Care Home: Warren The

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What the care home does well People living in the home who we spoke with considered that their needs were met. The day to day running of the Warren promotes individuals independence. Mealtimes offered choice and people are able to chose the foods they like to eat. We found a relaxed atmosphere in the home with good interactions between staff and the people who use the service. What has improved since the last inspection? One requirement was made at the previous inspection relating to obtaining references on prospective employees. This has been met. Recommendations were made in relation to care planning, medication, staff training, redecoration and complaints handling. These have either been or are in the process of being addressed. What the care home could do better: Requirements have been made with regard to the overall financial running of the home. We are concerned to receive reports from staff of not being paid on time. CQC has had to take action with regard to annual fees not being paid to them. Recommendations have been made in relation to furniture in the home and information requested on application forms. Key inspection report Care homes for older people Name: Address: Warren The 84 Coombe Road Croydon Surrey CR0 5RA     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: Janet Pitt     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 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) © 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 Older People Page 3 of 26 Information about the care home Name of care home: Address: Warren The 84 Coombe Road Croydon Surrey CR0 5RA 02086887022 02086868808 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr James Emmanuel Kwabena Safo Name of registered manager (if applicable) Mrs Bernadette Joan Redmond Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: A variation has been granted to allow one specified resident under the age of 65 to be admitted. Date of last inspection Brief description of the care home The Warren is situated in a pleasant residential area of Croydon, opposite a Tramlink stop and overlooking Lloyd park. The house itself is well named, with the two double bedrooms being situated in the turret of the home, and the top floor comprising of four single rooms each of intriguing dimensions. The accommodation comprises of the aforementioned two double rooms and fourteen single. There is a large lounge on the ground floor, which leads into the conservatory dining area. Part of the conservatory can be curtained off to provide a more secluded space for meetings. There is a second, smaller conservatory, which serves as the designated smoking lounge. The home has an extremely attractive garden, the feature of which is a large fishpond. The stated Care Homes for Older People Page 4 of 26 18 Over 65 0 Brief description of the care home aim of the home is for it to be run to a very high standard and to give effective environmental, physical and psychological care for the elderly, incorporating quality job satisfaction and status to the people it employs. 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 star. This means the people who use this service experience good quality outcomes. One inspector undertook this unannounced inspection. A site visit was made that lasted two hours. During this time we looked around the premises, viewed documentation and spoke with people who live in the home. Surveys were received from staff members and individuals receiving support. The home completed an Annual Quality Assurance Assessment [AQAA], that detailed how the service is operating. Notifications that we have on the service were looked at. Care Homes for Older People Page 6 of 26 Information from all these sources has been used in this report. 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. 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 8 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 9 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. People can be confident that an assessment of need will be made prior to moving into the home. Care is needed to make sure information is available, so that an informed choice can be made. Contracts specify what service provision a person can expect. Evidence: The Warren said in its AQAA: We always ensure that our service users are made to feel at home at the Warren and they are encouraged to participate in the running of the home. Prospective residents always have a full assessment of needs completed by our management team and a placing authority if applicable as to ensure the home can meet these needs, before offering a placement. Feedback from residents, their families Friends and stakeholders both verbally and in writing evidence that our staff care for individuals in a professional and dignified manner. On our site visit we were able to confirm that individuals have an assessment of need Care Homes for Older People Page 10 of 26 Evidence: undertaken. Peoples care plans that we looked at had a pre- admission assessment that covers health and social needs. Information form other health professionals, such as doctors, and from the placing authority was available. People had signed to indicate that they were involved in the assessment process. Each person had a contract that detailed what room they were to have and what service is provided for the fee. Survey respondents in general had received sufficient information to enable them to make a choice about living in the Warren, this needs to be consistent. Some people said they did not receive any information. Care Homes for Older People Page 11 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. People can be confident that their assessed needs will be drawn up into an accessible care plan. Independence is promoted within a risk assessed framework. Care plans are a live document and the home is continually developing the content to make sure that they are person centred and outcome focused. Evidence: All service users are registered with a GP. Where possible we encourage residents to visit the surgery for routine appointments. Specialist advice and support is sought where needed. The appropriate action is taken if the service users loses or gains weight or their health needs change. Annual health checks are