Inspection on 28/09/05 for Essex House

This inspection was carried out on 28th September 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Essex House 08/04/08

Essex House 06/08/07

Essex House 04/10/06

Essex House 22/03/06

Essex House 30/03/05

Essex House 24/01/05

Essex House 04/03/04

Similar services:

Ashlong House

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Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Essex House 117 Essex Road Leyton London E10 6BS Lead Inspector Sandra Jacobs-Walls Unannounced Inspection 28 September 2005 at 10:30am th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Essex House Address 117 Essex Road, Leyton, London, E10 6BS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8925 2451 Mrs Anis Chowdhary Mrs Anis Chowdhary Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th March 2005 Brief Description of the Service: Essex House is a care home for young adults with a learning disability. It can accommodate three service users. The service has had only two service users in residence for several years. The home is situated in a residential area in Leytonstone, within the London Borough of Waltham Forest. The home has easy access to the central line railway at Leytonstone and is on a main bus route. Nearby is the main shopping area of Leytonstone and other community resources such as the college, cinema, pubs and restaurants, all within easy walking distance. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of Essex House took place on September 28th 2005 for 5.5 hours. The home’s registered manager assisted the inspection process, the inspector also met with the two service users currently resident at the home and one other member of staff on shift at the time of the inspection. The inspection process included the review of both service users’ individual files, the review of key policies, procedures and other relevant documentation, staff personnel records and a tour of the home’s premises. As a result of the inspection thirteen (13) requirements and no recommendations were made. The inspector would like to thank all service users and staff who co-operated and contributed to the inspection. What the service does well: What has improved since the last inspection? The home continues to function at a similar level to that noted at the previous inspection. A number of outstanding requirements had been addressed, while others were repeated at this inspection. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 &5 The home has had no new admissions for a number of years; therefore standards 2-4 were not assessed on this occasion. Each service user file evidenced a written agreement. Prospective service users have access to good information about the home. EVIDENCE: The inspector reviewed the individual case files for both the home’s residents. Both files contained signed, written contracts. The home has a newly revised Statement of Purpose/Service User Guide, which was considered satisfactory. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 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 standard(s) 6,7,8,9 &10 Service user’s assessed and changing needs were very well reflected in their individual care plans. Service users are encouraged to participate in the decision making process and are consulted on aspects of life in the home. There is a need for residents meetings to be consistently held and documented upon. Service users are supported to take appropriate risks and their information is handled confidentially, although an Access to Files policy is in need of development. EVIDENCE: The inspector saw comprehensive current care plans on file for both service users; these were well documented and highlighted individual personal goals. Risk assessments were also seen on file. There was good evidence to suggest that service users participated in the decision making process, for example service users were encouraged to participate in meal planning, shopping for food, making choices with regards to preferred recreational activities etc. However, the home’s record of residents meetings needs to be more consistently recorded. Service users were also keenly encouraged to take part in the home’s daily chores such as meal preparation, ironing, mopping, clearing the table etc. The Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 10 inspector saw very good instructional guidance to staff in assisting service users with learning difficulties competently complete selected tasks. The inspector reviewed the home’s confidentiality policies, which were considered satisfactory; the inspector noted that service user files were kept locked away in the staff office and the registered manager commented that the home’s computer was password protected. The home needs to develop an Access to Files policy to ensure service users access to information held on site about them is made appropriately available. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16 & 17 Service users have opportunities for personal development and participate in a range of appropriate activities, some of which are conducted within the local community. They are encouraged to maintain personal, family and sexual relationships and are offered a healthy diet. Service users’ rights are well respected. EVIDENCE: The inspector saw in individual service user files activities and strategies to encourage service users’ personal development; these included specific tasks and activities to enhance service users’ independence and work with service users to develop communication using a variety of creative methods. Service users also attend day centres twice a week, which further enhanced their general development. On the day of the inspection, service users indicated that they had been out that morning shopping. They also indicated that they enjoyed being escorted to different places and activities within the community. Files indicated that service users frequently accessed local amenities such as the library, gym, Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 12 swimming pool etc. Contact with family and friends are keenly encouraged and supported by staff. One service user was supported to write to a relative who lived in the US, while the other service user spoke and met with her partner on a daily basis, often at the home. Service user files indicated their preferred food choices. One file stated, “She enjoys chips and saveloy, sausages, baked beans and peanut butter” The service user in question was asked about this and she confirmed that she did enjoy these foods and that she was readily served them at the home. A healthy diet was encouraged by staff to assist with her weight loss. The other service user was known to particularly enjoy curries. The inspector also saw a menu plan for the week of the inspection; meals were varied and nutritiously balanced. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 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 standard(s) 18,19,20 & 21 Service users receive personal support in accordance with their preferences and their physical and emotional needs are well met by staff. The home has a medication policy in place, however the recording of service user medication is in need of improvement. Information was available regarding the wishes of service users/their relatives in the event of their death, however the home’s ‘Death and Dying’ policy is in need of further development. EVIDENCE: Service user files seen by the inspector contained good information about the personal care needs of service users. There was also written guidance on how service users preferred these tasks to be conducted. Written guidance was documented regarding the level of support required, for example one service user needed only verbal prompting to complete personal care tasks, while the other service user needed “constant supervision”. Files seen also contained very good documentation about identified health care needs of service users and how these were to be addressed. One of the service users had a hearing and sight impairment. The file indicated good monitoring by staff and the appropriate referrals/appointments being made and kept. The other service user was referred to relevant sexual heath and breast screening clinics. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 14 Only one of the two service users was prescribed medication. The inspector reviewed medication information as recorded by the home. The registered manager informed the inspector that she was primarily responsible for the administration of service user medication. There is a medication policy in place. Medication Administration Records (MAR) sheets seen however, were inappropriately used. For example, details of medication offered for the months of August and September were documented on the same sheet. This made reading the information confusing. In addition, the inspector noted a number of gaps in the daily recording of medication information. The home will need to promptly address discrepancies in the recording of service user medication information. The inspector reviewed the home’s ‘Death and Dying’ policy, which is clinical in nature and does not address cultural or religious consideration. The inspector also felt that staff could benefit from written guidance about dealing with issues of bereavement with younger adults who had learning difficulties. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 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 standard(s) 22 & 23 Service users’ feel their views are listened to and acted upon, however, the home’s recording of complaints needs improvement. Service users are generally protected from abuse, neglect and self harm, but the home must develop one comprehensive adult protection policy and procedure. EVIDENCE: The registered manager informed the inspector that no complaints had been made against the home during the past year. The inspector reviewed the home complaints procedure, which was satisfactory. However, the home must develop a method that centrally documents any complaints received. The inspector saw a number of differing adult protection documents available to staff in the home. Collectively, the information was very useful, however the inspector felt that staff would benefit from one comprehensive policy/practice document and a access to local authority adult protection protocols on site. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 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 standard(s) 24, 25, 26, 27, 28 & 30 Service users live in an environment that is relatively homely, comfortable and safe. The home must evidence records of fire drills. Service user bedrooms met their needs and promoted service user independence. Communal spaces are adequate. The home’s toilets and bathrooms are sufficient in number, meet service user need and were adequately private. The home does not have any specialist disability equipment and was found to be clean and hygienic. EVIDENCE: The home’s premises is a two storey terraced house that has been extended towards the rear of the building. The inspector was accompanied on a tour of the home’s premises. At the time of the inspection, parts of the garden area were under construction, noticeably paving was being replaced and a shed was being built. The interior of the home and communal areas was fairly comfortably decorated. African artefacts seen throughout the house had been bought from Africa for one of the service users who is of Nigerian origin. The safety of the building was in question since no evidence of fire drills having taken place was evidenced. The inspector saw the two bedrooms occupied by service users. These were attractively decorated and evidenced the personal preferences of the service Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 17 users; bedrooms seen contained photographs, stuffed animals, teddy bears etc. The inspector was aware that service users were supported to maintain their bedrooms cleanly and tidily. The home’s toilet and washing facilities were adequate, both service user bedrooms had washbasins. Communal areas were well equipped with recreational materials such as jigsaw puzzles, magazines, board games, TV and audio equipment etc. Service users who met with the inspector indicated that they enjoyed the recreational activities made available at the home. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35 & 36 Staff are clear of their roles and duties, but staff files must evidence that individual staff induction and staff supervision is being conducted consistently. Staff files must also evidence fully the appropriate vetting of staff. An effective, competent staff team who are well trained support service users. EVIDENCE: The inspector interviewed a support worker who was on shift at the time of the inspection. She described well her role and duties and were clear of the responsibilities of other staff members. The support worker indicated that she had completed a number of relevant training courses, the registered manager commented that all newly appointed staff undergo an induction, although no documented evidence of this was produced. The support worker, who said she felt well supported by the manager and received adequate supervision. However, review of staff files indicated that the frequency of 1:1 supervision for some staff was in need of improvement. Staff training opportunities were good, the registered manager has recently completed NVQ training at level 4; another two staff members had completed NVQ training at level 2 and 3 respectively. All other staff was currently completing foundation courses. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 19 The inspector reviewed staff personnel files for four members of staff. The registered manager informed the inspector that in addition to permanent staff, a volunteer had recently been recruited as part of a local initiative to introduce long term unemployed individuals to the field of social care. The inspector asked to review the personnel information for the volunteer, but no information was produced. The personnel files for the four staff members that were seen were found to be missing some required information. This included employee photographs, proof of identity and in one case references. The registered manager must ensure that staff files evidence all required information as outlined in Schedule 2 of the Care Homes Regulations in order to enhance the protection of service users. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41,42 &43 The home is fairly well run; its general administration needs improvement. Service users benefit from the registered manager’s leadership, the home’s quality assurance systems need to be more frequent. Service user rights and best interests are not safeguarded by the home’s record keeping policies and procedures, which compromises their health, safety and welfare. The overall management of the home is generally competent, but this could be maximised by improvements in the home’s general administration, noticeably record keeping. EVIDENCE: The home was found to be fairly well run, the manager has appropriate experience and has completed all required training including NVQ training at level 4 and the Registered Manager’s Award. Staff and service users are complementary about her positive approach to managing the home. However the home’s administration and staff’s record keeping needs some improvement. For example consistent records of residents meetings, the Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 21 recording of service user medication, the maintenance of staff records was all found to be in need of improvement. Improvement in these areas would maximise service users health, safety and general well-being. The registered manager showed the inspector the home’s quality assurance form, which reviewed all of the home’s functions and service provision. This is completed on an annual basis. The monitoring form was very comprehensive, but the inspector felt the system would be more effective if completed at least every six months. Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 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 3 x x x 3 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 2 3 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Essex House Score 3 3 2 2 Standard No 37 38 39 40 41 42 43 Score 3 3 2 2 2 2 3 G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 23 YES 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 YA8 Regulation 12(1)(a) Requirement The registered manager must ensure that residents meetings are consistently held and documented The registered manager must ensure that an Access to Files policy is developed and implemented in the home The registered manager must ensure that service user medication information is appropriately documented on MAR sheets The registered manager must further devlop the homes Death and Dying policy to include issues of support and guidance regarding differing religious/cultural needs The registered manager must ensure that there are sytems in place to maintain records of complaints centrally The registered manager must ensure that staff have access to one comprehensive adult protection policy document on site The registered manager must ensure that staff have access to local authority adult protection Timescale for action 31/10/05 2. YA10 12(3) 31/10/05 3. YA20 13(2) 31/10/05 4. YA21 12(4) 30/11/05 5. YA22 22 30/11/05 6. YA23, 40 13(6) 30/11/05 7. YA23, 13(6) 30/11/05 Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 24 procedures on site 8. YA24, 41 17(2) The registered manager must ensure that the home can evidence the consistent conduct and documenation of fire drills The registered manager must ensure that staff records contain all information as specified in Schedule 2 of the Care Homes regulations The registered manager must ensure that personel records for any volunteers working in the home are maintained in accordance with Schedule 2 of the Care Homes Regulations and are made availanble for CSCI inspections. The registered manager must ensure that there is documented evidence of staff inductions The registered manager must ensure that there is documented evidence of regular individual staff supervision The registered manager must ensure that the homes quality assurance monitoring exercise is completed at least every six months 30/11/05 9. YA34, 42 19 31/10/05 10. YA34 19 31/10/05 11. 12. YA36 YA36 18(2) 18(2) 31/11/05 31/11/05 13. YA39 24(1)(a)& (b) 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Gredley House 1-11 Broadway London E15 4BQ 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 Essex House G56 G06 S7343 Essex House V223689 040505 Stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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