Inspection on 06/05/05 for Rachel House

This inspection was carried out on 6th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 but made no statutory requirements on the home.

Other inspections for this house

Rachel House 06/08/08

Rachel House 11/01/08

Rachel House 31/07/07

Rachel House 06/04/06

Rachel House 21/10/05

Rachel House 02/12/04

Rachel House 09/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Rachel House 103 Sixth Avenue Manor Park London E12 5PS Lead Inspector Sharon Lewis Announced Inspection 6 May 2005 at 10:00am th 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. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Rachel House Address 103 Sixth Avenue, Manor Park, London, E12 5PS 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 8514 2556 020 8514 6141 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 G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd December 2004 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 thehome 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 is a terraced property in a residential area of Manor Park within easy access to Ilford shopping area. A range of services and amenities are located in the Romford Road, which is within walking distance. The home is well served by several bus routes including 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. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was announced and started at 10:40a.m on a Friday morning. It took place over one day and lasted for approximately five hours. At the time of the Inspection one service user was accommodated in hospital due to a relapse in their mental health. The Inspector spoke seperately to the two other service users living at the home separately. Questionnaires were also received from a service user, a health care professional and a staff member. Individual discussions were also held with the Registered Provider/Manager and the Support Worker on duty. A tour of the premises was undertaken, service users’ files, medication, records, policies and related documentation were examined. In addition a lengthy discussion was held with the Registered Provider/Manager in relation to their plans to cancel registration and operate as supportive living. Rachel House hopes to make this transition by September 2005. This Inspection identified nine requirements and four recommendations. The Inspector would like to thank all service users and staff members for their assistance with this Inspection. What the service does well: What has improved since the last inspection? What they could do better: Health and safety and recruitment practices must be more robust. The home is intending to transfer to supportive living. Service users must be consulted and care practices must change. A greater level of independence and control must be actively promoted. Staff must move away from doing Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 Page 6 things ‘for’ service users. They should be supporting service users to do things for themselves. 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. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 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 Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 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, 2, 3, 4 & 5 Rachel House has developed the necessary information and procedures to meet the needs of prospective service users. EVIDENCE: Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 Page 9 The home has produced a Statement of Purpose and Service User guide, which provides prospective service users with the information they need, to make an informed choice about where they wish to live. The Registered Provider/Manager is currently updating this information to reflect the services transition to supportive living. Service users care plans detailed their aspirations and goals. The integrated Care Programme Approach (CPA) for people with mental health needs forms the basis of the single care plan. Service users’ files evidenced that service users are admitted to the home only after a full assessment has been undertaken. The assessment process is multi-disciplinary and includes health and social care professionals and previous care providers. Service users’ files and discussions with service users and the Registered Provider/Manager evidenced that the home was endeavouring to meet the assessed needs of the individual service users. The need for a sensory assessment for the identified service user remains outstanding. Evidence was seen of the Registered Provider/Manager chasing up this issue. Supportive living cannot be considered for this service user unless this assessment and subsequent rehabilitation is in place. Service user’s files evidenced that their respective religious and cultural needs are catered for, are recognised and met. The home has all necessary policies and eligibility criteria, which relate to the choice of home. Were the home is unable to meet the increased needs of service users appropriate action has been taken. Service users’ files evidenced that their placing authorities had contracts with the home. In addition separate contracts had been produced between the home and service users. These contracts outlined the services offered by the home and their respective rights and responsibilities. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 & 10 Rachel House endeavours to promote the individual needs and choices of all service users. EVIDENCE: Service users assessed and changing needs are reflected in their individual care plan. The care plan is subject to regular review during the CPA (Care Programme Approach) meetings with the consultant psychiatrist and other professionals. Service users’ individual choices were noted in their daily record. The home demonstrated that regular residents meetings were held. Service users were updated on developments within the home, staffing and the Commission for Social Care Inspection and menu planning. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 Page 11 Service users are supported to take risks as part of an independent lifestyle. A risk assessment and management policy is in place and all service users had current risk assessments. Service users’ files were securely stored. The Confidentiality policy has been further developed to include the details of when information will be shared without service users consent. