Care Home: Coxley House

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What the care home does well A range of tick box responses in the pre-inspection surveys from people using the service were predominately very positive and complimentary, indicating a good level of satisfaction experienced in the service, including support received from staff. One person commented, "It`s quite nice here." Staff survey comments include, "Staff have been encouraged to attend a lot of training;" "The service highly promotes independence, respect and dignity to all tenants;" "The service meets individualised needs;" "Support the service users according to their individual needs...include the service user in the dayto-day running of the home; ensure staff are well informed and trained." The health professional states, "The care service attends promptly to patients and district nurses when need arises." The environment is pleasant, welcoming and suitable for the needs of people living in the home. Service users enjoy sufficient private and shared spaces. Individuals` needs are appropriately assessed prior to admission and their diverse needs are identified. Individuals are consulted about their care plans and their needs are appropriately reflected in them. People have opportunities to participate in activities of their choosing and to engage in activities that maintain their independence. Staff are carefully vetted, recruited, well trained and appropriately supported to carry out their duties and responsibilities. The service is generally well managed and organised with systems, policies and procedures in place to effectively run the home. Health and safety procedures are well observed. What has improved since the last inspection? Requirements made at the previous inspection were met, including care plans being reviewed every six months; risk assessments are available for all individuals in the home; individual flats have decorated including the views of the individuals; fridge freezer temperatures are being recorded and staff receive regular supervision. What the care home could do better: The Expert by Experience observed that: "Coxley House is a well-designed, spacious home & provides a warm, comfortable physical environment. However, the emotional well-being of residents is sometimes compromised and policies promoting residents` rights need to be rigorously implemented and complaints dealt with effectively." The home needs to ensure safe medication practises at all times and requirements are given in this regard. Recommendations include improving the consultation and involvement in decision making of people using the service; improved recording of complaints and a more developed quality assurance process, including the views of service users, their families and other stakeholders. The quality assurance process should inform plans for the development and improvement of the service. CARE HOME ADULTS 18-65 Coxley House 28 Bow Road Bow London E3 4LN Lead Inspector Nurcan Culleton Key Unannounced Inspection 24th September 2008 10:15 Coxley House DS0000063898.V372579.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 Coxley House DS0000063898.V372579.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. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coxley House Address 28 Bow Road Bow London E3 4LN 020 8980 1599 0208 981 7528 benjamin.oni@east-living.co.uk 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) East Living Limited Benjamin Olugbemiga Oni Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13) of places Coxley House DS0000063898.V372579.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. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 13 22nd August 2006 Date of last inspection Brief Description of the Service: It is part of a group of homes run by East Thames Group. Coxley House is one of a group of homes run by the East Thames Group. Coxley House is a registered care home for 13 adults aged 18 years and over of both genders who have mental health needs. The registration of the service excludes people who have a learning disability or dementia. The home does not provide nursing care. The home is a 13 flat let residential home. All flat lets are of single occupancy, of which six are located on the ground floor making them accessible for people with mobility problems. Seven are located on the first floor accessible by stairway and lift. Service users share communal bathrooms, lounge, kitchen and ground area facilities. There is a pleasant courtyard garden. The home is situated on the Bow Road with good public transport links. East Living currently holds the Charter Mark Award for service in excellence. This is a government’s award given to organisations that have provided evidence of their ongoing commitment to service provision and delivery to its residents. Fees can vary according to levels of assessed needs. Currently the lowest fees are £450 per week and the highest fees are £897 per week. Coxley House DS0000063898.V372579.