Inspection on 23/03/09 for Arthur Lodge

This inspection was carried out on 23rd March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Arthur Lodge 30/09/08

Arthur Lodge 08/04/08

Arthur Lodge 23/05/07

Arthur Lodge 12/10/06

Arthur Lodge 24/10/05

Arthur Lodge 04/07/05

Arthur Lodge 23/02/05

Arthur Lodge 24/05/04

Similar services:

Ashlong House

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Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Arthur Lodge 16 - 18 Arthur Road London N9 9AE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Shamash     Date: 3 1 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Arthur Lodge 16 - 18 Arthur Road London N9 9AE 02083455743 02083455743 arthurlodge@googlemail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Dhenraj Hurdowar care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: As agreed on the 16th May 2006, one service user over the age of 65 years can be accommodated within the home Date of last inspection Brief description of the care home Arthur Lodge is a care home for 11 adults with learning disabilities. It was originally registered as a small home for 3 people, but expanded in 2001 to accommodate six people. 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 longterm 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 has a vehicle so that people living at the home can get out and about. Weekly fees are approximately 650GBP - 750GBP and the most recent CQC inspection reports can be obtained from the homes office, or the CQC website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 1 11 3 0 0 9 2 0 0 8 Brief description of the care home Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over approximately approximately seven hours. I was assisted by an expert by experience, accompanied by their support worker, for part of the inspection. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The proprietor and manager, Mr Hurdowar, was available to assist me throughout the visit. The deputy manager and other members of staff also assisted with the inspection visit. The expert by experience and the I spoke to four people living at the home, the manager, deputy manager and two other staff members during the visit, and conducted a tour of the premises and viewed various records and policies. Care Homes for Adults (18-65 years) Page 6 of 37 Information provided in the Annual Quality Assurance Assessment for the home was also taken into account as part of this inspection. What the care home does well: What has improved since the last inspection? What they could do better: The service needs to ensure that sufficient information is provided prior to respite residents returning to the home, and ensure that care plans and risk assessments are kept up to date for these people. Person centred plans should be used as working documents with people living at the home, including regularly reviewed goals, and progress made. More choices should be provided to people living at the home regarding food provision, activities, involvement in daily chores etc. Care Homes for Adults (18-65 years) Page 8 of 37 All medicines must be stored securely within the home, and administration of creams/lotions must also be recorded. Further staff training is needed in safeguarding adults alongside better monitoring of the teams training, and recording of all residents valuables kept by the home for safekeeping. The management style of the home should be reviewed to ensure that all people living at the home are treated as individuals and empowered to make their own decisions, and sn improvement in the standard of quality assurance systems is needed to ensure that a high quality of care and support is provided to residents. It is recommended that more accessible records be available within the home for residents including pictorial menus, the home would benefit from a computer with internet access, and some staff members being provided with Makaton training to support respite residents who use this language. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into the home have their needs assessed and goals recognised before moving into the home, to ensure that they can be supported appropriately. However there is room for improvement in ensuring that assessment information is up to date for people staying at the home on a respite basis, to ensure that their needs are met appropriately. Evidence: Six people were living at the home on a permanent basis at the time of this visit, with a further resident admitted to hospital, and one person staying at the home on a respite basis. There were no changes in the people living at the home on a permanent basis since the previous inspection. I inspected the care records of six people living at the home,including those for three person staying at the home on a respite basis. The files for permanent residents included full assessments of their individual needs, based on the activities of daily living. The records were suitably detailed and included risk assessments and information about social and cultural needs as appropriate. Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: However there was variable quantity and quality of information available with regard to people staying at the home regularly on a respite basis. The manager advised that he had been in contact with the relevant local authority regarding obtaining more up to date information, however this was not always provided. A requirement is made accordingly under Standard 6. I had the opportunity to speak to four people living at the home, including the person staying there on a respite basis. All confirmed that they had been involved in the assessments when they moved into the home and had received sufficient information about the way the home is run. Care Homes for Adults (18-65 years) Page 12 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home on a permanent basis have their needs and goals set out in an individual plan of care. They are encouraged to make some