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Inspection on 08/12/08 for Huddleston Close (34-35)

Also see our care home review for Huddleston Close (34-35) for more information

This is the latest available inspection report for this service, carried out on 8th December 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

We found that there had been positive improvements since the last inspection, which has resulted in the service being now assessed as good. We observed that there was a noticeable sense of staff having a clear understanding of the very individual and often complex needs of each resident, and how to respond to these unique needs. Residents were now being offered a wider scope of external and internally provided activities, for example, art therapy and individualised transport. We were pleased to note the enthusiasm and commitment of the staff that we met during this inspection,and to observe their good and respectful interactions with the residents.

What has improved since the last inspection?

Eight requirements were issued in the previous inspection report. However, at the time of the last inspection, the service was registered jointly with the three bedroomed house at no.36, hence some of the requirements might not have been specifically applicable to 34-35 Huddleston Close. All of the requirements have been deleted, with notable improvements in regard to the safety of the environment, such as the service demonstrating that the fusebox is now covered and the electrical installations check was up-to-date and available at the premises. The care plans now pursued a more detailed assessment in regard to individual religious needs, and a more homely menu was being offered with more meals cooked from kitchen ingredients.

What the care home could do better:

One recommendation has been issued in this report, which is for the service to record that a person does not have a known allergy on their medication administration chart (if this statement pertains to their circumstances). There is also a need for staff to be more vigilant regarding the safe storage of prescribed medications that do not need to be kept locked up but should not be easily accessible, and the safe storage of cleaning fluids. We have not issued requirements on this occasion, taking into account that the service otherwise demonstrated safe practices in these areas, but these issues will be checked upon at the next inspection.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Huddleston Close (34-35) 34-35 Huddleston Close Parmiter Street Bethnal Green London E2 9NR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Greaves     Date: 1 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 22 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 22 Information about the care home Name of care home: Address: Huddleston Close (34-35) 34-35 Huddleston Close Parmiter Street Bethnal Green London E2 9NR 02089833515 02089833484 h3m055sewell@mencap.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mencap care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 4 34-35 Huddleston Close is a care home registered to provide care, support and accommodation for up to five adults with a learning disability. The service is managed by MENCAP and the premises are leased from the Bethnal Green and Victoria Housing Association. The premises are two ordinary domestic properties located within a short walking distance of the shops, cafes and other amenities at Bethnal Green High Street. In addition to the underground and overground stations, frequent buses operate to East London districts and central London. The home contains a house that is occupied by three residents, and a flat for one resident. Each property has its own front door and there is a rear garden. Care Homes for Adults (18-65 years) Page 4 of 22 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: This unannounced key inspection was conducted over two days. We gathered information from speaking to and observing residents, the registered manager and staff. Evidence was also gathered through touring the premises and looking at documents related to environments safety, inspecting the management of medication and reading care plans. We also looked at staff files for information regarding staff training, recruitment and supervision. The service completed an Annual Quality Assurance Assessment, which is a detailed self-audit document. 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 set out 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 –03000 616161. 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. Prospective residents benefitted from clear systems to promote choice of care home, and a well supported admission. Evidence: We read the services Statement of Purpose and the Service Users Guide. It was noted that the Statement of Purpose was well presented, and the Service User Guide needed a few minor ammendments. The service has not admitted any new residents since the last inspection. Previous admissions to the care home have been carefully arranged to ensure that full health and social care assessments have been undertaken, and that prospective residents and their supporters (family, friends and/or advocates) received opportunities to spend time at the care home prior to making any decisions about moving in. Residents were provided with pictorial documents that welcomed them to their home and explained their rights as tennants. 