Inspection on 08/03/10 for Lansdowne Care Home

This is the latest available inspection report for this service, carried out on 8th March 2010.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Lansdowne Care Home 39 Lansdowne Road London London N17 0LS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nurcan Culleton     Date: 0 8 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Lansdowne Care Home 39 Lansdowne Road London London N17 0LS 02088014860 02082030430 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): DRS Care Homes Ltd Name of registered manager (if applicable) Mr Vijayan Krishnan Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 2 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 Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Landsdowne Care Home is a newly developed residential home in Tottenham for adults, managed by the company DRS Homes Limited. The Statement of Purpose of the home states that the motto for DRS homes is A posse ad esse, a Latin phrase meaning From possibility to actuality, reflecting the belief that anything is possible for service users. The service aims to help service users to progress and fulfil their Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 0 6 6 Brief description of the care home potential. The home is registered for people of either gender who have mental health difficulties and learning disabilities. The home is a large semi detached house with six single bedrooms, all with en suite facilities. The shared areas include a kitchen, lounge and dining room, utility room, smoking area and garden. It is close to local amenities in the Bruce Grove area of Tottenham and is served well by public transport. Care Homes for Adults (18-65 years) Page 5 of 25 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: This unannounced inspection took place over one day on 8th March 2010. We spoke with the manager and support staff on duty. We examined the files of individuals using the service, toured the premises and looked at a range of documents such as health and safety records and certificates. We also examined staff files to check the recruitment procedure of the service. Care Homes for Adults (18-65 years) Page 6 of 25 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 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 25 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 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents of the home can feel confident that their needs and aspirations are fully understood by the homes staff. Admissions to the home are carefully and well planned. Evidence: The service has a Statement of Purpose that includes services users rights and the aims and objectives of the home. Aims described include the provision of high quality care to meet the specific needs and wishes of their service users, providing high quality care with sensitivity and understanding, with staff available to give time, attention and support on an individual basis. The home has signed contracts with the local borough for each person, as seen in their files. Each person in the home is given a comprehensive Service Users Guide, providing essential detail about the homes general policies affecting them. Care Homes for Adults (18-65 years) Page 9 of 25 Evidence: We saw initial assessments in each persons file completed by the manager. These contained detailed information about each individual. Cultural and religious beliefs or needs particular to the individual were explored with each person during the assessment process and recorded accordingly. Effort was made to ensure the admissions process went smoothly for each individual. Each person had staggered visits, initially with short visits, then following funding approval, overnight stays then extended stays before their admission occuring after their hospital discharge meetings. Care Homes for Adults (18-65 years) Page 10 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are good and identify how the service will meet individuals assessed needs and goals. Individuals are supported and enabled to take responsible risks. Evidence: Care plans were available in each persons file completed by the manager. The manager explained that the initial care plan produced following the persons assessment acted as an interim care plan allowing time to developing the main care plan, following observations and more in-depth knowledge of each persons needs. Each plan was person-centred, including the persons views throughout, for example, their wishes and dreams, their likes, dislikes, how they communicate and their preferred routines. Staff then act according to the action plan produced as a result of this information. The home does not currently have people with learning difficulties admitted in the home, however if a resident with learning difficulties is admitted the manager advised that care plans will be suitably adapted to them, including pictures. Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: One recommendation we gave to the manager was that one main care plan is used for each individual as saw four different care plan type documents for example in one file and though the quality of these documents were good in each case. All individuals in the home are under a consultant and have regular contact with professionals from the local Community Rehabilitation Team. All individuals are reviewed under the Care Programme Approach according to their needs. Correspondence and reports were seen in each file demonstrating good communication with health professionals. Daily evaluation reports were clear and detailed for each person. These covered the persons mood, their behaviour, speech, daily living skills and use of community resources. The first part of the reports were in the form of mulitple choice answers and the second allowed for free hand reports. Night report were also provided. We thought the format of the evaluation reports were practical for staff to complete and well recorded. The home clearly promotes the individuals in the home to make their own decisions including managing their own money, all of whom did so at the time of inspection. Residents meetings take place monthly where their views are sought on issues affecting them in the home. Risks to individuals and ways to mimimise them are well assessed in the home. The Risk Assessment and Management Plan included a Risk Taking Plan followed by the identified risk activity, the hazard associated with the risk and what safety precautions were required to minimise the risk. Attention to detail was evident to ensure the likely success of the safety plan. Also available and good to see was the mental health relapse indicators and the management plan. Care Homes for Adults (18-65 years) Page 12 of 25 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. People in the home are supported to achieve and maintain independence. The home promotes healthy eating. Evidence: People in the home maintain and are encouraged to develop their independent living skills. Each person has responsibility for cleaning and tidying their rooms and doing their own laundry. Staff do the main shopping however people also shop for their own personal items if they choose. Similarly staff cook, however individuals are also encouraged to do so, in line with their assessed needs. No one in the home was in employed work at the time of the inspection, though it was clear that each individuals occupation had been explored with them. One person was attending a local authority run day service at the time of inspection. Whilst social contact and day time