completed by the GP. Records of all residents intake of food is recorded daily and monitored. [AQAA 2010] We looked at peoples care plans and found that they lead from their assessments. The plans covered identified health and social needs. These included the individuals past medical history, mental state and what significant relationships they had, such as family and friends. There was information on a persons insight into their illness. For example, one person did not believe they had a mental health diagnosis, but Care Homes for Older People Page 12 of 26 Evidence: experienced hallucinations. The plan detailed how the person should be cared for. People had signed to indicate they were involved in the care planning process. There was evidence that individuals had been present at formal reviews and evaluation of their plans. Details of what an individuals could do for themselves had been detailed and what support staff needed to give, eg prompt with personal care. There were records of visits by the general practitioner, community psychiatric nurses and hospital appointments. We noted that some people exhibit challenging behaviours. There was guidance on how staff should deal with individual challenging behaviour eg deliberate self harming. People had risk assessments in place if needed. For example, one person had a risk of overdosing on medication. Their risk assessment informed staff how this risk should be minimised and appropriate interventions. The manager told us that if anyone had a number of falls that required hospital attention, this was identified by the hospital. A professional from the hospital visits the home and carries out an assessment to make sure the home are taking the correct action to minimise risk. We discussed with the manager the homes proposals to further develop the care plans in order that they are consistently outcome focused and evidence choice. From information we hold there are no issues with medications handling. The Warren plans to develop self medication for those who are able in the next twelve months. Survey respondents consider that staff treat them with respect and care for them appropriately. Care Homes for Older People Page 13 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. People are able to chose how they spend their day. Mealtimes are flexible and people are able to decide what is on the menu. Support is given to enable individuals to access the wider community. Evidence: We looked at care plans on our site visit and found that there was information on interests and hobbies. eg Enjoys Countdown and Deal or no Deal on TV. One person we spoke to said they did not like watching a particular programme, so they would go and sit elsewhere or in their room. People were enjoying watching television and they had all agreed on what to see. Individuals who smoke had their own lounge that had a large screen television. Care records details whether people were able to follow their chosen religion. One person regularly received Holy Communion at the home. Individuals are able to go into the community if they want. One person uses the trams to co into Croydon town centre. Care Homes for Older People Page 14 of 26 Evidence: If people chose to have an intimate relationship this is supported and privacy respected. Individuals had been asked about sexual needs, but often declined to discuss this. We saw one person seen offering biscuits with afternoon tea. Two people were walking around in their nightclothes, staff offered support with shower to bath. If they did not want a shower or bath at that time staff were seen to come back later to ask them again. One person went out with staff member to the shop. One person has their own telephone and attends to Bensham day centre. Most survey respondents said they usually or always made decisions about what they did during the day. Only one said sometimes. Generally people are satisfied with the food menu. Comments on food from surveys included: More personal choice on food. We have excellent and very nutritious food which helps people keep mentally and physically well or to get them well again. As a trained nutritionist this is very important. If people only eat it all. Very nice tasty food. Care Homes for Older People Page 15 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. People usually know how to raise any concerns, this needs to be consistent. Progress has been made on making sure that all staff have had recent training in Safeguarding Vulnerable Adults. Evidence: There are policies and procedures in place in safeguarding adults, whistle blowing and complaints. All staff have had POVA and CRB checks completed prior to commencement of employment.[AQAA 2010] We have not received any concerns or complaints. Most survey respondents told us that they knew how to make a complaint. Comments included: person not always available. and The manager who will always try to help. The AQAA detailed the fact that if an individual did not have a nominated next of kin then they would discuss getting an advocate at the persons review. We found that the majority of staff had receive training on Safeguarding. The home has had no Safeguarding alerts in the past twelve months. Training is planned for the remaining staff in the next twelve months. We observed positive communication between staff members and people that live in the home. For example one person was concerned about their income and staff took Care Homes for Older People Page 16 of 26 Evidence: time to explain how their monies were allocated. 