Care Home: Edward House

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What the care home does well The home’s manager has applied to the Commission to be the registered manager of the home. The manager and staff are working hard to improve the quality of care it provides to meet the needs of the residents, including addressing their needs and preferences regarding equality and diversity. Residents we met were well presented and were generally satisfied with the service they were receiving. One resident told us, “I am reasonably happy here and staff will do things for us”. Another resident told us, “I can generally do what I want” A healthcare professional told us, “My client has settled very well at the home, I am particularly pleased that some of the staff can speak her first language, (which is not English), and help her cook meals from her culture”. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 What has improved since the last inspection? At the last key inspection eleven requirements were made and we were pleased to see that these had all been complied with. The required improvements made were in the following areas: to be able to demonstrate how people’s gender preferences are being monitored, to provide a more sensitive service; to improve people’s care plans, to make sure staff had up to date guidance; to ensure that a clear record was kept of prescribed medication entering the home and the disposal of unused medication, to assist the safe administration of medication; to ensure staff received up to date training on safeguarding adults, for the protection of residents and staff; for the home to have a regular maintenance programme, to assist keep people safe; for staff to receive core training and/ or refresher training, to assist keep their skills and knowledge up to date; that staffing levels be reviewed, to ensure residents needs and preferences could be properly met; for evidence to be available that all staff recruitment checks had been carried out, to better protect residents; for staff to receive regular supervision, to assist them undertake their job more effectively; for policies and procedures to be reviewed on a regular basis, to assist staff be aware of the home’s current expectations of them and to improve the home’s quality assurance mechanism by receiving more structured feedback from residents. A good practice recommendation regarding the availability of a contract/ terms and conditions for each resident had also been acted on. What the care home could do better: Six new requirements are made at this inspection in the following areas: For the Commission to be notified of any serious illness or accident to residents, to maximise protection to residents and others; for the home’s medication policy and procedure to include guidance for staff on the safe administration of medication when residents are temporarily absent from the home on a planned basis, to assist maximise protection for all in this area; for fire doors to be able to close properly, to assist improve fire safety; for clear evidence that the provider organisation undertakes monthly monitoring visits to the home, to help the home develop the quality of the service it provides and two requirements relating to health and safety checks of the gas and electric supply to the home, to maximise the health and safety of all. Two good practice recommendations are also made. These are in relation to records kept of resident’s health appointments and also records kept of how residents make decisions about their day today lives, to assist in promoting their health care and independence/ quality of life.Edward HouseDS0000069877.V378012.R01.S.docVersion 5.3 Key inspection report CARE HOME ADULTS 18-65 Edward House 7 Cottenham Road Walthamstow London E17 6RP Lead Inspector Peter Illes Key Unannounced Inspection 16th November 2009 09:10a Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Edward House Address 7 Cottenham Road Walthamstow London E17 6RP 020 8509 3429 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) edwardhouse_carehome@yahoo.co.uk Ashley House Care Homes Ltd Manager post vacant Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories 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: 3 3rd December 2008 Date of last inspection Brief Description of the Service: Edward House is a privately operated care home, registered to provide personal care and support to three younger adults who have mental health needs. The registered provider also operates a number of other registered care services in North London. The home is a converted terrace house with accommodation provided on two floors. The ground floor contains an entrance hall, one bedroom, lounge, kitchen/ diner, a bath room/toilet and provides access to the rear garden. The first floor contains two further bedrooms, a separate toilet and an office. The home is situated in a quiet residential area in Walthamstow and is close to shops, public transport links and a range of other multi-cultural amenities in the area. A stated aim of the home is to provide a happy, friendly, individual, supportive and empowering service where residents can achieve as high a quality of life as possible, by connecting them with their community. At the time of the inspection, the weekly fee was from £700 per week. Information about the service, including inspection reports, is available on request from the home. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 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. The last key inspection of this service took place on 3rd December 2008. This key inspection took approximately five hours and was undertaken by the lead inspector. However, terms such as we, our and us are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. There were three people living at the home at the time and no vacancies. No new residents had been admitted to the home since the last key inspection. The manager was available to assist throughout this inspection. The inspection activity included: meeting and speaking to two residents; detailed discussion with the manager and independent discussion with one member of staff. We also spoke independently by telephone to a community psychiatric nurse (CPN) who is involved with one of the residents, to obtain their feedback on the home. Further information was obtained from a tour of the building, documentation kept in the home and from survey forms sent to us by two residents and two staff. The manager sent us an Annual Quality Assurance Assessment (AQAA) when we asked for it. What the service does well: The home’s manager has applied to the Commission to be the registered manager of the home. The manager and staff are working hard to improve the quality of care it provides to meet the needs of the residents, including addressing their needs and preferences regarding equality and diversity. Residents we met were well presented and were generally satisfied with the service they were receiving. One resident told us, “I am reasonably happy here and staff will do things for us”. Another resident told us, “I can generally do what I want” A healthcare professional told us, “My client has settled very well at the home, I am particularly pleased that some of the staff can speak her first language, (which is not English), and help her cook meals from her culture”. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 6 What has improved since the last inspection? What they could do better: Six new requirements are made at this inspection in the following areas: For the Commission to be notified of any serious illness or accident to residents, to maximise protection to residents and others; for the home’s medication policy and procedure to include guidance for staff on the safe administration of medication when residents are temporarily absent from the home on a planned basis, to assist maximise protection for all in this area; for fire doors to be able to close properly, to assist improve fire safety; for clear evidence that the provider organisation undertakes monthly monitoring visits to the home, to help the home develop the quality of the service it provides and two requirements relating to health and safety checks of the gas and electric supply to the home, to maximise the health and safety of all. Two good practice recommendations are also made. These are in relation to records kept of resident’s health appointments and also records kept of how residents make decisions about their day today lives, to assist in promoting their health care and independence/ quality of life. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 7 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 8 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 Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Up to date information is available for prospective residents and other interested people to make an informed choice about living in the home. People’s needs are properly assessed before they move into the home to ensure that staff can meet their needs. People’s needs are regularly reviewed once they are living in the home, to assist staff be aware of any changes in these needs. People also benefit from having a clear contract/ terms and conditions, specifying their rights and responsibilities regarding living at the home. EVIDENCE: The home’s annual quality assurance assessment, AQAA, states; “We have developed client focused and holistic client assessment criteria, where prospective service users’ individual aspirations and needs are assessed holistically. We do these by involving the service user, using appropriate communication methods and with an independent advocate as appropriate. We believe, by being open, service users are enabled to make an informed choice of the home they would like to live in”. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 10 The home has a satisfactory statement of purpose and service user guide that were seen. These documents give clear information about the home and the services it offers and a note on both documents stated that they had been reviewed in June 2009. No new people had been admitted to the home since the last key inspection. The files of the three current residents were inspected and showed that the home had a range of satisfactory assessment information that had been made available to the home before each person was admitted. It was also noted that an annual re-assessment/ review of each person’s needs and preferences had been undertaken in either May or June 2009 and the record of those meetings had been signed by the respective resident. Each residents’ file showed evidence that they were receiving appropriate support from specialist health care professionals, including each having regular care planning approach (CPA) meetings. CPA’s are review meetings that include relevant health and social care professionals, which are required by law for some people with mental health needs. One of the residents was accompanied by a staff member to their CPA during this inspection. We spoke independently by telephone to the community psychiatric nurse, (CPN), involved with one of the residents. She told us, “My client has settled very well at the home, I am particularly pleased that some of the staff can speak her first language, (which is not English), and help her cook meals from her culture”. At the last inspection a requirement had been made that the home must demonstrate that people’s gender preferences regarding support from staff are being met at all times. The home is working hard to comply with this requirement. Evidence was seen on each person’s file that their wishes regarding gender preferences of staff had now been recorded and that the record of this had been signed by the resident. It was also noted that none of the three current residents needed direct support with their personal care and that the home had taken action to deploy an even mix of male and female support staff at the home. Although there is often only one member of staff on duty on a shift we were told that if a person wanted support from a member of staff of a specific gender this would be planned and accommodated wherever possible. At the last inspection a good practice recommendation was made that the home should complete a contract/ terms and conditions for each resident detailing the service provision, rights, responsibilities and fees. We were told by the manager that these were in place at the last inspection although copies of all of them were not accessible at the time. A signed copy of a completed contract/ terms and conditions was seen on each of the three residents’ files at this inspection. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 11 Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are consulted when their needs are assessed and both people’s needs and preferences are recorded in their care plans to assist staff in meeting these. People are supported to maximise their independence by making as many decisions as possible for themselves. People are also supported and guided to take appropriate risks in their daily lives to assist them to safely achieve their aspirations. However, the home needs to inform all relevant parties when a serious incident involving a resident occurs, to maximise protection to all concerned. EVIDENCE: The home’s annual quality assurance assessment, AQAA, states; “Our service users’ best interests are protected with their individual needs and choices Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 13 reflected well on individual service user plans. They are on the whole encouraged to make informed decisions about their life and are supported appropriately to take risks as part of an independent lifestyle. Our risk assessments are comprehensively carried out highlighting clearly the history of risk and current level of risk”. The three residents’ files all contained up to date care plans that were primarily based on current assessment information. At the last inspection a requirement was made that people’s care plans must clearly record people’s behavioural and dietary needs. Evidence was seen on the files inspected that this requirement was being complied with. The care plans seen also included information about the person’s needs, preferences and guidance for staff in meeting these, including in the following areas: mental health needs, access to the community, finance, compliance with medication and family contact. In addition files contained information on people’s individual preferences, including regarding any personal or intimate care (although none of the current residents needed direct assistance with this), religious observance, serious illness or death and gender, relating to the support received from staff. As a result of their often complex needs identified residents had specific limitations in place, e.g. regarding travelling independently in the community. Evidence was seen that these had been properly agreed, including at multidisciplinary meetings such as care planning approach meetings, and that these limitations had also been agreed with the resident concerned. Residents are supported to manage their finances as independently as they can although the home does hold some money for some residents. We sampled the cash held for one residents and the respective record, both of which matched and were up to date. One resident told us, “I am reasonably happy here and staff will do things for us”. Another resident told us, “I can generally do what I want”; although they did go on to tell us that they sometimes got fed up at having to live at the home. The files inspected all showed a range of risk assessments that were specific to the individual. These included risks relating to the use of alcohol, aggressive behaviour and self neglect. It was noted that one resident had been admitted to the local hospital’s accident and emergency department on two occasions since the last inspection following incidents relating to risk taking. Evidence was seen that appropriate action had been taken following these admissions to try to lower the risk in future and this had involved multi-disciplinary input. However, although community based health staff and the person’s placing authority had been informed of these hospital admissions the Commission had not been informed, as is required by government regulations. A requirement is made regarding this in order to maximise protection to residents and others. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 14 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): This is what people staying in this care home experience: 12, 13, 15, 16 & 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are generally encouraged and supported to participate in a range of activities, including within the wider community, although further work is needed to evidence how people decide what to do with their time. They also enjoy contact with relatives and friends to the extent that they wish. People are supported to be as independent as possible including regarding their choice of meals. EVIDENCE: The home’s annual quality assurance assessment, AQAA, states; “At Edward House we belief that lifestyle aspirations will naturally vary according to the person’s age, culture, experience and interest as well as their disability or Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 15 illness. Our staff help our service users to take part in valued and fulfilling activities. We support and encourage our service users to take part in activities in the local community.” One resident attends a specialist day service three days a week, although we were told that the person does not always want to attend on the day and the person