Inspection on 02/12/05 for Churchill House

This inspection was carried out on 2nd December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Churchill House 01/09/06

Churchill House 26/10/05

Churchill House 18/08/04

Churchill House 27/04/04

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]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Churchill House 48-50 Mawney Road Romford Essex RM7 7HT Lead Inspector Joanna Moore Unannounced Inspection 2nd December 2005 11:00 Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 1 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 Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 2 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 Stationery 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. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Churchill House Address 48-50 Mawney Road Romford Essex RM7 7HT 01708 732558 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Kulwant Singh Mann Mr Ramjit Nunkoo Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include 4 named people over 65 years of age Date of last inspection 26th October 2005 Brief Description of the Service: Churchill House is a care home providing personal care and accommodation for twelve service users who are younger adults, all of whom have a mental illness. The home provides a service to both men and women. It is a privately owned and managed facility and accepts service users on the basis that they meet the home’s criteria for admission. The home is located in a residential area of Romford near to Romford High Street shops, local transport, banks, hospitals, post office, hospitals, parks, leisure centres, a market and cinema. Opened in 1996, Churchill House consists of a three-storey building that is divided into two units and annexed via an activity room. There is a large garden with a shared patio area and swimming pool for the enjoyment of service users. All bedrooms are single, one of which in each unit is sited on with the rest on the second and third floors. Some bedrooms facilities. There is a lounge in each unit on the ground floor users relax, smoke and watch television or engage in activities the ground floor contain en-suite in which service of their choice. Care and support is provided within a supportive framework with service users having access to individual key-workers, who are on hand to assist them in achieving their goals. There is multi-disciplinary input from the various community resources that compliments the provision of the specialist needs for service users. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the annual inspection program. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that the care plan is constantly updated and changed to reflect recommendations made through the Cpa reviews or status in mental health and impendence skills. The home must ensure that all relevant and essential information is detailed in the care plan. The home must ensure that new staff are only put in post following a pova first check has been carried out. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 6 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. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 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 the following standard(s): 2, Service user needs are assessed prior to coming into the home to ensure that their needs can be met. EVIDENCE: One service users file was checked. An assessment of need had been undertaken by a community psychiatric nurse before the service user’s admission to the home. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 9 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 the following standard(s): 6,7,8,9 The home did not in all cases ensure that assessed changing needs were included in the care plan. There was serious concern about the quality of one service users care plan, with significant information missing, this could put service users at risk. Service users were encouraged to take risks and be as independent as they were able. EVIDENCE: One service user appears to have a good level of independence, which is a positive experience for them. For example, they go out unaccompanied, spends time with family members has regular contact with their child and has regular telephone contact with their family. This service user is subject to the conditions of a licence which means that there are certain restrictions in place. However, there was no reference in the care plan as to how the home was managing and reviewing the situation. The home is required to be clear regarding any restrictions in place and the care plan must clearly document this. In addition, decisions from the Care Planning Approach meetings(CPA programme) were not routinely incorporated into the care plan and the Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 10 manager was unaware what level of CPA the service user was receiving. Eventually it was confirmed after an extensive search. This is poor practice. Details of CPA level and recommendations from CPA meetings must be incorporated into the care plan. In general, there was some evidence that parts of the care plan were updated and reviewing quarterly. There was no risk assessment on file for this service user and this presents a risk to the service user, residents and staff. Records supported that the home keeps service user care under review, one service users CPA recorded that the home had some concerns and that it was not felt that in the long term the home remained a suitable placement due to increasing need and the aging process. CPA reviews had been held as required but it was not easy to locate some of the information regarding the provision of health support to service users. It is recommended that the home review the way the files are made up to enable easy reference to important information. The second service users care plan identified clearly the issue relating to their care and how to address these. Records were held which evidenced that their care had been regularly reviewed and that issues of concern were raised with the Gp and consultant psychiatrist. Specific cultural needs were met for service users via the provision of a ethnically mixed staff team and variety of languages spoken which reflected diversity within the resident group. The home had made arrangements to assist one service user attend the temple but this had not been able to continue due to issues of the service users behaviour. Celebrations appropriate to the faith of service users such as Divali are celebrated within the home. The home is able to respond to dietary requests of service users such as the provision of rice and peas and chapatti. One service user has links with the local Asian association. