Care Home: Walterton Road (Flat A&B)

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What the care home does well The home continues to give good quality person centered care and support provided by dedicated, professional, competent and friendly staff teams. The care planning whilst having slightly different formats on the two floors had similar good quality content that can easily be used to understand the needs and wishes of people who use the service and support them to meet these needs and enable them to achieve their wishes. The medication records were up to date and correctly filled in. What has improved since the last inspection? Whilst the care plan formats differ slightly the quality of content is much closer than it had previously been. The statement of purpose, guide for people who use the service and fire procedure have been updated. The hot water problems have been resolved. What the care home could do better: The organization must decide if the Walterton Road would benefit from being registered as one or two homes. Key inspection report Care homes for adults (18-65 years) Name: Address: Walterton Road (Flat A&B) 65 Walterton Road London W9 3PF     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: Wynne Price-Rees     Date: 2 9 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 22 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 22 Information about the care home Name of care home: Address: Walterton Road (Flat A&B) 65 Walterton Road London W9 3PF 02072890533 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Westminster Society for People with Learning Disabilities Name of registered manager (if applicable) Manager post vacant Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is:10 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 The home is located in the Maida Vale area with easy access to transport and local amenities including shops. It is registered to provide support for up to ten younger adults with learning disabilities and the accommodation has a lift and is located on the ground and first floors. There are currently no vacancies. The building is in a Victorian terraced suburban street and blends in with its surroundings. Fees chargeable can be obtained from the Westminster Society for People with learning Disabilities that run the home. Care Homes for Adults (18-65 years) Page 4 of 22 Over 65 0 10 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means people who use this service experience good quality outcomes. This key inspection was unannounced and took place over six hours on 29/04/2010. During the visit we spoke to people who use the service, staff and the two deputy managers. Due to differing levels of communication skills of people who use the service we also observed care practices to give us a better idea of how their needs and wishes are met. We also checked records, policies and procedures and walked around the building. We compared what we found with other information we had gathered before the visit including an AQQA self assessment document the home filled in and sent to us. An AQQA is a self assessment document that tells us how the home thinks it is performing against the national minimum standards. We also looked at the care plans and health files of four people who use the service. We took all the information and then decided on the new quality rating for the home. Care Homes for Adults (18-65 years) Page 5 of 22 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 6 of 22 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 7 of 22 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people who use the service are fully assessed before they move into the home and they and their family or other representative can visit before deciding if they want to move in. Evidence: No new people that use the service have moved in since 2007 and the assessment information on their files indicated they have been fully assessed and able to visit where possible before moving in. The assessment policy and procedure remains the same as it did at the last in inspection in July 2008, although it has been annually reviewed. A requirement was made at the last inspection for the statement of purpose and guide for people who use the service to be updated. This has been carried out and now reflects the current staff team. Care Homes for Adults (18-65 years) Page 8 of 22 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. Care plans are comprehensive and show how staff help people to meet their social, health, cultural, emotional and communication needs to promote independent living. There is a slight difference in format between the homes two floors although content is similar. People who use the service are encouraged to make their own decisions and take responsibility for them within a risk assessed environment. Evidence: A sample of four files demonstrates people who use the service have all about me person centered plans that include basic information, communication plan, methods of support wanted, needed and how to help people express themselves. Much of the information is conveyed pictorially including birthdays, favorite things, what makes me happy, friends and who I live with. It also gives information about what makes me angry, unhappy and sad. The initial assessments provided original care plan goals and over the considerable interim period these have been developed, refined and updated by key workers and people who use the service. The goals are reviewed in partnership during key work sessions, particularly action points and then discussed at individual Care Homes for Adults (18-65 years) Page 9 of 22 Evidence: planning meetings that are attended by people who use the service, care workers from day centres attended and the homes staff team and manager. This gives a better reflection of progress made towards goals in the different environments that people who use the service experience and also helps to identify any differences the environments may have, good or bad on goal achievement. A person centered plan review took place the day before we visited. The home keeps daily logs that feed further information into the plans and identify if activities take place that contribute towards goal achievement. The care plans are under pinned by regularly reviewed individual risk policies, assessments and annual placement reviews take place. There are also separate up to date health care files for everyone. Currently one bedroom is being made into a more sensory environment to identify what makes the person who uses the service most comfortable and enhances their access to choice. A flat screen television has been purchased with a person who uses the service to improve visual communication. Someone else has identified, with support from their key worker a need to keep their beard trimmed for reasons of personal hygiene and now visits a barber regularly. Each Sunday menus for the week are discussed at the weekly meeting for people living at the home. This is also used as a forum to discuss any issues that may arise from communal living and to make suggestions such as outings, holidays or general living. It is an opportunity for people to say what they think. Although the ground floor and first floors operate slightly different formats for their all about me person centered plans the content is similar with the main difference being one floor uses first tense I terminology whilst the other doesnt. This is primarily because although registered as one home it operates as two separate units and staff teams. The Society is currently considering re-registering as two separate units as it was previously registered. During our visit the care practices observed indicated that people who use the service are encouraged and supported to make their own decisions and this is reflected in the many different activities they choose individually and as a group. Care Homes for Adults (18-65 years) Page 10 of 22 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. People who use the service take part in appropriate activities at home and within the community, maintain good contact with family and friends and their rights and responsibilities are recognized. Evidence: People who use the service have full and active lifestyles based on their wishes