occupation is encouraged in the home, the manager explained Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: how this was dependent on the mental health of the individual. Contact with family and friends is maintained. People in the home have a choice of healthy meals. Care Homes for Adults (18-65 years) Page 14 of 25 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 healthcare needs of individuals are assessed and promoted. Evidence: Files examined evidenced that care is taken to ensure that staff provide a sensitive service that is flexible and promotes the dignity of people in the home. Recorded evidence and other documentation in files showed that the service works well in partnership with social workers, care coordinators, health and education professionals as well as family members to help individuals towards achieving their potential. Each person has freedom of movement in the home. None of the individuals were self medicating at the time of inspection, though the policy of the home states that each person has the right to manage and administer their own medication following individual risk assessments. Medication was given under supervision and included in individual care plans. There were no controlled drugs in the house during the inspection. Individuals received injections at their health clinics. The homes medication was comprehensive. Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: There was evidence that staff address the issue of illness and death with individuals in the home and their wishes recorded in their files. Care Homes for Adults (18-65 years) Page 16 of 25 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. The home ensures that individuals are aware of how to complain and procedures are in place to protect individuals from harm. Evidence: The home has in place a satisfactory complaints policy and safeguarding adults policy, however there were no complaints or adult protection referrals at the time of inspection. Individuals are made aware of how to complaint during the trial period before and after their admission to the home. Care Homes for Adults (18-65 years) Page 17 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is decorated and furnished to a high quality standard that creates a theraputic environment for people living in the home. Evidence: The home provides a welcoming, secure, relaxed environment. Effort has been put into the decor to the environment is attractive environment and theraputic. The home has six ensuite bedrooms with wash facilities, a bathroom and combined lounge and dining room. Bedrooms were decorated to a high standard and individuals were consulted to ensure they liked their rooms. On touring the premises we found that windows lacked window restrictors in bedrooms. These are recommended for health and safety purposes, or risk assessments in their place to demonstrate why they may not be required. Opened foods in the fridge were not labelled. A recommendation is given under the standard for health and safety. We also noted that some notices on walls were detracting from the otherwise homely appearance of the environment, such as fire safety and health and safety notices dominating the hallway. We recommend that adorments on walls are chosen to create and maintain a homely environment throughout the home. Care Homes for Adults (18-65 years) Page 18 of 25 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. Staff support individuals in the home and are appropriately supported themselves. A good recruitment procedure is in place to ensure the safety of individuals in the home. Staff receive relevant training to provide them with the knowledge and skills they need. Evidence: Evidence seen in the files of individuals living in the homes indicated that staff are supportive and provide encouragement to people to work towards their aims. The service has four permanent support staff. There is one person on shift during the day plus the manager. In the evening there is a staff member between 4pm and 8pm to cover evening shift and at night there is one wake in support staff. Three staff members have NVQ Level 2 qualifications and one is a registered mental health nurse. There is a dedicated bank staff so shortages can be pulled from within the organisation. Recruitment files examined showed that robust recruitment procedures are in place. All essential documents were available, such as application forms, references, criminal records bureau checks and health declarations. Staff members are employed on the basis of the range of qualifications and skills they will bring to the home. Individuals Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: receive induction and training. Staff induction covers subjects including their care code of conduct, confidentiality, the rights of service users, equality and diverstity, health and safety, food hygiene and safety and personal care. Staff job descriptions were seen in their files. We recommended that staff files contain an index at the front and documents filed accordingly to ensure that staff records are more easily accessible. Supervision is underway in the home. The service needs to ensure that staff are supervised to the frequency level set by National Minimum Standards and these sessions are recorded. Staff will also need annual appraisals. Care Homes for Adults (18-65 years) Page 20 of 25 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 service is managed by a competent manager. Good management systems and procedures are in place to ensure the successful running of the service. Evidence: The registered manager has a relevant qualification in social work. He has worked in the local borough mental health services for over twenty years. He also has a background in nursing but is no longer registered. The manager informed that he will be reapplying for the Registered Managers course in September this year. The manager showed good knowledge and experience in the mental health field. We advised however that as this is their first managers post in a residential setting that relevant support may be needed as may be required to maintain the ongoing quality of service provision. The service has established a quality assurance system for seeking out the views of people living in the home. They have already completed surveys about their experiences of the home showing positive outcomes. We advised that the home needs Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: also to think about how they will obtain the views of professionals and family members about the quality of service provision to help with the ongoing improvement and development of the service. Health and safety procedures are generally well observed. Certificates examined were available and current. Exceptions have been referred to earlier in this report and recommendations given. Relevant policies and procedures are in place that support the functions and underpin the aims and objectives of the service. Legally required records were generally available and of a good standard. Care Homes for Adults (18-65 years) Page 22 of 25 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 23 of 25 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 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 24 We recommend that adorments on walls are carefully chosen to create and maintain a homely environment throughout the home. Window restrictors to be put in place in all bedrooms. All opened foods to be labelled in the fridge. 2 3 42 42 Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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