Inspection on 31/08/05 for Abbey Lodge

This inspection was carried out on 31st August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Abbey Lodge 09/08/07

Abbey Lodge 08/05/06

Abbey Lodge 27/02/06

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Conquest House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Abbey Lodge 55 Harvey Road London Colney Hertfordshire AL2 1NA Lead Inspector Judith Kent Unannounced 31/08/05 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 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 Stationary 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. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Abbey Lodge Address 55 Harvey Road, London Colney, St. Albans, Hertfordshire, AL2 1NA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01727 825899 01727 825899 Mrs Meetranee Chintaram Mr Krishna Iyapah CRH 4 Category(ies) of MD registration, with number MD(E) of places Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: There are none Date of last inspection 30.11.04 Brief Description of the Service: Abbey Lodge is located in a semi-detached house in a residential area of London Colney, with access to both local shops and services and by public transport to St Albans city centre. The home offers a service for four adults of any age who have a mental disorder. Accommodation is on two floors - there is one bedroom with en-suite shower on the ground floor and three bedrooms on the first floor, one with an en-suite toilet and wash basin. Staff sleeping-in accommodation is also on the first floor. There is a lounge/dining area, kitchen and office on the ground floor. The laundry is in an outhouse linked to the kitchen by a covered walkway, where service users may smoke if they wish. The garden is laid to lawn and flowerbeds. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. While Abbey Lodge had previously been registered in different premises, this was the first inspection of the newly registered home, which provides two additional places. This inspection took place over four hours during the middle of the day and was conducted with both proprietors, one of whom is the registered manager. There were two service users at home and two were attending day centre. Both service users spoke well of the home and were content with their lives there. What the service does well: What has improved since the last inspection? What they could do better: There is a serious concern about medication recording which must be dealt with and staff rotas indicate that long hours without breaks are worked by some staff. Accurate records of the rota actually worked must be kept. The identification of hazards and recording of risk assessments could be improved and progress towards meeting the aims set out in care plans is not always recorded. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 6 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. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 2 Service users are assessed before they move into the home to make sure that the home can meet their care needs. The information in the Statement of Purpose Service Users’ Guide, while consistent in most instances, may give rise to confusion in some areas for prospective service users. EVIDENCE: The manager carries out assessments for new service users and gains information from both medical and social care sources before confirming a placement at Abbey Lodge The home’s Statement of Purpose and Service Users’ Guide both need amendment to ensure that prospective service users have current home information. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 & 9 Service users are involved in making decisions about their lives in the home and their care plans reflect their needs. However, there is little to show whether progress is being made towards achieving the aims set out in the care plans. Absence of risk assessments could result in harm to service users. EVIDENCE: There are detailed care plans setting out objectives for each service user, although there is little information in the records of in-house reviews as to whether these are met. Each service user has regular Care Programme Approach (CPA) reviews involving, in addition to themselves and family members, a range of health and social care professionals. Notes of these reviews were not always available on service users’ files and the manager was advised to obtain copies for reference in respect of changing needs and decisions made at the reviews. The manager and staff are advised to note progress towards achieving the set objectives and revise care plans accordingly. There are risk assessments on files, although the need for additional assessments for particular concerns, specifically in relation to a diabetic service user, was discussed with the manager at the inspection. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 10 Service users at Abbey Lodge are encouraged to contribute to the running of the home and meet regularly with the manager and staff to discuss any issues which arise. These meetings are recorded and action is taken to deal with problems and suggestions. There is considerable scope in the home for service users to develop daily living skills with the support of the staff and discussion with one person showed that she enjoys shopping for and cooking her own meals and does her own laundry and ironing. The current service users are independent in many areas of their lives and take control of their daily activities. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 13, 14, 15 & 17 There is the opportunity for service users to participate in a range of activities and to take advantage of community resources so as to lead fulfilling lives. Family contacts are encouraged and there is a social atmosphere in the home. EVIDENCE: The home supports service users in their daily lives to take up activities outside the home – one service users does voluntary work for a national charity - and all attend day centres at some time during the week. They all enjoy meals out, visits to the cinema and other local activities together, and the home arranges holidays for the group. Family links are supported and each service user maintains contact with people of their choosing who are invited to share meals, parties and other social activities in the home. Choice of menu is up to the service users and while at least one person usually self-caters others are expected to have some input into meal preparation and cooking with staff members. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Service users’ health needs are met by a range of services. However, the system of recording medication gives rise to concern and could potentially harm service users. EVIDENCE: Each of the service users at Abbey Lodge is independent in their personal care and needs no input from the home’s staff. The home holds and administers medication for all the service users, save for insulin for one person who self-administers. The home keeps the insulin in the domestic ‘fridge, but advice from the pharmacy inspector is that a small, temperature controlled and lockable ‘fridge would be a more suitable storage place. Service users take responsibility for collecting their own prescriptions and medication with support from the staff at the home. Medication records were looked at during the inspection and were found to be poor – the inspector, the manager and the proprietor were unable to reconcile the records with the medication held in several instances and a reliable system of auditing must be developed. The returned medication book was unclear and several alterations had been made. Each person is registered with a local GP practice and there is regular contact with and support from the health and social care professionals involved with each service user. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 13 Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Service users and their families and supporters can be confident that they will be protected from abuse and that their concerns will be dealt with. EVIDENCE: There is a complaints procedure included in the service users’ guide, although the manager reported that there had been no formal complaints made since the last inspection. Service users are protected from abuse by the homes’ whistle-blowing and adult protection procedures. In addition to working at Abbey Lodge, staff at the home are all employed in other health care settings and the manager reported that they have all received training based on the HCC Adult Protection handbook in their places of work. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 Service users live in a safe, comfortable, clean environment. EVIDENCE: Abbey Lodge has recently moved to larger premises a few doors away from the previous home so as to be able offer two additional places. Consequently, decorations, carpets and fittings have all recently been renewed and are in good condition. The home is domestic in scale and is comfortably furnished and fitted, although it was noted that several lampshades are needed. Service users can bring their own personal items to the home with them. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 & 36 Staff at the home have the skills and knowledge to care for service users, although some mandatory training needed updating and staff and service users would benefit from receiving guidance on how to deal with specific health problems . Little supervision has taken place this year which could result in staff members not being fully aware of service users’ needs and their own training needs being neglected. Service users could be placed at risk by staff working long hours without breaks. EVIDENCE: Staff at Abbey Lodge all have other employment within health or social care settings and work in the home on a part-time basis. Their experience in care is recorded on their files along with certificates of training and qualifications gained. Two of the care staff have achieved the National Vocational Qualification (NVQ) Level 2 in Care – one is currently doing NVQ Level 3 and the other will be taking Level 3 in the near future. The manager has developed a good supervision system for the staff although records revealed that they had received very little during 2005. Records also showed that there was a need to update some mandatory training and since there is now a person with diabetes living at the home, a training course on the condition is indicated. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 17 The rota provided by the manager showed that staff members were working back-to-back shifts without breaks, which could result in tiredness and failure to respond to service users’ needs. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 & 42 Service users are able to make their views about the home known and to influence how the home operates. The absence of an annual development plan could hamper individual and collective progress towards meeting set goals. The manager has failed to keep accurate records of the staff rota or to recognise the risk of harm coming to service users from tired staff who work long hours in the home with no breaks. EVIDENCE: Service users are involved in the decision making process in the home through regular meetings with the manager and proprietor and family members and other stakeholders are surveyed as well. Records of meetings were seen at the inspection and showed full participation by service users. The development and review of an annual plan linking individual goals and outcomes with the home’s overall aims, and using information gained from quality monitoring exercises, was discussed with the manager and proprietor. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 19 Health and safety records are kept and those relating to fire safety were checked. Service users in the home are given clear guidance about what to do in case of fire. There had been a recent satisfactory visit and report from the environmental health officer. The staffing rota was looked at during the inspection and posed some questions; it showed that staff members were working extended hours without a break – in one case 2pm one day until 8pm two days later, including two oncall night duties. This is unacceptable and illegal. The manager said that in this instance the worker had not been on duty for the length of time shown, but he must make sure that legal employment practice is observed and that accurate records of hours worked are maintained. Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 3 x 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Abbey Lodge Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 1 x I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 21 yes 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 1 Regulation 4 Requirement The Statement of Purpose and Service Users Guide must be revised to give accurate information Risk assessments must be written when hazards which may affect service users well-being have been identified Accurate records of medication held and administered must be maintained Staff members must be given appropriate rest and break times so that they are able to respond to service users needs. Staff members must receive supervision at least six times annually and this should be recorded An accurate record of the rota worked must be kept. (This has been a requirement in the last two inspection reports and has not been met) Timescale for action By 30.11.05 By 15.10.05 From 31.08.05 From 31.08.05 From 31.08.05 From 31.08.05 2. 9 13(4)(c) 3. 4. 20 33 13(2) 18(1)(a) 5. 36 18(2) 6. 42 17 & Schedule 4 Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 22 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. 3. 4. 5. Refer to Standard 2 19 20 24 39 Good Practice Recommendations Care plans should record progress made in meeting service users aims and objectives Notes of CPA reviews should be held on service users files A lockable fridge should be available for medication storage. Lampshades should be provided for all lights in the home An annually reviewed development plan should be in place Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts. AL7 3BQ National Enquiry Line: 0845 015 0120 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 Abbey Lodge I52_62483_AbbeyLodge_v213105_310805_Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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