Inspection on 06/08/08 for Rachel House

This inspection was carried out on 6th August 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Rachel House 11/01/08

Rachel House 31/07/07

Rachel House 06/04/06

Rachel House 21/10/05

Rachel House 06/05/05

Rachel House 02/12/04

Rachel House 09/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOME ADULTS 18-65 Rachel House Rachel House 103 Sixth Avenue Manor Park London E12 5PS Lead Inspector Lea Alexander Unannounced Inspection 6 August 2008 12:40 th Rachel House DS0000022872.V364533.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 Rachel House DS0000022872.V364533.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. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rachel House Address Rachel House 103 Sixth Avenue Manor Park London E12 5PS 020 8514 2556 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) rachellhouse@hotmail.com Ms Estelle Moyo Ms Estelle Moyo Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th January 2008 Brief Description of the Service: Rachel House is a three-bedded care home for people with mental health support needs. A private individual Estelle Moyo owns the home and is also the Registered Manager. Newham Registration and Inspection Unit initially registered Rachel House in August 2000. The home offers 24-hour care and accepts emergency placements. The premises are a terraced property in a residential area of Manor Park, with easy access to Ilford shopping area. A range of culturally diverse services and amenities are located in the Romford Road, which is within walking distance. The home is well served by several bus routes, which includes the 25 and 86. Ilford, Manor Park and Woodgrange Park British Rail stations are approximately a mile away. Unrestricted car parking is available. All service users have their own room. Each service user is provided with his or her own room key. Service users are able to personalise their rooms to reflect their individuality. There are no placement vacancies. Currently two African Caribbean females and one White British male reside at the home Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector carried this inspection over the course of a day. We spoke privately to people who use the service and to a member of staff. We also spoke with the Manager and looked at a range of documentation relating to the running of the home including health and safety records, resident’s personal records and staff personnel files. The home completed and returned an Annual Quality Assurance Assessment (AQAA) within the timescales we requested. The quality rating for this service is * stars. This means the people who use the service experience adequate quality outcomes. What the service does well: What has improved since the last inspection? The home develops care plans with people who use the service and has developed a tool to make this process more person centred. The home works individually with residents to help them identify personal goals. Residents are Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 6 supported to engage in a range of community and leisure activities. A variety of nutritious meals that reflect resident’s cultural backgrounds are provided by the home. The home has updated its complaints procedure to include the timescales within which it aims to deal with complaints. The homes adult protection policy makes appropriate reference to local safeguarding protocols. The homes employment practises comply with current legislation and the home is on target to provide a minimum of five days paid training to all staff. A quality assurance exercise has been completed and the outcomes collated and made available to interested parties. Weekly testing of the homes fire protection systems are carried out and recorded. Evacuation drills have also been carried out and recorded with timings. The homes food hygiene practises had also improved and some minor repairs had been carried out. 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. The summary of this inspection report can be made available in other formats on request. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has developed systems to assess prospective residents prior to their moving in. EVIDENCE: There have been no new admissions to the home since the last inspection. We looked at the personal records for two residents. There was not a record of their being assessed prior to their moving in, however there was a completed assessment of need from 2007 on file for each. The Manager assured us that any new residents would be assessed prior to their moving in. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan that is regularly reviewed. However, risk assessments are not comprehensive and contain only basic information. EVIDENCE: We looked at the personal files for two people who use the service. A range of individual care plans had been developed for each. These covered areas such as personal care, activities, family, health and finances. Since the last inspection the home has developed a person centred assessment that had been completed for each of the residents we sampled. This included information on their likes, dislikes, hopes for the future and important people. We spoke with the Manager on how this information could be used to make individual plans more person centred and reflective of residents preferences. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 10 Individual plans are signed by residents to evidence their participation in their development. The plans we saw were annotated to evidence their review at least every six months. Sampling of personal files also evidenced 1:1’s with residents with a focus on their identifying goals for the future. One person who uses the service is independent in managing their finances. The two other residents receive support, and this is detailed in their individual care plans. With the residents agreement the home retains a small amount of money on their behalf and residents are able to access this whenever they require. A logbook detailing the date, nature and amount of each deposit and withdrawal is signed by staff and the resident. One resident expressed concern about the level of benefits they were receiving. We noted that the home had referred them to the Citizens Advice Bureau (CAB) earlier in the year, but that the CAB had not responded. The home holds regular meetings that residents and staff attend. We looked at the minutes of these meetings and these evidenced that recent discussions had included household chores, activities and staffing. The home has developed risk assessments, but these are very basic. For the two residents we case tracked the risk assessments were very brief and limited in scope. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are given the opportunity to take part in a variety of activities within the home and the community. Staffs give residents information on community-based events. However, the home should ensure that sufficient staff is available to accompany residents who need support on community outings. EVIDENCE: We spoke with residents, the manager, and staff on duty and looked at the homes activities log. This evidenced that a range of community and leisure activities had been discussed with residents although they had declined to pursue them. In the previous month however residents were evidenced as having visited the local church, attended a social club and day service open Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 12 day, gone for walks in the local community and engaged in structured activities within the home including discussion groups and activities of daily living. Two residents who use the service are able to access the community independently. A third requires a member of staff to escort them. This resident told us that there were not always enough staff available to enable them to access the community. We spoke with the Manager who told us that since the last inspection two staff members had left and that they intended to recruit to their posts. Sampling of the minutes of residents meetings and discussion with one resident evidenced that a day trip to a local seaside resort had been requested over several months, but that this had not yet occurred. People who use the service told us that they choose their own daytime routines, for example when to get up or go to bed or prepare their own snacks. Residents within the home are supported to maintain contact with their families, and the frequency and level of contact is recorded in the notes. Some residents have family living locally who they visit several times a week. Other residents are supported to maintain phone contact with family members living in other parts of the country and require staff support to facilitate the contact. During the course of the inspection we observed staff interacting with residents. People who use the service told us that they choose when to be alone or to join in with an activity. We looked at the homes log of meals provided. This evidenced that the meals provided are generally varied, nutritious and reflective of resident’s cultural backgrounds. Two residents are able to prepare light meals and snacks of their choice unsupervised. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has sound medication practises. Residents are encouraged to be independent in their personal care and supported to access healthcare services. However there are some gaps in the healthcare information recorded. EVIDENCE: Our discussions with the homes residents evidenced that each is supported to make their own choices with regards to their clothing, and that and their appearance reflects their personalities. The home records the medical appointments attended by people who use the service, but there is no system for recording the outcome or follow up of these appointments. Recent healthcare appointments attended by two residents included the dentist, diabetes clinic and chiropodist. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 14 The Manager told us that at the time of this inspection none of the residents were taking any controlled drugs or self-medicating. We looked at the Medication Administration Record (MAR) sheets for two residents and compared these with the actual medication available. Medication was appropriately stored in a locked cabinet. Appropriate stock levels were available. The available medication corresponded with that listed on the MAR sheet, and the MAR sheets were properly completed. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are listened to and protected. The home has a clear complaints procedure that residents understand. Staffs demonstrate a good understanding of adult protection issues and their responsibilities. EVIDENCE: We looked at the homes complaints policy. This had been updated since the last inspection to include the timescales within which the home aims to deal with complaints. We also looked at the homes complaints log. One complaint had been received since the last inspection. The date, nature of the complaint, investigation undertaken and outcome were all recorded. The complaint related to the local post office and upon investigation was not upheld. People who use the service told us that they knew how to make a complaint if there was anything they felt unhappy about and that they felt comfortable raising their concerns with staff. One resident who had recently made a complaint told us that they were happy with how this was dealt with. We looked at the homes adult protection policy and procedure. This includes information on the types of abuse vulnerable adults might experience and details the responsibilities of staff should they have any adult protection concerns. The policy also includes contact details for the local authority Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 16 safeguarding team and guidance on the circumstances in which to contact them. There have been no adult protection matters raised since the last inspection. We spoke with the member of care staff on duty. They were able to identify a range of abuses that vulnerable people might experience and their responsibilities should they have any safeguarding concerns. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 17 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, 28 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have their own rooms that they are able to personalise. The home has a range of communal space. EVIDENCE: The home is located within a terraced house in a quiet residential location. Works in progress at the previous inspection to turn the staff sleep in room into a fourth bedroom have now been completed, although the homes recent application to vary its registration to increase the number of beds to four was withdrawn. The home has a large entrance hallway and a comfortable lounge with TV and stereo is situated off this. One resident’s bedroom is located on this level, and to the rear of the ground floor there is a kitchen diner. This has a range of fitted units and appliances and a dining table and chairs. A large bathroom Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 18 with WC, tub and sink is situated off a corridor from the kitchen. The home has small rear garden that is accessed via the kitchen. Access to the first floor is via staircase, and two residents bedrooms and an empty