CARE HOME ADULTS 18-65
Arthur Lodge 16 - 18 Arthur Road London N9 9AE Lead Inspector
Margaret Flaws Key Unannounced Inspection 12th October 2006 11:15 Arthur Lodge DS0000010577.V312891.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 Arthur Lodge DS0000010577.V312891.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. Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Arthur Lodge Address 16 - 18 Arthur Road London N9 9AE 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) 020 8345 5743 F/P 020 8345 5743 Mr Dhenraj Hurdowar Mr Dhenraj Hurdowar Care Home 11 Category(ies) of Learning disability (11), Learning disability over registration, with number 65 years of age (1) of places Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. As agreed on the 16th May 2006, one service user over the age of 65 years can be accommodated within the home 24th October 2005 Date of last inspection Brief Description of the Service: Arthur Lodge is a care home for 11 adults with learning disabilities. It was originally registered as a small home for 3 residents, but expanded in 2001 to accommodate six residents. In Spring 2005 it expanded further with the conversion of a neighbouring property so that Arthur Lodge now has 3 places for respite care and 8 places for long term residents. Mr Hurdowar both owns and manages the home. The home is situated in a residential street, a short walk from the local shops and business premises in nearby Edmonton Green. It consists of 2 adjoining properties with a shared garden at the rear. The residents’ rooms are located on the ground and first floors. The home is well furnished, comfortable and decorated to a high standard. The home has a vehicle so that residents can get out and about. Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place in one day in October 2006. The proprietor and manager, Mr Hurdowar was available to assist the inspector throughout the visit. Two service users were spoken with during the inspection from the three who were at the home during the visit. A local authority outreach worker was also spoken with before she took out one of the service users. The deputy manager was spoken with, as was the wife of the proprietor who was on duty. A tour of the premises was undertaken and various records and policies were viewed. Subsequent to the inspection a service users relative was contacted by phone for their views and some additional staff were also contacted in this way. What the service does well: What has improved since the last inspection? What they could do better:
The inspection highlighted a number of requirements that need to be met in order to enhance the overall quality of care for service users. Medication for some service users was being decanted from prescribed bottles or boxes into wallets which is not good practice and can increase the risk of mistakes in
Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 Page 6 administration. The home has not implemented an effective quality assurance system involving service users and other relevant people that follows an annual cycle of review, audit and action planning to improve the service where necessary. A couple of issues needed improvement regarding the premises, which are listed at standard twenty four of this report. Although service users meetings had taken place since the last inspection, none had been recorded since May 2006. The Homes policy in respect of protecting vulnerable adults from abuse needed to reflect the role and policy of the local borough. 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. Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 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 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. Prospective service users have their needs assessed and their aspirations recognised before moving to the home. EVIDENCE: A full assessment of needs was seen for a service user admitted since the previous inspection. The assessment was based on the activities of daily living. Assessments were seen for people who use the respite care service offered by the home. Since the previous inspection, risk assessments had been undertaken for respite service users thereby meeting a requirement of the last inspection. Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 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 the following standard(s): 6,7 and 9 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users have their needs and goals set out in an individual plan of care. Service users are encouraged to make as many decisions as possible about their own lives. Service users are supported to take risks in pursuit of as independent life as possible. EVIDENCE: Individual plans of care were seen for three service users. These were seen to take a holistic approach to service users care. The plans were regularly reviewed with any changes being documented. An annual review by either the placing authority or the home was seen to take place. Service users are enabled to make choices in their day-to-day lives. For example on what to wear, what activities to pursue and when to go to bed. At the previous inspection it was stated that risk assessments for long-term service users needed to be more detailed and regularly reviewed. This inspection indicated that this had happened. Assessments were seen which had actions detailed as to how risks could be minimised for individual service users.
Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 12,13,15,16 and17 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users have a range of appropriate activities to choose from, many of which are based in the local community. Service users have good contact with family and friends. Service users have their rights and responsibilities recognised. They are able to eat an appropriate range of meals. EVIDENCE: Service users likes and dislikes in respect of activities were seen to be recorded by the home. Service users had individual weekly activities plans. Activities taken part in by service users include within the home: Bingo, table football, videos and music. Outside of the home: various college courses, bowling trips and visits to restaurants and pubs. Service users are part of the local community and utilise facilities such as those detailed above. During the Inspection one service user went out in the local area with a social services outreach worker. Most of the service users were out during the inspection at local colleges and day centres. Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 Page 11 Most of the current service users have contact on a regular basis with family and others. At the time of the inspection, one service user was taken out by their sister. A relative spoken with after the inspection day said they were pleased with the way their relative is cared for at the home. Service user meetings take place of which some minutes were seen. These showed that service users are respected and their views taken into account. Service users, where able, are encouraged to participate in the running of the home and to carry out tasks such as keeping their rooms tidy. The manager and staff were seen to show respect to service users during the inspection. Service users spoken with during the inspection praised the quality of food on offer at the home. One commented: “the food is nice and there is plenty to eat”. Stocks of food seen on the day of the inspection were sufficient and were related to the menus seen during the inspection. The main meal of the day is taken in the evening when all service users are at home. Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 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 the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users receive support in a way they need and prefer. Service users health needs are given good priority as part of their overall care. The medication system and procedures were in need of some change to enhance safety for service users. EVIDENCE: Service users preferences in the way they are cared for are outlined within their assessments and care plans. A service user spoken with during the inspection said that the staff were good and helped her in an appropriate manner. A keyworker system is in place to help promote an individualised care service. Service users health needs form an integral part of assessments and care plans. Records of appointments with health professionals are kept which also serve as a reminder of when new appointments such as check ups with opticians and dentists are needed. The home operates a monitored dosage system of medicine administration. Most service users take some form of medication and none are able to selfadminister their own prescriptions. Staff who administer medication have had training in uses and side effects. A service user spoken with during the inspection confirmed their medication was given at regular times. On the day
Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 Page 13 of the inspection it was apparent that some service users medication was being decanted from bottles into seven-day medication wallets. This practice is not acceptable, as medication should only be administered from the prescribed bottle or box to avoid the possibility of mistakes being made. The manager was advised to cease the practice with immediate effect. Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 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 the following standard(s): 22 and 23 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users feel their views are important to the operation of the home. Complaints are handled appropriately. The policy on protecting vulnerable adults needed some additional work. EVIDENCE: The home has an appropriate complaints policy and procedure in place. This is given to service users and their representatives as part of the service users guide. Two complaints had been recorded since the previous inspection and both had been dealt with appropriately. No service users or others, with whom the inspector spoke, had any complaints or issues of concern to raise. The home has a policy on the protection of vulnerable adults. Although generally appropriate it needed to allude to the relevant London boroughs policy and procedure. Staff have received training in adult protection and the assistant manager of the home was interviewed and showed his awareness of abuse issues. Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 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 the following standard(s): 24 and 30 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service live in a homely, comfortable and generally safe environment. The home is clean and hygienic. EVIDENCE: The proprietor advised that there had been no major changes to the homes premises since the previous inspection. Mr Hurdowar has plans over the coming months to replace the shower base in the downstairs shower room where this has become worn with use. The premises were found to be homely and service users rooms were personalised with items of interest such as pictures and photographs. A couple of safety and aesthetic issues needed to be attended to. These were: putting a new toilet seat in the upstairs bathroom opposite the office and ensuring the carpet in one of the ground floor bedrooms is refitted as it had become rucked and therefore a potential hazard. The home was found to be odour free and was clean and tidy during the visit. Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users benefit from a trained and competent staff team. The recruitment policies and practices of the home were designed to support and protect service users. EVIDENCE: More than fifty percent of the current staff group have achieved National Vocational Qualifications at level two or above. Staff spoken to presented as professional and knowledgeable about service users needs. Service users and others spoken with during and after the inspection were positive in their comments about the staff team. The recruitment policy and practices of the home were seen to be supportive of service users. Evidence was seen that staff complete application forms, attend interviews, have references taken up on them, are subject to Criminal Records Bureau checks and have photo identity held on their files. Staff spoken to confirmed these practices and said they received an induction period to familiarise themselves with the home and service users. There was evidence seen during the inspection of various training courses having taken place since the last inspection. Two requirements from the last inspection regarding staff receiving training in medication and health and safety had been met. Other training in which staff have participated included: first aid, food hygiene, fire safety, epilepsy and manual handling.
Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 Page 17 Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. The home is generally well run. Service users cannot yet be confident their views underpin selfmonitoring, review and development of the home. The health, safety and welfare of service users are promoted and protected. EVIDENCE: Mr Hurdowar the provider and manager has owned and managed the home for a number of years He holds a city and guilds 325.3 qualification which although relevant to care home management has now been superseded by the NVQ care and management qualifications which he has yet to pursue. A staff member spoken to on the day of inspection said they got on well with and respected His management of the home. Another staff member contacted after the Inspection also held a positive view on the support given to her by Mr Hurdowar. Although a quality assurance manual was available in the home, there was no evidence of service user and other surveys having been carried out on an annual basis. There had also been no annual quality audit or action plan
Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 Page 19 undertaken. Service users meetings were evidenced as have taken place regularly although not recorded up to date, the last minuted one seen being in May 2006. The home demonstrated that it protects and promotes the health, safety and welfare of service users. Certificates of safety were seen for gas and electrical installations. Certificates in respect of fire equipment safety were also seen. Issues relating to fire safety matters raised at the last inspection appeared to have been dealt with. Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 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 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 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X 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 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 1 X X 3 X Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 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 YA8 Regulation 24 Requirement The registered persons must ensure that residents’ meetings take place regularly and are recorded. Every three months is recommended. The registered persons must ensure that medication for service users is not decanted into wallets from the original prescribed bottle or box. The registered persons must ensure that the homes’ policy on the protection of vulnerable adults from abuse makes reference to the appropriate London boroughs policy and procedures. The registered persons must ensure the premises and furnishings are kept in a good state of repair and safety. (See standard 24 for detail). The registered persons must ensure that the process for monitoring and reviewing the quality of care provided by Arthur Lodge incorporates the views and wishes of residents and includes an annual audit and action plan. This requirement is
DS0000010577.V312891.R01.S.doc Timescale for action 30/11/06 2. YA20 13(2) 12/10/06 3. YA23 13(6) 30/11/06 4. YA24 23 30/11/06 5. YA39 24 31/01/07 Arthur Lodge Version 5.2 Page 22 restated. Previous timescale of 31/01/06 not met. 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. Refer to Standard YA37 Good Practice Recommendations It is recommended that the registered manager obtain qualifications at level4 nvq in both management and care. Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Arthur Lodge DS0000010577.V312891.R01.S.doc Version 5.2 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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