decisions about their own lives and supported to take some risks in order to develop independence skills. However there is insufficient current information recorded for people staying on a respite basis, to be sure that their needs are met appropriately. All residents can be assured that their confidentiality will be adequately protected within the home. Evidence: Individual plans of care were seen for three people living at the home on a permanent basis. These were seen to take a broadly holistic approach to peoples care. The plans were regularly reviewed with any changes being documented. Records of review meetings by the placing authority were available, as appropriate. As recommended the manager had contacted relevant local authorities to ensure that people living at the home have at least an annual review with their social workers. Care plans indicated that people are able to make choices in their day-to-day lives, for example Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: on what to wear, what activities to pursue and when to go to bed. This was confirmed by residents who spoke wiTh the Expert by Experience. Records also indicated that peoples cultural and religious needs are assessed, so that these can be addressed appropriately. Risk assessments were available alongside the care plans in sufficient detail to show how risks could be minimised for individual people living at the home. However these had not been reviewed for approximately a year. It is recommended that these can be reviewed without the need for them to be rewritten unless there are major changes required. Otherwise minor revisions can be made to the notes, and the date and signature of the review recorded. Inspecting three respite residents care files, I was concerned at the variable nature of information available, with little current information available with regard to changes to care plans or risk assessments. The manager advised that he had been in contact with the relevant local authority regarding obtaining more up to date information, however this was still not always provided. He also showed me a letter that he would be sending to the local authority expressing concerns about the lack of current information provided. However it remains required that current assessments, care plans and risk assessments must be in place for all respite residents. I had the opportunity to speak to or spend time with four people living at the home, including the person staying there on a respite basis. In addition the Expert by Experience spoke to four service users and three staff members (including the registered manager). Residents confirmed that they were able to make decisions about their support, and had keys to their bedrooms and were now looking after their own money following assessments, as recommended at the previous inspection. People I spoke to also advised that they were aware of their care plans and had been consulted about them as indicated in the plans. Two staff members had undertaken training in person-centred planning, and the home had obtained formats to produce person-centred plans in this way. The deputy manager advised that the majority of the plans were now complete. However inspection of these formats indicated that they were not being used as working documents, with up to date goals set, and progress recorded. A requirement is made accordingly. Storage areas for residents care plans, were in place so that they were locked away as appropriate to protect peoples confidentiality. Residents the Expert by Experience talked to said they were happy living at the home, Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: staff treat them well, and they get along well with the other people who come in on respite. Care Homes for Adults (18-65 years) Page 15 of 37 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 living at the home have a range of appropriate activities to choose from, many of which are based in the local community. They have good contact with family and friends. They can be assured that their rights and responsibilities will be recognised. They are able to eat an appropriate range of meals that meets their nutritional needs, however they would benefit from more choices regarding meals and snacks. Evidence: Peoples preferences are recorded with respect to activities available to them, and information is also recorded about peoples cultural needs including religion, preferred language and food preferences. There were individual weekly activities plans including such activities as indoor games, videos and music, college courses, bowling and cinema trips and visits to restaurants and pubs. Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: Residents confirmed that they continue to be part of the local community utilising local shopping and recreational facilities such as those detailed above. Approximately half of the residents were out at day care services on my arrival at the inspection, returning later in the afternoon. However, I noted that for people who were not out during the day, there remained a limited number of indoor activities for them to be engaged in. Inspection of daily records for people living at the home also indicated that whilst a variety of activities were available in total, these were not always undertaken regularly, although some improvements had been made to the number of activities available at weekends and in the evenings. It remains recommended that the home continue to increase the selection of in-house activities available to people living at the home. Since the previous inspection visit, a pet budgerigar had been provided in the home, residents spoken to indicated that they enjoyed having a pet in the home. Most of the current people living at the home have contact on a regular basis with family and others. Details of this contact were clearly recorded in their care plans and those spoken to confirmed that they were encouraged to keep in touch with these contacts. Residents meetings