Care Home: Langthorne Road

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What the care home does well People who spoke with us during this visit told us that staff treat them with dignity and respect. They told us that they liked living in the home and that they were able to make decisions about their activities and food. People who use the service were consulted about how the home should be run and their views were respected. What has improved since the last inspection? Some improvements have been made to the premises since the last inspection and the registered manager has ensured that all parts of the home are reasonably decorated and that they are kept clean. New recording systems have been introduced in respect of recording any financial transactions made on behalf of each service user, as previously required. The registered person has ensured that emergency lighting checks are carried out on a regular basis, in order to comply with the fire safety and the home`s fire risk assessment has been updated/reviewed to include information and frequency for testing emergency lighting. What the care home could do better: Improvements are required to the home`s admission, care planning and risk management systems. Further improvements are required to ensure that the home can adequately meet the assessed health care and emotional needs of the people accommodated in the home. A new washing machine should be provided in the home in order to comply with the infection control standards. Minor improvements are required to the way care staff are recruited. The registered manager must obtain the relevant qualification as required by law. The registered person must ensure that fire alarm systems are maintained on a regular basis. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Langthorne Road 136 Langthorne Road Leytonstone London E11 4HR     The quality rating for this care home is:   one star adequate 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: Robert Sobotka     Date: 0 7 0 4 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 30 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 30 Information about the care home Name of care home: Address: Langthorne Road 136 Langthorne Road Leytonstone London E11 4HR 02089895768 02089895768 joomascarehome@gmail.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 Rooksanah Jooma,Mr Yusuf Oomar Jooma care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 5 The maximum number of service users who can be accommodated is: 5 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 136 Langthorne Road is a care home offering support, guidance and accommodation to a maximum of five service users who have learning disabilities. The home is privately owned. Service users are encouraged to participate in a range of activities and hobbies of their choice. The home is located in the Leyton area, within the London Borough of Waltham Forest. Bus and rail links are nearby, as are local amenities. At the time of the inspection, there were 4 service users accommodated in the home. Three people were funded by the London Borough of Waltham Forest and one person by the London Borough of Hackney. Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home The current range of fees charged by the home ranges between £573 to £1017. Care Homes for Adults (18-65 years) Page 5 of 30 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: one star adequate 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: This inspection took place over one day and was unannounced. We spoke with four people who use the service, the registered manager, and one member of staff. We also conducted a tour of the premises and viewed various records. Prior to this inspection, we asked the registered manager to complete the Annual Quality Assurance Assessment. We included some of the information provided in the assessment in this inspection report. The aim of this unannounced inspection was to check the homes progress towards full compliance with the National Minimum Standards for Younger Adults (18-65) and the Care Homes Regulations. Care Homes for Adults (18-65 years) Page 6 of 30 We would like to thank everyone who contributed to this inspection. 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 8 of 30 Care Homes for Adults (18-65 years) Page 9 of 30 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 10 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes admission systems are not robust enough to ensure that new service users are admitted only on the basis of a full assessment and that the home can fully meet their needs. Prospective service users are given an opportunity to visit the home prior to moving in there. Evidence: There has been new admission to the home since the last inspection, which took place in January 2009. We checked the file of that person and we found that the information in relation to the persons assessed needs was incomplete. The service user was placed by the London Borough of Hackney, however there was no evidence on the persons file that appropriate assessment had been carried out by the placing authority. The service users file did contain one care plan written by his placing authority, however it was written in March 2007. Minutes from the review meeting, which took place at his previous service in June 2008, were also on file. Although both documents offered some information about the service user, it was of our opinion, that this did not provide the home with sufficient information about the service users needs. We noted Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: that the service users previous placement provided a brief summary of which health care services the service attends, however we did not see any evidence that the information was transferred to the service users current care plan. The assessment, which was carried out by the home was only partly completed and did not include sufficient information in relation to the service users needs. The registered person stated that the document was completed by staff working in the home following a discussion with the service user and manager of the sheltered accommodation project where the service user had previously lived. We were concerned that the information obtained by the home was not sufficient to justify an admission to the home. We were informed the the service user was able to visit the service prior to moving in there and he confirmed this when speaking with us. Information to that effect was also included in his file. Care Homes for Adults (18-65 years) Page 12 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are required to the homes care planning and risk management systems in order to ensure that the home can adequately and safely meet the needs of each person accommodated in the home. Evidence: As part of this visit we checked care plans of all people using the service. Whilst care plan of the service users who have lived in the home for a number of years were appropriately maintained and kept up-to-date, care plan of the service users who was admitted in January 2009 was incomplete