concerned confirmed this. Another resident, who we were told will soon be moving on to more independent accommodation, travels independently. This person largely makes their own arrangements for activities, spending most days out of the home visiting family and friends. The third resident was not at all keen on planned or structured activities and told us that quite firmly. Evidence was seen that residents are encouraged and assisted to participate in daily activities in the home including helping keep their rooms clean and in cooking their meals. We were also told that the home organised a trip to Southend during the summer and is in the process of organising Christmas activities, possibly in conjunction with other services run by the registered provider. We were also told in the AQAA that; “Community visits, day centres, indoor games and activities,gardening, beauty therapy, light exercises,brisk walks, cooking skills, religious observance, building relationships with friends and family, shopping trips, day trips, holidays, visits to museums, parks and other places of interest are some of the opportunities offered to service user in line with their assessed needs”. However, the daily notes and other records that the home keeps on each resident are not detailed enough to evidence this statement. The records were also not detailed enough to show a record of what individual residents actually do during the day and how they have made decisions regarding their day to day activities. A good practice recommendation is made regarding this. People living at the home originate from different ethnic communities and evidence was seen that their needs and preferences, including in such areas as food and places of worship, were discussed with the person and recorded. People are supported to make their own decisions about how and to what extent they pursue their culture and religion. Residents are able to maintain contact with family and friends to the extent that they wish. We saw evidence that each of the three residents were supported to maintain contact with family and friends. However, residents are supported and encouraged to manage relationships that may have consequences in achieving their rehabilitation goals. The home has a sample menu that was seen and we were told that this was compiled with the residents on a seasonal basis. The menu seen was adequate although we were also told that residents had the choice each day of what they wanted to eat if they did not fancy what was on the menu that day. On the day Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 16 of the inspection one resident was out for the day, one resident had a lunch of freshly cooked yams and other vegetables; the other person had savoury mince and rice, which was on the menu. Residents spoken to confirmed that they were consulted about the menu and were encouraged to take part in cooking their meals. The meals seen on the day looked appetising and well presented, with each being prepared individually. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home receive appropriate personal support in accordance with their needs and wishes. They are also supported in meeting their physical, mental and emotional healthcare needs, including by accessing relevant health care professionals. The medication administration procedures within the home assist in safeguard people living there. However, improvements are needed with regard to recording of aspects of both healthcare appointments and the safe administration of medication, to maximise protection to residents and staff in both these areas. EVIDENCE: The home’s annual quality assurance assessment, AQAA, states; “Our service users’ best interests are protected with their health and personal care goals reflected well on individual plans. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 18 All three residents are independent with regard to their personal care and this is recorded in their files although the manager stated that individuals sometimes needed verbal prompts in this area. Residents spoken to independently indicated that staff were sensitive to any specific support needs they may have and during the inspection the residents spoken to were appropriately dressed and presented. Evidence was seen that the three residents were registered with a GP and had contact with a range of mental health specialists including psychiatrists and community psychiatric nurses. Minutes were seen of Care Planning Approach meetings with mental health specialists and who was to take responsibility for actions agreed. In addition each resident had a year planner for healthcare appointments in their files. These showed that residents have access to services from a dentist, optician and a range of other community and hospital based healthcare professionals. However, although appointments attended and planned were logged there was no record of the outcome of the (non mental health) appointments that residents attended. A good practice recommendation is made regarding this to maximise the promotion of residents’ healthcare. At the last inspection a requirement was made that the home amends its medication policy to support staff with adequate guidelines regarding an audit trail for medication entering and being disposed of by the home. This had been complied with and a separate record of medication being received into the home and being returned to the pharmacist was in place and current. Medication and medication administration record (MAR) charts were inspected for all three people living in the home. These were generally accurate, indicating medication was being given as prescribed and there was no evidence of missed doses. However, one resident who often visits their family for the day is given their medication for the day to take with them. The MAR chart on the day of the inspection had been signed as if the person had already taken their evening medication. The manager stated that the signature meant that the medication had been given to the person to take themselves that evening, although acknowledged that this could be confusing as the entry was not clear. The medication policy did not outline a procedure for when medication needs to be given to residents in advance, to be taken when they were away from the home on a planned basis (often known as “social leave”). A requirement is made that the home must include guidance for staff on supplying and recording medication given to residents to be taken when they are away from the home and that staff are made familiar with this. Evidence was seen that medication is stored properly and that staff that administer medication have been trained to do so. This was confirmed by a member of support staff spoken to independently. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported to express their views and concerns and have these acted on appropriately. The home’s safeguarding adults’ policy and procedures assist in protecting people from abuse. EVIDENCE: The home’s annual quality assurance assessment, AQAA, states; “At Edward House, we promote good relationships and clear client centred communication that enables our service users to feel free to complain when they feel unhappy”; and. “………….Our service users benefit from a clear complaints procedure which is availed to them under the service user guide given to them prior to admission to the home”. The home has a satisfactory complaints procedure that was seen in the Service User guide and a summary was displayed in the home’s entrance hall. One resident spoken to confirmed that they had been given a copy of the complaints procedure to keep in their room. Residents spoken to told us they could raise any issues or concerns they have, with staff or the manager, and generally felt they were listened to and that their concerns were acted on. No complaints have been recorded in the home or made to the Commission since the last inspection. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 20 We saw a copy of the home’s in-house safeguarding adults’ procedure and a copy of the LB of Waltham Forest’s safeguarding adults’ procedure, the local authority that the home is situated in. At the last inspection a requirement was made that staff receive training in safeguarding adults. We saw documentary evidence that staff had been provided with that training and a staff member spoken to independently confirmed this. There have been no allegations or disclosures of abuse made to the home or to the Commission since the last inspection. The home also had an in-house whistle blowing policy, which was seen although not looked at in detail. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is domestic in scale, adequately decorated and that generally meets their current needs. However, further work is needed to the environment to maximise fire safety within the home. People who live in the home, staff and visitors benefit from the building being kept clean and tidy. EVIDENCE: The home’s annual quality assurance assessment, AQAA, states: “Our home environment is kept clean, comfortable, bright, cheerful, odour free and is well maintained to ensure full safety for service users. It is in keeping with the local community and have a style and ambience that reflect the home’s purpose. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 22 Service users are provided with adequate communal and private space in a clean and well maintained environment”. The home is a converted terrace house with accommodation provided on two floors. The ground floor contains an entrance hall, one bedroom, lounge, kitchen/ diner, a bath room/toilet and provides access to the rear garden. The first floor contains two further bedrooms, a separate toilet and an office. The home is situated in a quiet residential area in Walthamstow and is close to shops, public transport links and a range of other multi-cultural amenities in the area. The AQAA also told us under “Barriers to improvement” that; “We have had some few budgetary constraints which has made it hard for us to do what we would have liked to do or plan to improve within a given time frame”. During a tour of the building we noted that the decoration, furniture and fittings were domestic in scale and generally comfortable but often quite “tired” looking. However, residents spoken to indicated that the premises generally met their needs and it is acknowledged that sometimes residents are not particularly motivated to keep the home looking as nice as it could be. At the last inspection a requirement was made that the home has a regular maintenance programme for the premises, following an incident caused by a faulty appliance. This requirement was being complied with, including a monthly health and safety check. However, despite the monthly checks it was noted that the door to the lounge, which is a fire door, was significantly catching on the carpet and did not close on its own when released from the fully open position. We were told that his was due to some recent damage and that the door usually closed independently when released. A requirement is made regarding this to maximise fire safety to all that use the home. We were invited by one of the residents to look at their bedroom as part of the inspection. The room had been personalised by the resident to a certain extent and they told us that the room was warm and comfortable and that they had everything they needed in the room. None of the current residents had needs in relation to continence. The home’s laundry facilities were domestic in scale and suitable to meet the current residents’ needs. Cleaning materials and other potentially hazardous material are kept locked when not in use. The home was generally clean and tidy during the inspection and free from unpleasant smells. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff with a range of appropriate qualifications and competencies are deployed in sufficient numbers to support people living in the home. The home’s recruitment policy assists in protecting people living in the home. People are supported by staff who have access to a range of appropriate training. Staff also receive formal supervision to assist in meeting the needs of people living in the home and in their own personal development. EVIDENCE: The home’s annual quality assurance assessment, AQAA, states; “Our staff are well trained as we have in place a comprehensive training plan that was put together following a proper skills scan, appraisal and good supervision. These process enabled us to assess actual training needs and plan for them. 100 of our staff have already achieved the relevant NVQ in care or are working Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 24 towards it”. The home employs a manager (who has applied to the Commission to be registered as such), a deputy manager and three support workers. We were told that the provider organisation has identified bank staff that can also work at the home when required. The manager told us he has recently completed his Registered Manager’s Award, a national vocational qualification, (NVQ), level 4, and is waiting for his certificate; the deputy manager has achieved her Registered Managers Award and the three support workers have either achieved or are working towards NVQ level 2 in care. Staff files sampled and staff spoken to assisted to evidence this. At the last inspection a requirement was made that the home must deploy appropriate staffing levels that match the needs of the residents, including taking into consideration of their gender preferences. This requirement had been complied with, including having a gender mix of the staff employed at the home. The staff rota was seen, was up to date and accurately reflected the staff on duty on the day. A minimum of one support worker covers the early and the late shift, and one waking support worker covers the night shift. The manager’s hours in addition to this although the manager spends his time working between Edward House and another of the provider organisation’s registered care homes. As stated above, we were told by the manager that additional bank staff could be deployed at the home if needed, e.g. to assist with individual appointments for residents. At the last inspection a requirement was made that the home must make available all the appropriate evidence regarding pre-employment checks for staff. This was because the Criminal Records Bureau (CRB) checks for 3 staff at that time had not been carried out by this provider organisation. This requirement had been complied with. We were told that all staff working at the home had current enhanced CRB and protection of vulnerable adults (POVA) checks taken out by the home’s provider organisation. We checked staff files to evidence this. No new staff have been employed by the home since the last inspection. At the last inspection a requirement was made that the home must produce evidence of all core training for staff and other training that matched with their roles and responsibilities at the home. This requirement was being complied with. We saw evidence of core and other training undertaken since the last inspection and this included training in the following: mental capacity act; dealing with aggression and violence; dealing with challenging behaviour; safe administration of medication; safeguarding adults and fire safety. The manager informed us that the home has also joined the Waltham Forest Partnership, Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 25 which provides local care homes with staff training either at no charge or at a subsidised cost. At the last inspection a requirement was made that the home must carry out regular supervision of all staff. We saw evidence to support this from staff files and also from an independent discussion with a support worker. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ benefit from a manager who is enthusiastic to develop the home further. Residents also benefit from their views being sought regarding the quality of life they experience, however, there needs to be more evidence of monitoring of the quality of the service from the provider organisation. Health and safety procedures generally assist in protecting people at the home although further attention is needed to ensuring that identified health and safety checks are undertaken by people competent to do so. EVIDENCE: Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 27 The home’s annual quality assurance assessment, AQAA, states; “At Edward House, there is a competent, well experienced and qualified manager who runs the home. The manager is friendly, supportive and always caring. He is always there to support service users and empower them to lead dignified lives in privacy and with respect, choice and individuality. Service users benefit from the ethos, leadership and management approach in all areas of the home”. The manager has been in post since September 2008. He has applied to the Commission to be the registered manager of the home and we are currently processing that application. The manager told us that he had completed his registered managers’ award, RMA, and was waiting for his certificate to be sent through. The manager is also managing another small home owned by the provider organisation although tells us that he is at Edward House for at least half of each working week. The manager told us that he was enthusiastic about continuing to develop the quality of life for residents at the home. Evidence was seen that the home has worked hard to meet the requirements made at the last inspection, which is reflected in this report. We received positive feedback about him from a resident and a support worker spoken to at this