Care Home: Walm Lane Nursing Home

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What the care home does well The home continues to provide a service mostly for younger adults with predominantly substance misuse care needs. The residents are cared for and supported to lead an independent lifestyle that suit their wishes and choices. Each resident has a key worker that works with them to identify their needs and to provide support as required. The home has a core staff group that is familiar with the needs of the residents and ensures that residents are cared for as appropriate. They receive the necessary training to ensure that they are able to perform their duties. Care plans and risk assessments generally address the needs of residents in a comprehensive manner. Residents are supported where required to ensure that theirhealthcare needs are met. The grounds of the home and the home itself are appropriately maintained to ensure a quality environment for residents. The bedrooms of residents are also appropriately personalised to provide a homely environment. What the care home could do better: There must be a clear care plan or financial profile for each residents about the management of their personal money. The records that are kept must be clearer than they were during the inspection, to make sure that any person reading them will immediately understand how the personal money of residents is being managed and how residents can access their personal money. When residents are admitted to the home their property and valuables must be recorded as far as possible, to provide an audit trail and to ensure the safety of the residents` property and belongings. The home must ensure that all staff are fully aware that it is not acceptable to use correcting fluid in care records as this may affect the authenticity of these records. A few issues that were noted with the management of medicines must be addressed to fully ensure the safety of residents. The instructions about the location to apply cream and lotions must be clarified on the medicines charts. Random inspection report Care homes for adults (18-65 years) Name: Address: Walm Lane Nursing Home 141 Walm Lane London NW2 3AU two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Ram Sooriah Date: 0 3 0 8 2 0 0 9 Information about the care home Name of care home: Address: Walm Lane Nursing Home 141 Walm Lane London NW2 3AU 02084508832 02088307426 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ibexbrook Limited care home 21 Number of places (if applicable): Under 65 Over 65 0 0 0 0 21 0 0 past or present alcohol dependence past or present drug dependence dementia learning disability old age, not falling within any other category physical disability sensory impairment Conditions of registration: 21 21 21 21 0 21 21 The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Past or present drug dependence - Code D Past or present alcohol dependence - Code A Old age, not falling within any other category - Code OP Dementia - Code DE Learning disability - Code LD Physical disability - Code PD Sensory Impairment - Code SI Care Homes for Adults (18-65 years) Page 2 of 13 Date of last inspection Brief description of the care home 141 Walm Lane is a nursing home that provides accommodation for 21 adults over 18 years. At the time of this inspection there were no residents with older person care needs. All the residents had younger adults care needs that mostly included mental health and alcohol dependency care needs. The home is a large detached building on three floors. It is located close to Cricklewood Broadway and Willesden Green with good access to a variety of shops and local amenities. The home is about 5-10 minutes walk from Willesden Green underground station and is easily accessible by buses, which travel down part of Walm Lane. There is parking for about 3-4 cars in front of the home. Walm Lane and most of the surrounding areas contain resident parking or parking meters. There is a small area with shrubs and bushes in the front of the home and a large garden at the back of the home accessible to all residents. These are appropriately maintained. Accommodation for residents is found on all three floors and a mezzanine floor in 19 single bedrooms and 1 double bedroom. There is a shaft lift but the mezzanine floor is not served by the lift. The home currently has 3 bathrooms and one shower for the 21 residents. There are 4 bedrooms, no bath and 1 small toilet on the second floor. The home has a smoking room with a kitchenette facility. The communal areas are on the ground floor and consist of a main lounge/conservatory and dining area. The home charges 850 pounds-900 pounds for younger adults depending on the needs of the residents and 800 pounds for older people, again depending on their needs. There were 18 residents in the home at the time of the inspection. Care Homes for Adults (18-65 years) Page 3 of 13 What we found: The random inspection started on Tuesday 7th July at 13:20-15:40. It continued on Friday 10th July at 12:30-15:30 and finished on 3rd August at 12:30-14:30. The last key inspection took place on the 10th July 2007 when the home was rated as providing a good service (Two Star). During the course of the inspection we spoke with 5 members of staff and 4 residents, toured some of the premises and discussed compliance of the service with past requirements that were imposed on the home, with the manager. The manager completed an Annual Quality Assurance Assessment (AQAA) that has been used where possible to inform this report. We would like to thank the residents who talked to us during the inspection, Mr Granger(the responsible individual), Mr Raffick Juhoor (the manager of the home), and all his staff for their kind support and cooperation during the inspection. CARE PLANS. Each resident has a key worker but this information was not recorded in any part of the care records when we looked for this information. We asked about this and we were told that there was a list of key workers on a notice board. The care records were however updated on the third day of the inspection and those residents that did not have photographs on the first day of the inspection had photographs in place. The home keeps two files that contain residents care records. There is a working file that consists of the care plans, risk assessments and daily progress records. The other file contains the admission details of the resident, the assessments that has been carried out by the home prior to admission of the resident and the needs assessment of the funding authority that has placed the resident in the home. The manager stated that the needs assessment of residents are kept under review every six months and are updated when required and that plans of care to address the needs of residents are reviewed every month. We indeed noted that care plans were reviewed on a monthly basis. The preadmission assessment of residents that is incorporated in the care records of residents also contains information about the