and did not fully outline the service users assessed needs and how these would be met. This was of concern to us, as there was no evidence that the home was clear as to how to work in partnership with the service user and how to best manage his needs. This required improvement. Three out of four people who used the service have received monitoring visits form their placing authority, however at the time of this inspection, no reports from their Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: reviews have been forwarded to the home. Service users who spoke with us confirmed that there were encouraged and supported where necessary to make decisions about how the home should be run. They also told us that they were able to make informed choices and decisions and that both staff and the registered manager respected their views. During this visit we also checked risk assessments maintained in respect of the service users accommodated in the home. There were two risk assessments in place in respect of the newly admitted service user, however these did not identify any risks related to the service users condition and how the home could work with the service user to minimise any risks. The registered person must ensure that appropriate risk assessments are in place in respect of each person who uses the service. During the review of care plans and risk assessments we identified that staff working in the home did not always use appropriate language and they used phrases such wet himself accidentally. It is recommended that the registered person reviews written records and offers support and advice in using appropriate language when writing reports and other documents maintained in the home. In addition some of the files contained old documents, which were no longer needed and made files very bulky and difficult to navigate through. It is recommended that individual care plan files are re-organised and that old files, which are no longer valid are archived, to allow easier access to current files. Care Homes for Adults (18-65 years) Page 14 of 30 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. Those who live in the home are encouraged and supported to become part of the local community and develop and maintain friendships and family links. Service users enjoyed food in their home. Evidence: Following discussion with the people who used the service and review of their care plans and records of daily activities, we were satisfied that people who used the service were supported and encouraged to take part in appropriate leisure activities. Daily records reflected that service users are encouraged and supported to become part of and participate in the local community. Each person had an activity timetable in their care plan folder. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: One of the service users told us that he was fairly new to the neighbourhood and he needed more support from staff in order to get to know the local area and transport links. He also said that he would like to continue to maintain links with his friends from the area where he used to live. He also told us that at the time of this inspection he did not have a front door key. His care plans did not contain any information as to why the front door key was not offered to him and there was no risk assessment in place to suggest that it may be inappropriate for the service user to hold a front door key. People who use the service told us that they were able to access a wide range of activities, attended local colleges and day centres. The home adequately supported service users in attending places of worship. Annual holidays were organised. Those living in the home were supported and encouraged to maintain appropriate friendships and family links. One of the service user regularly visited her mother. People who used the service told us that they enjoyed food served in the home. There were sufficient food supplies in the home at the time of this unannounced inspection, which were appropriately stored. Records of food offered to each person living in the home was maintained. Care Homes for Adults (18-65 years) Page 16 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements were required to ensure that the health care and emotional needs of each person who uses the service are met. Medication systems were satisfactory. Evidence: Whilst we were satisfied that the home was being able to appropriate meet the assessed health care and emotional needs of the service users who have lived in the home for a considerable period of time, we were unable to fully establish the needs of the newly admitted service user. There was no health action in place and the existing information did not fully explain as to what this persons needs were and how they would be met. Records seen did not seem to be fully outline details and outcomes of each health care appointment and this required improvement. Medication systems were checked and there were found to be appropriately managed. At the time of this inspection none of the service users were self-medicating and they did not express any wish to do so. Care Homes for Adults (18-65 years) Page 17 of 30 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. People who use the service can be confident that their complaints are going to be taken seriously and that they will be investigated and resolved without delay. Improvements have been noted to the homes financial systems to ensure that the people who use the service are protected from financial abuse. Evidence: As part of this visit we reviewed the homes complaints folder. There has been one complaint made to the home and we were satisfied that it was appropriately dealt with by the home. People who use the service told us that they would raise any complaints with the registered manager and felt that she would deal with their concerns in a prompt manner. Appropriate complaints policy was in place. We also checked the homes record of accidents and incidents and we were satisfied that these were appropriately maintained. The home had an appropriate adult protection procedure/policy in place. The registered manager informed the inspector that all staff working in the home have received Adult Protection Training. At the last inspection we identified that financial systems should be more robust and that the registered manager should ensure that appropriate systems are in place for Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: maintaining records and auditing any finances kept in the home on behalf of each service user. The homes financial systems were checked during this inspection visit and we are satisfied that they were now robust enough to protect service users from financial abuse. Care Homes for Adults (18-65 years) Page 19 of 30 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. Improvements have been noted to the premises. Further improvements are required to prevent the spread of infections. Evidence: The home has recently been refurbished and extended. Two additional bedrooms have been added. Four out of five bedrooms have now en-suite