Inspection on 09/02/09 for Emmanuel House

This is the latest available inspection report for this service, carried out on 9th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Emmanuel House 7 Chalgrove Road Tottenham London N17 0NP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Margaret Flaws     Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Emmanuel House 7 Chalgrove Road Tottenham London N17 0NP 02088019923 02088019923 ashleycarehome@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashley House Care Homes Ltd care home 3 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 3 The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 3 Date of last inspection Brief description of the care home The home was established to provide residential care to people with enduring mental health needs. It is a small three bedroomed house in a residential street in North Tottenham, London. The home is served by local transport, shops, parks and community facilities. The home is an ordinary small terraced house and has been refurbished to a reasonable standard. There are three bedrooms on the first floor. All rooms have a washbasin and are basically furnished. The bathroom is on the first floor and there is an additional toilet downstairs off the kitchen, adjacent to the laundry. There is an ordinary kitchen/dining which backs onto a paved outside space. This is Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home shared with the house next door. The fees for the home are up to 700 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unnannounced inspection was took place over one day. The Registered Manager was present during the inspection and the Registered Provider also visited. We spoke to both of them during the inspection. This inspection consisted of interviews with one residents and staff. We toured the premises and observed interactions between staff and the resident. We inspected care, staff and general records in the home. The home provided CSCI with a basic Annual Quality Assurance Assessment (AQAA),which contributed information to this inspection. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents needs are assessed for the home is able to plan their care. Evidence: This is the homes first inspection since new residents moved into the home last year. At the time of this inspection, there were three people living in the home. All of these residents came to live there as a result of an emergency admission from another care home where all the residents had to leave. Haringey Council is the placing authority. We checked the files for all the people living in the home. They are young men with enduring mental health needs, in line with the stated purpose of the home. The home had copies of the residents files from the previous home, along with their own files and assessments. The home completed its own assessment for these new residents and obtained background information from the previous provider. Not all the residents contracts were held at the home and the Registered Provider had to bring them from the main administration office of Ashley Care Homes. A requirement is Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: given that copies of the contracts be kept on the residents files at the home. The home has a Statement of Purpose and Service User Guide. It gives reasonable information about the home and what is offered. Care Homes for Adults (18-65 years) Page 10 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their care planned according to their needs and wishes, and they are involved. Residents are supported to make their own decisions and choices, working towards degrees of independance. Risks to their wellbeing are generally assessed and managed to protect their interests. Evidence: We saw the care files and plans for the three people living in the home. There were basic care plans for each person, which had been reviewed by the staff at the home since the residents arrived last year. The Registered Manager and another staff member on duty were able to give a good account of how the home worked to consider, plan and meet the individual needs and wishes of each resident. The daily notes also provided a good record of how the home Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: worked with each person. Some risks had been assessed and documented for each person. The residents will benefit if these were further developed. A recommendation is given. We observed good communication throughout the day between the resident who was at home and the staff on duty. We spoke to the resident and he told us that he was happy living at Emmanuel House; that he felt staff understood his needs and supported him appropriately. There is a basic system in place for supporting people with their finances. The Registered Manager told us that the residents manage their own finances and the staff support them with budgeting and managing their money. Care Homes for Adults (18-65 years) Page 12 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to engage in the community in a way that meets their needs and preferences. Contact with relatives and friends is supported in line with their wishes. Their rights and responsibilties are respected and promoted within their daily lives. The dietary options available in the home are limited and the residents would benefit if these were reviewed and improved. Evidence: We spoke to one resident who was at home on the day of the inspection. He said that he was free to pursue his interests inside and outside the home. He showed me how Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: the home had been supporting him with improving his literacy and during the inspection, did some work on this project on his own