take place regularly, and I was able to inspect the minutes of these meetings. At the last meeting activities had been discussed, with one person wishing to go to the cinema, and two people wanting to have hair cuts. The menu had also been discussed. The meeting minutes showed that people living at the home are respected and their views taken into account. My observations indicated that where able, they are encouraged to participate in carrying out tasks such as keeping their rooms tidy, making drinks etc. although there is room for more development in this area. Staff were seen to show respect to people living at the home during the inspection. Staff and residents advised that friends and family can come and visit when they wish, and the visitors record for the home confirmed that this was occuring. One resident advised that their parents come to visit every weekend and he can choose if to go out or not. Residents confirmed that they have a choice of when to go to bed or stay up and that they have televisions sets in their bedrooms. People living at the home participate in housework to some extent, although it is recommended that they could extend these activities e.g. being involved in doing their own laundry, cooking etc. Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: Residents keep small amounts of their own money, and go shopping with staff support. They also usually go on an annual holiday away from the home. People spoken to, were positive about the food served. One person confirmed, I like the food here. Stocks of food seen on the day of the inspection were sufficient including fresh vegetables, however I was concerned at the large proportion of food in stock that were value brand or other cheap alternatives. Food in stock related to the menus seen during the inspection, however the menu did not include more than one choice for each meal. Whilst it is appreciated that the menu is discussed with residents at meetings, there is still a need for more choices to be available to people living at the home on the day of each meal. It is understood that some variation is provided informally according to peoples preferences, however this is not being recorded. The Expert by Experience spoke with residents over tea-time, and noted that staff gave all residents the same drink and a piece of cake without offering them choices. The main meal of the day is taken in the evening when all residents are at home, and observation of people living at the home showed that this was a relaxed and enjoyable affair. It is recommended that use of a pictorial style menu with various photos/pictures of meal options might also be helpful for communicating with non-verbal service users. Care Homes for Adults (18-65 years) Page 18 of 37 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. People living at the home receive support in a way they need and prefer and their health needs are given appropriate priority. Medication administration systems are appropriate, however people living at the home would benefit from more rigorous recording procedures to safeguard them from errors. Evidence: Peoples preferences in the way they are cared for are outlined within their assessments and care plans. Those spoken to during the inspection said that staff treated them well, helping them in an appropriate manner, and this was confirmed by my observations. A key worker system is also in place to help promote an individualised care service. The residents who talked to the Expert by Experience said they were happy living at the home, staff treat them well, and they get along well with the other people who come in on respite. Inspection of care files indicated that peoples health needs form an integral part of assessments and care plans. Records are kept of appointments with health Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: professionals, which also serve as a reminder of when new appointments such as check ups with opticians and dentists are needed. Residents feel well supported and safe in the home. Staff are able to tell what residents with high communication needs want by body language or signs, as they have worked with them for a long time. The Manager also showed us communication folder (PEC) which he had started compiling to help people with high communication needs. The home operates a monitored dosage system of medicine administration. Most people living at the home take some form of medication and none are able to selfadminister their own prescriptions. Staff who administer medication have had appropriate training as confirmed by certificates in their staff files, and people spoken to during the inspection confirmed that their medication was given at regular times. The deputy manager advised that all medicines are either provided by the pharmacist in blister packs, or administered directly from their original containers, with no secondary dispensing. This was confirmed by inspection of the medication cabinet and discussion with staff. There were no gaps in the medication administration records, and these appeared to be current and accurate. Although there was a suitable medication cabinet in use, I was concerned to find some medicines (non-prescribed homely remedies) in an unlocked kitchen cabinet). A requirement is made accordingly. As required previously, medicines received at the home were being recorded as required, however medicines in stock were not being carried forward to clarify stocks in place. The administration of prescribed creams and lotions was also not being recorded on administration records despite staff input being required in this area. It is recommended that the residents GP/s should be asked to provide a list of homely remedies suitable to be given to permanent residents within the home, with guidelines for how these can be used. Care Homes for Adults (18-65 years) Page 20 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home feel that their complaints are handled appropriately, and staff training and