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. Residents are assured that staff are committed to identifying and supporting individual needs and choices. Evidence: We read two randomly selected care plans during this inspection, inclusive of the risk assessments. It was noted that the care plans were clearly written, individualised and regularly reviewed. Both the care plans and the risk assessments indicated that staff possessed a thorough and supportive understanding of the individual needs of the residents; this was also demonstrated through discussions with the registered manager regarding the planned personal, health and social care for the two people whos care plans were not read on this occasion. We spoke to a resident that was able to discuss the decision-making that occured in their daily life, such as activities, shopping, holiday plans and home decorations. Through discussions with staff, observations and the reading of care plans and reviews, we were able assess how the care home supported residents that were not Care Homes for Adults (18-65 years) Page 9 of 22 Evidence: able to verbally explain their choices. For example, we were previously aware that one of the residents enjoyed pampering sessions such as relaxing baths, foot spas and aromatherapy massage; these activities continued to form part of the day-to-day care plan. 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. Residents were offered a varied programme of daily activities, that reflected individual wishes and needs. Evidence: We found that all of the residents were supported to undertake meaningful activities at home and in the community. This information was gathered through reading care plans, speaking to and observing residents, and discussions with the registered manager. Activities since the last inspection included a short stay at a well known health spa, a day trip to France, coastal holidays to destinations in Sussex, art therapy, drives and walks in the park, bingo and aroma therapy. We observed that residents went out during the course of the inspection for local shopping and cafe lunches. We noted that the registered manager and staff worked with residents in a clearly Care Homes for Adults (18-65 years) Page 11 of 22 Evidence: individualised way; for example, a member of staff supporting a resident with an art therapy (card-making) project explained why a particular theme of work had been chosen with the resident; a discussion with the resident confirmed that the topic for card-making was an important way to express their thoughts. It was noted in the previous inspection report that the care plans should more clearly assess whether people had religious/spiritual needs; this requirement had been met. The last inspection report commented that the service should focus upon providing more meal that were cooked from scratch, rather than providing ready meals. We checked the menu plans and looked at the contents for the store cupboards, refrigerator and freezer. We found that this suggestion had been acted upon, and residents were being offered a healthier and more balanced diet. We have advised that the menu plan needs to accurately reflect the food provided; for example, staff stated that a salad was provided with pizza, but this was not documented. It was acknowledged that food cupboards and the refrigerator needed to be kept locked but we observed that residents were offered snacks, such as savoury or sweet biscuits with beverages. 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. Residents are assured that their personal and health care needs will be comprehensively addressed; some minor improvements are needed to the medication practices. Evidence: We found that the care plans demonstrated that the service carefully identified the individualised personal care needs of each resident, and developed plans to meet these needs. We looked at documentation that clearly stated whether a person preferred baths or showers, and what kind of assistance was needed to maintain their chosen hair style. The health care plans were also detailed. Via discussion with the registered manager, we were informed of the current health needs of each resident and how the service was addressing these needs; for example, whether residents were attending appointments with health care professionals such as practice nurses, hospital consultants and phychologists (this was in addition to statutory or annual appointments). We were satisfied that the service had good systems for supporting residents with their health needs, including escorting people to appointments and Care Homes for Adults (18-65 years) Page 13 of 22 Evidence: documenting the outcomes, and further liaison with health care profesionals as necessary. We looked at the actions that had been taken in order to support a resident that had been diagnosed with a healthcare condition since the last inspection. The documentation indicated that the service was satisfactorily addressing this health care need, in accordance to the guidelines established via consultation with the residents doctor. A requirement was issued in the last inspection report for the service to ensure that any alterations to medication charts were clearly initialled by the person responsible. We checked the management of medication during this visit and made the following observations: 1) An item (fybogel) found at the care home was stated to have been acquired through prescription but there was no pharmacy label on the product. This should have been observed and investigated. 2) A prescribed topical cream (sudocrem) was found in a prominent place in an unlocked bedroom. This item should have been kept within a more secure place in the bedroom; for example, a drawer or lockable facility. 