Care Home: Equinox, Lower Clapton Road

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What the care home does well There are currently five people who arrived on different dates and three people stated `they have no complaints` about staff and `have had good support` when needed. Two people had a difficult time settling into the programme and explained that `staff took time to talk and help them through` this period. There are a variety of rooms that provide ample opportunity for one to one discussions, private meetings and reviews. What has improved since the last inspection? N/A What the care home could do better: While the home is currently bright and clean, the environment is rather basic and this is particularly true of the dining room area. While on a six week programme, eating can be particularly difficult, a welcoming and comfortable dining room would encourage regular meals. Further details can be found in the section headed `Lifestyle` in the body of this report. Staff must follow a set procedure to monitor the amount of food eaten by any person who is refusing meals. This is currently not the normal practice.Those using the home must be included in discussions when meals are being planned and alternative meals available when required. CARE HOME ADULTS 18-65 Equinox, Lower Clapton Road 126 Lower Clapton Road London E5 0QR Lead Inspector Brenda Pears Announced Inspection 3 January 2008 11:00 rd Equinox, Lower Clapton Road DS0000070069.V355314.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 Equinox, Lower Clapton Road DS0000070069.V355314.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. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Equinox, Lower Clapton Road Address 126 Lower Clapton Road London E5 0QR Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8525 7680 020 8533 5895 Equinox Miss Victoria Dunlop Care Home 20 Category(ies) of Past or present alcohol dependence (20), Past or registration, with number present drug dependence (20) of places Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Past or present drug dependence - Code D 2. Past or present alcohol dependence - Code A The maximum number of service users who can be accommodated is: 20 Date of last inspection Brief Description of the Service: Equinox has been operating since October 2007 and provides support for people with past or present drug and/or alcohol dependency, providing a detox and stabilising programme that takes place over a six week programme. The home is situated on a busy street near Clapton Pond within the London Borough of Hackney with easy access to train stations, bus routes, local shops and amenities. There is some off road parking to the front of the property and the home is spread over four floors. People currently in the home have been placed through the borough of Hackney and the home is working to encourage other local authorities to utilise this service. As a guide to costs, following assessment, fees currently are £155.00 per night and an additional £10 per week is paid by the individual personally. Any difficulties with this payment are managed and discussed with the manger of the home, however, personal lack of funds do not automatically exclude anyone from this programme. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was undertaken on the 3rd January 2008 and started at 11.00 am. This was the first inspection that has been carried out since the home has been registered and fully operational. The methods used to complete this inspection consisted of a review of records, discussions were undertaken with three people using the service and also with members of staff. A tour of the building was carried out and the inspector also observed interactions between staff and service users at this time. What the service does well: What has improved since the last inspection? What they could do better: While the home is currently bright and clean, the environment is rather basic and this is particularly true of the dining room area. While on a six week programme, eating can be particularly difficult, a welcoming and comfortable dining room would encourage regular meals. Further details can be found in the section headed ‘Lifestyle‘ in the body of this report. Staff must follow a set procedure to monitor the amount of food eaten by any person who is refusing meals. This is currently not the normal practice. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 6 Those using the home must be included in discussions when meals are being planned and alternative meals available when required. 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. Equinox, Lower Clapton Road DS0000070069.V355314.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 Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An assessed is completed before a person is accepted into the home, ensuring a full awareness of individual needs. EVIDENCE: All needs are fully assessed and agreed prior to any admission. The local authority assessments and care plans developed by the home were seen at this time. Those using the service stated they had been given information prior to admission. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans are in place to fully support those staying in the home. EVIDENCE: Care plans were orderly and information was easily accessed. People using the home know they have needs and goals set out in care plans and agree to this information being retained by the home when they sign their admission agreements. Programmes are undertaken over the course of six weeks and people understand that this time is needed to fully complete their detox or maintenance programme. One person informed the inspector they had not eaten for three days due to difficulties swallowing. When this person’s care plan was seen, there was no record of what had been eaten or offered. An appointment had been made with the doctor for the next day and observations made on the care plan of these difficulties. However, there was no plan of action to ensure some Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 10 nutrition was being given or to monitor this situation. The person concerned had not been informed of this appointment and felt that no one was