Inspection on 08/04/08 for Essex House

This inspection was carried out on 8th April 2008.

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

Other inspections for this house

Essex House 06/08/07

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 Unannounced Inspection 8th April 2008 09:40 Essex House DS0000007343.V361678.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.V361678.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.V361678.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.V361678.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th August 2007 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.V361678.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. The inspection was undertaken by one inspector. It was however undertaken on behalf of the Commission for Social Care Inspection (CSCI). The term we will therefore be used throughout. We attempted to undertake an unannounced inspection of the home but found no-one home on two occasions. This was therefore an announced key inspection which took place over two half days. We spoke with the two residents of the service and with staff and the manager. We looked at key documentation, records and residents and staff members files. We inspected the arrangements for administering medication and the environment of the home. What the service does well: The residents are happy and content in their home. They get on well together and with staff and the manager. The home provides a safe, secure environment where their complex needs are understood and met. The manager has been a stable figure in their lives for ten years and they trust her. A structured programme of activities is provided inside and outside of the home so that residents are well stimulated and have plenty of enjoyable experiences. The manager has worked to make documents user friendly for the residents and there is a lot of pictoral material in the home. Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The inspection resulted in 11 legal requirements, 2 of which are restated and two good practice recommendations. The home needs to develop an admission policy and procedure. The vetting of staff, before they start work must be thorough and robust. Residents care plans and risk assessment must evidence that they have been shared with them. The commission must be advised of any adverse event in the care home. All staff who administer medication must be trained to do so. Meetings held with residents must always be recorded. The business plan for the home must be updated. Opened foods stored in the refrigerator must be dated with the date of opening. Data sheets must be obtained for all Control of Substances Hazardous to Health (COSHH) substances stored. Portable appliances must be tested. Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 7 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.V361678.R01.S.doc Version 5.2 Page 8 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.V361678.R01.S.doc Version 5.2 Page 9 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 outcome area. This judgement has been made using available evidence including a visit to this service. The practice at the home for admitting a new resident would be good if undertaken now, but a policy needs to exist to guide practice. EVIDENCE: The home has not admitted a new resident for some time. It has a statement of purpose which describes in outline the procedure which would be followed should they admit a new person. We are satisfied that the present manager would undertake assessment and integration in a way which reflects good practice. We have told the manager to prepare a separate admissions policy and procedure document, to guide practice in the home (see requirements). Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 10 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 good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Individual plans and risk assessments are good but need to show that residents have shared in them. Residents make their own decisions and are well supported to do this. EVIDENCE: We looked at care plans for residents. They were comprehensive and detailed and gave good guidance for staff. One service user is able to sign her name and one is able to add her initial. We told the manager to ensure that care plans are dated and residents either sign their names on them or a sheet is added to explain how the resident shares in her plan (see requirements). Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 11 There was evidence on file of recent review of the care plan by social services with the residents and manager of the home. The manager stated that plans are reviewed every six months and there was evidence of this in the form of review dates. We are satisfied that care plans are reviewed regularly. The manager stated that residents have many opportunities in their lives to make decisions. They decide what they want to wear, what they want to eat, when they want to go to bed, what activities and holidays they want to undertake. She further explained that a variety of mediums are used to support decision making, also that body language and facial expression help staff to understand what residents are communicating. We inspected the risk assessments. These covered a variety of risks and were of an acceptable standard with risks graded low to high and strategies identified to reduce them. Again the manager has been told to ensure that risk assessments are dated and residents either sign them or a sheet is added to explain how the resident has shared in the risk assessment (see requirements). Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 12 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): People experience good quality in this outcome area. This judgement has been made using available evidence including a visit to the service. Residents have a variety of experiences and opportunities. Their relationships with others are supported. They choose their food and their mealtimes. EVIDENCE: The residents take part in a variety of activities inside and outside of the home. Their daily logs evidenced this. They attend day centres and clubs, take trips into London, go swimming, shop, go to the cinema, etc. In the home the residents take part in the domestic routines and are encouraged to be as independent as possible. We saw illustrated, user friendly weekly timetables for both residents. The residents both have some family and they are supported to have contact with them. Family are encouraged to visit and telephone. One service user Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 13 has a close friend who calls often at the house and also talks to her on the telephone. We looked at the material which is used to support residents to choose their food and meals. Some of the material is from the lending library and is changed regularly. Resident sit down with staff to look at pictures and choose what they would like to eat the following week. The manager said she knows which foods one resident likes best and that she always eats her food but eats things she really likes more quickly. Both residents love ice cream and were enjoying ice cream and banana when the inspector arrived about 4.30p.m. on the first day. One resident made herself a cup of tea afterwards. We saw the record which is kept of what residents eat each day. As well as eating at home both residents enjoy cafés and restaurants and eat out every Sunday regularly and often during the week. Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 14 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. Support is tailored to the individual and health care is good. However there is a shortfall in medication practice, and the manager has been encouraged to advocate more forcefully for the residents. EVIDENCE: The care plans which we saw were written well enough to support good individual, personal care for residents. The importance of communication is stressed and there is plenty of advice about how to be understood and to understand. One resident is independent with a little prompting and supervision. The other residents has many skills of independence in personal care, but tends to get stuck on a task and needs prompting to move on. The manager stated that both residents sleep well. Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 15 Both residents have health action plans and we looked at one of them. It was clear and comprehensive. One resident has epilepsy but there are no other health problems. The manager stated that the residents have their eyes tested every three years. We recommend that this is increased to every year even if the resident has to pay for two out of three tests (see recommendations). The residents have a dental check up every six months. The manager suspects that one resident may be experiencing some early signs of dementia. Her general practitioner has not referred her to a specialist. We recommend that the manager try to identify a consultant psychiatrist who specialises in people with learning disabilities and ask for a referral to them for assessment of the resident (see recommendations). We inspected the arrangements for the administration of medication. The manager had the key to the medication cupboard on her person. Only one of the residents takes medication and she takes it twice a day. Her photograph was with her Medication Administration Record (MAR) sheet in its own folder. The sheet was properly completed and the two dosages of medication balanced with the stock held. We saw a book where the manager records all medication received into the home. She said that they have not had occasion to dispose of medication but if they did they would return it to the pharmacy and ask the pharmacist to sign for it. There are two people in the home who administer medication. One is the manager who has had the appropriate training, and the other one is a member of staff who has not had medication training. The manager stated that the staff member administers medication in the evenings only and she leaves the tablet dispensed from the blister pack, out for her. We told the manager she must not do this as it is a form of secondary dispensing and is risky. As the administration of the medication is very straightforward, one tablet to one person once a day, we have not stopped the worker from administering medication altogether. The manager stated that she has explained medication administration to the worker. However she must ensure that the worker has medication training as soon as possible. There must be no secondary dispensing (see requirements). Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 16 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 listened to but verbal complaints should be recognized and recorded. CSCI must be notified of any adverse event occurring in the home. EVIDENCE: The home has a complaints policy with a pictoral version in the service user guide. There is also a complaints form. We looked at the complaints and compliments folder. We noted several handwritten letters thanking the home and praising the care given to the resident. There were no complaints. We discussed with the manager what would constitute a verbal complaint. She stated that a resident had said that her television was broken. We said that this would be a complaint and should be recorded along with the action taken to rectify the matter (see requirements). The home has an adult protection policy and this has been amended to refer to the local social services policy. the home has a copy of this. Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 17 The manager explained how the residents finances are safeguarded and how they are given access to their monies. Residents monies are kept separately. We are satisfied with the measures which have been taken to safeguard residents monies and that they have access to their money with supervision. The manager stated that a regular visitor to the home maliciously damages it at times, usually by breaking glass in the front door. She said that this was why we found sheets of broken glass in the front garden. We told the manager that this type incident is an adverse event and must be notified to CSCI (see requirements). Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 18 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 good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home environment is clean hygienic, comfortable and generally safe. EVIDENCE: We called at the service twice finding no-one home. We then arranged the inspection time and date. On the second visit to the service we noted sheets of broken glass at the side of the porch in the front garden, and a window left open at the front upstairs. We informed the provider by e-mail that the glass should be disposed of immediate, and the open window was a security risk. When we returned to the service at the arranged time and date, the glass had been removed and residents and staff were at home. We inspected the home environment including, with their permission, the residents bedrooms. The environment is homely and comfortable and the Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 19 residents both said that they like their bedrooms. The bathroom facilities are more than adequate. A second bathroom has been created and one of the toilets upstairs has been turned into a shower. A television has been provided in the lounge and the owner has turned the annexe room under the stairs into an office and sleep in room. There are no infection or hygiene issues in the home. It is clean and fresh with no unpleasant odours. Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 20 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): 32,34,35 and 37. People experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents are competently supported, trained and supervised staff, but the homes recruitment practice has fallen short. EVIDENCE: We inspected the staff files including looking at recruitment practice, qualifications and training and supervision. The recruitment process is generally sound however one worker is working at the home without a Criminal Records Bureau disclosure (CRB) in the name of the home, and also she has had no Protection of Vulnerable Adults check. The manager was told that the worker must not return to the home until she has both of the above. She agreed to this (see requirements). The staff at the home are competent to meet the needs of the service users. One has NVQ 2, and one has NVQ 2 and 3. The manager keeps a clear record Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 21 of training . The level of training is satisfactory with the exception of medication training, which has been addressed above. The manager stated that she aims to supervise staff six times per year. The supervision notes were signed and dated and evidenced this frequency and regularity. Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 22 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): 37, 39 and 42. People experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home is generally well run but more can be done to ensure quality and to protect the health and safety of residents. EVIDENCE: The managed did her registered managers award several years ago. She is an NVQ assessor. The manager runs the home fairly. Most necessary systems are in place but need to be adhered to at all times. The manager demonstrates leadership and models good one to one practice. She stated that she encourages workers to actively stimulate the residents, especially one who is inclined to be a little passive. Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 23 The manager stated that a weekly meeting is held for residents but the records did not evidence this. The manager stated that the meetings have happened but not always been recorded (see requirements). The manager stated that she has a business plan but that it needs to be updated (see requirements). We looked at the contents of the refrigerator. There was an opened jar of mayonnaise and an opened jar of peanut butter. Both of these should have had opened on dates of them (see requirements). We inspected the arrangements for the storage of Control of Substances Hazardous to Health (COSHH). The substances are stored in a locked cupboard. There is only one data sheet and the manager must obtain data sheets for all the COSHH products (see requirements). Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 24 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 2 23 2 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 1 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 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 3 x 2 x 3 2 x Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES 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 appdx 3 15 Requirement Timescale for action 01/07/08 2. YA6 2. 4. YA9 YA20 13 13 The manager must develop a policy and procedure to guide admission to the home. 01/07/08 The manager must evidence that 01/07/08 residents have been consulted regarding their care plans. The manager must evidence that 01/07/08 residents have been consulted regarding their risk assessments. The care worker who administers 01/05/08 medication must be trained as soon as possible. There must be no secondary dispensing of medication. The manager must record verbal complaints and their outcomes as well as written ones. Any event which adversely affects the residents of the home must be notified to CSCI. Workers at the home must have a clear CRB disclosure and a clear POVA check before starting work there. Records must be kept of all residents meetings. The manager must develop an updated business plan. DS0000007343.V361678.R01.S.doc 5. 6. 7. YA22 YA23 YA34 13 37 19 01/07/08 01/05/08 01/05/08 8. 9. YA39 YA39 24 24 01/07/08 01/07/08 Essex House Version 5.2 Page 26 10. YA42 12 11. YA42 12 All opened food stored in the 01/07/08 refrigerator must be marked with the date of opening (previous timescale of 01/10/07 not met). Data sheets must be kept for all 01/07/08 COSHH products stored (previous timescale of 01/10/07 not met). 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 YA19 YA19 Good Practice Recommendations We recommend that residents have an annual eye test, even if they have to pay for two of them. We recommend that the manager pursue specialist psychiatric assessment for the resident whose intellectual needs appear to be changing. Essex House DS0000007343.V361678.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection London Regional Contact Team Caledonia House 223 Pentonville Road London N1 9NG 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.V361678.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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