and with staff. He described how maintains his friendships and relationships, with support. The other two residents were out at day centre and on visits. We saw their files, which documented their activities and involvement with the community. Residents are supported to maintain the level of contact they wish with family. There are no significant organised activities in the home but the Registered Manager described how she is working to support two residents who do not attend day centre to do so. We saw the menus for each individual. Menus included the cultural choices of the residents. There is a four week cycle but staff said that it can vary according to the residents choices on a daily basis. The home did not have a stock of fresh fruit and vegetables. Food in the home was either tinned food or frozen foods. There was very little fresh food in the fridge. On the day of the inspection, a hot meal of chicken and vegetables was provided. A requirement is made to review the nutritional needs of the residents with a dietitians support and improve the quality of food offered in the home. Care Homes for Adults (18-65 years) Page 14 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not need personal care support. Their physical and mental health needs are assessed. They are protected by the homes new medication policies and procedures. Evidence: The residents do not need any support with personal care, other than occasional prompting and verbal support.We saw the files for all the residents. All had had regular physical health checks. Peoples mental health needs are supported by the involvement of community mental health teams and we saw some evidence on file of how the home works with these teams. The Registered Manager described how she consults with professionals as and when required. Along with the staff member we spoke to, she had a good understanding of the mental health needs of the residents and how to support them. The home has a medication policy and procedure which covers the storage, administration and safe handling of medications. It also has a section on the selfCare Homes for Adults (18-65 years) Page 15 of 28 Evidence: administration and states that all residents who self-administer their medications will have a risk assessment to cover this. We discussed medication with the Regulation Manager and she showed us the medication storage arrangements (a medication cupboard in the office, which was in good order). We checked the Medication Administration Records (MAR charts) for two residents. There were no errrors or omissions on these records. Medication cupboard and fridge temperatures are checked and recorded daily to ensure medications are stored at safe temperatures. Care Homes for Adults (18-65 years) Page 16 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can express their views and concerns and know that these will be addressed appropriately by the home. They are also safeguarded from harm by the homes policies and procedures. Evidence: The home has an accessible complaints policy and procedure, which is displayed in the home. The resident we spoke to knew what to do if he had any concerns. We saw the complaints records. No complaints had been recorded since the home started operating last year. The home has a safeguarding adults policy and procedure. Haringey Council has recently visited the home and provided an up to date copy of their safeguarding adults policy and procedure, which was prominently displayed. Staff had safeguarding training in October 2008. Care Homes for Adults (18-65 years) Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is well decorated and maintained to meet their needs. The home was clean and tidy throughout. Improvements are needed to the laundry facilities. Evidence: We toured the building with a staff member and a resident. The home has been refurbished to a average standard of decoration and furnishing. The communal facilities are adequate for the needs of three residents and the resident we spoke to said he liked the spaces (personal and communal). There is a front room/lounge with TV and DVD. One resident showed us his room. It was reasonably personalised and basically furnished. The small kitchen was in reasonable order, although it felt spartan. There is a locked cupboard for dangerous substances (COSHH), adequate work surfaces and normal domestic food storage arrangements. Fridge and freezer temperatures are recorded daily. There is a washing machine in a gallery laundry area to the side of the house. This laundry has been shared with the other Emmanuel House home next door. This practice must stop and each home must have its own, sufficient facilities for washing and drying laundry. A requirement is given. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: The bathroom is upstairs and there is a second toilet downstairs on the ground floor (which needs a lock, requirement given). The residents use the outside patio area shared with the other Emmanuel House care home next door for smoking. During the inspection residents from each home spent time outside having a cigarette. This area is covered to protect it from rain. The office is in a small room off the lounge. The home was clean and hygienic on the day of the inspection. Care Homes for Adults (18-65 years) Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are generally protected by the staff recruitment, training and support policies and procedures, although there is a need for improvements in the way the home is staffed. Evidence: On the day of the inspection, there was one staff member and the Registered Manager on shift. The Registered Manager also manages another Ashley Care Home in Tottenham. The home has a deputy manager. We saw the staff