Inspection on 09/09/05 for Cherry Tree House

This inspection was carried out on 9th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

Cherry Tree House 23/04/07

Cherry Tree House 05/01/06

Cherry Tree House 16/12/04

Cherry Tree House 16/04/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Ashwood House (Leyton)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 49 Hainault Road Romford Essex RM5 3AA Lead Inspector Roger Farrell Unannounced 9 September 2005 - 14:00 hrs 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 49 Hainault Road Address 49 Hainault Road, Romford, Essex, RM5 3AA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01708 735387 01708 735387 Outlook Care Rita Evelyn Hall CRH - Care Home 5 Category(ies) of MD - Mental Disorder - 5 registration, with number of places 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 16 December 2004 Brief Description of the Service: 49 Hainault Road is a registered care home that provides accommodation and support for up to five people. Opened in 1991, it is run by Outlook Care Limited, a ‘not for profit’ organisation that operate a range of accommodation and support services for vulnerable adults in North East London and Essex. Residents who live at this care home have experienced mental health difficulties in the past. Four of the residents are over sixty. Staff are on hand to help them with their day-to-day living needs. A fifth resident joined this established household group in May, one person having moved out last year. The original funding was a block contract operated by Barking, Havering and Brentwood Health Care Trust as part of the closure of old style long-stay wards. Outlook Care took over the running of the home from the Trust six years ago.The house is a detached property on a corner plot just beside the busy A12 duel carriageway. The building is owned and maintained by North East Thames Housing Trust. 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Thursday 8 September 2005, between 11.40am and 1.45pm. Rita Hall, the registered manager was at the home. She was helpful and efficient in answering the inspector’s questions and showing the records he asked to see. Two residents were at home, one of whom was helping with household chores. The manager provided a description of the move-in arrangements for the most recent resident to move in and how he had been helped make the transition from his family home. She also gave an update on how the team were monitoring changing needs to do with the established residents growing older. The new resident, who had moved in on 27 May 2005, was away on a holiday break accompanied by the deputy. The inspector checked the main communal parts of the building, and looked at a range of documentation. This included, service users files, and health and safety records and certificates. He is appreciative of the welcome he receives at this home, and the efficient way the manager deals with his enquiries. What the service does well: The home is an end of terrace property in a residential area, close to local shops and amenities, and has good transport links. The house is well maintained and decorated, with many homely touches. East Thames Housing Trust own the house, and are responsible for building maintenance. The manager said she is satisfied with the level of support provided by the landlords. The top ‘commendable’ rating is again awarded for the high housekeeping standards. This is a well-established household group. Two of the original residents moved here in 1991 when the home opened. Another joined the group in 1996, and the fourth person arrived in 1999. A more recent resident moved out last year, and from May of this year a new person has taken the fifth place. The documentation covering his assessment and move-in arrangements were thorough. The way in which this service user’s file has been set-up means that the ‘commendable’ score can again be entered for the important Standard 6 covering service users’ files. This level of planning shows a continuation of the team’s ability to target help where needed - through understanding individual’s abilities and offering assistance only where this is essential. One comment from a staff member summed up this approach - “The overall quality of care provided to residents is excellent. It allows them to maintain an independent lifestyle but with lots of care and encouragement on hand when needed.” One relative wrote –“I am very happy with the home. [My relative] has been well looked after. Lovely staff, very caring. I am happy with the home.” 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 and 5. Good information is available about this home. Outlook Care have a good set of guidelines and assessment forms covering move-ins. These were used during the introduction of the new resident, showing a thorough approach to assessment and planning. EVIDENCE: There is a detailed and attractively presented ‘statement of purpose’. This is in a format that is understandable to service users, including the using pictures. Of an equally high standard is the ‘service users’ guide’, that also makes good use of pictures. They cover all areas asked for under these standards, including a section on service users’ views. Copies of these and other main documents are available in the hall, along with a pictorial version of the complaints’ procedure. Both the service users’ notice board and the one for staff have on display an appropriate range of up-to-date information. The manager gave a description of the planning, introduction and move in of the new resident, including consideration of the age difference of this person compared to the four established residents. The inspector looked at the paperwork covering the move in. This showed that the organisation’s policy, ‘Referral Procedure – Residential Care’, was followed. The service user’s file contained the required range of information. This included – a good referral report from the social worker; the organisation’s referral form; the manager’s detailed assessment and checklist; planning and progress reports covering the introductory visits and stays, and the early period following moving in. The 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 9 standard format ‘health file’ and ‘pcp file’ had been set up, and this had a copy of the recent CPA review. Good links had been established with staff at the resource centre the resident attends during the week. Good attention to detail evident in this documentation, including picking up on an error in the main social work report, shows a very high standard of practice and manager coordination. Residents’ files have signed copies of the contracts issued by Havering Housing Consortium to the original tenants; the more recent version of the Licensee Agreement provided by East Thames Housing Association; and letters from Outlook Care on rent adjustments. There is also a pictorial licencee agreement. 