3) We observed that there was a blank space on the medication administration charts, in the allergies section. It is noted that staff will record a known allergy, by writing it into the blank space in block capitals and using a red pen. We would advise that the absence of any comment in this space could occur as the result of a person forgetting to record an allergy, hence it is advised that a statement such as No Known Allergies is recorded. The registered manager conducted regular audits of the medication administration charts and checks of medication balances. Care Homes for Adults (18-65 years) Page 14 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. The service provided clear measures for listening to and protecting residents. Evidence: We looked at the services complaints procedure; there was a pictorial guide for residents and a written version. The complaints book identified that there had not been any complaints since the last inspection. The service produced its own Adult Protection policy and procedures, and the guidance issued by the local social services. The staff training records demonstrated that staff attended Adult Protection training. The requirement for staff to be advised of organisations that they can whistle-blow to has been deleted, as staff were aware that they could approach Tower Hamlets Social Services and the Commission. Procedures were in place for specific circumstances, such as residents that make frequent allegations. Care Homes for Adults (18-65 years) Page 15 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. Residents are provided with a homely and comfortable home. Evidence: We found that there had been changes to the environment since the last inspection visit. The service had built an office in the rear garden so that the former office could be converted into a sensory room. It was noted that although the external office was a timber building, it was kept warm and welcoming (this was important as some of the residents chose to spend time in the office speaking to the registered manager. We did not observe the sensory room being used at the time of the inspection but one of the care plans indicated that it was part of the daily life of one of the residents. There had been a programme of decorating and repairs undertaken since the last inspection. A requirement in the previous inspection report to place a cover over an open styled fuse box had been met. We found that the premises were satisfactorily maintained, clean and free from any offensive odours. Care Homes for Adults (18-65 years) Page 16 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. Residents are assured that they will be supported by staff that have been suitably recruited, trained and supervised. Evidence: We read to staff files in order to assess the services recruitment, staff training and supervision practices. It was noted that staff received approriate mandatory (such as medication, Adult Protection, health and safety, and fire awareness) as well as training that was focused on the individual needs of the residents (such as diabetes care and intensive interactions training). The recruitment procedures demonstrated full compliance with the stipulations of the Care Standards Act. The service evidenced an active approach to supporting staff to undertake National Vocational Qualifications in Care. We observed that there were several new staff since the last inspection; however, staff brought relevant experience and knowledge from other settings. A requirement was issued in the previous inspection report regarding frequency of supervision, which has now been deleted. 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. Residents have benefiited from positive developments in the daily management of the service. Evidence: We were informed by the registered manager that she was leaving and a new manager had been appointed. It is our view that the registered manager had not only addressed issues from the last inspection report, but had generated a number of positive changes. There was a recognisable improvement in areas such as consultation and interaction with the residents, and working with well considered individualised approaches. We noted that the service was supporting a resident that wished to move to a different care home; staff were escorting the resident to visit other places and it was understood why a change of environment could offer positive benefits to meet this persons individualised needs. There was also good work being undertaken to meet the needs of people with challenging behaviour. The service demonstrated systems to audit the quality of its care, such as monthly Care Homes for Adults (18-65 years) Page 18 of 22 Evidence: unannounced monitoring visits by the area manager. These reports were detailed and identified areas for improvement. The registered manager also undertook her own checks of care plans, medication charts, health and safety records and other relevant documents. We found that there was better evidence at this inspection of how the service responded to the wishes of the residents; for example, we observed how a resident without verbal communication was supported to get up at the time that they wished and to choose the items they wanted for a late breakfast. We looked at the financial records for two of the residents; there were no concerns with the care homes arrangements for banking, and maintaining receipts. The following health and safety records were checked and found to be satisfactory; water temperatures, electrical appliances testing, landlords gas safety certificate, electrical installations inspection by a competent person, emergency lighting testing, weekly fire alarms testing, professional maintenance of the fire equipment and piper alarm testing. It was noted that an anti-bacterial fluid had been left in an open cupboard; staff must be more vigilant in ensuring that such items are kept locked up. 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 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 20 The service should record on the medication administration record if a resident does not have an allergy. Care Homes for Adults (18-65 years) Page 21 of 22 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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