Most medication is stored in a monitored dosage system which is supplied by Boots. We found that one resident had recently not been given a dose of a medication he takes regularly. The manager said that this error was due to a member of staff not understanding her instruction, possibly because of language issues. The home must take steps to ensure that residents receive their medication safely. We noted that staff interaction with residents was good. Staff attended to residents needs promptly and provided support in a manner that maintained residents dignity. We observed that staff addressed residents with respect and always knocked before entering a residents room. Care Homes for Older People Page 14 of 26 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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 home provides an environment where Hindu Gujarati residents religious and cultural needs are met. Relatives can visit whenever they wish and are made welcome when they visit. The food provided is fresh and of good quality. Residents are consulted about what they would like to eat. Evidence: The home provides an environment where Hindu Gujarati residents religious and cultural needs are met. The home has a Hindu shrine in the lounge and the manager said that residents are supported to visit the temple if they wish. Once a month the home holds a bhajan, which is a religious event involving songs and prayers. The manager said that residents enjoy celebrating Hindu and Christian festivals. Diwali decorations decorated the home at the time of inspection. Gujarati television stations are available in the home and the Harrow mobile library service visits monthly and supplies Gujarati books and films. The manager said that all Care Homes for Older People Page 15 of 26 Evidence: residents have regular contact with their families and that relatives are welcome to visit the home at any time. One relative visited a resident during the inspection. The homes garden is an inviting space in which to spend time and the manager said that residents enjoy going for walks with support from staff in warmer weather. All food served at the home is vegetarian and is cooked fresh each day by staff. The manager said that some residents choose to take part in preparing meals. The food served on the day of inspection was fresh, well prepared and was enjoyed by residents. The manager said that residents choose not to have a menu that is planned a week in advance but prefer to choose what they would like to eat each day. Care Homes for Older People Page 16 of 26 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 a clear complaints procedure which is easily available. Staff are trained to recognise and report abuse. Evidence: The home has a written complaints procedure, which is included in the Statement of Purpose and service user guide. The manager said that the home had received no complaints since the last inspection and that there had been no referrals to the local authority under safeguarding vulnerable adults procedures. The manager said that the owner checks with residents whether they have any complaints during his monthly monitoring visits. There was evidence that staff attend training in the protection of vulnerable adults (POVA). Care Homes for Older People 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, 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. 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 location of the home means that residents have easy access to local community facilities and open spaces. The house is clean, homely and well decorated. The home installs adaptations or obtains specialist equipment where necessary to meet residents mobility needs. Evidence: The home is situated in a quiet residential area near Harrow town centre. Accommodation is arranged over three floors. The ground floor has a shared lounge, conservatory, kitchen and a bathroom with toilet and shower. There is also a twin bedroom on the ground floor. There is a raised divider on the floor between the lounge and the conservatory. One resident found this divider difficult to negotiate when using his walking frame. It is recommended that this divider be removed if possible so that residents can move around the home more easily. There is a well maintained rear garden, which the manager said is well used by residents in summer. The first floor has one bedroom with en suite bathroom facilities and two single bedrooms. There is also a shared bathroom and toilet on this floor. The second floor has one single bedroom. There are mobility aids in place throughout the home, such Care Homes for Older People Page 18 of 26 Evidence: as ramps at the entrances, grab rails where necessary and chair lifts to all floors. The manager said that district nurses obtain pressure relieving equipment for the home should residents need this. All bedrooms and bathrooms have call bells and smoke alarms. The manager said that the owner responds quickly to resolve any maintenance problems that occur. Carpets have been replaced with solid flooring since the last inspection as it was felt this better suited residents needs. Care Homes for Older People 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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 cared for by people they know and who understand their needs well. The home carries out appropriate checks on staff when they start work. Staff have access to relevant training and one to one supervision. Evidence: The manager said that the home currently employs four care staff, some of whom work part time. The manager said that the staff team has remained stable since the home opened, which means that residents are cared for by staff who know them well. The manager said that she