Inspection on 08/05/08 for Denron Lodge

This is the latest available inspection report for this service, carried out on 8th May 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Denron Lodge 01/09/06

Denron Lodge 28/02/06

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Denron Lodge 120 Dowsett Road Tottenham London N17 9DH Lead Inspector Jackie Izzard Unannounced Inspection 8th May 2008 Denron Lodge DS0000062333.V364524.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 Denron Lodge DS0000062333.V364524.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. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Denron Lodge Address 120 Dowsett Road Tottenham London N17 9DH 020 8216 9875 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) wimbourneh@aol.com Wimborne House Limited Edem Fiawoo Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: this home is registered to accommodate five people who have a mental disorder. Date of last inspection 15th May 2007 Brief Description of the Service: Denron Lodge is a part of Wimborne Houses Ltd, an organisation that supports people with mental health disorders in the community. The first home was registered in 1996. Denron Lodge was registered in August 2005 and is able to accommodate up to five people between ages of 18-65 years with mental health issues. Denron Lodge is a five-bedded house situated in North Tottenham in London. All bedrooms have en-suite facilities and are appropriately sized. The communal areas include a lounge/activity area, kitchen/diner, and a separate bathroom on the first floor, a computer room that is accessed by a separate front door and a garden accessible through the kitchen/diner. Denron Lodge is near to Bruce Grove shopping area and Bruce Grove main line station, which runs regular trains to Liverpool Street Station. There are also other good transport links. The other areas of interest close to the home are Bruce Castle Park museum, Tottenham Green sport centre and Tottenham Hotspur football ground. The aim and objective of the home is to ensure an efficient level of work with the service users. All attempts have been made to ensure an effective community rehabilitation of the service users. Service users are encouraged to pursue their interests in relation to social activities, education and hobbies. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. The cost of placements is £700 upwards. There are no other additional charges. Following Inspecting for Better Lives the provider must make information available about the service, including inspection reports, to people living at the home and other stakeholders. . Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This inspection was unannounced and took place on 8 May 2008. The inspection lasted one day. We were able to meet with the manager and staff on duty as well as four of the five people who live at Denron Lodge. We were able to speak individually with these four people to ask for their views on the service the home is providing to them. The fifth resident was in hospital at the time of this inspection but gave his views in a questionnaire which was posted to the inspector shortly after the inspection took place. The inspection also included assessing the home against their own selfassessment which had been forwarded to CSCI prior to the inspection. A tour of the home was undertaken and three residents’ files and three staff files were inspected. Medication records and a sample of health and safety records were also inspected and discussed with the manager. Three staff were interviewed during the inspection for their views. The requirements and recommendations made at the last inspection were checked and discussed with the manager. What the service does well: The organisation, responsible for the running of the home, employ staff who visit this and the other homes within the company to provide an extra service. Residents of this home said they benefited from these staff who are responsible for ensuring they have the furniture they need and also for supporting them with their activity programmes. The residents said they feel settled at the home and are generally quite satisfied with the service provided. The company seeks their views in an annual questionnaire and attempts to improve the service. Residents are encouraged to get out of the home and take part in community activities which is very positive. Residents say they received support from staff with all their needs. Staff are provided with training so that they can understand the complex needs of the resident group better. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Twelve new requirements are made as a result of this inspection. A requirement is made to ensure that staff have up to five paid training days a year, as currently staff are contributing financially to their own training. A requirement is made to ensure that the companys recruitment procedure is followed properly as it was found that some staff references had not been authenticated properly and that a reference from the past employer was not always requested, despite this being company policy. This requirement is made so that any risks to residents from unsuitable staff being employed in the home is minimised. A requirement is also made to improve the content of staff supervision and appraisal to ensure that these systems are used to fully to benefit staff and help them develop their work practice. Requirements are made to replace carpets which have been burned by cigarettes and sofas, plus to repair the sink and shower in one resident bedroom and remove a broken desk. These requirements are made to improve the physical environment for the residents. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 7 A requirement is made to purchase a new freezer as currently there is insufficient storage space for frozen foods. A requirement is also made to consult with residents and make improvements to the meals, at residents request. A requirement is also made to update the risk assessment and care plan for two residents to ensure that all their needs/risks are recorded and therefore known and addressed by staff. A final requirement is made to undertake a risk assessment regarding secondary dispensing of medication. Two recommendations are made in this report. These are good practice recommendations and do not have to be complied with. One is to develop the central staff training record to make it easier for the manager to plan for required refresher training. Another recommendation is made to review the practice of locking up tinned food as this reduces residents opportunities to become more independent in preparing food. 