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 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place over one day visiting the premises, meeting and talking with the manager, staff, people living in the home and examining records and documents. These included individual’s files, staff files, policies and procedures, health and safety procedures. At this inspection we involved an Expert by Experience who spent time observing and speaking with people living in the home. Their views and observations are included within this report. We also received a total of 19 surveys, 12 from people living in the home and six from staff and one from a health professional. Their views are also included and taken into account in the overall outcome of this inspection. What the service does well: A range of tick box responses in the pre-inspection surveys from people using the service were predominately very positive and complimentary, indicating a good level of satisfaction experienced in the service, including support received from staff. One person commented, “It’s quite nice here.” Staff survey comments include, “Staff have been encouraged to attend a lot of training;” “The service highly promotes independence, respect and dignity to all tenants;” “The service meets individualised needs;” “Support the service users according to their individual needs…include the service user in the dayto-day running of the home; ensure staff are well informed and trained.” The health professional states, “The care service attends promptly to patients and district nurses when need arises.” The environment is pleasant, welcoming and suitable for the needs of people living in the home. Service users enjoy sufficient private and shared spaces. Individuals’ needs are appropriately assessed prior to admission and their diverse needs are identified. Individuals are consulted about their care plans and their needs are appropriately reflected in them. People have opportunities to participate in activities of their choosing and to engage in activities that maintain their independence. Staff are carefully vetted, recruited, well trained and appropriately supported to carry out their duties and responsibilities. The service is generally well managed and organised with systems, policies and procedures in place to effectively run the home. Health and safety procedures are well observed. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Coxley House DS0000063898.V372579.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 Coxley House DS0000063898.V372579.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): 1-5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides appropriate information about the service provision to prospective users of the service. Individuals’ needs are appropriately assessed prior to admission and their diverse needs are identified. EVIDENCE: The home has a satisfactory Statement of Purpose however it is recommended that Statement of Purpose to be updated with new centralised contact details of CSCI. A Service Users Guide is available that is specific to Coxley House. However the information contained in it relates to the previous organisation of Springboard Housing Assoc and needs to be updated. Additionally the regionalised contact details of the CSCI need to be updated. An East Living handbook is also given to all individuals about the services provided by East Thames Group. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 9 The home obtains referral information including reports and assessments from other professionals. The home then carries out its own assessment as part of the admission process. The home operates corporate East Thames policies and procedures, including an admissions policy that details variable trial periods and the admission process. The manager described how the religious needs of individual persons are met both in the home and in their day- time activities in the community. The home uses a multi-cultural calendar to ensure significant festivals are not missed. Last month for example the home celebrated black history month and posters were displayed of prominent people who have made significant achievements; there was a steel band and then a cultural dance. Individuals in the home each have contracts which are called License Agreements. Coxley House DS0000063898.V372579.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): 6-10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Individuals are consulted about their care plans and their needs are appropriately reflected in them. However policies promoting residents rights need to be better implemented. EVIDENCE: We viewed four individual files. Each file was well indexed and contained key personal information. Social and medical reports; crisis and contingency plans; hospital discharge summaries and past assessments and reports were available. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 11 The home uses the East Living Support and Guidance Plan as their care plan form. Files seen had each been reviewed and planned review dates were stated. The plans contained numbered indicators of current levels of need to assist with monitoring individuals’ progress. An associated measuring tool was shown to the inspector to guide staff as to what level of support intervention is required. The plans also identify the outcome areas, for example, mental and physical health, and emotional wellbeing; a summary of needs and the desired outcome; how this will be achieved; by whom; by when and the actual outcome. The plans showed good insight into individual needs which also focus on the individuals’ own preferences and how they respond to different types of support. Plans were signed and dated. Currently no one living in the home has an advocate however some individuals have relatives who support them. Information about advocacy was seen displayed on a notice board. People using the service are consulted for their views in a number of ways. A group of service users across all services meet with directors face to face to express their views first hand about the quality of service provision. This group meets quarterly. The various schemes receive minutes of these meetings. The Expert by Experience questioned why people in the home were referred to as ‘service users. ’ The manager responded that people had been given a choice and had decided on that term. The Expert reported that she could not find record of any decision in the minutes of residents’ meetings and did her own spot survey. One person in the home told her, “I hate that name, it’s horrible’” and that several others