Inspection on 06/08/07 for Essex House

This inspection was carried out on 6th August 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 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 04/10/06

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 Anne Chamberlain Key Unannounced Inspection 6th August 2007 10:00 Essex House DS0000007343.V348031.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.V348031.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.V348031.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 020 8534 4280 achowdhary5@aol.com 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.V348031.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2006 Brief Description of the Service: Essex House is a care home for young adults with a learning disability. It can accommodate three residents. However the service has had only two people in residence for several years. The home is situated in a residential area in Leyton, within the London Borough of Waltham Forest. It has easy access to the central line underground station at Leytonstone and is on a main bus route. Nearby is the shopping area of The Bakers Arms. Other community resources such as swimming pool, pubs and cafés are quite close. Fees at the home are £548.04 - £524.74 Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the site visit the inspector received an AQAA completed by the provider with useful information about the service. The inspection took place on one day and over eight hours. The aim of the inspection was to inspect the key standards and also revisit any requirements from the last inspection. The inspector met with residents and a staff member. She toured the premises and viewed the arrangements for medication. The inspector was assisted by the manager and viewed two service user files, two staff files, policies and procedures and other key documentation. The inspector would like to thank the residents, staff and manager for their cooperation with the inspection. This is what the Inspector did when she was at the home Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 6 She spoke to two people who live at the home. She looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. What the service does well: The service provides a safe and secure home environment for the residents, and a structured programme of activities to stimulate them. Staff work proactively with residents to improve their communication and other skills. The service meets the identified needs of the residents in a consistent way. A good relationship has been fostered between the two residents in the home and they live together very compatibly. Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 7 What the home does well The people who live in the home are given good support to develop their social skills, and their skills around the house. The people in the home are supported to make their own decisions. What has improved since the last inspection? Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 8 The home has responded to the requirements of the last inspection and none of them have been restated in this report. There was evidence of reviews of care. Care plans were on files, although further improvements to these have been suggested. There was no out of date medication. The manager has made appropriate reference to Protection of Vulnerable Adults (POVA) arrangements in the Adult Protection policy. The level of staff supervision is now satisfactory. Care plans are in place and are being reviewed regularly to make sure peoples needs are met. What they could do better: The inspection resulted in fourteen legal requirements and two good practice recommendations. Paperwork needs to be clearer and less confusing. This could be achieved by archiving old information from all files, sectioning up residents files, and having one clear assessment document, which is easily accessible. Also to have one clear care plan which can be updated and which is easily accessible. And to have clear review paperwork, going back for just a few reviews, to support and inform the care plan. The manager needs to address the training issue with the sleep in staff and also to ensure that she records appropriately. Control of Substances Hazardous to Health (COSHH) regulations must be followed with substances stored appropriately and information about them kept. Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 9 Poisons in the home must be locked away and information kept about what to do if they are spilt. The overnight sleep in staff must have the same training as other staff. Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 10 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. The summary of this inspection report can be made available in other formats on request. Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 11 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.V348031.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People experience adequate quality in this outcomes area. This judgement has been made using available evidence including a visit to this service. Assessment is adequate but the information is hard to locate. EVIDENCE: The service has recently provided a respite break to an individual and the inspector viewed the assessment information which had been gathered prior to the visit. She felt that this was sufficient for the planning of the stay. The inspector also viewed the assessment information in the files of the two permanent resdients. There was a wealth of assessment information, but this was distributed over, care planning and risk assessment documents as well as assessment documentation. The inspector has asked the manager to locate the assessment information as far as possible in the assessment document with a clear section of the file dedicated to this. She has asked her to archive old assessment (see requirements). Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. People experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Care planning and risk assessment were evidenced, but the paperwork was confusing and needs to be separated into documents and sections. EVIDENCE: The inspector viewed the care plans on the two residents files. There were a number of different care plans on each file, in varying formats, going back over years. There were also many reviews recorded. There was a wealth of care planning information, but it was difficult to go straight to the upto-date current care plan. There was no section in the file for care planning. Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 14 As mentioned above, there was evidence of regular reviews. The manager has not been in the practice of updating the care plan after a review, to make it a living document. The inspector explained how this can be done and asked the manager to adopt the practice. If a review does not indicate any change to the care plan then this should be stated on the record and signed off by the manager. The inspector asked the manager to have one section of the file where the current care plan information is kept. She asked the manager to archive all the old assessments, care plans and reviews (see requirements). The inspector noted that there were many documents in the files which were either undated or unsigned or both. She asked the manager to ensure that the practice of dating and signing all documents is adopted (see requirements). The manager explained that the practice of the home is to talk through with residents what is planned for each day, on the day. If a service user wants to change the plan this is possible. The inspector felt it would be very helpful to residents to have a weekly activity timetable, and this is discussed later in the report. The manager was able to cite areas where residents make their own decisions. They choose their own meals, clothes and holiday locations. The home has residents meetings, minutes of which the inspector viewed. Issues discussed included food and holidays and activities. Service users are supported to take risks as part of an independent lifestyle. Both service users are vulnerable in the community and the manager described to the inspector how the activity of swimming has been made safer with the co-operation of the pool staff. One service user is able to visit the corner shop with her boyfriend who has well developed skills of independence.. There was evidence of individualised risk assessment on the files of service users. At times this was mixed up with assessment and care planning documentation. The inspector has asked the manager to keep risk assessment documentation separate and in its own section of the service user file (see requirements). Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. People experience good quality in this outcomes area. This judgement has been made using available evidence including a visit to this service. Residents take part in appropriate educational, leisure and recreational activities. They have a community presence and are supported to maintain relationships. Residents enjoy their food and mealtimes together. EVIDENCE: The manager has a background in teaching and both residents and staff benefit from this. The residents have structured programmes designed to improve their skills over a range of areas. Communication is a major focus and the inspector heard of the considerable progress, which has been made by both residents during their time at the home. The residents attend a day centre two days a week where they participate in community activities. They also enjoy swimming, library and trips to places Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 16 like St Katherines dock. The residents go out every Friday for a recreational outing. They attend an evening club once a week and also other social events. The inspector suggested that the residents each have a timetable (to be made as user friendly as possibly over time), which shows the activities of the week ahead for them visually. The manager said staff are already working on this. Both residents have some family but neither has much contact with them. The home supports and encourages contact and the maintenance of family relationships. One resident has a boyfriend and although the relationship is at times stormy, it is an important relationship for the resident and is supported by the home. Residents appeared very relaxed in the house. They interacted comfortably with staff and the inspector noted a resident sitting in the garden with a staff member enjoying some writing activity. The inspector felt from the reading of much documentation that privacy, dignity and respect were values which are upheld at the home. The manager said that as the home is so small, menu planning is a verbal activity. She said that carers know the food the residents like and if they fancy something different they will ask for it. Discussions about food are supported with a picture book, which the inspector viewed. The inspector viewed the recording of food eaten by residents. It seemed quite varied and healthy. She was told that residents get involved in the preparation of meals and one in particular loves to cook. Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 and 20. People experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Personal, emotional and physical support needs are understood and met. Some improvements have been identified for medication practice EVIDENCE: Both of the resident have been at the home for several years and their support needs are well known to the manager and staff. They are also outlined in care plans. The manager stated that privacy and dignity are covered in staff induction. The inspector noted that one resident took a bath quite independently whilst the inspection was in progress. The manager stated that both residents need behaviour support and this is a main part of their support needs. The inspector saw much evidence of work to Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 18 support behaviour and felt that it was skilled. Strategies are well thought out and designed to empower residents to behave appropriately. The health needs of the two residents are well understood. One resident has epilepsy which causes her to have petite mal seizures. These are well controlled on medication. One service user has sensory losses. She also has Downs syndrome and the manager was very aware of the possible health implications of this. One resident is threatened with obesity as her weight has climbed steadily. The care plan is to discourage fattening foods and to encourage healthy food. This sometimes triggers challenging behaviour in the resident. The inspector suggested the manager make a referral to the dietician for advice and assistance. Both residents have health action plans. There was evidence that residents have been supported to attend health appointments and the inspector felt that the manager had a very good understanding of their health needs. The inspector viewed the arrangements for the administration of medication. One resident takes one preparation twice a day. Medication is kept in a locked cupboard in the kitchen. The inspector informed the manager that the key should be kept on the person who is in charge on any shift. The Medication Administration Record (MAR) sheet is kept in a kind of day folder along with other frequently needed records. The inspector asked the manager to put it in its own section clearly marked Medication Records. There was no photograph of the person needing the medication and the inspector asked the manager to affix one to the front of the documentation. The MAR sheet of a respite resident no longer in the home had been retained in the day folder. The inspector told the manager this must be filed away in the file of the resident. The home does not keep a record of medications IN and OUT of the home. The inspector asked the manager to introduce such a book. When medication is returned to the pharmacy the signature of the pharmacist must be obtained in the book. The inspector could not check the remaining stock of the medication because there was no record of when it had been started. She asked the manager to write on the MAR sheet the number of tablets started on what date. In this way the manager will be able to audit the medication and so will the inspector (see requirements). Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 19 Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents views are held to be important and residents are protected from abuse. However the management of finances needs to be safer and more empowering. EVIDENCE: The inspector saw blank complaint forms in the day folder. The home does not keep a complaints book. The manager said that informal complaints from residents are discussed verbally with them. The inspector viewed the policy for the protection of vulnerable adults. It requires a small amendment to state that it must be followed in conjunction with the local authority policy (see requirements). The inspector viewed the arrangements for the management of residents finances. Currently the system covers rent money and spending money and basically service users run up a debt to the manager of several hundred pounds. Periodically the manager repays herself from their bank accounts. Service users are given small amounts of money as when it is perceived that they need it, and have no access to any other pocket money. Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 21 The inspector told the manager the above is not a suitable arrangement and could lead to all kinds of financial complications. The inspector suggests that the rent money is transferred separately and that the manager withdraws a months pocket money for residents which they can keep in a purse in the home. Access can be supervised but the residents have choice about their own spending money and are able to see it visually and handle it if they want to. This would be more realistic for them than the above rather abstract arrangement (see requirements). Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The environment is clean and hygienic and provides a comfortable home for the residents. However there is an issue over access for inspectors, and a need to give residents the opportunity to relax downstairs. EVIDENCE: The inspector made a tour of the premises including one residents bedroom, and the garden. She was not allowed access to the night staff sleep in room, which was locked. Regulation 23 (3) (b) of the Care Homes Regulations states: (3) The registered person shall provide for staff:Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 23 (b) sleeping accommodation where the provision of such accommodation is needed by staff in connection with their work at the care home. The means that the sleep in room is part of the registered premises and as such must be open for inspection. If the room were not part of the registered premises it would have to have a separate entrance and no interconnection with the rest of the home. This is not the case. The manager must ensure that she has a key to the sleep in room available for the next inspection by the commission. The house provides a homely environment for residents but the inspector was concerned about two aspects. There is a television in the kitchen but no television in the lounge. The manager described this room as a quiet room. It had the appearance of a room little used and kept for best. The inspector was told that residents retire to their rooms usually at around 8p.m., where they have their own televisions, which they watch. The inspector felt that residents should be able to sit downstairs in their own lounge and watch television in the evenings as most people do. The manager has been asked to install a television in the lounge (see requirements). Another