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. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. 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. The people in this home are assessed to ensure that staff know their needs and are able to meet them when they move into the home. EVIDENCE: We examined the files of three people living at the home. All showed that their needs had been assessed and were known to staff. Information provided by the people responsible for each resident’s placement at the home was included in their file. This showed evidence that staff were aware of peoples needs when they moved into the home. The assessments are reviewed on a regular basis. One resident was asked if he felt that the manager and staff had assessed his needs and were aware of what his needs and aspirations were. This resident said that he was satisfied that this was the case. He said, “They know me quite well and give me quite a bit of support.” Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents needs are recorded in their care plans and risk assessments. They said that staff were aware of their needs and what they need to do in order to meet them. People are supported to take risks as part of an independent lifestyle and to make their own decisions where this is possible and appropriate. EVIDENCE: Care plans, reviews and daily records were inspected for the three of the five people currently living at Denron Lodge. Each resident had a care plan which was reviewed on a monthly basis. Each resident also had a risk assessment which was evaluated regularly to make sure it was still up to date. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 11 From the examination of the care plans and risk assessments and subsequent discussion with the manager, it was evident that some people in the home have additional needs as well as their mental health issues, such as physical health problems and drug and/or alcohol dependence. There was evidence that staff work hard in supporting people to address their problems. The company provides individual and group counselling on drug and alcohol issues on a monthly basis. The informal one-to-one counselling also takes place on request. Record showed that staff have encouraged people to use local drug and alcohol services, but the residents did not necessarily agree to do so. A requirement is made to ensure care plans contain information on peoples physical health issues. In two of the three files seen, residents had medical risks/needs which were not recorded in the care plan or risk assessment. It was clear from discussion that their needs were being met but it is necessary to record the need and how it should be met to ensure that all staff are fully aware of what is expected of them in order to meet this need. The provider has introduced some recording of peoples cultural needs. This mainly addresses food preferences at the present time. Residents said that they were able to make their own decisions where possible, despite the limitations of living in a care home. Their risk assessments showed that they are encouraged to be as independent as possible. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 12 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, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at this home are encouraged and supported to take part in activities in the home and within the local community. They maintain relationships with family and friends who are able to visit them at the home provided that the house rules are complied with. Residents are satisfied with the service but said they would like some improvement in the meals available to them. EVIDENCE: These standards were assessed by individual discussion with four residents, discussion with the manager and three staff, examining residents’ records and inspecting the food stocks and menu in the home. People living in this home are encouraged to take part in activities both in the home and in the local community. A pool table was provided in the home along with television and music facilities. The organisation provides two staff Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 13 responsible for activity programmes. Both these staff visited the home during this inspection to meet and consult with residents. A group visit to the cinema was planned to take place on the afternoon of the inspection, and the staff member visited the home in the morning to confirm who wanted to go. The activities coordinator met individually with one resident to plan his enrolment in a local gym. Residents are encouraged to use community facilities and are supported by staff where they feel they need support. Some residents are able to go out independently without staff. Residents also visit the other care homes owned by the organisation and said that their friends visit them. Residents said they were happy with the level of support and activities on offer to them. They maintain relationships with family and friends. One resident said that staff are not always welcoming to his visitors and have been rude to them. This was discussed with the manager who said that this issue has been addressed. There are sometimes difficulties in ensuring visitors meet the house rules. Records show that residents are encouraged to attend day centres and educational courses. In practice, it is not easy for them to do so. Residents said they did enjoy visiting the cinema with staff and being supported to follow their individual interests. Residents rights and responsibilities are laid out in the house rules which they are fully aware of and they understand the consequences of inappropriate behaviour. A recent improvement made by the organisation is for residents to become involved in food shopping for the home rather than this being done for them. Written evidence was seen that residents are able to request certain food items and they confirmed that this was the case. The menu states that residents prepare their own breakfast and dinner with staff support and that lunch is cooked by staff. In practice this does not necessarily happen and there was some confusion about what the current practice should be. The menu was varied and included meat, fish, eggs, vegetables and salad. However 50 of residents spoken to said they would like the food on offer to be improved. They would like less frozen food and more fresh vegetables, fish and meat. The menu says that specific cultural food requirements are welcomed. There are two Muslim residents, one of whom eats Halal meat and there was evidence that a weekly allowance is