usually works from 8am until 7pm, Monday to Friday. Following a requirement made at the last inspection of the home there is now always a member of staff on duty with the manager from 8am until 7pm. One member of night staff is on duty from 7pm until 8am. The manager said that night staff are expected to remain awake to make checks on residents and to be available to respond to their needs. The manager said that staff are always able to contact her or the owner in an emergency. Information held about staff has been organised since the last inspection. We checked three staff files. These contained proof of identity, two references (although these Care Homes for Older People Page 20 of 26 Evidence: were often personal not professional references), evidence of Criminal Records Bureau disclosure and PovaFirst check. Staff files also contained evidence that staff have an induction when they start work and ongoing supervision. There was also evidence that staff are issued with a written contract, which sets out the terms and conditions of their employment. Two of the staff we checked were students and therefore the hours they can work at the home are limited to 20 hours per week in term time and 40 hours per week in holiday periods. The manager is aware of these restrictions and said that she monitors staff hours so that no one exceeds the hours they are entitled to work. We found that one care workers UK entry clearance permit had expired in March 2009. The manager was aware of this and said the member of staff was currently on maternity leave and would not be allowed to work at the home again until her UK entry clearance permit had been renewed. Staff files contained evidence that staff attend training appropriate to their roles, such as giving medication, safeguarding vulnerable adults, moving and handling and dementia but the member of staff on maternity leave had missed most of these sessions. The manager said that this member of staff would attend this training when she returns to work. The manager said that one member of staff has completed NVQ level 2 and is working towards NVQ level 3 and another member of staff is working towards NVQ level 2. The two remaining staff are to start NVQ level 2 in 2010. The manager said three staff had attended an English for speakers of other languages (ESOL) course to enable them to access further training relevant to their jobs. Care Homes for Older People Page 21 of 26 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 manager is competent and has access to appropriate management support and relevant professional training. Residents have opportunities to have their say about the service they receive. Checks are carried out regularly to maintain residents health and safety. Evidence: The home opened in July 1997 and the manager has been employed since that time. The manager is registered with the CQC and has almost completed the registered managers award. Following a requirement made at the last inspection of the home the manager now has access to regular professional supervision. The manager said that she finds these sessions useful in terms of professional support. The manager said that her knowledge of Gujarati is improving slowly through contact with residents and staff. It is recommended that the manager continue to improve her Gujarati language skills so that she is able to communicate with residents in their first Care Homes for Older People Page 22 of 26 Evidence: language. The manager said that residents choose not to have regular meetings but that they are able to have their say about the service they receive at any time. The owner carries out a monitoring visit to the home each month and residents are encouraged to raise any issues at these visits. The manager said that feedback questionnaires are distributed twice a year to residents, their families and health care professionals who have contact with the home. These questionnaires give people the opportunity to contribute their thoughts about the service the home provides. The home does not deal with residents finances. We checked health and safety records and found that: Water temperatures are checked regularly to make sure there is no risk of scalding to residents. Portable electrical appliances had been tested in July 2009. The Gas safety record was issued in May 2009. The Electrical installation report was issued in June 2007 and is valid for three years. The home had Employers Liability Insurance until August 2010. We found evidence that staff check the fire alarm and emergency lighting systems each week. The homes fire fighting equipment was serviced by an engineer in April 2009. The last fire drill took place in August 2009 and a fire risk assessment was last carried out in October 2009. We found evidence that the home complied with the fire regulations at the last visit of the London Fire and Emergency Planning Authority (LFEPA) in May 2008. Care Homes for Older People 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 Older People 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 7 15 Review risk assessments regularly to take account of any changes in residents needs. Ensure that residents receive their medication safely. 31/12/2009 2 9 13 11/12/2009 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 1 2 7 20 Review moving and handling assessments at least once a year. Remove the raised divider on the floor between the lounge and the conservatory so that residents can move around the home more easily. The manager should continue to improve her Gujarati language skills so that she is able to communicate with residents in their first language. 3 32 Care Homes for Older People 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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