spiritual and cultural needs of residents. The care plans had signatures of residents or their representatives to show that the care plans, risk assessments and actions to meet the needs of residents have been discussed and agreed with them. The manager stated that care plans are updated when residents condition change and that residents and their relatives are kept informed of any changes. A few residents that we talked to and who were willing to talk to us told us that they have seen and have agreed their care plans. The home uses a range of risk assessments and during the last inspection it was not always clear when these were reviewed for individual residents, as the dependency of residents and their needs varied. The manager said that all residents have an initial risk assessment and depending on the level of risk, these are reviewed at timescales that are identified on the particular risk assessment. We also noted that residents who were acutely ill, such as when they had an infection that was being treated, had short term care plans in place to address these needs. We Care Homes for Adults (18-65 years) Page 4 of 13 were informed that residents are always referred to the GP when there are changes in their condition. At times the GP is even called for home visits, if residents are unable to attend the surgery. This is good practice. We noted that those residents who needed their vital signs monitored had charts in place that had entries about all the monitoring of the residents condition. One can then at a glance see if their are any changes in the residents condition. The manager stated that other needs of residents are monitored according to their individual condition. This might include oral intake or bowel care. The home provides care and support to a number of younger adults who have needs in relation to substance misuse. While they are in the home, staff support them in maintaining independent living skills and in getting involved in the community. We noted some progress with regards to residents having care plans in place addressing these areas of care and support, but there were still residents who did not have care plans addressing these needs. We however noted that staff worked with residents and encouraged and supported residents to be independent and to develop confidence outside the home by accompanying the residents in the community. The care records of residents and discussion with the manager showed that new residents to the home were registered with a GP within a few days of admission when residents physically visit the surgery for a health check. The manager informed us that residents are accompanied by a trained member of staff and that on most occasions that would be him. He added that any information that came with residents on admission, such as discharge letters, are then passed on to the GP. During other visits to the surgery residents are often accompanied by the manager or by care workers. We were informed that the home pays for a taxi if residents have to go to the GP surgery by car. MEDICINES MANAGEMENT. We looked at the management of medicines in the home. Medicines charts were on the whole appropriately written and the medicines that we sampled were all in stock.The manager stated that the amount of all medicines are monitored to ensure that the home does not run out of the medicines. A prescription is requested from the GP when a new resident is registered with the GP to ensure an adequate supply of medicines. Subsequent prescriptions are then requested at the same time as for other residents to ensure that all residents medicines run to the same cycle. This then ensures that no resident run out of medicines in the middle of a medicines cycle. The amount of all medicines that are received in the home are recorded in a book and signed by the person receiving the medicines. Any new box/container of medicine that is opened is dated to provide an audit trail. We noted that a medicine was written on both of the medicines charts of a resident. As there is a possibility of errors if a medicine is written twice, one of the entries must be deleted. The management of residents who are on anticoagulants was generally good. Any instruction to change the dose of the medicine is faxed to the home from the anticoagulation clinic and staff can then make the necessary entry in the medicines charts. Nursing staff stated that they do not take verbal instructions about medication over the phone. A few residents were prescribed creams and ointments for topical conditions. The instructions about the location to apply these medicines were not always clear. This Care Homes for Adults (18-65 years) Page 5 of 13 would be particularly useful when a new cream/ointment has been prescribed or when there is a new nurse or a bank nurse administering medicines. We noted that the blood sugar levels of people with diabetes were being monitored regularly depending on their individual care plan. We checked the lancing devices that are in place in the home for the testing of blood sugar levels for residents who are diabetic. We found that individual lancing devices for self testing were in the home. These devices must not be used by a third party in a care setting as these increases the risk of transmission of blood borne infection. Staff told us that they did not use these and that instead they used a lancet without a lancing device to draw blood to check for the blood sugar. However, this is not recommended by the Medicines and Healthcare Regulation Authority (MHRA) as this method might not only be painful to residents but is against the designated use of the lancet. The MHRA instead recommends the use of single use disposable lancing device. We noted that these devices were in use on the second day of the inspection. MANAGEMENT OF RESIDENTS PERSONAL MONEY. The home has had 2 referrals made to the safeguarding adults team of the local borough in the past two years, both related to the management of the financial affairs of residents. None of the allegations were substantiated but we made a number of recommendations in the last key inspection report to improve transparency and clarity around the management of residents money. We noted that the home has not yet fully put in place a care plan or a financial profile for each resident that have personal money with the home. This would have provided information about the personal money of residents, including the social benefits that the residents receive where this information is available and relevant, how this is managed and about the ability of the residents to understand their financial affairs. On the third day of the inspection we noted that the manager was working on these care plans and financial profiles. We looked at the records regarding the management of the personal money of two residents. Mr Granger is the main person responsible for the management of residents money. We noted that records were kept about the receipts of money for each resident and their expenses. While Mr Granger, the provider, could