Inspection on 01/12/09 for 39 Alconbury Road

This is the latest available inspection report for this service, carried out on 1st December 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: 39 Alconbury Road 39 Alconbury Road London London E5 8RG     The quality rating for this care home is:   one star adequate 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: Robert Sobotka     Date: 0 1 1 2 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 Adults (18-65 years) Page 2 of 27 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) 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 Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: 39 Alconbury Road 39 Alconbury Road London London E5 8RG Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) 39 Alconbury Road Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 6 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: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home 39 Alconbury Road is a registered residential care home, which offers care, support and accommodation for a maximum of six female service users within a community setting. The home provides rehabilitation services for females with a history of mental health problems and subject to community sections as a discharged person on Sections of the Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 6 Brief description of the care home Mental Health Act i.e. 37/41 or the Mental Health (Patients in the Community) Act 1995 i.e. supervised discharge. The home is situated at 39 Alconbury Road, London E5 8RG and is within ten minutes walking distance of Rectory Road train station and fifteen minutes by local bus routes to/from Seven Sisters underground station. Care Homes for Adults (18-65 years) Page 5 of 27 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place and was unannounced. As part of this visit we visited the home, where we spoke with two out of three people who use the service. We also spoke with care staff working in the home, as well as the management team. We undertook a tour of the premises and viewed various records. Prior to this inspection, we asked the manager to complete an Annual Quality Assurance Assessment. Some information from this document was included in this inspection report. Care Homes for Adults (18-65 years) Page 6 of 27 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 7 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 27 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. People who use the service have sufficient information about the home to enable them to make a decision whether to move in there. Appropriate admissions systems were in place. Evidence: The home had an up-to-date statement or purpose and the service users guide. Both documents include sufficient information about the home and its aims and objectives. There were three service users accommodated in the home during this inspection visit. We checked files for each person and we were satisfied that appropriate pre-admission systems were in place. Prior to each person moving into the home, the organisation carried out a pre-admission assessment and this included meeting with the service user. Additional information was also obtained and this included reports from multidisciplinary teams and other assessments in relation to each person who used the service. People who use the service are encouraged to visit the home where they can meet Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: those who use the service and staff working in the home. Overnight trial visits are also organised. At the time of this inspection, the home accommodated one service user, whose needs could not be fully met. We were informed that the home was in the process of supporting the person to move to a more suitable environment. Care Homes for Adults (18-65 years) Page 10 of 27 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. Some improvements are required to the homes care planning systems. People who use the service are enabled to make decisions about their lives. Appropriate risk management systems were in place. Evidence: During our visit to the home we reviewed care plans of all three service users. Two are of three care plans were up-to-date and there was evidence that service users were involved in the care planning process. One of the service users care plan was found to be incomplete. We were told that this was due to the fact that the service user refused to engage in the care planning process. Whilst we appreciate that this may be the case, there must be a care plan in place, which clearly indicates as to how the persons assessed needs are going to be met to how staff working in the home should work with each service user. This requires improvement. Following our discussion with the people who use the service and review of the documentation in place, we were satisfied that the service users are enabled and Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: supported to make decisions about their lives and in relation to their finances. Appropriate risk management systems were in place. Each person had a risk assessment in place, which identified any risks and how these could be minimised. Care Homes for Adults (18-65 years) Page 12 of 27 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 are encouraged to be a part of the local community and to pursue their leisure and educational interests. Some improvements are required to the homes records of what food has been offered to the service users. Evidence: The acting manager stated that staff working in the home encourage and support service users in engaging in meaningful activities outside the home, which will assist them in living a regular life and contributing to the local community. They assist service users in seeking employment as they have expressed the desire to work in a charity shop or pursue courses at a nearby college. They have also sought advice from the local job centre to assist them in sourcing paid and volunteer work. The home has also paid the service users therapeutic earning for completing household tasks when not able to quickly engage in outside paid activities, as an incentive for completing an agreed task. Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: One service user attends a local college once a week, where she engages in a guitar course. The home provides £15 a month for each client, which they can spend on an activity of their choice. The home has supported residents to join a local library and gyms. For those individuals who have shown similar interests in activities, they home has booked tickets to attend a Christmas pantomime. Service users who spoke with us confirmed that they were satisfied with the quality and choice of activities on offer. The acting manager also stated that they encourage their residents to maintain contact with friends and relatives. One of the service users visits her family regularly and contacts them on a weekly basis. Her family also visited the home. There were adequate food supplies in the home during this unannounced inspection visit. Service users who spoke with us told us that they were happy with the quality and range of food on offer. They confirmed that they were involved in menu planning. We checked the homes menu. These were maintained, however some improvements were required, as at the time of this visit staff did not fully record what food was offered to the people who use the service, for example the only entry made against the breakfast section was cereal and against the lunch section residents choice. This requires improvement. Care Homes for Adults (18-65 years) Page 14 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are required to the way those who use the service are supported and facilitated to take control of and to manage their own healthcare. The homes medication systems also require improvements. Evidence: At the time of our visit, none of the people who used the service required support with attending to their personal care. As part of this inspection, we reviews service users care plans, including information in relation to their medical appointments and how the home was supporting them to meet their healthcare needs. Each person living in the home was registered with a General Practitioner in a local area. We were informed that the people who use the service sometimes attend their healthcare