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. People live in an environment that suits their needs. Individuals have positive input into the way the home looks. bedrooms can be personalised if this is what the person choses. There is ongoing redecoration and refurbishment. Evidence: We looked around parts of the home on our site visit. The premises were clean and tidy. We were told by the manager that the room by the kitchen was to be decorated and a new carpet put in. Communal areas were arranged in a way that promotes interaction and also allows people to have space for quiet time. There were small table available for drinks etc to be put on. It is recommended that hospital type tables are replaced with a more domestic style. People we spoke with said they had what they wanted in their rooms. All survey respondents said that home usually clean and tidy. Comments included: Very clean toilets. A very clean lounge sitting room. The home has a separate dining room and an individual told us that people were able to sit in their preferred place. The Warren has a large garden with tables and chairs. Care Homes for Older People Page 18 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. Poeple are protected from harm by the homes recruitment procedures. Appropriate checks are carried out prior to an individual starting work. Training plans are in place and the Warren is now accessing more external providers for this. Evidence: Staff are recruited appropriately and all necessary checks are carried out before they start employment. We sampled some staff files and found that Criminal Records Bureau checks and references had been obtained. Prospective staff members had completed application forms that requested explanations for gaps in employment. Individuals were asked about any previous convictions, it is recommended that any previous cautions are declared. The AQAA stated: All senior staff had either completed or are in progress of attaining NVQ level 3 or above. We have a training programme in place which includes all the mandatory courses and mental health training. All staff have induction and access to bi monthly formal supervision sessions and an annual appraisal. We were able to confirm this when we examined staff files. They contained details of induction training, supervision and appraisals. Each staff member had a Workforce Development Plan that detailed training given and planned training. These included Care Homes for Older People Page 19 of 26 Evidence: food hygiene, fire safety, health and safety, and Safeguarding Adults via e learning. The manager informed us that training on Deprivation of Liberty and Mental Capacity had been planned for the next year. Staff raised concerns on their surveys about not being paid on time. The manager reported that this situation was being addressed. One issue are late payments from placing boroughs. The manager said that the system would change to BACS transfers and the pay date would be altered to make sure funds are available. Other issues raised by staff were having external trainers and improving activities for people. These are areas for improvement that have been commented on in the AQAA. Survey respondents said that generally staff treat them well and listen and act on what they say. I cannot think of anything the staff could do to improve our care here, Day staff and evening staff friendly and caring. There were sufficient numbers of staff on duty on the day of the site visit. Care Homes for Older People Page 20 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 day to day running of the home is satisfactory. However, concerns about the overall financial management does not give us confidence that people are receiving the best service possible. Individuals monies are handled appropriately and the environment is kept safe. Evidence: The Warren has a stable management structure in place. They consider that:We are open and transparent in our approach and welcomes peoples comments and suggestions on how we can improve our service.[AQAA 2010]and The Warren continues to provide a homely atmosphere and strives to maintain a high standard of individualised care for our service users who have mental health needs. We have limited rules and routines. We saw that the AQAA gave good detail on how the service is operating at the moment. There was detail about areas that could be improved and what plans there are for this. Care Homes for Older People Page 21 of 26 Evidence: All financial transactions on behalf of service users are supported by receipts and countersigned by both the resident and a senior staff. Service users are encouraged to maintain their independence of managing their own affairs if possible.[AQAA 2010]. When we spoke with people that live in the home and look at records we were able to confirm this. The manager was present during the site visit. Information we needed for inspection purposes was readily available. The documentation was seen as live and detailed awareness of individuals and their needs. All staff interacted well with people, smiling and talking about things the individual interested in. We noted that Portable Appliance Testing had been carried out. the manager was in the process of chasing up the fire extinguisher checks, as they were due. We did not identify any issues relating to health and safety, during our time at the Warren. CQC has concerns about the financial management of the home, as requested for the service to pay their annual fees to us were not actioned in a timely manner. Also, the situation over staff pay give cause for concerns. Unfortunately because of this were are only able to judge this area as good. Care Homes for Older People Page 22 of 26 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19 There must be appropriate 30/07/2008 references obtained on people who want to work in the home. There must be a full employment history for each person. This will make sure that good recruitment processes are following, thus protecting people who live in the home from harm. Care Homes for Older People Page 23 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 33 25 staff need to be confident that they will receive their salary as detailed in their contract. This will make sure that people that live in the home are not at risk of having no one available to support them. 17/08/2010 2 34 25 The registered persons must 17/07/2010 make sure that fees required by CQC are paid on time. This will make sure that the home is operating legally at all times. 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 1 It is recommended that people are provided with sufficient information to enable them to make a choice about moving into the Warren. Care Homes for Older People Page 24 of 26 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 3 20 29 It is recommended that hospital type tables are replaced with a more domestic style of table. It is recommended that prospective employees are asked about any previous cautions prior to commencing employment. 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. 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