Inspection on 11/05/06 for Earlham House

This inspection was carried out on 11th May 2006.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Earlham House 07/10/08

Earlham House 04/04/07

Earlham House 06/12/05

Earlham House 09/12/04

Earlham House 24/06/04

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 Earlham House 7 Earlham Grove London N22 5HJ Lead Inspector Mr Teferi Degeneh Key Unannounced Inspection 11th May 2006 09:30 Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 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 Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 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. Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Earlham House Address 7 Earlham Grove London N22 5HJ 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) 020 8881 3064 020 8881 3064 Dr Peter Theodore Clayton Mrs Bridie Clayton Mrs Bridie Clayton Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two specified service users who are over 65 years of age may remain accommodated in the home. The home must advise the registering authority at such times as either of the specified service users vacates the home. 6th December 2005 Date of last inspection Brief Description of the Service: Earlham House is a registered care home for seven adults with mental health needs. Two of the people currently living at the home are over 65 years of age. The home is privately owned with the registered manager also being the registered provider jointly with her husband. The home is a large converted domestic property, which is suitable to meet the needs of the current service users. The accommodation is spread over three floors with the first and second floors being on split-levels and referred to below as front and back on each floor. The ground floor contains the communal facilities comprising a lounge and a large kitchen/ diner and also two service user bedrooms, one with ensuite and a shower and bathroom as well as the home’s laundry facilities. The first floor front contains three service user bedrooms and the first floor back contains one service user bedroom and a toilet and a bathroom with an adapted bath. The second floor back contains one service user bedroom and a shower room/ toilet. The second floor front contains the office and staff facilities. The home has a pleasant accessible rear garden. The home is located close to public transport and within easy walking distance of the multi-cultural amenities and shops in Wood Green. Information about the home including service users’ guide and the CSCI inspection reports are available from the home by contacting the providers. The weekly fees of the home range between £475 and £702 per week. Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over a period of 7 hours, commencing at 9.00 am and concluding at approximately 4.00 pm. Mrs Bridie Clayton, the registered person, was present throughout the inspection. The inspection activity undertaken included a tour of the building, the examination of service users’ files including care records, the examination of health and safety records, the viewing of staff rotas and an examination of the menus and medication administration records. Discussions were also held with four of the people who live at the home and three care staff. What the service does well: What has improved since the last inspection? What they could do better: The registered person needs to ensure that all staff working at the home have two written references in their files. The home’s quality assurance system must be fully implemented. The registered person must seek the views of service users, visitors and professionals and develop an action plan with a view to improving the quality of the services and facilities provided at the home. The gas boiler must be serviced and certified that it is safe to use. The registered person is required to ensure the health and safety, and welfare of service users Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 6 while undertaking extension to the building to provide improved kitchen and lounge facilities. 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. Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 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 Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New service users are confident that their admission to the home is dependent on the outcome of their needs assessment and the ability of the home to meet their needs. EVIDENCE: An examination of two newly admitted services users’ files showed that service users’ assessments have been completed by their social workers and health professionals before their admission. The registered person said prospective service users are visited and assessed at their homes’ by the manager. The service users spoken to confirmed that they were involved in their assessments before moving in to the home. They said that they have been offered an opportunity to visit and to have short stays before their admission. Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 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, and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good system of updating and reviewing care plans and risk assessments. Service users have benefited from the system of identifying and reviewing care plans and risk assessments. EVIDENCE: Four service users’ files were assessed. It was evident from the files that the care plans have been updated regularly and that service users and their representatives have been involved. Discussion with the registered person and an examination of the files showed that social workers, health professionals and service users’ families have been invited to review meetings. Service users’ care plans are detailed and cover areas such as health, physical, psychiatric, accommodation, financial, behavioural and leisure needs of service user. The staff keep daily records of service users’ activities. Risk assessments are completed for all service users. The four service users spoken to said they have front door and bedroom keys. Service users said they can go out and return to the home. They said that they could make hot drinks and snacks when they wanted. The registered person has a plan to refurbish the kitchen and lounge areas to make the home more spacious and comfortable. Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 10 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): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activities and the food provided at the home are good and service users are engaged. The home has good independent living arrangements that have enabled service users to travel independently to access local facilities and to visit friends and families. EVIDENCE: Discussions with the registered person and an assessment of the home’s records showed that two of the people who live at the home attend a day service three times a week. It was evident from observation and conversations with service users that some of them travel independently to places where they access leisure and social activities. Two of the people who live at the home said they regularly go to the Central London and to the parks using the London transport including the Underground. It was clear from discussions with the service users and an examination of the files that service users are regularly visited by their families. Some service users also visit their families and friends. The registered person confirmed that all service users are registered on the electoral roll. She said that the home encourages and supports the people who live at the home to observe and celebrate cultural and Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 11 spiritual occasions such as the St Patrick’s Day, St David’s Day and Christmas. It was noted by the registered person that service users have been to Stratford-Upon-Avon and the seaside resort of South End. All the people spoken to said they liked the food provided by the home. They said they are happy with the amount and variety of food items the home provides. From staff records it was evident that the staff have attended training in basic food hygiene. There is a four weekly rotating menu. The service users spoken to said they have been consulted about the food they eat. The registered person has a plan to improve the kitchen by carrying out an extension to the building. Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 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 the following standard(s): 18, 19, and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ health care needs are met by the home’s procedures of medication administration and provision of ongoing medical care. EVIDENCE: The registered person confirmed that all service users are registered with their own general practitioners. Documents seen in service users’ files contained evidence of psychiatrists’ involvement in the provision of health care for people who live at the home. One of the people who live at the home explained how they received medical care in relation to their ear infection following a referral made for them by the registered person. Records and discussions with the registered person indicated that service users have received appropriate support, advice and health care from dieticians, opticians, general practitioners and dentists. One service user said they have been escorted to a health centre for a blood check. At the time of the visit one person was in a hospital receiving medical care. All the people at the home at the time of the inspection were presentable. The staff and the registered person gave satisfactory explanation of how they support the people who live at the home with their personal care by ensuring that their rights, privacy, choice and dignity. They said there are happy with the staff Medication is kept in a locked cabinet in the office and is administered by the staff. The medicines and medication Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 13 administration record sheets were checked and were correct on the day of the inspection. Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 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 the following standard(s): 22, and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has satisfactory systems in place to ensure that service users are protected from abuse. The complaints procedures are clear and service users are reassured that they can make complaints to the responsible person. EVIDENCE: The registered person said that all care staff have attended training in relation to the protection of vulnerable adults from abuse. This was confirmed in staff records, which were inspected. The home has a satisfactory procedure on adult protection and has obtained a copy of relevant procedures. All staff employed at the home have undergone satisfactory CRB checks. However, the registered person is yet to obtain second written reference for one member of staff. This is stated below under National Minimum Standard (NMS) 34. The people who live at the home and who were spoken to said they are happy with the way the staff interact with them. The home has clear policy and procedure on complaints. The service users spoken to said they are able to discuss concerns with the staff and the registered person. The home’s policy titled “How to make a complaint” is prominently displayed at the home. Previous CSCI inspection reports stated that the relatives are aware of the home’s complaints procedures. No complaints have been recorded since the last inspection. Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 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 the following standard(s): 24, and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The location of the home and cleanliness of the rooms are good making the home a comfortable place for service users to live in. Despite these positive aspects of the home, service users not reassured by the long time taken to provide new kitchen and lounge facilities. EVIDENCE: Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 16 The home was clean and tidy and there were no offensive odours on the day of the inspection. The registered person has employed a domestic who cleans the communal areas. Satisfactory infection control policies and procedures are in place. An officer from the environmental health services confirmed that the kitchen areas were satisfactorily maintained. The service users also take part in cleaning and keeping the home tidy. This was confirmed through observations and discussions with the people who live at the home. Each service user has a single bedroom and they confirmed that they are happy with their rooms and the home’s facilities. The home is located in a residential area within walking distance of Wood Green shopping complex. There are local shops, cafés and a bus stop very close to the home. It was noted from previous inspection reports, preinspection questionnaire and a discussion with the registered person that there is a plan to make some changes to the structure of the building to enable the home to provide a bigger lounge and a more suitable kitchen for the service users. The registered person is aware that issues relating to planning permission and risk assessment in respect of arrangements for service users while the work is in progress need to be specified and communicated to the CSCI. The service users confirmed that they are aware of the plan to make changes to the building and that they are excited about it. Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 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 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, and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have benefited from the home’s experienced, trained and committed staff. But the recruitment processes can be improved by ensuring that two written references are taken before new staff start work at the home. This will reassure service users that they are supported by are appropriately vetted and are fit to work at the home. EVIDENCE: At the last inspection the registered person was required to provide all members of the staff with training in mental health needs. Certificates were seen to confirm that care staff have attended training titled “mental health awareness” and “promoting positive mental health wellbeing”. The staff files showed that they have attended other training programmes such as first aid, food hygiene and manual handling. Two care staff have completed NVQ level 2 (care) and three others are currently undertaking to achieve a similar qualification. The service users spoken to stated that they are happy and confident with the staff. Three care staff, who were observed and spoken to, were experienced and knowledgeable in the provision of support and in their interaction with the people who live at the home. The home has a recruitment procedure. The registered person said vacant posts are advertised and new applicants are recruited based on the information Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 18 given in their application forms and their performance at interviews. New staff are confirmed in post only after supplying undergoing satisfactory CRB checks and providing written references from previous employers. An assessment of the staff files revealed that a newly employed member of staff have only one written reference in their file. The registered person said they have unsuccessfully contacted a named referee who is yet to provide a reference for the member of staff. The registered person is clear that staff should start work at the home only after providing all necessary documents including two written references and various identity forms. The registered person has identified a list of training programmes that the staff need to attend during the year. There is also a list of dates and courses that the staff have attended. The registered person said that courses are identified agreed for staff at their individual supervision sessions. Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 19 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, and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Even though the management of the home is good, the system of quality assurance and the monitoring of health and safety of some equipment, for example, the gas boiler, are not satisfactory. This means that service users do not know if their views about the home are sought and taken seriously and that the equipment provided at the home is safe to use. EVIDENCE: The registered manager is also a joint provider of the service with her husband. She was a qualified nurse but her registration has lapsed. The manager has embarked on NVQ (Management) Level 4 training and she said she has three more units to complete before achieving her qualification. A deputy manager who is also undertaking training to achieve management qualification currently supports the manager. The registered person has been running the home for a number of years. The registered manager was observed interacting in appropriate and inclusive manner with both the staff and the people who live at the home. A number of service users were seen Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 20 going to the office and talking to the registered manager. The staff confirmed that the registered manager is approachable and supportive. At the two previous inspections requirements were made for the registered person to implement a quality assurance system for the home. The registered person is yet to make a significant progress regarding this. So far a questionnaire has been designed and distributed to the people who use the service. However, a tool of gathering feedback from other stakeholders such as service users’ relatives, visitors and professionals is yet to be developed and implemented. The registered person is aware that there is a need for the home to seek the views of all the stakeholders about the quality of the service and to develop an action plan as to how to improve the service. The home was clean and tidy and risk assessments have been completed for all service users. All bedrooms are fitted with smoke detectors and records showed that fire alarms are checked weekly and fire drills are carried out quarterly. Certificates were seen to confirm that fire extinguishers were serviced on 5/8/05, and the call points were checked on 15/7/0. The portable electrical appliances were last tested on the 4th of May 2005 and were overdue for testing. Subsequent to the inspection the registered person sent a confirmation through email stating that all portable appliances have been tested and marked “pass” to show that they are safe to use. A certificate dated 21/4/06 states that there were no species of legionella bacteria were found from water samples taken from the home. The gas boiler was last serviced on 18/4/05. It was mentioned earlier that the registered person has a plan to make changes to the building to provide improved kitchen and lounge facilities. The registered person said that an architect has been commissioned to ensure that all relevant regulations, including fire safety, are complied with before, during and after the building work is completed. Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 21 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 22 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 YA24 Regulation 23; 17(3); 13(4)(a)(b) and (c) Requirement The registered person must ensure the health and safety, and welfare of service users while providing a new kitchen and sitting area. The registered person must update the CSCI from time to time regarding the progress of the building work and the arrangements put in place to ensure safety and welfare of service users. Timescale for action 30/06/06 2 YA34 Sch 2 & Sch 4 (6); 19(1)(a)(b)(i) and (c) 3. YA39 24(1)(2) The registered person must 30/06/06 ensure that two references (one of which is from the most recent employer) are obtained for each member of staff and are available for inspection. The registered person must satisfy herself that the references are verifiable. The registered person must 31/08/06 consult service users and visitors about the quality of services and facilities provided at the home. The feedback obtained through the quality assurance must be summarised with action plans Version 5.1 Page 23 Earlham House DS0000010706.V291394.R01.S.doc and made available to all stakeholders including the CSCI. (Time scales of 31/03/05 and 30/01/06 not reached). 4. YA42 23; 13(4) The registered person must ensure that the gas boiler is serviced. 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Earlham House DS0000010706.V291394.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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