policies on protecting vulnerable adults ensures that people living at the home are safeguarded appropriately. Evidence: The home has an appropriate complaints policy and procedure in place. This is given to people living at the home and their representatives as part of the service users guide. No complaints had been recorded since the previous inspection. None of the people I spoke to, had any complaints or issues of concern to raise and all indicated that they would feel able to complain to the manager if they were unhappy about something at the home. However one member of staff was not aware of the complaints procedure for the home. Residents said they are free to talk to the Manager when they want to and if they are not happy would know who to tell. The home has a policy on the protection of vulnerable adults, and included the relevant local authoritys policy and procedure. Inspection of staff files showed that all but one staff member had undertaken training in adult protection, and this was confirmed by staff spoken to. The manager and deputy manager were aware of the procedures to be followed in the event of an allegation of abuse. As recommended the deputy manager had enrolled to undertake Enfield Local Authoritys adult protection training, although this was not yet available. Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: Care Homes for Adults (18-65 years) Page 22 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home live in a homely, comfortable and generally safe environment. The home environment is clean and hygienic so that people are protected from the spread of infection. Evidence: The premises continue to be homely, with the bedrooms of people living at the home well decorated, and personalised with items of interest such as pictures and photographs. Staff and people living at the home advised that facilities at the home met their needs and that when repairs were necessary, these continue to be carried out swiftly, as appropriate to improve the environment for all concerned. The home was found to be odour free and was clean and tidy during the visit. The lounge area, near the entrance to the home, was comfortable, roomy and appeared to be well used by people living at the home. Hand-washing facilities were available in all bathrooms and toilets, however soap had run out in two of these facilities at the time of the inspection. Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: Storage of care files for people living at the home was appropriate to protect peoples confidentiality. The manager advised that he is still planning to create a games room in the garden area, for the use of people living at the home. The expert by experience noted that people living at the home benefit from a spacious lounge and conservatory/rest area where residents can relax listening to music if they want to. However concern was raised that all residents sat in specific chairs in the lounge, and one said that every person has their sitting place. Also when the residents with high support needs came in from day services, they walked through the lounge straight into the conservatory, and did not come through into the lounge. One resident also advised that residents were not allowed into the kitchen without staff permission. A requirement is made accordingly under standard 8. A small number of maintenance issues needed to be addressed; there was no lock fitted on an identified bathroom door, the flush mechanism on an identified toilet was in need of repair and the staff toilet room was in need of repainting, for the comfort of people living or working at the home. It is recommended that internet access is made available within the home for the use of staff members in making records more accessible to people living at the home, and in supporting residents to develop their computer skills. Care Homes for Adults (18-65 years) Page 24 of 37 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. People living at the home benefit from an experienced, supervised and competent staff team. The recruitment policies and practices of the home are designed to support and protect them. Staff are generally trained appropriately to ensure that the needs of all people living at the home are fully and safely met. Evidence: More than fifty percent of the current staff group have achieved National Vocational Qualifications at level two or above or are undertaking this training. Staff spoken to presented as professional and knowledgeable about people living at the home. Residents were also very positive in their comments about the staff team, and I witnessed appropriate and supportive interactions in the home. Residents told me and the expert by experience that they feel well supported by staff, and safe within the home. Staff are able to tell what residents with high communication needs want by body language or signs, having worked with them for a long time. Four staff files were inspected, and evidence was available that prospective staff complete application forms, attend interviews, have references taken up on them and are subject to Criminal Records Bureau checks prior to being allowed to work at the Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: home. Files also included photo identity checks for each staff member. Staff spoken to confirmed these practices and said they received an induction period to familiarise themselves with procedures and people living at the home. Staff files provided evidence that induction training had been provided, and the subjects covered in this training. I saw evidence in the form of certificates held on staff files that various training courses had taken place since the last inspection. As required staff members had undertaken mandatory courses including first aid, safeguarding adults, fire safety, epilepsy and manual handling. However I was concerned to note from staff certificates on file that one staff member had not undertaken training in safeguarding adults. A requirement is made accordingly. More