agreed. In her report, the Expert states, “Management needs to ensure that the level of consultation and involvement is inclusive of all residents & decision-making is evidenced.” The Expert also reports that one individual felt that staff ‘don’t really listen’ to residents’ concerns and she was ‘fed up with asking’ for a holiday as excuses kept being made. The Expert states, “Management needs to ensure that residents’ concerns are fully addressed and not ignored. There is evidence in the minutes of residents’ meetings of a number of long-standing, unresolved issues that are brought up on a regular basis, notably the drainage in the wet room, the milk issue, food and holidays.” The Expert states additionally that, “The home needs to employ the services of an independent advocate to assist residents’ understanding of representation & facilitate the capability to challenge effectively.” And “Assertiveness training could be used to increase residents’ confidence and negotiating skills.” Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 12 The Statement of Purpose states that individuals are provided with a supported environment within which the resident can develop confidence and personal responsibility. People are supported to make their own decisions and are assisted to manage their own money. Systems are now in place to minimise the risk of financial abuse one person manages their own money. Risk assessments were available for all individuals whose files were sampled and reviewed between March and September this year. All staff have access to the organisations’ policy on confidentiality available on the intranet and in manuals. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 13 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): 11-17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People have opportunities to participate in activities of their choosing and to engage in activities that maintain their independence. Staff may need to ensure that their judgements on the levels of emotional & practical support of individuals in the home realistically reflect the needs of those individuals. EVIDENCE: All individuals have set days where they go with staff to do house shopping. Each individual has a washing day and are supported to do their own washing if needed. People are supported to maintain their own flats and a general assistant cleans and tidies communal areas. In a pre-inspection survey one person wrote, “Staff clean the communal spaces but residents clean their own rooms with staff support. This helps concentrate my mind.” Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 14 Generally people in the home are encouraged to undertake tasks that support their independence. Gardeners are contracted. However, the Expert observed an encounter between one distressed individual and a member of staff where she felt the member of staff could have been more supportive or more sympathetic over a particular issue which the individual had handled herself and that this lack of support could have taken away from the individual’s confidence to act independently again in a similar situation. The Expert reports: “ I feel that staff should take responsibility for potentially stressful encounters and offer more assistance in these areas. Staff need to take the initiative in dealing with sensitive issues & offer support & advice when needed. Residents should be offered the resources to live life as they would in their own homes with no restrictions on necessities. Staff need to be supportive in helping residents work towards independent living but should ensure they don’t have unrealistic expectations. Inappropriate judgement of the levels of emotional and practical support needed might leave people feeling vulnerable and unsafe. Progress can be achieved through positive intervention and individual motivation. There is a danger that in just ‘leaving them to it’ with little help or encouragement people will become frustrated and stop trying.” Out of 12 surveys, nine people ticked always to the question ‘Do you make decisions about what you do each day.’ Two people ticked sometimes and one did not respond. 10 people ticked that staff always treated them well and two ticked sometimes. In their survey one staff member also stated that the service could encourage service users to be more independent still. The inspector also observed positive interaction during the inspection between staff and residents. Additionally we observed in records that individuals are consulted on their individual interests, hobbies and what they wish to pursue on a day to day basis. There is a structured activity timetable and other activities which occur throughout the day, evening and weekends. Individuals are supported to engage in a wide variety of amenities in the local community, including a bingo hall, leisure centres, cinemas, pubs and bowling. A recommendation from a member of staff in a pre-inspection survey includes, “If the scheme can acquire a car/bus it may be able to arrange day trips more easily.” The Expert agreed that a minibus could improve the service provision for people in the home. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 15 Several individuals are currently attending local day services and the centre attended by one individual is suitable to meet their cultural needs. Some individuals access day centres with assistance from their support workers where this support is needed. Individuals are also supported to visit local shops to purchase their personal care items and to participate in weekly shopping for the home at a local supermarket. The Expert noted that, “A range of activities is available at the home, including bingo on Monday, art on Thursday and regular cookery sessions. Residents also visited the local day centre, ‘for coffee and a chat’ according to one lady and were supported in attending houses of worship.” Entertainments also included social evenings where service users choose DVD’s or join sing-a-long groups. The home is particularly proud about the success of ‘Coxley Fun fit.’ This is competitive table tennis indoors where service users from other schemes are encouraged to participate. The home also runs regular art sessions with an art therapist, a music group and a cookery group. Residents are supported to maintain family links and friendships outside of the home. Some individuals choose to have overnight visits to family; whilst others have family members who visit them at the home. Residents are supported to participate in cooking meals and are able to make snacks and drinks when they wish. Menu planning meetings are every Tuesdays and residents choose meals that are reflective of their personal choice and cultural background. The weeks’ menu included a range of nutritious meals. Feedback given to the inspection indicated that people are generally satisfied with their meals. The Expert wrote a detailed account about her experience and the experience of others at mealtime as she observed on the day of inspection: “I joined the residents for lunch in the dining area, which was an attractive café-style arrangement of tables & chairs. There was a choice of menu & the tuna casserole deserves a special mention, as it was a culinary masterpiece! Unfortunately there was a shortage of fresh fruit & the squash provided on the tables was unappetising. Fresh juice would have been a great improvement & a healthier, additive-free option. I requested a cup of tea and although it was provided, I was a ‘special case’ & a resident’s request was quietly ignored. I offered to help but she politely declined, saying it ‘didn’t matter’. I witnessed one particular member of the kitchen staff, who was serving the meals, being quite abrupt & dismissive with residents …….. The cook, however, was polite & friendly, as were other staff members. I spoke to several residents over lunch & most expressed satisfaction with the choice & quality of the food provided, although some seemed subdued & some were absent completely. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 16 One lady had specially prepared meals using halal meat. One of the deputy managers joined us for lunch & he confirmed that residents could eat in their rooms if they preferred, although isolation was discouraged. The two kitchen staff also joined us. All three staff members agreed that they received appropriate training & they were satisfied with their terms of employment with East Living. Minutes of residents’ meetings indicated some dissatisfaction with the food & people had complained about the lack of milk. It was minuted that complainees could not ‘demand’ more milk! The manager told me that residents were only allowed one pint of milk a day & were supposed to order any extra in the morning. I spoke to one lady, who had asked a fellow resident to buy her a pint of milk that day, did so on a regular basis as she was anxious about running out in the evenings. ……” The manager needs to ensure that the whole mealtime experience is a pleasant one for people living in the home and their views about their food and drink are taken on board. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 17 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): 18-20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People in the home are consulted for their views about their service provision and their individual physical and mental health needs are generally addressed. However the home must ensure that peoples’ emotional needs are also taken into account in their service provision. Some improvement needs to be made as regards medication practises. EVIDENCE: Residents meetings take place on a monthly or two monthly basis. Minutes of meetings demonstrated that individual were able to express their wishes about their service, for example, one persons’ preference for Halal meat was agreed to be added to the shopping list on an ongoing basis. Views on holidays were also discussed as were house issues, though the Expert noted, as recorded under Standard 8, that some of these issues were long-standing or unresolved. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 18 The Expert states that, “Residents reported that relationships with staff were generally good although I did see some evidence of conflict in the minutes of residents’ meetings.” The service generally promotes the health and wellbeing of people using the service, however observations made as noted in this report need to be taken into account in the management and delivery of service to ensure that people’s emotional needs are not compromised and the experience that people have of living in the home improves further. See also Lifestyle section above. Files showed evidence of annual health checks by the GP and hospital appointments attended by individuals independently or with support from staff. A form is completed for every health visit plus its outcome. Community psychiatric nurses visit the home to currently to administer depot injections and insulin to residents. Staff administer medication and all staff have received medication training from Boots. One individual is self medicating and a risk assessment was available for this in their file. However this was dated 10/08/06. It is recommended that risk assessments are reviewed annually, regardless of any changes to demonstrate that risks to individuals are systematically reviewed. All medication is administered in peoples’ flats rather than in the main communal areas to ensure their privacy and dignity. Medication administration checks are now incorporated into the managers’ monthly monitoring of systems and