provided by the organisation to buy this meat. A requirement is made to consult with residents regarding the food and mealtime arrangements and make any requested improvement. The majority of residents said they enjoyed being independent with their cooking. It was noticed that all tinned food, such as baked beans, tuna and tomatoes, were kept in a locked cupboard and residents were required to sign Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 14 that they had been given a tin of food. A recommendation is made to cease this practice as it does not encourage independence and dignity. This was discussed with the manager and it was recommended that some tinned food is placed in the kitchen for residents to choose from without having to ask staff. It is acceptable for some stocks of food to be locked away but the practice of asking residents to sign for a tin of beans should be reviewed. Two residents have seen a dietician due to physical health needs. The choice as to whether to follow the dietary advice given is left to the resident but the manager said that staff encourage them to eat healthily. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 15 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. Residents receive personal and healthcare support from staff and are protected by the home’s practices in managing medication. EVIDENCE: We met four residents on the day of the inspection. It was evident from meeting them, discussion and examination of care records, that the residents are independent with their personal care. All residents had a mental health diagnosis. Some residents also have physical health needs and emotional health needs. Some residents’ health needs are complicated by use of illegal drugs and/or alcohol. Drug and alcohol support services are available to residents and records show that they have been offered these. Records of appointments with health care professionals were recorded in the files Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 16 including evidence that some people refuse to attend health appointments, for example with the dentist. A residents decision is respected and staff continue to offer and record support. Some staff have undertaken training in counselling which is used in one-to-one and group sessions with residents. From examination of three residents’ medication records, it was noted that two residents were taking medication for health conditions which were not recorded in their care plan nor risk assessment. There was no indication that these needs were not being properly met, but, because they were not recorded, there was no evidence that staff were aware of their health condition and knew what support they needed with it. A requirement is made to address residents’ physical health needs in their care plan, and if necessary also in their risk assessment, if it is a condition which poses a risk to them. In practice, residents said they were receiving support from staff with their health needs. Medication records were inspected. Staff have received training in administering medicine and, from the selection of three charts inspected, were completing the charts properly. None of the current residents is self medicating. One resident’s prescribed painkillers were being transferred from the original container into a dossette box on a weekly basis. No record was being made to show that this process had been checked by the manager or another member of staff to ensure that the staff transferring the medication had not made any mistakes. The manager was advised that transferring medication out of the original container was inadvisable as it increased the risk of error and being given an incorrect dose. The manager said that he considered use of the dossette box for painkillers was safer for the resident as it ensured he could not be given too much medication. This same result could be achieved by ensuring staff always complete the medication record as soon as they administer any medicine. A requirement is made to undertake a risk assessment into the use of dossette boxes and provide a copy of the risk assessment and outcome to the CSCI. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 17 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. Residents generally consider that their views are listened to and feel safe in the home. They know what to do if they feel dissatisfied or unsafe and staff have been trained to recognise and respond to signs of abuse. EVIDENCE: The complaints procedure is displayed in the home for residents to refer to. One resident pointed this out to us. The home’s self assessment document (called an AQAA – Annual Quality Assurance Assessment) stated that there has been one complaint in the last twelve months which was not upheld. Examination of the complaint record in the home showed that this was not accurate. The home’s record indicated three complaints. These were upheld and resolved. The complaints were all from neighbours and related mainly to the behaviour of an ex resident. The issues have now been resolved. All residents said they felt able to complain if they were unhappy at the home. The home has had ongoing contact with the local Council regarding noise levels. We were informed that there is no current problem with residents causing excessive noise. The manager was advised that the information provided to CSCI in the AQAA must be accurate. At this inspection, we carried out an audit on safeguarding on behalf of the Commission of Social Care Inspection. This looked in detail at safeguarding issues and the results will contribute to a national study. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 18 We met with three staff, the manager and four residents individually to talk about safeguarding issues. Three staff and the manager confirmed that they had received training on safeguarding issues but two were not familiar with the term “safeguarding” as they know the term “adult protection”. Staff said they had read the home’s policies on this issue. The manager was advised to ensure all staff did understand the correct procedures to follow if they received a disclosure of abuse from a resident, to ensure staff have understood the information learned when they attended the training. All four residents spoke to said they felt safe in the home. However, there had been two incidents where a resident felt unsafe and these had not been recorded on incident reports nor in this person’s records. A requirement is made to update this person’s records about the incidents and to update the person’s risk assessment regarding the risk of being bullied. This will then inform staff on how to safeguard this resident from any bullying and help him to continue to feel safe. In practice, appropriate action had been taken but not recorded. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 19 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, 28, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a home that is comfortable but some improvements are needed to ensure the home is more hygienic, safe and homely for the residents. EVIDENCE: An inspection of all communal rooms and areas was carried out along with a random sample of three of the five bedrooms. The home was adequately decorated. The home needs frequent redecoration and refurnishing due to the needs of residents. Two residents said that whenever they had broken items which needed repair or replacing, that the organisation was very quick as giving them what they needed. One resident’s curtain rail was broken at the time of the inspection and he was able to say when it was going to be replaced. Bedrooms were personalised according to each resident’s preference and the level of tidiness was again dependent on their own preference and ability to Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 20 keep the room tidy. One resident said that he would like more help with his room and two said they could manage to clean and tidy their room without help. One room was temporarily vacant at the time of the inspection as the resident was in hospital. This resident’s sink was broken along with the shower head on his shower. Also the desk in the room was damaged. A requirement is made to repair or replace these items. The house was generally clean and tidy. The lounge had deteriorated since being inspected a year ago. There were many cigarette burns on the carpet. The home self-assessment (AQAA) stated that laminated flooring was to be provided this year. The manager was not aware of any date for this to take place. In addition, there were cigarette burns on the sofas. The sofas were covered with two covers which were both dirty. There was also a rug in the lounge which was stained, burned and dirty. I discussed this room individually with four residents, three of them said they would like to see the carpets and rug replaced. There were mixed views as to whether the sofas should be protected with loose covers but one resident pointed out that the current arrangement did not protect residents from risk of fire. A requirement is made to replace the sofas. The kitchen and bathrooms are seen to be clean and suitable for residents to use. There is a weekly clinical waste collection for dressings as one resident uses dressings at all times. The clinical waste bag was seen to be opened in this resident’s room which is not satisfactory as this is not hygienic. A requirement is made to provide a bin in which to store the clinical waste bag until the collection day. The resident said that he would prefer this. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 21 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, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents of this home benefit from an experienced and well trained staff team who understand their needs. The recruitment practices to protect residents have not been sufficiently rigorous in the past to ensure that all staff employed do not pose a risk to residents. Therefore there is a possibility that unsuitable people could be employed and pose a risk to residents. EVIDENCE: Staffing levels were discussed with the manager and residents and compared with the staff rota. Two staff were on duty during the day and there is a one staff awake on duty at night. A manager is on call at night who can attend the home if there is an emergency. The manager said that this rarely takes place as one staff is sufficient to meet residents’ needs during the night. At the weekend there is one staff on duty until 11 am after which there is two staff on duty. The manager said this is because people tend to get up later at weekends and do not therefore need two staff on the premises until 11am. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 22 It was noted that the manager was at times working long hours and during the week of this inspection was on the rota to work 61 hours. It is not good practice to expect any staff to work so many hours a week and the registered provider needs to ensure that staff are not expected to work excessive hours. Staff have received a good level of training to help them undertake their jobs and meet residents’ needs. There were individual training records in their personal file. Three staff members’ training records were inspected and one of these was not up to date with certain core training (food hygiene) so a recommendation is made that a central record is produced of staff training including the dates when refresher training is due, so that the manager can see at a glance and plan ahead for the required training to be provided. The manager said that all staff have achieved a minimum of NVQ level 2 in care and inspection of three staff files showed that certificates were in place for the NVQ level 2 and/or 3 . It was evident that staff some staff had paid for their NVQ training at considerable expense. We were informed that staff contribute to the cost of all training. A requirement is made to ensure that staff receive a minimum of five paid days training per year, which the company must pay for. The three staff files inspected showed that, as well as the NVQ training, staff have been provided with training in other relevant topics for the job; medication, misuse of drugs, food hygiene, manual handling, first aid, fire safety, epilepsy, antipsychotic medication, management of aggression, schizophrenia, suicidal ideation and the protection of vulnerable adults. Two had also attended training in counselling. Staff are also working through safe food training at the time of the inspection. All this training helps staff to understand their duties to residents and to understand the residents’ quite complex needs. Examination of supervision records showed that staff were receiving supervision on a regular basis and the standard of six times per year was almost met in that they had received five supervisions in the last year. An annual appraisal had also taken place although this was not a fully completed appraisal as it consisted of the self appraisal by the staff member and the supervision session. A requirement is made to undertake appraisals as detailed in the National Minimum Standards. It is important staff receive an appraisal to assess whether they are undertaking their duties properly