rigorous monitoring is needed to ensure that all staff have appropriate training in all areas, and undertake updates when needed. As recommended the deputy manager advised that she had made arrangements to undertake training in the Mental Capacity Act 2005 in the next few months, to ensure that the rights of people living at the home are respected. Records of supervision sessions indicated that regular one-to-one sessions are held with all staff members, and this was confirmed by staff spoken to, the manager and the deputy manager. The deputy manager was also receiving supervision sessions from the manager as required. Care Homes for Adults (18-65 years) Page 26 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally run efficiently so that people living there can be confident that their welfare is promoted and protected, however they would benefit from a management approach that values them more as individuals, with more rigorous quality assurance systems. They can be confident that their views will be taken into account in determining the support that they receive. A high standard of health and safety management is in place, and improvements have been sustained in the management of peoples finances giving them more independence in this area. Evidence: The registered provider who is also the registered manager, has owned and managed the home for a number of years and holds a City and Guilds qualification which although relevant to care home management has now been superseded by the NVQ care and management qualifications which he has not yet pursued. He advised that it remains his intention that the deputy manager would complete these qualifications and then apply to be registered as the manager of the home. The deputy manager advised that she has almost completed the Registered Managers Award at NVQ level 4. Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: Staff and residents spoken to said that they had a good relationship with both the manager and deputy manager and felt confident about the way the home was managed. However the expert by experience witnessed an inappropriate interaction between the Manager and one person living at the home, and a requirement is made accordingly. As noted earlier in the report, it was also observed that the management approach of the home, results in people living at the home frequently being treated the same, with all residents being given the same drinks, snacks and meals, all having the same arrangements for support with finances, none involved in laundry duties etc. There is also room for management to further devlop the skills of the staff team in being involved in reviewing an updating care plans and person centred plans, and addressing peoples individual goals. Although a rudimentary quality assurance audit had been undertaken for the home including an up to date Annual Quality Assurance Assessment (AQAA), and residents had been asked for feedback, other stakeholders such as relatives, staff members, social workers/care managers, day service workers, and healthcare professionals, had not yet been approached for feedback. There is also room for more depth to be incorporated into the audits of each system within the home. The findings of the most recent audit had been incorporated into the business plan for the home, as required at the previous inspection. However information provided in the homes AQAA did not sufficiently demonstrate the homes ability to identify areas requiring improvement, such as care planning records, more opportunities for residents to develop independence skills, and gaps in staff training. Records of staff and resident meetings were available indicating that these meetings are used to discuss a range of topics and consult with staff and people living at the home. This was confirmed by staff and residents that I spoke to. The manager advised that he no longer maintains all monies for safekeeping for people living at the home, with residents now looking after certain amounts for themselves. As specified at previous inspections, these needs to be monitored and reviewed according to individual peoples abilities. Procedures for monitoring peoples monies were generally found to be appropriate to ensure that people are protected from financial abuse, with records of all transactions recorded. As required previously, no pin numbers were held on behalf of people living at the home. However a record must be maintained of any valuables kept for safekeeping including bank cards and building society books, and these must be signed in and out of the home, to improve the financial protection of people living at the home. Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: The Public and Employers Insurance Liability Certificate was displayed prominently within the home as required, and all appropriate health and safety records were available for the home including gas, electrical installation and portable appliances testing certificates, and current service certificates for fire equipment safety. Records also indicated that weekly fire alarm tests are carried out as appropriate, and regular drills are held at the home. However the specific fire call points tested were not being recorded on weekly fire call point test records, and the time at which fire drills are undertaken needs to be recorded to evidence that the times of drills are varied, including at least one night drill each year. Fire doors at the home had been tested to ensure that they were self-closing and these were being checked regularly to ensure that they remain effectively self-closing at all times. A fire risk assessment was available for the home, and the manager is aware that this needs to be reviewed six-monthly. General risk assessments about all areas of the home had also been undertaken as required to ensure the safety of people living and working at the home. Care Homes for Adults (18-65 years) Page 29 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 6 15 The registered person must ensure that more detailed information is obtained and recorded for some respite residents who return to the home, to ensure that care files include current information about how peoples needs are to be met. 28/11/2008 Care Homes for Adults (18-65 years) Page 30 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 16 The registered person must 22/05/2009 ensure that more choices are available to people living at the home at the time that snacks or meals are to be served, to increase their quality of life. . 