room are located on this level, as well as a WC with hand basin. The homes office is located in the basement. We looked at the homes maintenance log. This evidenced that since the last inspection a range of general maintenance tasks had been carried out including the fitting of some new fixtures, a clean up of the garden and some new carpets. Some minor repairs identified at the previous inspection had been completed. We found the home to be generally comfortable and well maintained; although we noticed that the lounge was crowded with furniture and that the bathroom and WC were quite bare. During the course of our site inspection we noticed that some potentially hazardous cleaning materials had not been securely stored. Since the last inspection a sofa bed had been installed in the lounge. We spoke with the member of staff on duty who told us that they carried out waking nights and did not use sleep in facilities. This contradicted information provided by residents who told us that staff slept on the sofa bed in the lounge. We subsequently spoke with the Manager who told us that a sleeping night cover is provided, and that staff use the sofa bed in the lounge when working this shift. The Manager also told us that they were reviewing the night staffing cover and were considering changing to a system of waking night cover. We found the home to be hygienic and free from offensive odours. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 19 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are generally satisfied with the care they receive however there are times when they may need to wait to receive staff attention. The home has a recruitment procedure that meets statutory requirements. EVIDENCE: We looked at the homes current staffing rota. This evidenced that in addition to the Manager the home employs two care staff. Two care staff that had been recruited since the previous inspection had subsequently left the home. The personnel files for two members of staff were inspected. These evidenced that two satisfactory references and an enhanced Criminal Records Bureau (CRB) check had been obtained for each prior to their starting work. Copies of their employment terms and conditions were also found on their file. The personnel files we sampled also evidenced that staff receive an induction upon joining the home. We spoke with the Manager and one care worker and Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 20 also looked at the minutes of staff meetings. This evidenced that since the last inspection moving and handling training and medication training had been provided. Refresher training in core areas was also being arranged, and specialist training in diabetes and stroke was scheduled. The staff member on duty at the time of this inspection had completed their NVQ level 2 training. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 21 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 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Manager is suitably qualified and experienced and prepared an Annual Quality Assurance Assessment (AQAA). Staffs are generally knowledgeable and competent and some developments have been made with regards to person centred planning. EVIDENCE: The Manager is a Registered Mental Nurse (RMN) with experience of running a care home. The Manager is employed within the home on a part time basis and has completed their NVQ level 4 studies. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 22 Prior to the inspection we received from the home information relating to its most recent quality assurance exercise. This evidenced that the home surveyed residents, their families and health and social care professionals. The results had been collated and feedback on the service provided was positive. The Manager told us that they had been in contact with the LFEPA to arrange an inspection of the home but that a date had not yet been fixed. We looked at the homes fire records. This evidenced that weekly testing of the homes fire protection system was occurring and that recent fire evacuation drill had been carried out and the timing to complete the drill recorded. The home displays a current insurance certificate with adequate cover. The home has a Portable Appliance Testing Certificate valid from January 2008. We looked at the homes accident and incident reports and found these to be in order. We looked at the homes log of fridge and freezer temperatures. These are tested and recorded each day and were found to be within acceptable limits. We also looked at the contents of the homes fridge and freezer and found that started and prepared foods had been appropriately date labelled. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 23 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 3 2 X LIFESTYLES Standard No Score 11 X 12 2 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 3 X 3 X X 3 X Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 24 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 YA7 Regulation 12 Requirement The home should chase up its referral to the CAB for one resident who has queries about their benefits. The home must develop comprehensive risk assessment and management plans for identified potential risks. The home must have sufficient staffing to accompany residents who need support on community outings. Timescale for action 30/10/08 2. YA9 13 30/12/08 3. YA12 16 30/12/08 4. 5. YA19 YA28 12 23 Where outings are requested and agreed with residents the home must ensure that these are provided in a timely manner. The home must ensure that the 30/10/08 outcome of healthcare appointments is recorded. The home must also ensure 30/12/08 appropriate facilities are provided to staffs that are required to sleep in the home. This is a restated requirement. The previous target of the 30/05/08 was not met. The home must liaise with the London Fire and Emergency DS0000022872.V364533.R01.S.doc 6. YA42 12 & 37 30/12/08 Rachel House Version 5.2 Page 25 Planning Authority (LFEPA) to arrange for them to inspect the home. This is a restated requirement. The previous target of 30/05/08 was not met. Potentially hazardous cleaning materials must be securely stored. 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 YA15 Good Practice Recommendations Where residents require support to maintain contact with their families the nature of the support should be detailed in their care plan. Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor 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 Rachel House DS0000022872.V364533.R01.S.doc Version 5.2 Page 27 - 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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