appointments without any support from the care staff. This meant that staff were not always fully aware of what decisions have been made by the healthcare practitioners in relation to the persons health, including changes for the persons medication. During the case-tracking exercise, we found that that one of the service Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: users told staff that her medication had been stopped. This was recorded by staff working in the home on the medication administration sheet, however there was no written written confirmation in place from the doctor to state that the persons medication has been amended/stopped. There was also no written record of the appointment attended by the service user. Whilst we acknowledge that people who use the service should be encouraged to access healthcare resources independently where appropriate, adequate systems should be in place between the home and the healthcare professionals for conveying any important information, such as outcomes from medical appointments attended by the people who use the service independently. During our audit of the homes medication systems, we found several shortcomings. These included: - Medication administration contained gaps where no records has been made by staff to indicate as to whether the medication has been administered to the service users, - During our audit we found that 37 tablets of Co-Dydramol 10/500mg that were prescribed to one of the service users were unaccounted for. This requires improvement. Our concerns were brought to the attention of the Operations Manager, who started to review the homes medication systems with an immediate effect. We were also informed that the home was due to receive a visit from the Boots pharmacy, so that a dosage monitoring system could be introduced and implemented in the home. Care Homes for Adults (18-65 years) Page 16 of 27 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. Appropriate complaints systems were in place. People who use the service are protected from abuse and neglect. Evidence: There have been no complaints made to the home since the last inspection. The home had appropriate complaints policy in place. Staff who spoke with us said that they would support people who use the service to facilitate their complaints. We received one complaint about the home and this was in relation to the recent flood in the home. This matter was passed to the London Borough of Hackney Social Services Team, who visited the home and were satisfied that this matter was appropriately dealt with. During our visit to the home we were provided with a written confirmation from the electrician that the home was deemed as safe for the service users and staff to use. We reviewed the homes accident/incident folder and we were satisfied that the appropriate action is taken following each incident to minimise any risk for incidents to reoccur. We were informed that all staff working in the home were due to receive adult protection training the following day and that it would be provided by the London Borough of Hackney. Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: At the time of this inspection all of the people who used the service managed their finances independently. Care Homes for Adults (18-65 years) Page 18 of 27 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 benefit from a homely environment. Evidence: The home is located in a residential part of Stoke Newington. As it has been registered within the last 6 months, it is well decorated and provides a homely environment to the people who use the service. We spoke with two of the service users, both of whom stated that they were happy with their rooms and communal areas. All of the bedrooms were en-suite. One of the rooms was not-operational at the time of this visit due to the flooding caused by one of the service users, we were satisfied however that remedial and decorative work was being carried out. The premises were clean and hygienic. Appropriate laundry facilities were in place. Care Homes for Adults (18-65 years) Page 19 of 27 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. Appropriate staffing levels were in place. People who use the service benefit from a staff team that is committed to providing good quality outcomes. Evidence: As part of this inspection we viewed the staff duty rosters. These showed that appropriate staffing levels were in place in the home at all times. Due to the complex needs of one of the service users, there are three staff on duty between 9 am and 5pm and two members of staff on duty at other times. There staff team consisted of the home manager, deputy manager and three permanent staff. We were informed that there were three care staff vacancies in the home and that the organisation was in the process of recruiting more permanent staff and that where necessary shifts were covered by bank staff. We spoke with 2 care staff, both of whom confirmed that they ave received an induction and there were receiving training on the regular basis. Staff are encouraged and supported to undertake an NVQ qualification. We checked a random selection of staff personnel files, which showed that appropriate recruitment checks were being carried out. Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: Staff working in the home appeared to be aware of the assessed needs of the people who used the service. Care Homes for Adults (18-65 years) Page 21 of 27 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. Some improvements are required to the way the home is managed to ensure that the welfare and safety of the people who use the service and staff working in the home are maintained at all times. Evidence: At the time of this inspection there was no registered manager in place. There was an acting home manager and we were told that there organisation was in the process of applying for the home manager to become formally registered with the CQC as the registered manager. Regular visits from the registered provider were taking place on a monthly basis and reports from these were available for inspection. As the home has been operational for less than 6 months and some of the service users have been in the home for a few weeks, the home has not been able to distribute service users questionnaires. As part of the visit we checked the homes health and safety folder. The majority health and safety checks were being carried out, with the exception of testing fire Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: alarms systems, which have not been tested for several weeks. This requires improvement. The home was appropriately insured for its stated purpose. Care Homes for Adults (18-65 years) Page 23 of 27 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 24 of 27 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 6 15 The registered person must 05/01/2010 ensure that unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service users plan) as to how the service users needs in respect of his health and welfare are to be met. To promote the health and welfare of the people who use the service. 2 17 17 The registered person must 05/01/2010 ensure that records of the food provided for service users is sufficient in detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and Care Homes for Adults (18-65 years) Page 25 of 27 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 of any special diets prepared for individual service users. To promote the welfare of the people who use the service. 3 20 13 The registered person must ensure that appropriate arrangements are in place for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. To promote the health and welfare of the service users. 4 42 23 The registered person must ensure that fire alarm is tested on a weekly basis. To ensure the health and safety of the people who use the service and of the staff working in the home. 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 05/01/2010 05/01/2010 1 19 Appropriate systems should be put in place for monitoring service users healthcare appointments when attended by the service users independently. This includes effective communication in respect of any changes to the service users medication regimes. Care Homes for Adults (18-65 years) Page 26 of 27 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. 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