Care Home: Checaniah House

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What the care home does well The service continues to monitor and address well the individual needs of service users. Good care planning and risk management systems were in place. People who use the service benefit from stable staff team. There is a homely atmosphere in the home. Those who use the service access a wide range of leisure activities. What has improved since the last inspection? As there were no requirements made at the last inspection visit, the inspector was unable to comment whether there have been any improvements since the last inspection. The following comments were made by the registered manager in the home`s Annual Quality Assurance Assessment: "Through assessments and daily observations we have observed changes of improvements in our service users lives. A service user can now communicate her likes and dislikes much better, due to staff spending time encouraging her and engaging in conversation with her. Our service users are able to do more for themselves by staff supporting them, through their self help skills programme, with personal care and participating in house chores. A service user is able to cope better with travelling on public transport." What the care home could do better: Following this inspection three statutory requirements were made and one good practice recommendations. Improvements are required to the home`s medication systems. The registered manager must ensure that all parts of the home are reasonably decorated. She must also ensure that each person in the home has an enhanced Criminal Records Bureau disclosure, which includes checks against Protection of Vulnerable Adults Register and it is requested/processed by Checaniah House. In addition, it is also recommended that the registered manager designs and implements a more user-friendly system for recording any financial transactions made on behalf of each service user. CARE HOME ADULTS 18-65 Checaniah House 26 Chailey Street London E5 0RX Lead Inspector Robert Sobotka Key Unannounced Inspection 21st October 2008 10:30 Checaniah House DS0000010262.V371831.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 Checaniah House DS0000010262.V371831.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. Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Checaniah House Address 26 Chailey Street London E5 0RX 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) 020 8533 5400 020 7533 5400 joanita54@hotmail.com Mrs Joanita Tuitt Mrs Joanita Tuitt Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 3 7th November 2006 Date of last inspection Brief Description of the Service: Checaniah House is a small care home that offers support, personal care and accommodation to a maximum of three (younger) adults who have learning difficulties. The home’s premises are a large three bedroom terraced house in a residential area of Clapton within the London Borough of Hackney. The home is walking distance from local shops, a park, market and amenities. Local bus links are good. At the time of the inspection, the three service users who were living at Checaniah House at the last inspection (conducted in November 2006) were still accommodated by the home. The current weekly fee is £859.76. This includes service user’s contribution of £63.95 towards their rent. Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection visit took place over one day and it was unannounced. As part of the process, the inspector spoke with the registered manager and the deputy manager, as well as one member of care staff working in the home. He also conducted a tour of the premises and viewed various records. The inspector was unable to meet service users living in the home, as they were all out attending various day centres at the time of this inspection visit. Prior to this inspection, the home was asked to complete the Annual Quality Assurance Assessment. Some of the information provided in the assessment has been incorporated into this inspection report. The aim of this unannounced inspection was to check the home’s compliance with the National Minimum Standards and the Care Homes Regulations. The inspector would like to thank everyone who contributed to this inspection. What the service does well: What has improved since the last inspection? As there were no requirements made at the last inspection visit, the inspector was unable to comment whether there have been any improvements since the last inspection. The following comments were made by the registered manager in the home’s Annual Quality Assurance Assessment: “Through assessments and daily observations we have observed changes of improvements in our service users lives. A service user can now communicate her likes and dislikes much better, due to staff spending time encouraging her and engaging in conversation with her. Our service users are able to do more for themselves by staff supporting them, through their self help skills programme, with personal care and participating in house chores. A service user is able to cope better with travelling on public transport.” Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 6 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. Checaniah House DS0000010262.V371831.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 Checaniah House DS0000010262.V371831.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): 1, 3, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was sufficient information about the home, so that any prospective service users can make an informed choice about where to live and whether the home would be able to meet their needs. Service users had costed contracts/statements of terms and conditions/statement of terms and conditions in place. EVIDENCE: There was an up-to-date statement of purpose and the service user’s guide in place. There have been no new admissions to the home for a considerable period of time and there were no vacancies at the time of this visit. Standards relating to the home’s assessment process and trial visits could not therefore be assessed and will be retested once a new service user has moved into the home. Following the review of documentation kept in the home and interview with staff working in the home, the inspector was satisfied that the assessed needs of the person accommodated in the home were being met. Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 9 All service users had individual costed contracts, which included terms and conditions in place. Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate care planning systems were in place and there was evidence that those who used the service were encouraged to take active part in their care planning process and decision making about issues relating to the running of the home. Appropriate risk management systems were also in place, so that service users are supported to take risk as part of an independent lifestyle. Those who live in the home can now be confident that information about them is handled appropriately and any sensitive information is securely stored. EVIDENCE: The inspector review individual care plans for all three service users accommodated in the home and he was satisfied that these were kept up-todate and contained similar needs to those identified during statutory reviews undertaken by the placing authority. Wherever possible service users are encouraged and supported to be involved in the decision making process. This would involve choosing which clothes to wear, what kind of food to eat, when to get up and when to go to bed. Staff Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 11 working in the home would use pictorial cues to indicate to some service users choices with regard to recreational activities, location of activities, decisions about clothes to be worn and meal choices. Service users were then encouraged to make decisions for themselves. The deputy manager indicated that the rituals and habits of all service users were well known to staff and so interpretation of decisions made was respected by staff. Appropriate risk management systems were in place and each care plan viewed contained appropriate risk assessment, which were reviewed on a regular basis. Confidentiality was being maintained. All sensitive information was kept lock away when not in use and staff shared confidential information with the inspector on a need-to-know basis. Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those who live in the home were encouraged to and supported to lead active lifestyles within the local community and develop friendships. Their rights and choices were respected and they had opportunities for personal development. There were appropriate food supplies in the home. EVIDENCE: All three service users living at Checaniah House are involved to varying degrees with local day centre resources. Two service users attended different day centres five days a week, while the third service user attends twice weekly. The inspector saw on file good documented evidence of the effective working relationship between staff of the home and day centre staff in coordinating the service users overall care. Liaison between the two services was good; both services were involved in the statutory reviewing process. In addition to day centre attendance, service users participate in a range of community-based activities in the evening and on weekends. Service users Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 13 are encouraged outings to a disco specifically for people with learning difficulties. The following comments were made by the registered manager in the home’s AQAA: “We encourage service users to participate in various activities they were involved in prior to their admission in Checaniah House. Service users are encouraged and supported to travel on public transport, going on short breaks and annual holidays sometimes abroad. (…) We have purchased a DVD for service users to watch music entertainments and programmes of their choice Service users also have their own personal DVDs and TV in their bedrooms. We also provide various games to motivate them. Service users rooms have been personalised with personal choices of colours with support from staff and family. They rooms has also been fitted with new furniture’s and curtains which have been selected with support from staff and family.” The inspector checked record of food offered to service users, which was appropriately maintained. These also demonstrated that staff offered balanced diet to the people who lived in the home. Staff were also aware of each persons likes and dislikes in relation to food and these were clearly recorded in each person’s care plan. Staff working in the home informed the inspector that some service users may offer some support with meal preparation, although meals are generally prepared by care staff. Traditional Caribbean meals were largely offered on Sundays in accordance with the preferences of two service users in particular who were of West Indian origin. There were adequate food supplies in the home at the time of this inspection visit. Fridge/freezer temperatures were appropriately recorded. Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service receive care, which is appropriate to meet their physical, emotional and healthcare needs. Some improvements were required to the home’s medication systems. EVIDENCE: Staff working in the home commented that the personal care needs of all service users were well known to staff due to the length of time service users had lived at the home and the well established staff group. Since none of the service users where physically disabled, most were able to perform personal care tasks independent of staff, who were available for prompting and supervision only. So, for example, staff would encourage service users to brush their teeth effectively and bathe themselves adequately. Files examined showed that service users attended regular medical appointments and the registered manager ensured that they had access to community health resources, such as chiropodists, opticians, psychiatrists etc. Records of any healthcare appointments attended by each service user were recorded in individual files. Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 15 Medication systems were checked during this inspection visit. All medication was appropriately stored. There were some discrepancies noted in recording of medication administered to service users. The inspector also noted that staff sometimes used the symbol “O”, which stood for “other”, to indicate that a medication was not administered, however no explanation was given as to what the reason for not administering the medication was. In addition, staff must ensure that the allergy section is completed on each medication administration sheet to indicate whether each service user has any known allergies. If there are no known allergies, this should also be clearly recorded in the relevant box. Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service can be confident that their complaints will be listened to and dealt with appropriately and that they will be protected from abuse. Minor improvements are recommended to the record relating to service user’s finances. EVIDENCE: The inspector was informed that there had been no complaints made against the home or any suspicion or actual instances of an adult protection nature. The home’s incident book was checked during this inspection and it was appropriately maintained. The following comments were made by the registered manager in the home’s AQAA document: “We have provided staff training and information on protection of vulnerable adults. We are constantly enforcing the importance of these policies and procedures during hand- over, staff meetings and supervision. We have promoted service users rights to be able to travel in mini cabs without being discriminated. (…) Our plans for improvement in the next 12 months is to write the complaints procedure in a user friendly format using signs and symbols. We will continue to liaise with relatives regarding any complaints they may have regarding the service being provided.” As part of this visit, the inspector checked financial records maintained on behalf of the service users accommodate in the home. Whilst these were found to be satisfactory and there appeared to be no financial discrepancies, due to the volume of receipts and as all transactions were being recorded in small notebooks, it was the inspector’s view that these could be redesigned. The registered manager acknowledged this. It is recommended that the registered manager designs and implements a more user-friendly system for recording any financial transactions made on behalf of each service user. Checaniah House DS0000010262.V371831.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, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home benefit from a generally homely and comfortable environment. The premises were clean and hygienic. EVIDENCE: The home is situated in a residential area and it blends in with other home in the area. It is walking distance from local shops, a park and local amenities. Transport links are very good. The inspector undertook an accompanied tour of the home’s premises. Service users bedrooms have been furnished to meet their individual choices, needs and lifestyles. All furniture’s and equipments are safe and are of good quality. The premises have recently updated to comply with the fire safety regulations and this required some electrical rewiring. As a result some of the rooms and communal areas required repainting. The registered manager stated that this would be carried out without delay. New fire doors were also fitted. Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 18 There was a problem of rising damp in the front lounge. The inspector was informed that this was currently being treated. The registered manager stated that the home’s bathroom has recently been redecorated. She also stated that there were plans to upgrade the home’s kitchen, subject to sufficient finances in the budget. The home was found to be clean and hygienic at the time of this visit. Checaniah House DS0000010262.V371831.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 good. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from being supported by a dedicated and appropriately trained staff team. EVIDENCE: Duty rosters were viewed during this inspection visit. They demonstrated that appropriate staffing levels were in place. There is at least one member of staff on duty at all times. No new members of staff have been employed in the home since the last inspection. The inspector checked staff personnel files of two members of staff. It was noted that whilst both staff had Criminal Records Bureau disclosures in place, these were processed by their previous employers and they required updating to demonstrate that satisfactory checks have been carried out against the Protection of Vulnerable Adults register. The registered manager must ensure that each person employed in the home has an enhanced Criminal Records Bureau disclosure, which has been requested by Checaniah House. The deputy manager and the registered manager had both completed NVQ training at level 4 and the Registered Manager’s Award. One staff member had Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 20 completed NVQ2 training; the fourth member of staff was in the process of working towards their NVQ qualification. Since the last inspection, the staff group had also participated in key training such as food hygiene, first aid, POVA, manual handling and medication training; all training had been facilitated by an external training body. Checaniah House DS0000010262.V371831.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): Quality in this outcome area is (excellent, good, adequate or poor) This judgement has been made using available evidence including a visit to this service. EVIDENCE: Throughout this inspection it was transparent that people living in Checaniah House did benefit from a well run home. Both the registered manager and deputy manager of the home complete regular shifts and have a very ‘hands on’ approach to care and management. There was evidence that staff were encouraged to adopt the good practices of the management team and provide a service that where the individual needs and quality of life of service users were paramount. It was very clear that the conduct and management of the home was very effective and that this was to the positive benefit of service users living at the home. Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 22 Appropriate quality assurance systems were in place. As the responsible person is also the registered manager, monthly-unannounced “person in control” visits were not required. Appropriate health and safety checks were in place. Gas safety, fire fighting equipment, portable appliances and electrical wiring testing were found to be up-to-date. The home was appropriately insured for its stated purpose. Checaniah House DS0000010262.V371831.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 3 2 X 3 3 4 X 5 3 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 2 25 X 26 X 27 X 28 X 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 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA20 Regulation 13(2) Requirement Timescale for action 21/11/08 2. 3. YA24 YA34 The registered manager must ensure that appropriate arrangements are in place for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. 23(2)(d) The registered manager must 21/12/08 ensure that all parts of the home are reasonably decorated. 19(1)(b)(i) The registered manager must 21/12/08 ensure that each person employed in the home has an enhanced Criminal Records Bureau disclosure, which has been requested by Checaniah House. Checaniah House DS0000010262.V371831.R01.S.doc Version 5.2 Page 25 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 YA23 Good Practice Recommendations It is recommended that the registered manager designs and implements a more user-friendly system for recording any financial transactions made on behalf of each service user. Checaniah House DS0000010262.V371831.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. 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