procedures in the home. Medication is kept in peoples’ own rooms in locked cabinets. The medication fridge is kept in the office and fridge temperatures are taken. We observed the following when checking medication: The storage instructions of the medication in one persons’ cabinet stated that it should be refrigerated. This is insulin administered daily by the district nurse. One person who receives medication from the district nurse. The manager informed that the medication was being kept in the cabinet for convenience. Medication must be stored safely according to the manufacturers’ instructions. In another persons’ room, medication which had been discontinued and was no longer on their MAR chart was found in their medication cabinet. The disposal of medicines book could not be located at the time of the inspection. The manager must ensure that all discontinued medicines are returned according to the homes’ medication procedures. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 19 Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 20 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. Individuals are able to complain if dissatisfied with aspects of the service, however the home also needs to ensure that their views are taken seriously and the complaints process is effective in responding to complaints. EVIDENCE: The complaints policy is in accessible format in large print with pictures included. However contact details of CSCI needs to be updated. The complaints folder had four records of complaints since 14/05/07. These had been investigated and the outcomes recorded. It is however recommended to record whether the complaint is substantiated or not and whether complainants are satisfied with the outcome, as this was unclear in one of the complaints records. The Expert notes, “Complaints may not be dealt with appropriately if they are not recorded as such & progressed through the system towards a satisfactory conclusion.” There had been one safeguarding referral since the last inspection as regards theft from a person using the service. This was investigated with the police involved. Systems are now in place to safeguard individuals from financial abuse. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 21 The home has a policy and procedure on adult protection (POVA). It is also recommended that the POVA policy and procedure is expanded to include contact numbers of key professionals, such as the police, local authority team, and CSCI. Staff receive mandatory training from the agency including adult protection. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 22 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. The environment is pleasant, welcoming and suitable for the needs of people living in the home. Service users enjoy sufficient private and shared spaces. EVIDENCE: The Expert by Experience described the home in her report as follows: “The home stands in its own walled grounds set back from the main road, a two-storey building with an appealing exterior design & the appearance of a private residence. The reception area was bright & spacious with a welcoming feel. There was a range of seating, including two comfortable armchairs. A large montage of photos of staff & residents had pride of place next to a framed award certificate. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 23 “Leading on from reception was a spacious, open plan communal area with lots of windows & French doors leading to a pleasant courtyard garden. The main kitchen & dining area were at one end, a lounge area with comfy sofas & flat screen TV in the middle & a well-fitted residents’ kitchen at the other end. This was used for cookery sessions involving residents. There was a table tennis table folded up which was used as required. Upstairs was equally spacious, comprising a pleasant balcony area with seating overlooking reception, a lounge area & an art room.” The home is a 13 flat let residential home in a two-storey building. All flat lets are of single occupancy, of which six are located on the ground floor making them accessible for people with mobility problems. Seven are located on the first floor accessible by stairway and lift. Service users share the communal bathrooms, lounge, kitchen and ground area facilities. There are laundry facilities in the home. Service users bedrooms are located around communal bath or shower rooms. Three of these contain a bathtub with mixer tap, and one has been converted to a walk in shower. All four also contain a WC and hand basin. Each persons’ room contains its own kitchenette and a WC with hand basin. The manager informed that there was a recurring problem with the blocked drain in the walk in shower room, however this had been reported and repaired again recently and recorded in the maintenance book. The manager needs to seek a permanent or more effective solution to address this problem. We visited two bedrooms. These were noted to be generally well maintained with personal furniture and service users mementos. The person we spoke with confirmed she had chosen the colour scheme in her room and that most of the items, including her bed, chest of drawers and television were hers. The Expert however noted that the armchairs in the room of one individual were both very worn & needed replacing. The home is bright, clean, adorned with pleasant pictures on the walls with a range of comfortable seating and has a welcoming feel. We saw photographs of staff engaged in activities with people in the home. Communal areas were furnished to a high standard and homely in feel. We observed a large lounge alongside the dining area where individuals relax and take part in activities, including the Coxley Fit table tennis. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 24 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): 31-36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff are carefully vetted and recruited, well trained and supported to carry out their duties and responsibilities. EVIDENCE: The staffing structure is currently made up of one Registered Manager, two deputies, seven support workers and one general assistant, who performs general duties like cleaning and filing. There are presently 13 service users living in the home. We were informed that East Thames are undergoing a reorganisation which will create two carer posts, who will focus more on personal care issues, while five support workers will focus on care plans and CPA meetings. The management structure in the home will remain unchanged. There have been changes in personnel working in the home as a result. All staff have had to be reinterviewed for their posts whereby some staff are being made redundant and some have resigned. In the last year and a half the staff have been through two restructures. With existing staff, morale has been low as a result, however Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 25 we were informed that they are continuing their duties effectively. New staff from other schemes will also be working in the home. The rota was checked and was accurate at the time of inspection. There are usually two support workers and one flexi support worker on the rota. The Registered Manager and deputy today were present on the day of inspection, however we were told that some days there may only be one manager with the Registered Manager on call. Overnight there are one wake-in night and one sleep in support workers on duty seven days per week. The minutes of team meetings were viewed that showed the team discussing a range of matters relating to residents and organisational issues. The last minutes available were on the 24th June 2008 and showed that team meetings were dated one to two months apart. East Thames operates a central human resources department that retains all personnel records. A local file is held at the home that includes a summary sheet detailing the pre employment checks completed prior to the care worker taking up their post. The summary sheets checked in three randomly selected staff files detailed all mandatory documents for each person which demonstrated that robust recruitment procedures are in place when vetting and selecting prospective workers to the home. Minutes of supervision meetings were viewed showing that staff receive regular supervision and support. Files also contained personal development plans and a range of training certificates. People in the home are able to be involved in staff recruitment though they are required to have basic training first. This is in place in other schemes. However the manager stated that no one has yet expressed an interest in taking the training in this home yet. The Expert by Experience recommended on the day of inspection and in her report for residents to be encouraged to attend staff interviews as observers or be mentored until they felt confident enough to take part themselves. The manager agreed that he would try to implement it. All support workers have NVQ Level 3s. The Registered Manager has an NVQ Level 4 in management and the Registered Managers’ Award. One deputy has an NVQ Level 3 and the other has NVQ Level 2. All staff undergo induction following the Skills for care Common Induction Standards. The Statement of Purpose states their staff undergo formal induction during the first six months of their employment, including being shadowed and coached by an experienced staff for first two weeks. We spoke with a staff member on the day of inspection who was undergoing induction and spoke positively about the home. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 26 We were advised that East Thames produces a training calendar on the intranet that is available to all staff and that training needs are discussed and identified in supervision. Staff book their training directly through the intranet. East Living also has the Investment in People Award for their training programme and effective investment in staff development. This is also recognised by CSCI. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 27 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): 37-43 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service is generally well managed and organised with systems, policies and procedures in place to effectively run the home. Health and safety procedures are well observed. An effective quality assurance system is needed to include the views of people living in the home, their family and stakeholders about the quality of service and areas for improvement. EVIDENCE: Staff spoken to on the day informed that they felt supported whilst working in the home and that the manager was always available and responsive to their needs. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 28 The Statement of Purpose states that all services are monitored for quality on a continual basis and sets out the number of systems are implemented to ensure that info about quality is collated and who is responsible. Monthly visits completed by service managers and heads of service. The last visit took place in August 2008. Additionally the managers in the home conduct monthly monitoring of the service to ensure the home runs in accordance with its internal policies and procedures. The Registered Manager stated that these slipped in the last couple of months due to the staffing and organisational issues previously referred to above. We saw evidence in records however that prior to July, these were being conducted on a monthly basis. The home have produced a stakeholder action plan in 2007 from a one off meeting with people using the service, their families and other stakeholders