taking any notice of this problem. This was discussed with the manager at this inspection. The manager was fully aware of this situation but understood all information had been passed to the individual. Keeping every person fully informed at all times about the support being provided, will ensure the well being of those working to complete their six week programme. The manager confirmed that this incident would be reviewed, discussed with staff and recording practices would be examined. Individuals do make decisions with assistance from staff. Any person making a decision to end their stay in the home is fully supported by staff to discuss any difficulties or problems. Discussions and conversations at this time confirmed that staff do support and encourage people to complete their full six weeks programme. Following this programme, an additional discharge strategy is developed to ensure there is ongoing support provided by other agencies. In the first instance, all trips outside the home are accompanied following assessments. When the programme is almost complete, again following assessment, individuals take trips out on their own. Tests and checks follow any outings and staff monitor routines and support each person on a one to one basis at all times during their stay. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. External activity programmes are being developed and each person is assisted in the way they need. EVIDENCE: As stated, initial outings are accompanied as part of the six week programme. Activities to date have included bowling, swimming, gym, walks and accessing the local leisure centre. The manager explained that any religious needs would be supported, but no request has been made to date. Programmes at the local college are also being reviewed, to further develop the support currently given. The inspector spoke to three people who are currently in the home and all three stated that some days can be ‘very boring’ and ‘more activities need to Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 12 be developed’. The manager explained that a fuller activity programme was being devised and some additional recreational equipment has been ordered. Three people discussed their experience in the home and while they agreed the food provided is good, they also said they found it ‘ rather heavy’ and ‘not what I would usually eat’ and ‘difficult to eat at such a time’. The chef is from an agency as the home is due to recruit a permanent member of staff. However, while the manager explained that the chef does talk to those living in the home and find out what they like, three people stated they just ‘eat what is served’. Those living in the home must be regularly consulted about meals and their preferences and alternatives made available. This should not be posing a problem when there are currently only five people in the home to cater for. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Emotional and physical needs are met by the home and medication is administered by qualified staff at all times, however, some areas of recording require improvement. EVIDENCE: Due to the nature of the support provided by the home, all medication is administered by a qualified member of staff and controlled drugs are also witnessed by a second member of staff. The medication room was orderly and tidy, all records seen were up to date and clearly completed and signed. The medication administration procedure is on display in the medical room and medication was stored appropriately. Additional support is provided by the local Drug Awareness Team, GPs and alternative therapies are also provided. Acupuncture and reflexology are some alternative treatments that are being considered to assist with calming and positive behaviour techniques. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 14 Staff complete daily records and one file seen at this time showed thorough records and details regarding the needs of the individual. There are also forms for morning and afternoon observations if any important information needs to be highlighted for the next shift. Records show that night checks are undertaken every hour, a summary of observations is recorded, there is a communication book and a verbal handover at the start of each shift. This data is then logged by an allocated member of staff onto the computer to confirm who has been updated and what information is current. All those staying in the home sign to accept this recording method and the organisation is registered under the data protection act. As previously stated in this report at standard six above, all changes for each person must be fully recorded, discussed with the individual and be followed by an adjusted plan of care. This will ensure the appropriate support is provided at all times and the person’s continued well being ensured. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and safety assessments have been carried out to ensure accidents are minimised for both staff and service users. Practices, training and induction also ensure safety and protection. EVIDENCE: Those spoken to at the time of this inspection confirmed that staff do listen and provide assistance and support as needed. There is a complaints policy in place that is set out in the service user guide and is also on display in two main rooms in the home. Information is provided to access alternative agencies if there is a complaint and these contact details are also in the service user guide. There are policies and procedures in place and risk assessments have been completed to ensure all areas of health and safety are appropriate. There are regular house meetings for those living in the home, providing an opportunity for any worries or areas of concern to be discussed and highlighted. Key worker and one to one discussions also support individuals in the home. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 16 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. In the main, the home provides a relaxed and comfortable environment, but there are some areas that would benefit from being upgraded. EVIDENCE: The home is clean and bright but has a rather stark atmosphere in some rooms, particularly in the dining room. There are currently no curtains in the dining room and the manager said that problems with leaks and window frames have been the reason for this. The manager also stated that the dining room, along with other areas, would be made more comfortable. One person in the home said that ‘ food is quite difficult to enjoy when the eating area is unwelcoming and not very comfortable’. It was also said that mostly people ‘eat quickly and leave’. The view from the windows is of external walls and this again does not help the atmosphere in this area. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 17 There is a large lounge with comfortable seating, this is currently adequate with only five people in the home. The maximum registration is for 20 people and communal areas will need to be reviewed when the home is full. The home is situated in a busy main street with local activities and amenities easily accessible. The home provides a variety of areas for private discussion and is spread over four levels. There are shower and bathroom facilities available throughout the home, there is a laundry room and an allocated smoking area available. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment and staff training do ensure the well being of those being supported, but staff files require additional information. EVIDENCE: There are three staff on duty during the day and two night staff, one member on each shift is a qualified nurse who administers all medication. There is a registered manager and two deputy managers. While staff do not start work in the home until all checks and references have been received, not all copies of these documents are on staff files. This was discussed with the manger who explained that some references are in the home but not all required documentation was available. There were some copies of identification but not on all files sampled. The head office of Equinox currently retains all recruitment information, however, copies of these documents are required on site for inspection purposes. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 19 A sampling of staff files was undertaken at this inspection and these were orderly but only contained some of the required information. There are dates that CRB checks have been received by the organisation and while the manager is one person who signs off references, there is no copy of these on staff files. This was discussed with the manager who stated that Equinox had recognised this did not meet requirements of registration and this area of information will be addressed. Following recruitment, staff do undergo ‘in house training that covers such areas as cognitive behaviour and other appropriate areas of training and awareness. Training is also provided through the Hackney Drug Action Team and the manager has undertaken ‘training the trainer’ to enable her to deliver some areas of in house training. Half the current staff team have additional training that is being booked by Equinox. Not all members of staff have an NVQ qualification and the manager stated that this is also being addressed through Equinox. Currently, three staff are to start NVQ level three in January, another three staff are to start level three in March with some staff also having additional degree and nursing qualifications. Staff were observed to be dealing with people in the home in an appropriate manner. Discussions and observations at this time confirmed that staff have a good knowledge of individual needs and of the practices and routines in the home. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. In the main, staff do ensure the safety and well being of those living in the home and work in an open and inclusive way. EVIDENCE: There is a clear organisational structure with staff working openly. People using Equinox stated they feel assured that staff are competent to meet their needs and do provide support on a one to one basis. The registered manager was at the centre of setting up this service, has a clear awareness of areas needing further development and is supported by a positive and competent staff team. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 21 This service is still in the early stages of being fully operational and the manager expressed a positive attitude regarding any areas requiring improvement and currently has plans to further develop the services currently being offered. Files did contain copies of supervision that is regularly carried out and staff were seen to be interacting with those living in the home with consideration for dignity and independence. The manager confirmed that a health and safety audit has been completed for the building along with other risk assessments that ensure the safety and well being of both staff and those staying at the home. Discussions undertaken at this time evidence that management and staff do work in a very open and inclusive way, making sure that the needs of anyone using the home are fully supported. Staff also expressed a clear awareness of their roles and responsibilities. Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 22 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 “ ” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 X 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 3 X 2 X X 3 x Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 23 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 2 Standard YA6 Regulation 12,13 12 Requirement Care plans must clearly identify any changes and support that is required. To ensure that discussions are regularly undertaken with people using the service about the meals that are offered and that the chef is also aware of these choices. To ensure that the healthcare needs of the individual are identified and that procedures are in place to address them. That staff files contain all required information as set out in schedule 4 (6). Timescale for action 29/02/08 29/02/08 YA17 3 YA19 12,13 29/02/08 4 YA34 17 (2) 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Equinox, Lower Clapton Road DS0000070069.V355314.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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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