inspection. At the last inspection a requirement was made that the home has evidence that its policies and procedures are updated and reviewed on a regular basis. The AQAA stated that all key policies had been reviewed in either June or July 2009; the policies we sampled also stated this. The manager also told us in the AQAA that the home was aware of the implications of the Mental Capacity Act 2005 and was currently in the process of further updating the home’s policies and procedures to incorporate this and other new legislation. We reminded him that this was important. At the last inspection a requirement was made that the home develops a more comprehensive quality assurance system. At this inspection we saw evidence that the home had sent out satisfaction surveys to residents and other stakeholders. We also saw evidence that the home had introduced a series of regular audits to monitor quality assurance and also that key workers now record monthly meetings with each individual resident. The manager told us that he was in the process of completing a business/ development plan for 2010. The registered provider also visits the home to monitor the quality of the service. However, we only saw four reports of these visits, which had been undertaken in December 2008, February 2009, May 2009 and July 2009. The manager told us that there had been other visits but did not have the reports to evidence this. Given that the manager also spends half of his time Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 28 managing another registered home a requirement is made that monthly visits are made to the home by the registered provider, or their representative, and that reports of these visits must be sent to the home in a timely manner. At this inspection a range of satisfactory health and safety documentation was seen. However, a current gas safety certificate and electrical installation certificate were not available for inspection and separate requirements are made regarding these. The home’s fire log was inspected and included a current fire risk assessment and fire plan, which had been undertaken by an external company since the last inspection. However, a requirement is made in the Environment section of this report regarding ensuring that fire doors close properly when released for the open position. Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 29 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 1 2 3 4 5 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Standard No 11 12 13 14 15 16 17 Score Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No 31 32 33 34 35 36 3 3 3 X 3 3 3 X 2 X Score Score X 3 3 X 3 3 3 X 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X 3 2 X Page 30 Edward House DS0000069877.V378012.R01.S.doc Version 5.3 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 YA9 Regulation 37(1) Requirement The registered persons must inform the Commission without delay of any incident involving any serious injury or illness to residents. This is to include when residents are taken to hospital on an emergency basis. This requirement is made to maximise protection for residents and others. The registered persons must make arrangements for the safe administration of medication at the home. This must include having clear guidance for staff on supplying and recording medication that is given to residents to be taken when they are away from the home on a planned basis and that staff are made familiar with this. This requirement is made to provide maximum protection for all concerned. 3. YA24 23(4) The registered persons must make adequate arrangements for detecting, containing and DS0000069877.V378012.R01.S.doc Timescale for action 16/12/09 2 YA20 13(2) 16/12/09 16/12/09 Edward House Version 5.3 Page 31 extinguishing fires. This must include ensuring that all fire doors must close properly when released form an open position. This is to maximise fire safety for all that use the home. The registered persons must 16/12/09 ensure that monthly visits are made to the home by the registered provider, or their representative, and that reports of these visits must be sent to the home in a timely manner. This requirement is made to promote the quality of care residents receive. The registered persons must ensure that unnecessary risks to the health and safety of residents are identified and as far as possible eliminated. This is to include that the home’s electrical installation is checked as being safe, by a person competent to do so. This requirement is made to maximise the health and safety of all that use the home. The registered persons must ensure that unnecessary risks to the health and safety of residents are identified and as far as possible eliminated. This is to include that the gas supply to the home is checked as being safe, by a person competent to do so. This requirement is made to maximise the health and safety of all that use the home. 4. YA39 26(3 &4) 5. YA42 13(4) 16/12/09 6. YA42 13(4) 16/12/09 Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 32 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 YA12 Good Practice Recommendations The home should make keep records, including in people’s daily notes, which are detailed enough to evidence what activities they are offered, those they take part in and how residents make decisions make their day to day lives. This is to help staff assist residents in developing further independence. The home should record the outcome of all resident’s appointments with healthcare professionals, including any follow up action needed by the home. This is to assist keep all staff up to date and to maximise the promotion of residents healthcare. 2. YA19 Edward House DS0000069877.V378012.R01.S.doc Version 5.3 Page 33 Care Quality Commission Care Quality Commission London Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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