One view expressed in survey seen in one files stated “; I like living here; I have no problem.” Others ticked or were variably described by staff as being ‘generally well satisfied, supported, engaged with staff, having no complaints, no concerns, sleeping well and settled.” Some files did not contain satisfaction surveys. It is recommended that the quality assurance process is systematically developed to include, wherever possible, all the views of people using the service and to use the feedback gained to assist with the ongoing development and improvement of the service. The Expert also notes, “Residents, relatives & other stakeholders need to be involved in a quality assurance process developed by the home.” A policies and procedures folder was seen, as were updated policies on the IT system whilst the home were awaiting hard copies. A wide range of policies and procedures relevant to minimum standards were available. Health and Safety procedures were generally examined. The home do not use gas the building. Necessary health and safety checks and certificates were in place and in order, including electrical, water and fire safety. The Health and Safety folder also contains a safety manual for staff at Coxley, Health and Safety at work policy; fire safety; COSSH; substance register and accident and emergency procedures. We saw the report of an incident occurring in June 2008 between a service user and member of staff, accident and incident accident form demonstrating how the home appropriately follow their procedures, taking action such as contacting the social worker; reviewing the individual’s medication and reminding staff about the homes’ relevant policy and procedure. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 29 We also saw that the requirements given at a Health and Safety inspection visit from Tower Hamlets in January this year had been met. Coxley House showed a business plan for 2008-9, including their mission statement, their team plans, targets, planned outcomes and proposed impact on the service. Additionally there is an East Living Business Plan available with key objectives and performance indicators for 2007-2012. We were also shown a diversity plan for 2008-9: stating its objectives: to improve the gender balance of the staff team; to improve cultural/ethnic balance of staff to reflect the ethnicity of service users. The plan also addresses sexual orientation; disability; age and culture and religion. A valid public liability insurance certificate was available. Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 30 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 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 3 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 2 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 2 3 3 3 3 Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 31 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) • Requirement Medication must be stored safely according to the manufacturers’ instructions. All discontinued medicines must be returned according to the homes’ medication procedures. Timescale for action 26/11/08 • 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 YA1 Good Practice Recommendations • The information contained in the Service User Guide needs to be updated as it refers to the previous organisation of Springboard Housing Association. Additionally the regionalised contact details of the CSCI need to be updated. DS0000063898.V372579.R01.S.doc Version 5.2 Page 32 • Coxley House 2 YA8 • The manager to ensure that the level of consultation & involvement is inclusive of all residents & decisionmaking is evidenced. The manager to evidence that individuals’ wishes and concerns are fully addressed in the matters they raise. Residents to be encouraged to be involved in the selection of other staff. • • 3 4 5 YA11 YA16 YA17 Ensure that staff interact with individuals’ living in the home in a way that is supportive to their emotional needs and promotes their ability to be independent. The manager to evidence that house rules promote independence and individual choice. • The manager needs to ensure that the whole mealtime experience is a pleasant one for people living in the home. 6 YA20 7 YA22 The home to have an adequate supply of fresh fruit in the home and, after adequate consultation, their views about food and drink to be taken on board. It is recommended that risk assessments, including individuals’ medication risk assessments are reviewed annually regardless of any changes, to demonstrate that identified risks to individuals are systematically reviewed. The contact details of CSCI need to be updated. It is recommended to record: 1. Whether complaints are substantiated or not and 2. 2. Whether the complainant is satisfied with the outcome of their complaint. • 8 9 YA23 YA27 It is recommended that the POVA policy and procedure is expanded to include contact numbers of key professionals, such as the police, local authority team and CSCI. The manager to seek a permanent or more effective solution to the recurring problem with the blocked drain in DS0000063898.V372579.R01.S.doc Version 5.2 Page 33 Coxley House the shower room. 10 YA39 It is recommended that the home further develops its quality assurance process, including the views of service users, their families and other stakeholders. This process should inform plans for the development and improvement of the service. The outcomes of this process should be collated and made available to interested parties. It is recommended that the home acquires suitable transport such as a minibus to arrange group day trips more easily. 11 YA14 Coxley House DS0000063898.V372579.R01.S.doc Version 5.2 Page 34 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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