facilities. In addition there is one bathroom located on the first floor. Since the last inspection the registered person has ensured that the condition of the premises has been improved. As part of this visit we viewed 4 occupied bedrooms, all of which were found to be clean and hygienic. One of the en-suite toilets was not working and required repair. The registered person stated that this has already been reported to her and that the toilet would be repaired without any delay. At the time of this inspection one of the service users had continence issues, which Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: meant that their clothes had to be laundered at high temperatures to thoroughly clean linen and control risk of infection. The washing machine kept in the home did not have the specified programming facility to meet disinfection standards. The registered person must ensure that the current laundering equipment is replaced with a washing machine that has a sluicing facility. Care Homes for Adults (18-65 years) Page 21 of 30 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. Service users are supported by appropriately trained staff. Some improvements are required to the way staff working in the home are vetted. Evidence: The home appeared to have appropriate staffing levels in place to continue to meet the needs of the current service user group. The registered manager works from Monday to Friday between 9 am and 6 pm. There is a member of staff in the late afternoon/early evening. The home has a sleep-in cover in place. A copy of the duty roster was available in the home for inspection. According to the Annual Quality Assurance completed by the registered manager, there were 5 care staff people employed in the home. Staff who spoke with us commented that they were happy with the level of training offered to them. The registered manager stated that in the next 12 months there were plans to update staff mandatory training, such as First Aid, Fire Prevention, Food Hygiene, and Health and Safety. There has been one new person employed in the home since the last inspection. We Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: checked files of two staff working in the home. Both files contained all relevant information, however the references of one person were not provided by that persons most recent employer. All of the staff working in the home have obtained National Vocational Qualification Level 2 or equivalent. Care Homes for Adults (18-65 years) Page 23 of 30 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 registered manager must obtain the National Vocational Qualification Level 4 in Care. Appropriate quality assurance systems were in place. Majority of health and safety checks were also in place. Evidence: The registered manager is also the proprietor. She has been managing the home since it was established. The registered manager has the NVQ Level 4 Registered Managers Award, however she must also complete the NVQ Level 4 in Care, as previously required. We received positive comments about the registered manager from the people who use the service and a member of staff working in the home at the time of this inspection. Based on the observation and discussion with the service users and during previous inspection with the service users relative , we were satisfied that she promotes the service users rights and encouraged them to maintain their rights and independence wherever possible. Service users who spoke with the inspector felt that they were well Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: looked after in the home. Appropriate quality assurance systems were in place. As the proprietor is also the registered manager, monthly visits from the responsible individual were therefore not required. There was evidence that those who use the service and their relatives (where appropriate) are asked to complete satisfaction questionnaires. The majority of health and safety checks were in place, however the fire alarm service certificate could not be located. The home was appropriately insurance for its purpose and the registration certificate was displayed. Care Homes for Adults (18-65 years) Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 37 9(2)(i) The registered manager must obtain NVQ Level 4 in Care. 01/08/2009 Care Homes for Adults (18-65 years) Page 26 of 30 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 2 14 The registered person must 07/05/2009 ensure that service users are admitted to the home only on the basis of a full assessment undertaken by the people competent to do so, involving the prospective service user, using an appropriate communication method and with an independent advocate as appropriate. To ensure that the home can fully meet the assessed needs of each person who uses the service. 2 6 15 The registered person must, after consultation with the service user, or a representative of his, prepare a written care plan as to how the service users needs in respect of his health and welfare are to be met. 07/05/2009 Care Homes for Adults (18-65 years) Page 27 of 30 To evidence how the needs of the service users are going to met. 3 9 13 The registered person must ensure that appropriate risk assessments are in place in respect of each person who uses the service. To ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. 4 19 12 The registered person must 21/05/2009 ensure that appropriate systems are in place to identify how the health care and emotional needs of each service user are going to be met. This included maintaining appropriate records from any health care appointments attended by service users. In order to demonstrate that the health care and emotional needs of each service user are being met. 5 30 23 The registered person must ensure that the current laundering equipment is replaced with a washing machine that has a sluicing facility. In order to prevent the spread of infection. 6 42 23 The registered person must 21/05/2009 ensure that the fire alarm system is regularly serviced. 21/05/2009 07/05/2009 Care Homes for Adults (18-65 years) Page 28 of 30 To evidence appropriate maintenance of the fire equipment. 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 1 6 It is recommended that the registered person reviews written records and offers support and advice in using appropriate language when writing reports and other documents maintained in the home. It is recommended that individual care plan files are reorganised and that old files, which are no longer valid are archived, to allow easier access to current files. It is recommended that the issue of holding a front door key is further explored with any service user who wishes to do so, any decisions as to why they cannot be provided with one should be recorded in their care plan. It is recommended that the registered person, where practicable obtains a reference from the new employees most recent previous employment. 2 6 3 16 4 34 Care Homes for Adults (18-65 years) Page 29 of 30 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. 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