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16 &17 Rachel House encourages service users to express and maintain their individual lifestyles. EVIDENCE: Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 Page 13 Service users have opportunities to fulfil their spiritual needs and are part of the local community. There was evidence that service users engaged in a range of activities in the community, which included attending social clubs, visiting family in the locality, regular walks, attending church and going out shopping. Service users use Dial-A-Ride, the taxi card scheme and their free bus pass as means of transport. Service users are able to take part in age, peer and culturally appropriate activities. The home demonstrated that service users are attending relevant day centre facilities and social groups. Service users are encouraged to use their independent skills. As previously mentioned the necessary aids or adaptations for the service user with sensory needs, is essential to the development of this service user’s independent living skills. The Registered Provider/Manager must continue to advocate and promote the independent living and personal development skills for all service users. Service users maintain family and personal relationships. This included visits to their respective families and visits by family and friends to the home. In addition to regular telephone contact. Service users are able to have three meals per day and the menu appeared varied, balanced, nutritional and culturally reflective. Service users are involved in menu planning through regular residents meetings. In addition service users had produced a list of their favourite foods. During the Inspection service users were observed eating their meals at their preferred time and choosing what they wished to eat. A service user complained that they would like larger meal portions. This issue was discussed with the Registered Provider/Manager. The identified service user is diabetic however, it was agreed that their meals would be increased through greater amounts of fruit and vegetables. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19, 20 & 21 Rachel House generally promotes service users health needs. Greater support is needed to access wider NHS healthcare facilities. EVIDENCE: Service users choose their own clothes and their appearance reflects their age and personality. Times for getting up/going to bed, baths, meals and other activities are flexible and dependent on service users needs and preferences. Service users are supported to access NHS healthcare facilities in the locality. Documentation evidenced that service users health is monitored and potential complications and problems are identified and dealt with at an early stage, including prompt referral to an appropriate specialist. All service users must benefit from dental and optician appointments at regular intervals. This is an outstanding requirement from the previous Inspection. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 Page 15 Medication administration records and medication were examined and were appropriated stored. The format for recording depot injections has been simplified, as recommended from the previous Inspection. Staff should ensure correction fluid is not used on medication administration records. A policy has been developed which address the ageing, illness and death of a service user. The home should further expand on the details in this policy. Service users respective wishes are noted in the event of death. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22&23 Rachel House has appropriate arrangements to address complaints and adult protection issues. EVIDENCE: The home has a complaints policy and procedure, there have been no complaints during the last 12 months. The home has produced an Adult Protection and Whistle Blowing procedure. The Commission for Social Care Inspection have not received any allegations in relation to adult abuse. Staff discussions demonstrated a good understanding of the Adult Protection and Whistle Blowing procedures. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 & 30 The environment and facilities at Rachel House generally meet the needs of service users. EVIDENCE: Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 Page 18 Rachel House is a terraced property, in a residential road in the Manor Park area of Newham. The property blends easily into the neighbourhood and presents as a large family home. The home is well decorated, comfortable, bright, airy, clean and free from offensive odours. The home has sufficient and suitable light, heat and ventilation. The location is within easy access to Ilford shopping area. A range of services and amenities are located in the Romford Road, which is within walking distance. The home is well served by several bus routes including the 25 and 86. Ilford, Manor Park and Woodgrange Park British Rail stations are approximately a mile away. Unrestricted car parking is available. All bedrooms have been redecorated in different colours and styles. Service users’ rooms were personalised to reflect their individuality. One service user has their own pet cat. A cat flap has been provided in their room along with a cat food and pet litter area. This area was found to be clean and no health and safety issues were noted. Shared spaces complement and supplement service users’ individual rooms. A lounge, kitchen with dining area and garden are available for service users. The communal lounge is homely, comfortable and well decorated. Facilities include a television, dvd player, video and computer. A service user requested the provision of Sky television, this should be considered. The current music speaker is in a state of disrepair, the proposal to purchase an updated music system should be actioned. Service users have a bathroom downstairs and an additional toilet with a hand basin upstairs. Separate laundry facilities are not provided. The washing machine is located in the kitchen. The laundry facilities are not suitable for service users with continence needs. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35 & 36. Generally staffing arrangements meet the needs of service users, however recruitment practices must be more stringent. EVIDENCE: Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 Page 20 The home has a Registered Manager and sufficient, competent support staff. Staffing rotas evidenced that one member of staff is on duty at all times. All staff have social care experience. Staff demonstrated an awareness of their roles, responsibilities and service users’ individual needs. Job descriptions have been developed for all levels of staff. All staff had been supplied with copies of the General Social Care Council’s code of conduct. A staff training programme is in place and an action plan to address NVQ qualifications is in progress. Documentation and staff discussion evidenced that staff were appropriately inducted, received regular supervision and appraisals were in progress. The recruitment policy must ensure the careful selection and vetting of care staff. The personnel file for a newly appointed staff member was examined and it was evidenced that a staff member had worked unsupervised without a criminal record bureau (CRB) check or Pova (Protection of vulnerable Adults) First check. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 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 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) 37, 38, 39, 40, 41, 42 & 43. Rachel House is generally managed well and has a homely, family orientated atmosphere. Health and safety practices must be more robust. EVIDENCE: The Registered Manager is also the proprietor of the home. The Registered Provider/Manager is a qualified Registered Mental Health Nurse and is currently undertaking the NVQ Level 4 in Management and Care. The Registered Provider/Manager has continued to make great efforts to comply with Regulations and meet Standards. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 Page 22 Rachel House provides an open, positive, inclusive and homely atmosphere. Staff meetings were seen to cover a range of issues and staff interviewed related they feel valued and are able to use their initiative. A quality assessment framework has been developed and evidence was seen of service feedback questionnaires. The home has updated their policies and procedures in accordance with Appendix 3, National Minimum Standards for Younger Adults. Records evidenced recording practices were satisfactory. Health and safety certificates are in place and incidents were recorded. There have been no accidents since the last Inspection. Fire safety records were examined. The home evidenced that regular fire drills were held and fire equipment was annually serviced. Fire records must additionally include the time of the fire drill, the evacuation time and any comments. A fire risk assessment must also be developed. Service users health and well being must be promoted by robust food hygiene practices. The home must ensure refrigerated foods are labelled on the date opened and fridge and freezer temperatures must be recorded daily. The first aid box was examined expired dressings were found and were appropriately disposed of. Further dressings must be purchased to restock the first aid box. The Inspector was not able to view the current business and financial plan. This requirement remains outstanding from previous Inspections. A copy of the current business and financial plan must be forwarded to the Commission for Social Care Inspection, The wish to cancel registration and provide supportive living accommodation was discussed in detail. A self- assessment tool has been completed to examine the viability of this proposal. Placing authorities have been informed and a proposed plan of action is in place. Service users must be consulted and care practices must change. Rachel House hopes to make this transition to supportive living by September 2005. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 2 3 3 3 3 3 2 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rachel House Score 3 2 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 2 2 G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 Page 24 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 11 Regulation 12 (1) Timescale for action The Registered Provider/Manager 01.09.05 must continue to advocate and promote the independent living and personal development skills for all service users. Larger portions of fruit and 01.06.05 vegetables must be made available to the identified service user. All service users must benefit 01.09.05 from dental and optician appointments at regular intervals. Timescale of 01.04.05 not met. Staff member must not work 01.06.05 unsupervised without a criminal record bureau (CRB) check or Pova (Protection of vulnerable Adults)First check. Fire records must include the 01.09.05 time of the fire drill, evacuation time and any comments. A fire risk assessment must also be developed. The home must ensure 01.06.05 refrigerated foods are labelled on the date opened. Fridge and freezer temperatures must be recorded daily. Dressings must be purchased to 01.06.05 restock the first aid box. Version 1.30 Page 25 Requirement 2. 17 16 (2) (i) 3. 19 12 (1) 4. 34 19 (4) (b) 5. 42 23 (4) 6. 42 13 (4) 7. 42 12 (1) (a) Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc 8. 43 25 9. 43 24 A copy of the current business and financial plan must be forwarded to the Commission for Social Care Inspection. Timescales of 01.10.04 and 01.04.05 not met A formal application to cancel registration must be submitted. Service users must be consulted and care practices must change. 01.09.05 01.09.05 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. 3. 4. Refer to Standard 20 21 24 &28 26 Good Practice Recommendations Staff should ensure correction fluid is not used on medication administration records. The ageing, illness and death of a service user policy should be further developed. The home should consider installing Sky television. A new music system should be purchased.. Longer length heavy curtains should be provided in the front bedroom. Rachel House G57 G06 S22872 Rachel House V213905 060505 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection 4th Floor, 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. 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