Care Home: Essex House

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What the care home does well The manager of the service has worked with the two residents for over ten years. She knows them and understands their needs very well. The home has provided great stability for the residents. The manager chooses staff carefully for their caring qualities and willingness to train and develop themselves. She spends a lot of time in the home coaching them and assisting in their training. The two residents have a full programme of activities and are out at activities they enjoy for a large proportion of their time. What has improved since the last inspection? The manager has continued to demonstrate a positive attitude to inspection and improvement. She has maintained the many improvements she had made in the home at the last inspection. The finances of the home have been well managed and there is now almost enough funding to build the extension to the house which has been planned. What the care home could do better: The inspection resulted in three requirements and three recommendations. A clear risk assessment must be written for interaction between the residents. The manager must review the important policies. The electrical hard wiring certificate must be available for inspection. The imanager s encouraged to pursue increased benefits for the resident whose needs have changed, and recording should be made in the appropriate records. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Essex House 117 Essex Road Leyton London E10 6BS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anne Chamberlain     Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Essex House 117 Essex Road Leyton London E10 6BS 02089252451 02085344280 achowdhary5@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Anis Chowdhary care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 The maximum number of service users who can be accommodated is: 3 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: Learning disability - Code LD Date of last inspection Brief description of the care home Essex House is a care home for young adults with a learning disability. It can accommodate three residents. However the service has had only two people in residence for several years. The home is situated in a residential area in Leyton, within the London Borough of Waltham Forest. It has easy access to the central line underground station at Leytonstone and is on a main bus route. Nearby is the shopping area of The Bakers Arms. Other community resources such as swimming pool, pubs and cafes are quite close. Fees at the home are #548.04 - #524.74 Care Homes for Adults (18-65 years) Page 4 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was undertaken on behalf of the Commission for Social Care Inspection and the terms we and us will be used throughout. The quality rating for this service is 2 stars. This means the prople who use the service experience good quality outcomes. was at short notice but not unannounced. The site visit was conducted over five hours. It included a talk with the two residents, a tour of the home, inspection of medication arrangements and inspection of the two residents files, key policies, records and documentation. Care Homes for Adults (18-65 years) Page 5 of 24 Care Homes for Adults (18-65 years) Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: 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 set out 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. Care Homes for Adults (18-65 years) Page 7 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents would have their needs assessed properly. Evidence: The two residents files inspected evidenced good assessment of needs. The referral and assessment policy showed the steps to be followed to undertake a thorough assessment, including a prospective resident visiting the home and meeting the existing residents. Compatibility with residents is stressed as important and a probation period is suggested. Issues of culture and gender are highlighted. Respite provision is covered in the policy. Care Homes for Adults (18-65 years) Page 9 of 24 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments are in place for residents. They have opportunities to make a range of everyday decisions. Evidence: The two residents both had care plans which addressed many aspects of their needs. These were signed by the manager and by the residents and dated. We noted that one resident had had a review of care with her local authority a year ago. The other resident had had an update of her care plan on 4/12/08. Both residents are now due for review and the manager stated that she has been told the local authority for one will be undertaking her review soon. There was evidence that the manager is researching the Mental Capacity Act which will be relevant for one of the residents. There was much evidence in daily logs that residents are given opportunities to make Care Homes for Adults (18-65 years) Page 10 of 24 Evidence: decisions. They have residents meetings where they discuss activities, and in addition to the day centres and clubs they attend, they decide where they would like to go when they go out and about in the community. One resident is partial to certain foods and this choice is respected, even though it limits her diet a bit. There was evidence of risk assessment. The file for one resident contained several as she has a range of behaviours which can put her at risk. The risk assessments included strategies for working with the behaviours and reducing the risks. The file for the other resident needs to contain a clear risk assessment which shows the actions the home successfully takes to reduce the risk to her from the other residents behaviours. Care Homes for Adults (18-65 years) Page 11 of 24 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents enjoy a variety of educational and recreational opportunities and activities. There is scope for choice in their daily routines. They choose what they would like to eat and enjoy convivial mealtimes together. Evidence: Both residents spend two days a week at day centres. On the day of the inspection they returned in good humour and said they had been dancing. In addition they attend weekend clubs and go out and about with a carers from the home. Daily records evidenced that they go swimming and shopping. At home the residents enjoy baking, watching TV, doing puzzles etc. They keep their rooms clean and tidy. Both service users have family in contact and they visit on special occasions. One resident has a boyfriend who calls every day and is made welcome. The residents have activities planned for every day with variety and choice, taking Care Homes for Adults (18-65 years) Page 12 of 24 Evidence: baths, going to bed when they choose etc. Residents choose what food they would like to eat and the freezer was well stocked with a variety of frozen foods. They enjoy a snack when they come in from day centre and on the day of the inspection it was chocolate artic roll. We inspected a record of food served. It evidenced a variety of wholesome foods. Care Homes for Adults (18-65 years) Page 13 of 24 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents personal support and healthcare needs are well met. The arrangements for the administration of medication are sound. Evidence: Both residents need a significant amount of personal support, and their needs are quite different. One service user needs assistance with personal care and also needs prompting and supervision to carry out tasks. The other resident is sociable and vulnerable and has behaviours which she needs support to manage. Both residents have been at the home with the proprieter for some years and she understands them very well. The residents have a range of healthcare needs. They have health action plans in their files and see various professionals as well as their general practitioners. One resident has been referred to a psychologist as she appears to be experiencing some cognitive deterioration as she ages. The manager stated that she believed this resident would now be eligible for higher benefits. We strongly recommend that this is followed through by the manager. Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: We inspected the arrangements for the administration of medication. One resident takes one medication twice a day. We checked the Medication Administration Record (MAR) sheet and the stock of medication and found no discrepancy. We were told by the manager that no staff administer medication unless they have medication training. Care Homes for Adults (18-65 years) Page 15 of 24 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns and complaints are well handled and the adults are protected from abuse. Evidence: We inspected the complaints information. There is a satisfactory policy and a leaflet in picture form. There were three completed complaints forms in the complaints log, one had no date and one had no actions. The importance of completing the whole form was pointed out to the manager. We inspected the policy for safeguarding adults which referred to the local authority policy. A copy of the local authority policy is held. One resident has challenging behaviour at times and we explored this with the manager. There are risk assessments in place to prevent the resident being agressive to the other resident and we needed to be sure that the other resident is not bullied. The manager stated that although this was a behaviour a long time ago, the staff are now very skilled at diffusing and deflecting the negative behaviour and it has reduced considerably. It is very rarely directed at the other resident and would be manifested in perhaps a light push. Care Homes for Adults (18-65 years) Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, comfortable and homely. Evidence: We viewed the environment of the home. It is generally good, clean and homely, with the two bathrooms at a good standard. The downstairs toilet needs refurbishment and the ceiling is in a particularly bad state. However the manager plans to have it demolished as part of a plan for a new extension. She states that this will be undertaken fairly soon so we have not made a requirement regarding the downstairs toilet. There are some incontinence issues with the residents and the washing machine is situated in the kitchen. The manager stated that any soiled underwear is washed out in the bathroom basins before it is brought down to the washing machine. Neither of the residents has an infectious disease. Care Homes for Adults (18-65 years) Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff at the home are carefully recruited, well trained and supervised. Evidence: We viewed the recruitment records for four staff. They all had Criminal Records Bureau (CRB) disclosures in the name of the home and appropriate references. The manager takes a great interest in the development of the staff who work at the home. She gave us information regarding the training they had undertaken. This included induction, manual handling, safegurding awareness, medication, food hygiene and fire awareness. The manager stated that the staff undertake the courses by distance learning which she supervises, as she has a teaching qualification herself. We viewed some certificates which had been awarded. The staff are also undertaking their NVQs 2 and 3. We viewed the records of supervision of the staff. The manager stated that she manages six supervisions a year each for them and also observes their practice constantly. Staff rotas evidenced that she does spend a lot of time in the home working alongside the staff. Care Homes for Adults (18-65 years) Page 18 of 24 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run but the manager needs to improve practice in quality assurance and record keeping. Evidence: The manager is qualified for her role and has several years experience of running the home. She demonstrates great concern for the residents. The manager stated that she had recently worked with a university who visited the home for the purposes of a research project. We noted a number of satisfaction surveys which the residents had completed as part of this exercise. The manager showed us earlier records of audits she used to undertake as quality assurance for the home. These were quite in depth and we suggested that in such a small home more simplified audits could be undertaken. We saw an earlier business plan and acknowledge that the proprieter has in her head a plan for the coming months. We have asked her to commit this to paper even if in a very simple format. The home has a number of relevant policies but they have not been reviewed since Care Homes for Adults (18-65 years) Page 19 of 24 Evidence: 2006 or in some cases 2003. The manager must ensure that she reviews the main policies. We were told by the manager and a staff member that a resident had recently had a minor episode of challenging behaviour when she was reluctant to leave the swimming pool. This had been recorded, but not in the daily record. We advised that all important events should be included in the daily record to give a full picture. Incidents should also be recorded on an incident form. Evidence was seen of the checking and maintenance of safety systems. The home has a fire risk assessment. Emergency lighting and smoke alarms were checked by an outside contractor on 26/6/08, the gas safety record was updated on 24/7/08. The manager stated that she checks the smoke detectors every week and the emergency lighting once a month. There is a fire drill once a month and the household assembles in the front garden. In January 2009 the London Fire Protection officer called. He stated that the three fire extinguishers were all in good working order and he made no recommendations. The manager stated that all electrical items have been replaced and are under a year old. She has purchased a testing machine and intends to check all the portable appliances herself when they are a year old. The manager was not able to locate the safety certificate for the electrical hard wiring of the home. This must be made available for inspection. Care Homes for Adults (18-65 years) Page 20 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 21 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The resident who may 15/04/2009 become the target of challenging behaviour must have a clear risk assessment for this. To protect the resident. 2 40 12 The manager must review the main policies of the home. To ensure the safety and wellbeing of residents. 01/07/2009 3 42 23 The safety certificate for the electrical hard wiring of the home must be available for inspection. To ensure the safety of residents. 01/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 22 of 24 1 2 3 18 41 41 The manager should apply for higher benefits for the resident who has deteriorated in health and abilities. All important events should be included in the daily record. Incidents should be recorded in the incident record. Care Homes for Adults (18-65 years) Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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