easily understand and explain the records that he kept, it was more difficult for a third party to understand and interpret these records. Mr Granger agreed to that and said that he would redo the records to make these clearer, so that a person looking at the records would easily understand and interpret these. OTHER FINDINGS. We toured some of the premises and noted that the home was appropriately maintained and was on the whole in a good standard of decor. None of the residents have a key to the front door of the home. According to the manager this is for security reasons, but there are a few residents with keys to their bedrooms. The manager stated that this is assessed when he carries out his preadmission assessment of residents needs, to find out if they would be suitable for the home. There were indeed details in the two preadmission assessments of residents that we looked at, about whether residents would require a key to their rooms. Bedrooms of residents were appropriately decorated and personalised to residents tastes. There are now grab rails in all the toilets to make sure that the toilets are accessible by residents who may have a disability impairment. A few residents who talked Care Homes for Adults (18-65 years) Page 6 of 13 to us said that they liked their rooms and were satisfied with them. We noted the use of correcting fluid in a few care records and on a few medicines charts. The manager stated that this was done by a new member of staff who has since been advised not to use correcting fluid in care records. We observed the activities that residents were engaged in during the inspection. Some residents stayed in their rooms, a few were out in the community, some watched TV, some talked among themselves and a few stayed in their rooms. The activities coordinator stated that she had been visiting residents in their rooms and having some one to one sessions. We also noted that she went out with residents to support them in the community and to increase the confidence of the residents in engaging with the local community. On the second day of the inspection we saw a notice board that said that a trip to Brighton was being planned. We were told that there were eleven residents going on the trip. Lunch had already been booked in a restaurant and residents said that they were looking forward to their day out. Lunch on the first day of the inspection consisted of chicken, vegetable pasta bake, potatoes, mixed vegetables and mandarine gateau. We were informed that other meals were prepared for residents who did not wish to eat the main meal. For example one of the residents had sausages for their main meal. Residents that talked to us told us that they were satisfied with the meals that they receive in the home. Residents belongings and valuables were recorded on a sheet, but we noted that the entries were not always dated and signed by the person making the entry and by the resident or a witness. To make sure that residents are protected as much as possible from financial abuse, the valuables and property sheets must be appropriately completed. We looked at the provision of statutory training for staff as the home had a requirement with regards to this aspect of the service. We noted that the training records of three members of staff showed that they were up to date with statutory training. The home therefore has met this requirement. During the last inspection we noted that there were a few windows with restrictors that could easily be disabled. The manager informed us that these have been replaced with ones that cannot be easily disabled and that all windows now have appropriate window restrictors. What the care home does well: The home continues to provide a service mostly for younger adults with predominantly substance misuse care needs. The residents are cared for and supported to lead an independent lifestyle that suit their wishes and choices. Each resident has a key worker that works with them to identify their needs and to provide support as required. The home has a core staff group that is familiar with the needs of the residents and ensures that residents are cared for as appropriate. They receive the necessary training to ensure that they are able to perform their duties. Care plans and risk assessments generally address the needs of residents in a comprehensive manner. Residents are supported where required to ensure that their Care Homes for Adults (18-65 years) Page 7 of 13 healthcare needs are met. The grounds of the home and the home itself are appropriately maintained to ensure a quality environment for residents. The bedrooms of residents are also appropriately personalised to provide a homely environment. 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 2. Care Homes for Adults (18-65 years) Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 5 5 The contract/statement of 30/09/2008 terms and conditions of the home with residents/representatives must be reviewed to make it more comprehensive (Repeated requirementtimescale 30/09/07 partly met). 2 9 13(4) The registered person must 30/09/2008 ensure that care plans and risk assessments address the promotion of the independence of residents, and the development of living skills as identified by the assessment of needs while focusing on the safety of the resident and of others through appropriate risk assessments. (Repeated requirementtimescale 31/04/06, 30/09/06 and 31/08/07 not met) 3 34 17(1), sched 2 All applicants who wish to work in the home must complete a comprehensive application form and must have a full work and 30/09/2008 Care Homes for Adults (18-65 years) Page 9 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action education history (Repeated requirement-timescale 30/08/07 partly met). Evidence of the eligibility of care workers to work in the UK must also be kept in the individual personnel files of staff. Care Homes for Adults (18-65 years) Page 10 of 13 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, 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 Each medicine must only be entered once on the medicines charts. The instructions to apply topical medicines must be clear about the location to apply these. To prevent the possibility of medicines errors. Residents property and valuables must be recorded when these items are brought into the home. To provide an audit trail and to safeguard residents property and belongings as much as possible. 08/11/2009 2 22 13 08/11/2009 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 41 Correcting fluids should not be used in care records, as this raises doubt about the authenticity of the care records. Care Homes for Adults (18-65 years) Page 11 of 13 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 2 41 The individual records about the personal money of residents should be written in a manner to make sure that these can be easily understood by a person checking these records. Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. 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