Inspection on 04/10/06 for Essex House

This inspection was carried out on 4th October 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Essex House 08/04/08

Essex House 06/08/07

Essex House 22/03/06

Essex House 28/09/05

Essex House 30/03/05

Essex House 24/01/05

Essex House 04/03/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

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 4th October 2006 10:30 Essex House DS0000007343.V314189.R01.S.doc Version 5.2 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 Essex House DS0000007343.V314189.R01.S.doc Version 5.2 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. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Essex House Address 117 Essex Road Leyton London E10 6BS 020 8925 2451 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) Mrs Anis Chowdhary Mrs Anis Chowdhary Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd March 2006 Brief Description of the Service: Essex House is a care home for young adults with a learning disability. It can accommodate three service users, but 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. At the time of the inspection, the home’s proprietor/registered manager was considering the re-location the service to alternative, larger premises. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of Essex House took place on October 4th 2006 for the duration of five hours. Assisting the inspector was the home’s registered manager and one other staff member on shift at the time of the inspection. The inspection process included the review of one service user’s case file, discussions with staff, brief discussion with the two services that were present for part of the time, the review of four staff personnel files and review of other key documentation. The inspector also participated in an accompanied tour of the home’s premises. As a result of the inspection ten requirements and one recommendation was made. The inspector would like to thank all service users and staff that co-operated and contributed to the inspection. What the service does well: What has improved since the last inspection? Generally, outcomes for service users are fair. Service users have lived at the home for a number of years and so their needs are well known to staff and the staff group’s relationship with service users is good. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 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 DS0000007343.V314189.R01.S.doc Version 5.2 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 Essex House DS0000007343.V314189.R01.S.doc Version 5.2 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): No new service users had been admitted to the home since the last inspection, therefore no standards under this heading were assessed during this inspection. EVIDENCE: Essex House DS0000007343.V314189.R01.S.doc Version 5.2 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 & 9 Quality in this outcome area is adequate. This judgment had been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the case file in detail for one service user living at Essex House at the time of the inspection. Initially, the file did not contain evidence of a recent care planning review meeting, although the registered manager had commented that these were done on a six monthly basis. Additionally, the file did not contain a recent care plan, although one was produced later during the inspection. The registered manager informed the inspector that in fact a review of the service user’s need had in fact been conducted weeks prior to the inspection, but that no documentation of its outcome had been recorded. The inspector was also informed that staff were still working on recording the subsequent care plan, which was then produced later during the inspection. The service must ensure that care planning reviews and subsequent care plans are recorded promptly on file and implemented. This should be the case even if, as suggested here that there had been no change in the service user’s circumstances or identified needs. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 10 With regard to service user’s participation in the decision making process, the registered manager gave good examples that illustrated this was the case. So, for example, service users decided where and when they wished to go out to complete shopping, attend recreational activities etc. They made decisions regarding holiday locations and sight seeing and souvenir purchases. On a daily basis, service users decided for themselves which clothes they would wear and meal choices. The inspector reviewed the home’s documentation of residents meetings, which were held fortnightly or every three weeks. Issues recorded as being discussed at recent meetings included the completion of household chores, holiday considerations, menu planning and issues of hygiene. The service user file that was reviewed by the inspector contained risk assessments that focused on the management of violent/aggressive behaviour, health and safety issues around the home and risks posed due to the service users physical health. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: The inspector was satisfied that service users had good opportunities to participate in a range of appropriate activities and that they enjoyed being part of the local community. The inspector was informed that service users attended day centres twice weekly. In addition, they participated in a range of recreational activities such swimming, going to the library, clothes and food shopping, accessing the local park and local area for walks and eating out at local restaurants. Service users had spent a week during the summer in Blackpool, which was thoroughly enjoyed. Service users have contact with their families although the registered manager felt that contact was not as frequent as service users might wish for. One service user shared a somewhat temperamental relationship with her partner, which was being monitored by the home. Staff were encouraging the other service user who was somewhat reserved to make new friends via the day centre she attended. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 12 Service users who spoke with the inspector indicated that they enjoyed meals provided by the home. The inspector saw service users enjoying a lunchtime meal and was aware that cake baking had been an activity service users had participated in earlier in the day. The inspector reviewed the menu planner of the home that covered a number of weeks and was satisfied that generally meals prepared were varied and nutritiously balanced. Records seen of meals offered however were incomplete in many instances and the registered manager indicated that meals that were particularly culturally appropriate for one service user had not been recorded. The service must ensure that complete records are maintained regarding meals provided by the home. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is adequate. This judgment had been made using available evidence including a visit to this service. EVIDENCE: The registered manager commented that despite communication issues for one service user in particular, all personal care needs were well known to staff and performed accordingly. The inspector was informed that both service users were able to communicate very clearly dissatisfaction and would do so if they were unhappy about the manner in which personal care tasks were being performed. The registered manager gave an account of one service user’s dislike of having her hair washed and how the service user had to be gently coaxed and encouraged to let staff assist with this task. Staff were instructed to be particularly patient and careful in this instance due to the service user’s reluctance. For one service user who was fairly independent in completing personal care tasks, staff offered encouragement and supervision only of most tasks. The registered manager spoke candidly about encouraging staff to acknowledge the capabilities of service users and prompting staff to work with service users in a manner that increased their level of independence. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 14 During the inspection however, the inspector observed a member of staff assisting to change the clothes of a service user with the bedroom door open and in clear view of others positioned in the corridor. The inspector was disappointed to note this practice and recommends that staff be given guidance about ensuring service user’s privacy is consistently maintained. The service user file reviewed contained good information about her health care needs and how these were to be met by the service. Both service users were registered with GP’s and accessed local optician and dental services appropriately. The service was monitoring the weight of one service user, as concern had been expressed for her increase in weight. This service user also lived with epilepsy that was being monitored and addressed via medication. The inspector reviewed medication information maintained by the home for one service user and was satisfied that the home’s kept current and accurate records. However on the day of the inspection the home’s medication cabinet contained very old (2004) prescribed service user medication that was no longer in use. The service must ensure that all service user medication no longer in use is promptly disposed. During the course of discussion with the registered manager about the administration of service users’ medication, it became apparent that it was the registered manager’s practice to solely administer all doses of medication, at all hours of the day, returning to the home in the evening if necessary. The inspector felt that this practice was not best practice and that this responsibility should be shared with other staff members, following appropriate training and guidance. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is poor. This judgment had been made using available evidence including a visit to this service. EVIDENCE: The registered manager commented that there had been no complaints made against the service since the last inspection and that similarly, there had been no instances of suspected or actual abuse against service users. The home must develop and implement policies and procedures that relate to the Protection of Vulnerable Adults (POVA). The inspector asked to see the home’s copy of local authority’s adult protection protocols and noted that the document produced was outdated. The registered manager must obtain an updated copy of the local authority’s adult protection procedures, which is made available to staff on site. The inspector observed that at no point during the inspection until it was brought to the attention of the registered manager, was the inspector invited to sign the home’s visitor’s book. A record of all visitors to the home is required to enhance the safety of service users living in the home. Staff must adhere to this practice at all times. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: The inspector participated in an accompanied tour of the home’s premises as part of the inspection process and was satisfied that the home was clean and hygienic and met the needs of service users. Overall, the home is comfortable and reasonably decorated, but the registered manager acknowledged that this aspect of the home could be improved upon. The registered manager (who is also the home’s proprietor) had shared that it was her intention to relocate the service to a larger, more modernised premises which she had already purchased for this purpose; she commented that she had liaised with the Commission’s Central Registration Team and architects about new build specifications. The registered manager anticipated that a move, if approved would occur early in the New Year. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 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, 35 & 36 Quality in this outcome area is adequate. This judgment had been made using available evidence including a visit to this service. EVIDENCE: The registered manager is qualified as an NVQ course assessor and at the time of the inspection was conducting competency assessments of all staff. The registered manager commented that overall, she was satisfied with staff competencies and was working towards improving staff’s knowledge and skills. Staff were encouraged to participate in NVQ training, this was confirmed by the support worker who was interviewed by the inspector; she was currently completing NVQ training at level 2. The review of four staff personnel files indicated that the staff group had experience of working in the social care field prior to taking up posts at Essex House. The support worker who was on shift at the time of the inspection, commented that she felt the staff team was effective in working with service users and met well identified needs. Service users who spoke with the inspector had similarly indicated that staff worked well with them. The review of four staff files evidenced that all files (with the exception of one) contained full information as required by the regulations. The inspector observed that for one staff member, no written references were produced. The registered manager commented that she had in fact collated these, but may have misfiled them. The registered manager must ensure that written Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 18 references for staff can be evidenced to enhance the safety and wellbeing of service users. Staff files reviewed indicated that individual supervision was conducted generally on a 3-monthly basis. The exception to this was the infrequent supervision of the home’s night staff of which there were no records In light of some of the staff issues identified during the inspection (inadequate service user records, poor monitoring of visitors to the home, one example of staff’s poor attention to service user dignity) it was the inspector’s view that service users and staff would benefit from increased levels of individual supervision. This should be addressed as a matter of priority. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 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 & 42 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: Overall, it was the inspector’s view that the home was well run, however, it was felt that the registered manager should consider increasing the delegation of care tasks to support staff and concentrating on management tasks. In response, the registered manager commented that she was in the process of reviewing the need for a deputy manager at Essex House in order to facilitate greater dedication to management duties. The registered manager shared with the inspector comprehensive selfmonitoring tools used by the home to assess performance and function. The tools reviewed explored the home’s functioning in many areas including the quality and provision of care, staffing issues, environmental improvements, management systems to identify a few. The registered manager undertook performance audit twice annually and produced supporting documentation. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 20 The service will need to improve upon practices in relation to adult protection and staff recruitment as outlined elsewhere in this report in order to evidence that the safety and welfare of service users are sufficiently promoted and protected. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 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 X 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 1 ENVIRONMENT Standard No Score 24 3 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 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 3 X X 2 X Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement The registered manager must ensure that care plan reviews are held at regularly and that outcomes are promptly made available on service users’ files The registered manager must ensure that comprehensive care plans are kept current and evidenced on service users’ files The registered manager must ensure that menu plans are accurately maintained and completed fully by staff The registered manager must ensure that staff completes service users’ personal care tasks in private. Guidance must be provided to staff that promote service user dignity and privacy. The registered manager must ensure that all service user medication no longer in use is promptly disposed. The registered manager must obtain an updated copy of the local authority’s adult protection procedures, which is made available to staff on site. The registered manager must develop and implement policies DS0000007343.V314189.R01.S.doc Timescale for action 30/11/06 2. YA6 15 31/12/06 3. YA17 17(2) 30/11/06 4. YA18 12(4)(a) 15/12/06 5 YA20 13(2) 30/11/06 6. YA23 13(6) 30/11/06 7. YA23 13(6) 15/12/06 Essex House Version 5.2 Page 23 that relate to POVA 8. YA23 13(6) The registered manager must ensure that all visitors sign the visitor’s book upon entry to the home. The registered manager must ensure that written references for staff can be evidenced. The registered manager must increase the frequency of individual staff supervision. 30/11/06 9. 10. YA34 YA36 19 18(2) 15/12/06 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations It is recommended that the registered manager consider training other staff members to administer service users’ medication so that this task becomes a shared responsibility amongst the staff group. Essex House DS0000007343.V314189.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection East London Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Essex House DS0000007343.V314189.R01.S.doc Version 5.2 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. 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