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 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 the following standard(s): 11,12,13,14,15,16 &17 Service users were encouraged to take part in local activities and make use of community facilities. EVIDENCE: One service user informed the inspector that they occasionally help out cooking and choosing the menu and also goes shopping with the manager once a week. He stated that on Friday nights the residents usually choose one of his films, and they all watch a film together, which they enjoy. Previously this service user attended college, but this has stopped for the time being at the service users request. They felt that they had a good amount of contact with family and has an appropriate amount of opportunity to go and do things independently. Three service users have sheltered employment/ work project placements three days per week. One service user attends a computer class once a week and another a maths class once a week. Currently there is an art group taking place once at week, and service users have the choice as to whether to participate or not. Service users had enjoyed an annual holiday in addition to some trips out organised by the home, which included a visit to the circus, the natural history Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 12 museum, the cinema, Southend, Clacton, Halloween party, bonfire night, Christmas party and a trip out for a pub meal. A barbeque had been held in the summer. Service users visit their families as often as both the family and service user agree and where appropriate staff support for these visits is provided. The homes service user questionnaires said that the food was of a good standard and that they liked it. When talking to service users they confirmed this and said that a variety of food available and that issues regarding food were discussed at service user meetings. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 13 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 the following standard(s): 18,19 &20 There was no evidence that specific health needs were incorporated into the care plan, which directs the care staff should be providing. EVIDENCE: A service user had specific health and dietary needs (high cholesterol) and again this had not been incorporated into the care plan. In addition, there was no specific diet being offered to support their dietary needs. There was some concern regarding the health appointments for one service user who has a level of independence to attend appointments unaccompanied. However, there was no follow up as to whether some of these appointments were kept, nor the outcome. There was evidence that the service user had been reminded to visit the dentist on a regular basis. Risk assessments were in place for one service user in relation to flooding, fire, burns, decline in mental health, violence and urinating in a public place. One service user is responsible for administering his own medication, and it was stored appropriately in a locked drawer in the service users’ bedroom. The service user stated that they felt capable of administering their own medication and keeps the key for the drawer with him at all times. There was a self medication assessment on file, however this information conflicted with the Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 14 care plan which stated that staff administered this service users medication. There had been changes to this service users’ medication and again this had not been incorporated into the care plan. There was, however, a letter from the Psychiatrist on file, which outlined the current plan. This is putting this service user at risk. The service user stated that if he felt unwell he would talk to people in his professional network and the staff at Churchill House. The registered person is required to ensure that accurate and current medical information is held clearly. Medications were stored appropriately and appropriate systems were in place to manage medication on a daily basis. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 15 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 the following standard(s): 22 Service users felt able to raise any concerns with staff and the manager of the home and were confident that their views would be listened to. The home however needs to be clear as to what constitutes a complaint in order to ensure an appropriate response. EVIDENCE: An incident between 2 service users has been recorded appropriately in the complaints log book. However, during this inspection of the complaints log book it became apparent that it was being used inappropriately. For example, staff issues/complaints/grievances were being inserted into the logbook. The registered person is required to ensure that issues of concern are appropriately recorded in the complaints book and that other appropriate recording strategies are used to support inter service user issues and staff grievances. One service user stated that he felt able to speak to the people in his professional network if he had any concerns. He stated that he was happy living at Churchill House and is also able to speak to staff members if he has any concerns. He stated that there is one service user who can be troublesome, however that did not affect him as any confrontation is not aimed at him. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 16 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 the following standard(s): 24,25,26,27,28,29,30 Service users benefited from clean and homely building which met their needs. EVIDENCE: The building was adequately maintained, homely and fit for the needs of service users. Service users confirmed that they were happy with the décor. The home is situated close to Romford town centre and it’s therefore quite handy for service users to go into Romford to shop, use the various leisure facilities or access transport into Central London. Each resident has his or her own room. The building is separated into two distinctly separate units which each have their own lounge, kitchen, dining room, bathroom and toilets. The home shares one main central office and activity room and the garden is partially separated with a central patio area, which is a common meeting point of service users in the summer months. One service users bedroom was observed and was seen to be clean and tidy, however the cover on the soft chair in the bedroom appeared dirty and needs replacing. The service user had a lot of his own personal things in his bedroom, for example photographs, a TV, and DVD’s which made it appear comfortable and homely. The service user stated that he brought his own bed when he moved into Churchill house because he was not happy with the one provided. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 17 The home owner and manager say that the bed was not purchased by the service user and was indeed the original bed provided by the home. The service user said that they are responsible for keeping their bedroom tidy however once a month a worker will come and tidy the wardrobes. There is a lock on the service users’ door and he has a key, however, he stated that he did not feel that he needs to lock the door as he “trusts the other residents”. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 18 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 &35 Service users needs require staff to have appropriate training including NVQ 2. Service users are generally but not robustly protected by the home s recruitment procedures. Staff benefit from clear supervision systems. EVIDENCE: One service user stated that they get on well with the staff at Churchill House and that they go shopping once a week with the owner, which they enjoy. Three staff recruitment files were viewed to understand the home recruitment processes. All three files evidenced two written references taken up, a medical declaration completed and information held regarding their employment history. Two staff had a recorded induction. The third staff was just starting at the home on the day of inspection. No Evidence of identity was held for one staff and two staff files did not hold photographs. A new staff had been employed with a Crb check from another employer. The home is required to carry out a POVA first check for this person. The other two staff had valid CRB checks in place. The registered person is required to ensure that a POVA first check is taken up for all staff before commencing employment, that a current photograph is held and that evidence of identity is held. The Manager advised the inspector that six members of staff out of the thirteen had done their NVQ2. In order to meet the national minimum standards more staff need to be enrolled on the training program. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 19 On the file for both staff members were supervision notes and a programme of dates for supervision. Staff meetings were held monthly. Two staff were on duty in each unit and staff shortages were covered when necessary by existing staff. No staff under the age of 21 are employed nor are volunteers used. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 20 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 &42 Service users benefit from a well managed home with clear quality monitoring system in place. The health and safety of service users staff and visitors is protected. The standard of record keeping within the home must be improved to be clear accurate and include all relevant information. EVIDENCE: The registered manager has been at the home for approximately eighteen months. Mr Nunkoo is a registered mental nurse with management experience. Service user questionnaires have been developed and sent out to all the service users, the findings from these will the inspector was advised be incorporated into a report. Service user meetings were held monthly and at the time of the inspection the main topic was plans for Christmas. A request to have the lounges of number 48 was made and the owner is looking into this. Service users also said they would like more outings. An issue was raised in these meetings regarding how some people felt when eating their food as the table manners of some other Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 21 service users made them not want to share a table. It is recommended that this issue be further explored with the service users to gain resolution. Correcting fluid was used on an incident form, this allows records to be altered. The registered person is required to ensure that correcting fluid is not used and that any alterations are clearly crossed out initialled and rewritten. Records regarding incidents were observed to include statements such as c was violent and aggressive to me, statements made in service users daily notes or incident reports must be clear as to what actually happened and the view of what is violent and aggressive may vary from person to person. The safety of the building was monitored through daily health and safety checks and weekly fire checks. Fire drills had been held in line with current guidance. The home had a fire risk assessment and the fire prevention systems were periodically checked by an external contractor. Safety certificates were in place regarding the electrical wiring, portable appliances and gas. The environmental health officer had visited in December 2005 and reported that they were happy with the home arrangements. No first aider was on duty at the time of the inspection, the inspector was advised that no staff have first aid training. The registered person is required to ensure that all staff complete a certified first aid training course. Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 22 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 x 3 x x x Standard No 22 23 Score 2 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 3 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 x 2 2 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Churchill House Score 2 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x 2 3 x DS0000027836.V272215.R02.S.doc Version 5.0 Page 23 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. Standard 1 YA6 Regulation 15 Requirement The home is required to be clear any restrictions in place and the care plan must clearly document this. The registered person must ensure that all key needs are incorporated into service user plans including changing needs. The registered person is required to ensure that accurate and current medical information is held clearly. Details of CPA level and recommendations from CPA meetings must be incorporated into the care plan. Where a service user has identified health needs the registered person must ensure that these are met. The registered person must ensure that risk assessments are complete for service users who self medicate. The registered person must ensure that the soft chair in one service users bedroom is cleaned DS0000027836.V272215.R02.S.doc Timescale for action 26/02/06 2 YA6 15 (1) 26/02/06 3 YA18 12 26/02/06 4 YA6 12 26/02/06 5 YA19 12 (1) (a) 26/02/06 6 YA20 12 (1)(a)(b) 16 (2) (c) 26/02/06 7 YA26 14/02/06 Churchill House Version 5.0 Page 24 or replaced. 8 YA34 19 The registered person is required to ensure that evidence of identity and a current photograph is held for all staff. The registered person is required to ensure that a CRB/ pova first check is carried out prior to the employment of new staff. Correcting fluid is not to be used on any record. Statements made in service users daily notes or incident reports must be clear as to what actually happened The registered person is required to ensure that issues of concern are appropriately recorded in the complaints book and that other appropriate recording strategies are used to support inter service user issues and staff grievances. 14/02/06 9 YA41 17 01/02/06 10 YA22 22 26/02/06 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 2 Refer to Standard YA41 YA39 Good Practice Recommendations It is recommended that the home review the way the files are made up to enable easy reference to important information An issue was raised in these meetings regarding how some people felt when eating their food as the table manners of some other service users made them not want to share a table. It is recommended that this issue be further explored with the service users to gain resolution. It is recommended that more staff complete their NVQ level 2 training. 3 YA35 Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford 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. Extracts may not be used or reproduced without the express permission of CSCI Churchill House DS0000027836.V272215.R02.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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