2 6 15 The registered person must ensure that no residents are admitted to stay at the home without a review of their care plan and risk assessments within the home, to ensure that their needs can continue to be met appropriately. . 22/05/2009 3 6 15 The registered person must ensure that person centred plans are used as working documents, with up to date goals set, and progress recorded by key workers, to ensure that residents are 12/06/2009 Care Homes for Adults (18-65 years) Page 31 of 37 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 involved in the process as far as possible. . 4 8 16 The registered person must ensure that all people living at the home are reminded that they are free to move around the home without restriction. Where individual restrictions are necessary, clear risk assessments must be put in place. . 5 9 13 The registered person must 12/06/2009 ensure that peoples risk assessments including those regarding their ability to look after their own finances, are reviewed at least six monthly (these do not necessarily need to be rewritten unless there are significant changes) they should be amended, signed and dated, to ensure that these assessments remain current to protect people from harm, whilst enabling them to take informed risks. . 6 20 13 The registered person must ensure that all medicines suitable for storage at room temperature(prescribed or 08/05/2009 22/05/2009 Care Homes for Adults (18-65 years) Page 32 of 37 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 unprescribed) are stored within the locked medication cabinet when not in use, that each administration of prscribed lotions or creams is signed for on administration records, and that stocks of medicines carried forward from previous months are recorded on records of stocks available, to ensure that peoples medication needs are met appropriately. . 7 24 23 The registered person must 29/05/2009 ensure that a lock is fitted on the identified bathroom door, soap is available in all bathroom/toilets, the flush mechanism on an identified toilet is repaired and the staff toilet room is repainted, for the comfort of people living or working at the home. . 8 35 18 The registered person must 19/06/2009 ensure that a training profile is available for the staff team to ensure that training is provided when updates are due. The identified staff member must be provided with safeguarding adults Care Homes for Adults (18-65 years) Page 33 of 37 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 training without delay, to ensure that people living at the home are supported in line with best practice. . 9 37 10 The registered person must ensure that the homes management style encourages people to speak out about what they think, and further develops the staff team to ensure that each person is treated as an individual. . 10 39 24 The registered person must 26/06/2009 ensure that a more rigorous quality assurance audit is undertaken for the home annually, including consultation with all relevant stakeholders and more in depth audits of all the homes systems, to ensure that people living at the home are provided with the highest possible standard of care and support. . 11 41 17 The registered person must ensure that a record is maintained of any valuables kept for safekeeping including bank cards and 08/05/2009 29/05/2009 Care Homes for Adults (18-65 years) Page 34 of 37 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 building society books, and these must be signed in and out of the home, to improve the financial protection of people living at the home. . 12 42 23 The registered person must 22/05/2009 ensure that specific fire call points tested are recorded on weekly fire call point test records, and that tht time at which fire drills are undertaken are recorded to evidence that the times of drills are varied, including at least one night drill each year, for the protection of people living and working at the home. . 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 11 It is recommended that more records relating to people living at the home are produced in accessible formats so that people are supported to take more individual decisions, e.g. the use of a pictorial style menu with various photos/pictures of meal options that are available, and choices of activities to go on activities records. It remains recommended that the home continue to increase the selection of in-house activities available to people living at the home, with opportunities for individual people to undertake their own choices of activity even if Page 35 of 37 2 16 Care Homes for Adults (18-65 years) 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 these differ from others living at the home. 3 20 It is recommended that the residents GP/s should be asked to provide a list of homely remedies suitable to be given to permanent residents within the home, with guidelines for how these can be used, to ensure that these can be administered to them without risk. It is recommended that internet access is made available within the home for the use of staff members in making records more accessible to people living at the home, and in supporting residents to develop their computer skills. It is recommended that some staff undertake Makaton training to communicate with an identified respite service user who uses this form of communication. 4 24 5 35 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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