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 and 10. Outlook Cares’ service user file format was mainly developed to cover services for people with a learning difficulty. Previous reports have praised the way that this home has developed a care plan and monitoring system appropriate to the needs of people who have had mental health needs. This system continues to be used effectively, including monitoring needs such as decreasing mobility. EVIDENCE: The manager and team continue to operate a very high standard of care planning and monitoring files. In addition to Outlook Cares’ main ‘pcp’ format, there are well-arranged ‘health care files’. The ‘pcp files’ continue to be used as the main method of including residents in making choices. The new resident had already completed a number of sections in his file. Additionally, the ‘health files’ have a more detailed practice planning system with relevant observations and monitoring suited to this service user group, including needs associated with getting older. They are efficiently arranged into modules, are kept up-todate, and entries are well expressed. That the new resident’s file had such a comprehensive range of worthwhile information, including liaison with others, means that the top ‘commendable’ score can again be entered for Standard 6. 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16 and 17. Residents continue to be supported to be involved in activities and social networks appropriate to their age, abilities and preferences. EVIDENCE: Some residents have been involved in supported employment in the past, but a number now consider themselves retired. One resident continues to do a part-time gardening job at another of the organisation’s homes, as was the case on the day of this visit. There is a good tradition of residents helping with household tasks. Residents do their own laundry with some minimal assistance. They help with meal preparation and prepare their own snacks. All use keys to the front door and their bedrooms. Each person’s file has details of regular social and leisure activities. As appropriate, options to be involved in groups for older persons have been offered and arranged. Discussions have taken place with staff at the most recent resident’s regular day centre about him spending more time at home being helped with day-to-day self-help skills. The group summer holiday remains popular, the older residents choosing to return to a favoured ‘no children’ holiday camp again this year. All comments made about the standard meals of meals are favourable. 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20. This home is able to show it supports individual needs in an appropriate manner. This continues to be delivered in a way that maintains personal independence. The systems for monitoring physical health remains very good. EVIDENCE: At the last inspection the manager gave an overview of each person’s health care needs and medical support systems. At this visit she gave an update on the person with the highest physical dependency needs, including the introduction of walking aides following assessments by an occupational therapist. As appropriate, psychiatric consultations and medication reviews are suitably documented. A description of the support needed by the most recent resident showed a considered approach to assisting with motivation. He has remained with his established GP. Ways of encouraging contact with a dentist were being explored. The ‘health files’ are still being maintained to a high standard, showing good health care monitoring and a sensitive approach to supporting residents with their personal care needs. At the last visit one relative commented – “My [relative’s] mental and physical well being has improved no end. The house and carers are what all homes should be like. The staff are very good at their jobs. “ The home uses the Boots’ monitored dose system. Medication is kept in a locked bureau in the dining area. Residents are encouraged to take their own medication under supervision, though there is a need for two staff to be 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 13 involved in giving one person’s their liquid medication. Residents have their own signing sheets, as well as staff signing the mar charts. Following one error, the medication cassettes are now separated in boxes for each person. There is good medication information available. All staff have recently done a more detailed medication course. 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. The necessary range of information on complaints and concerns are readily available. The manager and staff are fully aware of the steps that must be covered if they suspect or are made aware of a problem affecting a service user’s wellbeing. EVIDENCE: The complaints log has no entries for the past five years from residents or their representatives. The one entry made this year was a concern from a neighbour about a tree, a matter that was being dealt with by the landlords. The home has a copy of Outlook Care’s complaint pack. This includes identifying a complaint’s contact person; a complaints flow chart; a large print version of ‘How to Make a Complaint’; and a complaint contact card. There was also a laminated picture complaints guide in the hall, along with a supply of the complaint forms. Information on the Commission is included. One relative wrote – “I’ve only ever had one complaint and that was years ago, relating to only one member of staff. The staff always tell me about inspections. The care and commitment of staff is very good.” Copies of ‘No Secrets’, and the organisation’s relevant policies on adult protection are available, including on whistle-blowing, and Havering Council’s local guidelines on adult protection. There was also a copy of the General Social Care Council’s Code of Practice, extracts of which the manager has on display in the office. Staff have confirmed that they had been briefed on the role of the GSCC, and all staff have signed to say they have been issued with a copy of the Code of Practice. In his last meeting with staff they gave satisfactory answers on protection issues. Details of how to contact advocacy services were on display. 