aspect of the home which concerned the inspector, was the décor. The décor is in a reasonable condition but apart from their bedrooms has not been chosen by the residents. The home has many attractive pictures hung, but again they are not the choice of the resident and reflect the managers taste. The inspector emphasised to the manager that the residents should have the right to imprint their own personalities on their home and should be encouraged to do this. She suggested it would be nice to have some photographs of the residents on the walls apart from in their bedrooms (see recommendations). In addition there were two other necessary improvements noted. Old cupboard and buckets to be removed from the garden. Upstairs toilet needs some refurbishment. A lampshade needs replacing on the upstairs landing. The home was clean and hygienic. The manager stated that there is no foul laundry and there are no issues around the control of infection. Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35, and 36. People experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Recruitment is safe and supervision satisfactory, but there is a shortfall in training practice. EVIDENCE: The inspector asked the manager to describe her recruitment process, which sounded safe, robust and anti-discriminatory. However the manager records very little of the interviews she conducts which tend to be informal and spread over a number of visits. They cannot therefore be said to provide equal opportunity. The inspector suggested the manager take some notes of these interviews. The staff group is tiny as the home is so small but the inspector felt that the staff group reflects the cultural diversity of the local area. The inspector viewed two staff files. These were kept in plastic wallets in a lever arch file, which contained personnel information for previous workers. Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 25 The inspector asked the manager to separate current staff files from previous staff and archive previous staff records. The file for one staff member had no photograph of her on the front and the inspector asked the manager to affix one. The file contained two references a completed application form and health questionnaire and a Criminal Records Bureau (CRB) check along with some training certificates. The other staff file contained the same recruitment documentation. The inspector felt that recruitment is safe. As previously mentioned the inspector viewed two staff files. With regard to training, the first worker had undertaken training in Manual Handling 2005, Health and Safety 2005, First Aid 2005, Adult Protection 2006, Challenging Behaviour 2006 and Food Hygiene 2006, She has also done training in Fire in 2007, Adult Protection in 2007 Food Hygiene in 2007. The worker told the inspector she had undertaken induction training and was also working through a training manual which she produced. The inspector was satisfied that this worker is receiving sufficient training. The second worker had undertaken training in Recruitment and Induction in 2005, Risk Assessment in 2005, Food Hygiene in 2005 and Special Educational Needs in 2005. The manager stated that the worker had had induction into the home, but there was no evidence of this. The manager and inspector agreed that workers should undertake the following: Homes Induction training *Health and Safety *Food Hygiene *Manual Handling *Adult Protection First Aid Fire And that the starred training courses should be refreshed annually. The inspector is concerned that the second worker has not undertaken Adult Protection training, Health and Safety, Manual Handling, First Aid or Fire. The manager stated that this worker works every night as the sleep in staff and has permanent accommodation at the home. She also undertakes occasional shifts during the day. She also stated that as the second worker is a qualified teacher she feels she need not undertake any additional training. Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 26 Unless the second worker can produce certificates to show that she has undertaken the necessary training elsewhere, the situation is not acceptable. A requirement has been made (see requirements). The inspector viewed the supervision records for the two staff and noted that supervision was of a satisfactory regularity. She noted from the recording that the sessions are not particularly interactive and suggested to the manager that she might draw the supervisee out more. The inspector also noted that the manager had repeated on three occasions that she wanted the sleep in night worker to be more interactive with the residents in the evening. If the worker is reluctant to comply with instructions the manager might consider starting a disciplinary process (see recommendations). Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 41 and 42 People experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. There is comprehensive self-monitoring but limited mechanism for collecting views from residents and stake holders. There are two areas for improvement under health and safety. EVIDENCE: The manager and inspector discussed quality assurance. The manager stated that she undertakes an audit of her own systems twice a year and she produced supporting documentation. The home is currently undertaking work for the investors in people award. Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 28 Regular residents meetings are held as previously stated. The manager said that she would like to survey the residents about their views of the home but feels an independent advocate must be involved in the work. To date she has not been successful in identifying the advocate. The inspector said that she would consider using an Expert by Experience to enhance the next inspection. The policies and procedures for recording in the home are quite sound. However the sleep in night staff is not following them and does not complete any documentation for her night shift. Should she undertake a day shift, which happens occasionally she records nothing for this. The sleep in night staff must record appropriately after all her shifts (see requirements). As previously mentioned in the report, the inspector (and sometimes the manager) found it difficult to locate and view much of the documentation. Filing tended to be rather miscellaneous and files contained much mixed information. The home keeps a day folder with all kinds of records from refrigerator temperatures to medication. It is acknowledged that the home is very small and space limited. However the manager must archive old material and divide files clearly to make things easier to find and reduce the likelihood of error (see requirements). The inspector viewed the records for safety in the home. A Fire Assessment had been done by an outside agency on 25/07/07. Fire systems had been checked on 20/01/07. The manager stated that the home has no fire alarm system as such but that the smoke detectors are tested regularly. Emergency lighting is tested once a month and the inspector viewed the record for this PAT testing had been done on 10/07/07. Gas inspection was done on 20/06/06. The home checks the temperatures of the fridge and freezer every day. The inspector viewed the contents of the refrigerator and noted that the practice of labelling food with an opened on date is not followed. The manager confirmed this and said she did not feel it was necessary (see requirements). The inspector observed that COSHH products had been left on the window ledge of the office. These included Tesco Power Universal Cleaner, Rose Clear and slug pellets (garden products). The manager also keeps cleaning agents in a little unlocked chest in the conservatory. She stated that she has no locked storage for COSHH products although she showed the inspector some data sheets which she had created. COSHH products must be in a locked Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 29 cupboard and data sheets for every product must be stored (see requirements). Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 30 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 2 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 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x x x 3 x 2 2 x Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO NO 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 YA2 Regulation 14 Requirement The assessment information must be located in the assessment document with a clear section of the file dedicated to this. Out of date assessments must be archived. A current up-to-date care plan must be accessible on the file. Timescale for action 01/10/07 2. YA6 15 01/11/07 3. YA6 15 Old care plans must be archived. Recent reviews should be located 01/11/07 in their own section of the file. Old reviews must be archived. All documents must be signed and dated. Risk assessment documentation must be kept separate and in its own section of the service user file. 1.The key to the medication cupboard must be kept on the person in charge of the shift at all times. 2. The section of the day folder which pertains to medication administration must be clearly 01/09/07 01/10/07 4. 5. YA6 YA9 15 13 6. YA20 13 01/09/07 Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 32 marked as such. 3.The MAR sheet should be prefaced by a sheet with a photograph of the person who is to receive the medication. 4. The medication administration record must only contain MAR sheets for residents currently in the home. Any other MAR sheets should be filed away in the file of the individual. 5. An IN and OUT book for medication must be introduced. 6.The signature of the pharmacist must be obtained when medication is returned to the pharmacy. 7.When stocks of medication are received, in addition to entering them in the IN and OUT book a note should be made on the MAR sheet of how many tablets were started when. This will make it possible to audit stock. The adult protection policy must be amended to state that it will be followed in conjunction with the local authority policy. 1.The manager must keep her own and residents monies quite separate. 2. Residents should have access, with supervision, to their own pocket money. 1. The sleep in room must be open to inspection. 2. A television must be installed in the residents lounge. 3. The old cupboard and buckets to be removed from the garden. 7. YA23 13 (6) 01/10/07 8. YA23 13 01/10/07 9. YA24 23 01/11/07 Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 33 4. Upstairs toilet needs some refurbishment. 5. A lampshade needs replacing on the upstairs landing. All staff working at the care home must undertake training appropriate to the work they are to perform. The sleep in night staff must record appropriately after all her shifts Old material must be archived, and files divided clearly to make things easier to find, and reduce the likelihood of error. All opened food stored in the refrigerator must be marked with the date of opening. COSHH products must be stored in a locked cupboard and data sheets must be kept for all products stored. 10. YA35 18 (1)(c)(i) 17 17 01/01/08 11. 12. YA41 YA41 01/09/07 01/12/07 13. 14. YA42 YA42 12 12 01/10/07 01/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA24 YA36 Good Practice Recommendations It is recommended that the residents are encouraged to choose décor and ornamentation for the home. The inspector suggests that supervision sessions might be more interactive. Also that if a worker is reluctant to comply with instructions disciplinary measures might be considered. Essex House DS0000007343.V348031.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 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 © 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.V348031.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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