and what support ,training and goals may be needed for the next year. Likewise, the content of supervision was limited as the sessions were not being used fully to help staff develop their skills and expertise. The recruitment procedure followed for the last three staff appointed was checked as part of this inspection. The manager reported that there have been no new staff employed within the last two years. The manager said there were no concerns about the fitness of the current staff. The companys recruitment procedure states that two references must be obtained including one from their last employer and that these must be verified. Although this procedure is good Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 23 it had not been followed with the three staff whose records were inspected. References had not been authenticated by the company and there was no evidence that they were authentic. A requirement is made to ensure that the recruitment procedure is followed properly for the recruitment of any future staff as poor recruitment practice may put residents at risk. The home operates a staff disciplinary procedure where appropriate action is taken when a staff member does not fulfil their duties properly. This is positive as it shows the manager is monitoring staff to ensure they are meeting residents’ needs. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 24 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. People living at this home benefit from the regular monitoring by the registered provider and from the home being managed by a committed and experienced manager. They can feel assured that their needs and preferences are listened to and that the provider strives to improve the quality of the service. The residents’ and staff health and safety is protected and promoted. EVIDENCE: The registered manager of the home works hard to undertakes his duties and has completed the required training at NVQ level 4. The provider employs staff to undertake monthly unannounced visits to monitor the home and also undertakes an annual quality assurance audit. Questionnaires are given to residents and professionals who work with them to Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 25 ascertain their views on the service and what could be improved. This is very positive as it indicates that residents’ views are listened to. Residents’ meetings are held regularly and we advised the manager on how these could be developed to ensure that the topics discussed are raised by residents rather than staff and that their views are sought and recorded on each topic. A sample of health and safety records were inspected and found to be satisfactory. Fire drills were taking place regularly including at night so that all staff could become familiar with how to evacuate residents in the event of a fire. The fire alarm is tested weekly to ensure it is working. The home has sufficient insurance. The temperatures of fridges and freezers are monitored to reduce the risk of food poisoning for residents and staff. The home has a fire risk assessment and fire prevention work has been completed. Dates need to be recorded in this document for when each piece of work had been carried out. Staff are provided with training in health and safety topics and this is recorded in their files. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 x 27 X 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 X 3 X X 3 x Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 27 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA17 Regulation 16(2)(i) Requirement The registered person must, in consultation with residents, clarify which meals are to be cooked by residents and which by staff and provide more fresh foods, as requested by residents. The registered persons must ensure that any physical health need a resident has is clearly recorded in their care plan along with the support they need with this. If the health condition or the medication prescribed for it, poses any risk to residents, this must be recorded in their risk assessment. The registered persons must undertake a risk assessment on the practice of transferring medication from an original container to a Dossette box. A copy of the risk assessment and outcome must be sent to CSCI. The registered persons must ensure that a specified resident’s risk assessment is updated to include the risk of bullying. The registered persons must ensure that the sink, shower and desk in a named resident’s DS0000062333.V364524.R01.S.doc Timescale for action 30/06/08 2 YA19 13 (4)(c) 30/06/08 3 YA20 13(2) 30/06/08 4 YA23 13(6) 15/06/08 5 YA24 23(2)(c) 15/06/08 Denron Lodge Version 5.2 Page 28 6 YA24 16(2)(c) 7 8 YA24 YA24 16(2)(c) 16(2)(g) 9 YA30 13(3) 10 YA34 19 11 YA35 18(1)(c) 12 YA36 18(2) bedroom is repaired or replaced. The furniture and equipment supplied to residents must be in good working order and maintained. The registered persons must replace the carpet in all rooms where the carpet has cigarette burns with more suitable floor covering. The registered persons must ensure that the sofas provided in the lounge are fire retardant. The registered persons must provide adequate freezer space for frozen foods and refrain from storing any frozen food in a refrigerator, as this poses a food safety risk to residents. The registered persons must ensure that a proper bin or container is provided for the storage of clinical waste. The registered persons must ensure that a proper recruitment procedure is followed at all times. Particular attention must be paid to authenticating staff references in order to protect residents from risk. The registered persons must ensure that staff are provided with at least five paid training days a year and are up-to-date on all core training topics. The registered persons must ensure that supervision and appraisal content meet the required standards, to ensure that staff are undertaking their duties and meeting the needs of residents. 31/07/08 31/07/08 15/06/08 30/06/08 15/06/08 31/12/08 31/07/08 Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA16 YA35 Good Practice Recommendations The registered persons should review the current practice of locking all tinned food away and requiring residents to sign for it on but it is given to them. The registered persons should develop a central staff training record to make it easier for the manager to monitor and to plan for required refresher training. Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Denron Lodge DS0000062333.V364524.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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