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27, 28, 29 and 30. This house is well suited to the needs of residents, including the person who has now developed some problems moving around. Residents and staff take pride in maintaining the house in an excellent standard, and one residents efforts means that this also includes the garden. EVIDENCE: 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 16 The house is on a corner plot adjacent to a dual carriageway, but this does not seem to adversely affect the residents’ use of the garden, which is well screened and delightfully maintained by one of the residents. The main shared area of the house is the combined ‘L-shaped’ lounge and diner. This is well decorated, has good home entertainment equipment, and is comfortably furnished. All residents have their own bedrooms that reflect their individual tastes. The house is well served for bathrooms, with two upstairs, and a spacious showerroom on the ground floor with a walk-in shower. There is a separate toilet on the ground floor. All were found to be clean, with fresh towels and soap, and have suitable locks. One resident has now started using a walking frame, an occupational therapist having carried out an assessment at the house. This person’s bedroom is on the ground floor. She uses the walk-in shower, which has a seat. Other than a grab and a shower seat, no other environmental adaptations are currently needed. There is an assistance call system that is turned on for one resident, but has not been used. An excellent standard of cleanliness was again found in all parts of the home. In addition to residents helping with some household tasks, there is also a part-time cleaner. An independent infection control and hygiene assessment carried out last year awarded a 100 score. In recognition of this, and the consistently high standard found at successive visits, the household standard is again rated at the ‘commendable’ level. 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35 and 36. This home has a stable, experiences and well-qualified staff team. EVIDENCE: The normal pattern of cover is two people on both the early and late shifts, excluding the manager. Night cover is one person on sleep-in duty. Staff on duty at this visit corresponded with the rota details. The manager says this level of cover is adequate to meet the needs of residents. The staff team is very stable, with most support workers having over five years experience in this setting. There have been no changes in the team for over a year, the current deputy being the last person to join in February 2004. All the team have NVQ at Level 3. Outlook Care cover gaps by using staff from their other homes doing monitored extra hours through agency bookings. Staff files have copies of all the required documents, including showing that the required range of checks have been carried out, there being a separate file of CRB certificates. There is a regular programme of individual supervision, with a forward planning programme on display. The manager discussed with the inspector the issue of checks on volunteers who visit the home. 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 41, 42 and 43. The inspector again found this to be a very well managed service. The organisation have a systematic approach to operating their services by having up-to-date policies, procedures and accountability checks. This home’s manager operates well within this structure, and again was found to be competent and methodical in responding to the information asked for at this inspection. EVIDENCE: The manager has completed the ‘registered managers award’, having already gained NVQ in Care at Level 4. All documentation requested at this inspection was presented in an efficient manner. The organisation’s standardised policy and procedures files are available, listing when each was last revised. 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 19 The company operate a quality assurance scheme – called the ’Continuous Improvement Programme’ (CIP). The manager is familiar with the guidance booklet that steers this imitative. All staff have been given a copy; have attended briefings; and “signed up” to the scheme. This has been tied in with the company’s intranet computer system, including ensuring staff are familiar with all current policies, guidelines, and practice forms. Other quality assurance schemes that can be evidenced include ‘ISO9002’; ‘Investors in People’; ‘Positive About Disabled People’; and reports to confirm regular monthly service audits in compliance with Regulation 26 of the “Care Standards Act 2000”. The evidence is sufficient to confirm the company’s commitment to quality assurance and control systems required under this heading. The inspector asked to see a range of documentation and certificates covering health and safety. This included fire safety arrangements; electrical, gas and water safety checks; EHO inspections; and insurance cover. The ordered and efficient manner in which the manager again presented evidence under this heading justifies the award of the highest ‘commendable’ rating. The organisation’s summary accounts are published as part of their annual report, a copy of which is available at the home. More detailed accounts are available on request from the organisation. 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x 3 3 3 4 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 49 Hainault Road Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 4 G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement No requirements made at this visit. Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations 49 Hainault Road G55_G05 S27854 49 Hainault Road V248188 080905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford, Essex IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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