Inspection on 08/08/05 for Evelyn House

This inspection was carried out on 8th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Evelyn House 18/01/07

Evelyn House 03/09/04

Evelyn House 13/04/04

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 Evelyn House 221 Devonshire Hill Lane London N17 7NP Lead Inspector Peter Allcock Unannounced 08 August 2005 @ 09.00 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Evelyn House Address 221 Denvonshire Hill Lane, London, N17 7NP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8888 1649 Mrs Evelyn McVeigh Sylvester Lloyd PC Care Home only 5 beds Category(ies) of LD - Learning Disability registration, with number of places Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named individual whose date of birth is 22/09/1949 and who has a diagnosed mental disorder is permitted to remain in this home. That person may occupy one of the three places allocated to adults with a learning disability. Date of last inspection 03 September 2004 Brief Description of the Service: Evelyn House is a small residential care home situated in Tottenham North London, near to A10 the North Circular Rd and close to Tottenham High Rd and Wood Green shopping centre, New River sports centre and Alexandra Park are close by. Evelyn House has a lounge area, a kitchen and a small toilet and bathroom that is situated on the first floor. The home provides 24-hour care for up to three service users with learning disabilities between the ages of 18 and 65 and of mixed gender. Evelyn house was first registered in October 2001 with Haringey Inspection Unit as a small care home.The registered provider is Mrs Evelyn McVeigh who also operates Manor House, an adult placement scheme home in Tottenham. The service user group are of mixed ethnic origin, one service user is Ghanaian and the other is Turkish and the home is able to support them on activities in the home and in the community. The home provides twenty-four hour care and support and access to a range of residential specialist services geared towards meeting individual service users needs. Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken on an unannounced basis and took place between 10:30 am and 11:40am. The inspector was shown around the building, discussed care practice with the member of staff on duty and examined records kept in the home. The inspector also spoke briefly to the registered provider who was dropping off one service users medication, and also to the registered manager by telephone. The primary aim of this inspection was to assess the welfare of the homes twoservice users, and to check whether requirements made at the last inspection had been addressed. It was not possible to assess compliance with all the requirements made at the last inspection. The inspector plans to address this at a future inspection visit. What the service does well: What has improved since the last inspection? What they could do better: At the last inspection there were a total of twenty requirements. The absence of the registered manager meant that it was only possible to assess compliance with eleven of these requirements, and of these four have not been met and are restated in this report. This requirements concern the recording of complaints, the repair or replacement of the fax machine, and amendments to the statement of purpose. A further restated requirement is that accidents are appropriately recorded and that accidents in the home are monitored and any required action as a result is undertaken. A new requirement is made that the registered person must ensure that there is sufficient food in the home at all times. Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 6 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. Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 The ability of prospective service users to know about the service on offer is reduced by the absence of all the required information in the home’s statement of purpose. EVIDENCE: At the last inspection it was required that the registered person must amend the statement of purpose to include the dimension of the lounge, kitchen/dining room and the bathroom as set out in Regulation 4(1)(c) Schedule 1.16 of the Care Homes Regulations (CHR) 2001. This requirement is restated as examination of the statement of purpose shown to the inspector by the member of staff on duty showed that this information had not yet been included. Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 Service users are supported by a plan of care based on an appropriate assessment of their needs. EVIDENCE: The service user care plan examined at the last inspection included an appropriate risk assessment and a record of individual needs, aspirations and goals. Compliance with a requirement made at the last inspection with regard to an appropriate accounting procedure for service users monies held in the home was not assessed in the absence of the registered manager who would have this information. Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 15, 17 Service users benefit from the opportunities for personal development afforded by their attendance at appropriate day centres, and from the maintenance of relationships that are important to them. The ability of service users to enjoy a healthy diet and to exercise choice in the food that they eat is restricted by the limited quantity of food available in the home. EVIDENCE: On the day of this inspection, one service user was attending a day centre and the other had been taken out shopping and then for lunch with a member of staff. The member of staff on duty told the inspector that one service user attends a day centre. The second service users attends a day centre and also spends one day a week at college. Records in the home showed that one service user had recently been to the family home for five days, and that representatives of the placing authority had visited service users recently. There was only a small amount of food available in the home on the day of this inspection, with peas, corn and two types of meat available in the freezer, and Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 11 tinned vegetables (tomatoes, spaghetti and baked beans and kidney beans) in one kitchen cupboard. There was only one packet of cereal available in the home. The registered person must ensure that there are adequate stocks of food available in the home at all times to meet the needs of service users and promote the opportunity for choice. There was an appropriately stocked first aid kit in the office. Compliance with requirements made at the last inspection with regard to appropriate insurance for the homes vehicle and procedures for the governance of its use were not assessed in the absence of the registered manager, who would have access to this information. Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 Service users safety is compromised by the lack of appropriate training and management oversight of the recording of accidents in the home. The home has systems in place for the administration of medication which offers service users protection. EVIDENCE: At the last inspection it was required that the registered person must ensure that all care staff are given clear guidance on how to complete the home’s accident/incident forms. This is to be reviewed with care staff regularly. All accident/incident records are to be reviewed by the registered person ensuring that the correct information is recorded and if there is/are any further action/s to be followed they are to be recorded on the form in the appropriate section. This requirement is restated, as no evidence was made available to the inspector that this had been undertaken. One service user currently resident in the home receives regular medication, and the record of administration was seen to be complete. The member of staff on duty told the inspector that a doctor regularly reviews this medication, and that the service user was not able to administer their own medication. Medication was stored appropriately in a lockable cabinet. During this inspection the registered provider arrived with more medication, which the member of staff on duty entered onto the homes records. The member of staff Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 13 on duty told the inspector that she had received training on the safe handling of medication. Compliance with a requirement made at the last inspection with regard to training for staff who administer medication was not assessed in the absence of the registered manager who would have this information. Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The lack of the appropriate recording of complaints cannot give service users confidence that their views are listened to and acted upon. EVIDENCE: The inspector was asked to sign the visitor’s book on entering and leaving the home. The record of complaints showed that there have been no complaints made in the home since the last inspection. The inspector is aware of a complaint from a neighbour and this was not recorded. The registered manager must ensure that all complaints received are recorded. Compliance with a requirement made at the last inspection with regard to the provision of adult protection training was not assessed in the absence of the registered manager who would have this information. Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 30 Generally the homely environment in which service users live could be improved by the completion of outstanding repairs. The health and safety of service users is generally well managed. EVIDENCE: Records in the home showed that fire equipment had been regularly serviced, and that fire drills are carried out on a monthly basis. At the last inspection, a requirement was made that certain items of repair are carried out. This requirement is restated in part, as the following items remain outstanding: • • • • Plasterwork around the door to bedroom four requires repair Radiators throughout the home require a cover and independent thermostatic control Curtains in the home must be fire retardant The polystyrene ceiling tiles in the bathroom must be replaced. Following a requirement made at the last inspection, the registered provider has built a separate enclosed laundry area, and Control of Substances Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 16 Hazardous to Health (COSHH) materials are now stored appropriately in the laundry in a locked metal cabinet. The home was clean and tidy on the day of this inspection. Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 Service users know that there are sufficient staff on duty to meet their needs. EVIDENCE: It was not possible to access staff records during this inspection as the registered manager was out of the home. The rota on display in the office showed that there are two care staff on duty between 7am and 10 am during the week, and at all other times there is one member of staff on duty. A member of staff sleeping in provides night cover. The member of staff on duty told the inspector that the manager has a mobile phone and is always contactable. The member of staff on duty told the inspector that she held a CRB disclosure from her previous employment, which was less than three years old, and that she had recently re-applied to the Criminal Records Bureau for a further disclosure. Compliance with a requirement made at the last inspection with regard to the training of staff in the control of infection was not assessed in the absence of the registered manager who would have this information. Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Service users benefit from systems in place in the home to promote their health and safety. EVIDENCE: The member of staff on duty told the inspector that staff always have access to the office so that working documents can be referenced or recordings made as necessary. A current certificate of employers liability insurance was displayed on the office wall. The requirement made at the last inspection as to the repair or replacement of the fax machine has not been undertaken and is restated in this report. Compliance with a requirement made at the last inspection with regard to the policies and procedures of the home was not assessed in the absence of the registered manager who would have this information. Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x x x Standard No 22 23 ENVIRONMENT Score 1 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 2 x x x 3 3 1 Standard No 31 32 33 34 35 36 Score x x 3 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Evelyn House Score x 2 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 20 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 1 Regulation 4[1][c] Schedule 1.16 Requirement Timescale for action 30/09/05 2. 17 16[2][i] 3. 19 37 4. 22 22 The registered person must amend the statement of purpose to include the dimension of the lounge, kitchen/dining room and the bathroom as set out in Regulation 4(1)(c) Schedule 1.16 of the CHR 2001. (Previous timescale of 30/10/04 not met) The registered person must 08/08/05 ensure that there are adequate stocks of food available in the home at all times. The registered person must 30/09/05 ensure that all care staff are given clear guidance on how to complete the home’s accident/incident forms. All accident/incident records are to be reviewed by the registered person with care staff to ensure that the correct information is recorded and if there is/are any further action/s to be followed that they are recorded on the form in the appropriate section. (Previous timescale of 30/10/04 not met) The registered person must 08/08/05 ensure that all complaints are recorded. Version 1.40 Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Page 21 5. 24 23[2] 6. 35 18(1)(c) 7. 23 13(6) 8. 7 16(2) 9. 11 13 10. 20 18 The responsible person must ensure that the items of repair described in this report are undertaken. This requirement is restated The Registered Person must arrange for all care staff within the home to undertake training in Infection Control. In the absence of the Manager the inspector was unable to follow up whether this requirement had been met. The Registered Person must ensure all care staff undertake training in adult protection procedures and once completed evidence of this must be available. This requirement is restated from previous inspections. In the absence of the Manager the inspector was unable to follow up whether this requirement had been met. The Registered Person must ensure that a clear and precise accounting procedure is in place with regards to individual service users personal monies held by the home.This requirement is restated from previous inspections. In the absence of the Manager the inspector was unable to follow up whether this requirement had been met. The Registered Person must have in place a valid certificate of vehicle insurance in place and appropriate policies/procedures in place for staff who use the homes vehicle.In the absence of the Manager the inspector was unable to follow up whether this requirement had been met. The Registered Person must ensure all care staff that administer medication undertake medication training. Evidence 30/10/05 30/11/04 30/11/04 30/10/04 30/10/04 30/11/04 Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 22 11. 40 17 that this has taken place must be available for the purpose of inspection. In the absence of the Manager the inspector was unable to follow up whether this requirement had been met. The Registered Person must ensure that all the policies and procedures in the home are relevant to the specific client group ( ie adults 18-65 years of age). In the absence of the Manager the inspector was unable to follow up whether this requirement had been met. 30/11/04 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations There are no good practice recommendations made following this inspection. Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road London, N14 6HA 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 Evelyn House G59 S10793 Evelyn House V240784 08.08.05 Stage 4.doc Version 1.40 Page 24 - 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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