rota. The Registered Provider and Registered Manager said that the staffing level was adequate at present (one staff on duty during the day and one at night, with as and when staff bought in as needed) but this appears to be a minumum staffing level and it is required that the home keep this under regular review to ensure that there are always sufficient staff to meet the needs of the residents at all times. We also inspected the service next door run by the same provider. When we checked the staff files for each service and discussed the staffing arrangements with the Registered Manager and the Registered Provider of this service, it was clear that some staff are being shared between the two homes. There was some overlap on the rotas and staffing interdependencies have been created. While the Registered Persons made Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: a case for the benefit of having arrangements for cover between two adjacent services, this should only be the case in an emergency and each care home should be properly staffed and managed with its own staff team. A requirement is given that the home recruit and maintain its own staff team for this home, including bank staff. The home has a satisfactory staff recruitment process. We checked four staff files. The issues identified above were apparent, where staff from each of the two services next door to each other were shared. The Registered Manager described how the home is trying to recruit new male staff for the home. Some staff come from the Sure Care agency, also run by the Registered Provider. Staff had had pre-employment checks, including full Criminal Records Bureau checks, two written references obtained and photographic identification supplied. The staff member on duty described the training that they have received. The training records showed evidence of a rolling staf training programme. The staff member we spoke to told us about the supervision provided. Staff meetings are held regularly and we saw the minutes. Care Homes for Adults (18-65 years) Page 21 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are generally protected by the homes management arrangements systems and health and safety arrangements. Residents are consulted and their views considered. Evidence: The Registered Manager, Angela Dadzie, also manages another Ashley Homes care home. The Registered Manager has completed the Registered Managers Award and has experience in the care of people with enduring mental health needs.We discussed the management arrangements and how they work. She told us that there is a Deputy Manager always on site when she is not present. As indicated above, the home does not yet have its own full staff team. Because the home does not have a fulltime Registered Manager, the management arrangements must be clear and robust. A requirement is given that the home supplies CSCI with clear information about how the home is managed and who is on site. The home has a basic quality assurance procedure in place.This questionnaire is Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: provided to residents annually to complete. Because this service is new, we will check the results at the next inspection. Meetings with residents are held every two months and minuted. Residents have an opportunity at these meetings to discuss improvements they would like to see and things that they would like to do. The home provided CSCI with an Annual Quality Assurance Assessment. This provided some management information for this inspection, including the dates for health and safety certificates in the home. The home has fire safety policies and procdures in place. Care Homes for Adults (18-65 years) Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 15 The Registered Persons must ensure that copies of the residents contracts be kept on the residents files at the home. Services must be provided as contracted 01/05/2009 2 17 12 The Registered Persons 01/05/2009 must review the nutritional needs of the residents with a dietitian support and improve the quality food offered in the home. Residents must be offered a health, balanced and nutritional diet 3 24 23 The Registered Persons must ensure that the downstairs toilet has a lock. Privacy of residents to be protected 01/05/2009 Care Homes for Adults (18-65 years) Page 25 of 28 4 30 16 The Registered Persons must ensure that laundry facilities are sufficient for the home and not shared with next door. The home must have its own laundry 01/05/2009 5 31 18 The Registered Persons 01/05/2009 must ensure that there are clear arrangements in place to indicate whether a staff member is working as an agency staff member or as a permanent employee of the home. The home must have its own dedicated staff team 6 31 18 The Registered persons must ensure that the home recruits and maintains its own staff team, including bank staff. The home must have its own dedicated staff team 01/05/2009 7 31 18 The Registered Persons 01/05/2009 must ensure that there are adequate numbers of staff on duty in the home to meet the resident needs and keep this under regular review The home must be properly staffed 8 36 18 The Registered Persons must ensure that staff receive formal, individual supervision sessions six times per year minumum. 01/05/2009 Care Homes for Adults (18-65 years) Page 26 of 28 Staff must be professionally supported 9 37 10 The Registered persons must provide CSCI with full details of the management arrangements, including areas of responsibility, how the home is managed and who is on site. The management arrangements must be clear 01/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Risks assessements to be developed further Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!