and decisions. Activity likes and dislikes are well documented within individual care plans and recorded in daily logs when they take place. There are a variety of group and individual activities including arts and crafts, cooking and baking and music with drums and keyboards at home that help develop life skills. Visits to the theatre, cinema, London Eye and Aquarium also take place. These are supplemented by day center activities although these have reduced considerably in volume. Everyone is registered to vote and will be doing so. Recent activities include sensory room work, evening meals with key workers and dinner out in Kilburn as well as trips to parks and Care Homes for Adults (18-65 years) Page 11 of 22 Evidence: shops. People tend to prefer going out in smaller rather than large groups and are considering small group holidays. One person has just returned from a holiday at Butlins Bognor Regis with their key worker. A 50th and three other birthdays were recently celebrated. Im going to a musical, suns shining. One person was going to see the musicalStomp during our visit and another had a less exciting visit for a blood test. Someone visited the Ideal Home exhibition and bought some new lampshades. Day trips to Brighton, Chessington and Edinburgh have taken place with the latter involving a plane journey and someone went to a private movie showing and three course meal in the West End. The activities and memories evoked are reenforced by use of story boards and digital picture frames. People who use the service are encouraged to take the lead during their Sunday evening meetings discussing outings and other topics as well as the menu for the coming week. Whilst people who use the service plan the menu, staff support them to make choices that will provide a balanced diet. Friends and family are welcome to visit and stay for a meal. Care Homes for Adults (18-65 years) Page 12 of 22 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive support with personal care in the way they want, their health needs are met and medication is properly administered, stored and recorded. Evidence: People who use the service have access to community based health care services and are registered with a GP. A sample of four files showed us that everyone has an individual health care file and plan that is regularly updated and provides all the information we need to see it meet the standards. Staff have been trained and know how people who use the service prefer to be helped with personal care, from their care plans and staff training enables them to deliver appropriate health care. We checked the medication administration sheets for everyone who lives at the home and they are correctly filled in. The medication is also correctly stored. The home does not keep controlled drugs. Care Homes for Adults (18-65 years) Page 13 of 22 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. People who use the service know how and are enabled to make a complaint that is listened to, acted upon and they are provided with an outcome. They are kept safe from harm and abuse. Evidence: The complaints procedure is available in written and pictorial format to make it easy for everyone to understand. There has been one complaint over both floors since January and this was fully investigated with outcomes. There is also a whistle-blowing procedure. There is an adult safeguarding policy and procedure and staff receive core induction and refresher training linked to this. The training makes them aware of what abuse is and the action to take and people to contact to raise a safeguarding alert if necessary. There is currently one safeguarding issue that is under investigation by the local authority safeguarding team. Care Homes for Adults (18-65 years) Page 14 of 22 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. People who use the service live in a clean, tidy, safe and homely environment with enough communal and private space to meet their needs. Evidence: The home is fit for its stated purpose and is clean, tidy, safe and well maintained. There is adequate communal space and it is well used. There is a nice garden area that people who use the service have been developing together. They had a gardening competition but a person who uses the service decided they didnt want to show us the pictures. Everyone has their own TV and DVD and their bedrooms are decorated in the way they choose. New kitchens have also been installed. Care Homes for Adults (18-65 years) Page 15 of 22 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. There are qualified and competent staff on duty at all times in sufficient numbers to meet the needs of people who use the service. They have been properly vetted prior to starting work. Evidence: Staff are nice to me. The staff observed are very encouraging and enable people who use the service to get across their points of view and what they want. At the same time they also point out what is unacceptable behaviour in a constructive way, maintaining appropriate boundaries. They also have thorough knowledge of everyone living at the home on the floors they work on, through key working, care plans and team reviews. All staff are fully vetted by a robust recruitment process that meets the standards. Two new staff members have been recruited and are awaiting CRB clearance before starting work on one floor whilst there are two vacancies on the other. The vacancy shifts are covered internally, bank staff or agency as a last resort. CRB is the Criminal Records Bureau. Staff confirmed that a thorough induction training programme is in place that they felt enabled them to understand and do their jobs quickly and safely. There is also a mandatory annual refresher training rolling programme as well as career development paths with specialized training available. All staff are expected to do a minimum NVQ Care Homes for Adults (18-65 years) Page 16 of 22 Evidence: level 2 course and seven out of nine staff have either attained this award or are working towards it. Supervision takes place monthly or more frequently if required and there are annual appraisals. Care Homes for Adults (18-65 years) Page 17 of 22 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. Although the home is well managed by the two deputies, it could be better managed if the organisation makes a decision regarding future registration giving further opportunity to develop opportunities for people who use the service to live the way they wish. Evidence: Currently the manager post is vacant whilst the society decides if Walterton Road should be registered as one home or two. A decision must made soon as currently it is operating as two homes with separate staff teams, led by two deputy managers under one registration. This is fragmenting the team into two separate entities and will make it difficult to be run efficiently should a single registration be maintained. One deputy manager has attained NVQ level 4 management award and the other is currently undertaking it. There is a comprehensive quality assurance system that contains performance indicators and meets the requirements of the standard. The home gets feedback from people who use the service on a daily basis and the organisation obtains feedback through questionnaires, regulation 26 visits and user forums that people who use the Care Homes for Adults (18-65 years) Page 18 of 22 Evidence: service attend. Regulation 26 visits are monthly management quality assurance visits. The fire fighting equipment is regularly serviced and other safety checks are carried out that meet the appropriate standards. Care Homes for Adults (18-65 years) Page 19 of 22 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 20 of 22 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 39 8 The organisation must decide if one or two separate registrations for this home are appropriate and appoint and apply for registration accordingly. Currently the home is running as two separate homes on different floors under one registration with two distinct deputy managers, staff teams and groups of people who use the service. 02/08/2010 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 21 of 22 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. 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