Inspection on 15/05/06 for Lower Clapton Road (Flat 1)

This inspection was carried out on 15th May 2006.

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

Other inspections for this house

Lower Clapton Road (Flat 1) 08/01/08

Lower Clapton Road (Flat 1) 09/10/06

Lower Clapton Road (Flat 1) 25/07/05

Lower Clapton Road (Flat 1) 13/04/05

Lower Clapton Road (Flat 1) 25/10/04

Lower Clapton Road (Flat 1) 24/05/04

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 09/07/2008.

CARE HOME ADULTS 18-65 Lower Clapton Road (Flat 1) Flat 1 219 Lower Clapton Road Hackney London E5 8EH Lead Inspector Sandra Jacobs-Walls Unannounced Inspection 15th May 2006 10:00 Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 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 Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 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. Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lower Clapton Road (Flat 1) Address Flat 1 219 Lower Clapton Road Hackney London E5 8EH 020 8986 1876 020 8986 1876 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) Hackney Independent Living Team Ms Jennifer Johnson Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th July 2005 Brief Description of the Service: Lower Clapton Road (Flat 1) offers support, personal care and accommodation for a maximum of four service users who have learning difficulties. Some of the current service users are physically disabled and are living with complex health conditions. The home is situated within a modern small complex of flats at a busy intersection near Clapton Pond within the London Borough of Hackney. The home has good bus links and is within walking distance of local shops, and amenities including a post office. Hackney Independent Living Team, (HILT) manages the home, which is a voluntary sector provider of care services. Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of Hackney Independent Living Team (HILT) Lower Clapton Road, Flat 1 home was conducted on May 15 2006 for the duration of 4.5 hours. The purpose of the inspection was assess the home against key National Minimum Standards and to review the home’s progress in addressing outstanding requirements made at the last inspection conducted in July 2005. Assisting with the inspection process was the home’s deputy manager as the registered manager was not on shift that day. The inspection process included discussions with management, the review of one service user file in detail, the review of six staff personnel files, an accompanied tour of the premises, the review of key documents and policies and discussions with staff. As a result of the inspection ten requirements and two recommendations were made. The inspector would like to thank all service users and staff who co-operated and contributed to the inspection What the service does well: What has improved since the last inspection? The service continues to operate at similar levels as noted at the previous inspection. The inspector observed however that a significant amount of repair Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 6 and decoration had been completed to the home’s environment, making the home’s premises more homely and comfortable. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Information available to assist prospective service users with choice of home is in need of improvement EVIDENCE: No new service users had been admitted to the home since the last inspection. The previous inspection had highlighted the need for the home’s Statement of Purpose and Service User Guide to be revised to include amended information regarding the home’s complaints procedure. The inspector reviewed both documents, which were yet to be revised. The requirement is therefore repeated. Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Individual needs are generally well met, although information on file needs to be kept current. Choices available to service users are good. EVIDENCE: The inspector reviewed in detail the case file for one service user living at the home at the time of the inspection. While documentation was fairly comprehensive, the inspector noted that there was no current assessment or care plan in place. This was despite a review meeting having taken place in February 2006. Hand written notes were on file, but no record of review decisions or an updated care plan despite clear documentation of the deterioration of the service users health condition over the last year. The file also failed to contain updated risk assessments. The deputy manager informed the inspector that the service was in the process of updating all service user risk assessments and was yet to complete a new risk assessment for the service user whose file the inspector had reviewed. The inspector saw good evidence to suggest that service users were encouraged to participate in the decision making process. There was clear written guidance on file outlining the likes and dislikes of service users in relation to many aspects of their daily living. This was particularly true of Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 10 decisions in relation to meal choices, activities external to the home, like church attendance and contact with family and friends. Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12,13,15,16 & 17 Service users’ lifestyles are generally good EVIDENCE: Service users were encouraged to participate in appropriate activities of generally their choice. However, the inspector was concerned that the level and creativity of these activities had generally remained the same for a number of years and did not encourage the personal development of service users. The inspector was aware of some service users having access to HILT’s occupational team, who on a weekly basis escorted service users out into the community. On the day of the inspection one young man was preparing to go on a trip and was clearly excited by this prospect. Other service users appeared to have a less opportunity to access new experiences when not out with the occupational team and largely remained in the home watching television. The inspector had observed this on a number of occasions in the past for two service users in particular. The home should consider devising more stimulating activities for service users when in the home. The inspector was satisfied that service users largely maintained good contact with family and friends and that their rights were well respected. The deputy Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 12 manager told the inspector that menu choices were decided upon on a weekly basis with service users. Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Service users’ personal and health care needs are well met. EVIDENCE: The inspector saw on file the careful monitoring of the health care needs of the service user who was living with a degenerative neurological condition. There was good documentation that offered guidance to staff of the service user’s management of his condition and appropriate safeguards were in place, although not particularly current. Information about the service user’s medical condition was displayed in the office space and assessments made reference to specific needs. All service user files have a healthcare section that identified health and medical needs, how these were to be monitored and actioned. Medical and health care appointments and their outcomes were well recorded. The inspector reviewed in detail the medication information available for one service user and was satisfied that the home’s administration of service user medication was sound. The service user file reviewed had good documentation of precisely how the service user preferred personal care tasks to be performed. Records were sensitively written and appropriately detailed offering staff relevant guidance. Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 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 the following standard(s): 22 & 23 The management of concerns, complaints and protection are in need of improvement. EVIDENCE: The deputy manager informed the inspector that no complaints or allegation /actual incident of an adult protection nature had occurred since the last inspection. The inspector was aware and discussed a complaint made against the home since the last inspection that related to the home’s heating system, which potentially was also an issue of adult protection, since the welfare of service users were compromised. The inspector at that time was not satisfied with the information supplied and subsequent action taken at the time complaint came to light. The home must ensure that complaints are robustly investigated in accordance with the service’s complaints procedure and that accurate information regarding complaints is supplied to CSCI upon request. The registered person must ensure that managers and staff strictly adhere to the home’s complaints procedure. Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 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 the following standard(s): 24 , 27 & 30 The home’s environment has improved significantly, but further repair to some areas is needed. EVIDENCE: The previous inspection had highlighted the need for the home to redecorate specific area of the home that had deteriorated. The inspector participated in an accompanied tour of the home and noted that major re-decoration of service user bedrooms and some communal areas had been completed. Service user bedrooms had been re-painted and damaged walls re-plastered, which gave the home a far more pleasant and comfortable feel. An ongoing issue with a shower seat had been resolved, however, a more structural problem had developed in the shower room that rendered a key corner inoperable. Staff who spoke with the inspector commented that as a result the safety and welfare of both service users and staff was compromised. The home must ensure that work required to the shower room is completed to ensure its safe and comfortable use. On the morning of the inspection domestic staff was cleaning the home. The cleanliness and hygiene of the home has been consistently been good. Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 The staffing of the home is in need of improvement EVIDENCE: Some staff who spoke with the inspector commented on the limited opportunity to further develop their skills and knowledge. Whilst an agency training plan appears to be in place, training opportunities in recent months were said to be limited. Staff also alluded to their overall performance being hampered by low staff moral, contributed by the lack of clarity and direction from the home’s registered manager. On the whole, the staff team performed their duties well, however the general feeling was that the team would be ore effective if strong leadership featured on a day-to-day basis. The inspector reviewed the staff personnel file for five staff members and noted improvement in information to be evidenced. The inspector noted that for one bank staff who regularly worked at the home over the past seven months, no staff file was evidenced. The deputy manager explained that it was likely that these records were yet to be transferred from the agency’s head office. This was also the case for the file of a newly recruited domestic. Staff who spoke with the inspector commented that individual supervision at the home was inadequate. The inspector reviewed the supervision files for four staff members and the evidence seen supported the view shared by staff. Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 17 Only one staff file seen evidenced any supervision had taken place in 2006. There was also no evidence of staff appraisals although the deputy manager said the registered manager had recently conducted his appraisal, which was not without issue. Night staff in particular appears to be poorly supervised. Staff must, as a priority, receive documented, regular, formal supervision and staff appraisals must be conducted at least annually so that training needs can be appropriately identified and met. Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 & 43 The overall management of the home is poor EVIDENCE: The inspector is concerned for the overall management of the home, in particular the extended absences of the registered manager over a significant period of time, the clear lack of strong leadership as commented upon by staff during the inspection and negligence of clear management responsibility such as staff supervision, the appropriate management of complaints and the general lack of progression in service users lives is unacceptable. The apparent low morale of staff and potentially their ability to work together effectively appears directly attributable to poor leadership. Senior staff must address these issues as a matter of priority and offer, if necessary, additional support to the registered manager in order for management issues to be resolved satisfactorily. The home will need to improve significantly upon internal monitoring systems to support the efforts of the registered manager. The inspector noted that the home could not produce evidence of any monthly monitoring visits having been Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 19 conducted for several months. The inspector was of the opinion that such measures was crucial in identifying areas in need of development that might also improve upon the quality of service users lives at the home. Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 20 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 2 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 1 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 2 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 2 X X X 2 2 Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 6 Requirement The registered person must ensure that the homes Statement of Purpose and Service User Guide is amended to include revised information regarding the homes complaints procedure. (Previous timescales of 15/05/05 & 01/09/05 not met) The registered person must ensure that all service user care plan are kept current. The registered person must ensure that updated risk assessments are maintained on file. The registered person must devise activities in the home that proactively encourage the self development of service users. The registered person must ensure that managers and staff strictly comply with the DS0000010272.V293874.R01.S.doc Timescale for action 01/09/06 2 A6 15 01/07/06 3 YA9 14 01/07/06 4. YA11 12 01/07/06 5. YA22 22 01/07/06 Lower Clapton Road (Flat 1) Version 5.1 Page 22 6. YA27 23 7. YA36 18(2) 8. YA35 18 9. YA37 9 10. YA39 26(4) home’s complaints procedures. The registered person must ensure that structural work needed to the home’s shower room is completed so that the entire shower is safely accessible to staff & service users whist in use. The registered person must ensure that staff receive regular 1:1 supervision that is documented (Previous timescale of 01/09/05 not met) The registered person must ensure that staff appraisals are conducted at least annually and that training needs are identified and addressed. The registered person must devise a plan that outlines support available to ensure the home is managed effectively. The registered person must ensure that monthly monitoring reports are made available to staff on site. 01/10/06 01/07/06 01/09/06 01/08/06 01/09/06 Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 23 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 YA12 YA34 Good Practice Recommendations The home should consider offering service users more stimulating activities on days they are on the home’s premises. It is recommended that staff information maintained by the agency is made available on site for the purposes of inspection. Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lower Clapton Road (Flat 1) DS0000010272.V293874.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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