Inspection on 24/10/05 for Arthur Lodge

This inspection was carried out on 24th October 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Arthur Lodge 23/03/09

Arthur Lodge 30/09/08

Arthur Lodge 08/04/08

Arthur Lodge 23/05/07

Arthur Lodge 12/10/06

Arthur Lodge 04/07/05

Arthur Lodge 23/02/05

Arthur Lodge 24/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

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 08/07/2008.

CARE HOME ADULTS 18-65 Arthur Lodge 16 - 18 Arthur Road London N9 9AE Lead Inspector Brian Bowie Unannounced Inspection 24th October 2005 08.30 Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 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.V253730.R01.S.doc Version 5.0 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.V253730.R01.S.doc Version 5.0 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 020 8345 5743 Mr Dhenraj Hurdowar Mr Dhenraj Hurdowar Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2005 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.V253730.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and lasted 6 hours. The manager and deputy manager were both interviewed and helped with the inspection. The home was looked round and all 6 people at the home on the day of the inspection were seen, with 4 of the residents interviewed for their comments and views on the home. Both members of care staff on duty were also spoken to. A variety of records, including careplans and health & safety documents, were looked at. The overall impression was that Arthur Lodge is continuing to provide a good standard of care and has a relaxed family-like atmosphere. Most of the residents have lived at the home for a number of years and enjoy living at Arthur Lodge. The new respite service located in the adjoining house is still getting established. Areas for improving the service were discussed and agreed with Mr Hurdowar. What the service does well: What has improved since the last inspection? The rear garden at the original house has been improved so that there is an attractive sitting area together with disabled access to the garden. The staff team has been increased in order to meet the needs of the additional people coming to stay at the home. The management structure in the home has also been improved and strengthened with the appointment of a deputy Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 Page 6 manager. Training in adult protection and fire safety has been provided for care staff. The home had responded positively to the last inspection so that 6 of the 9 areas which needed attention had been dealt with. What they could do better: 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.V253730.R01.S.doc Version 5.0 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.V253730.R01.S.doc Version 5.0 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 People moving into the home for respite care have their needs and wishes assessed so that the home can be sure that it can meet these needs and wishes. However individuals having short stays at Arthur Lodge are not fully protected by having a risk assessment made before they come to stay. EVIDENCE: At the time of the inspection there were no respite care users staying at the home. Records for people having respite stays were looked at. These included detailed assessments by local authority social workers together with the home’s own initial assessment so that the home could make an informed decision whether Arthur Lodge was the right place for the person to be having short stays. However the home had not been making its own risk assessment of new respite care visitors. The home must make sure that risk assessments are in place for all new respite care users and that these are reviewed and updated after the person has had a stay. Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 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): 8,9 Residents benefit from the very regular contact and support from the manager of the home which makes it easier for them to make suggestions or raise issues. However the home needs to make sure that there are regular residents’ meetings so that they can contribute more to how the home is run. The home is good at ensuring each resident has risk assessments in place in order to keep them as safe as possible. However the home is failing to ensure that residents are fully protected through the provision of detailed risk assessments. EVIDENCE: The informal atmosphere in the home helps the residents to feel relaxed and more able to choose what they do and when they do it. There are close and supportive relationships between staff and residents which make it easier for the residents to say how they are feeling and what they want to do. However the residents’ meetings had not taken place for some time which had in the past been a valuable opportunity for residents to be consulted about and take part in the running of the home. The manager needs to ensure that these meetings take place regularly so that residents have the opportunity as a group to make suggestions on how the home is run. Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 Page 10 Case records included risk assessments for each resident to ensure that any risks identified could be managed by the home. However one individual who had had a coupe of falls had not had their risk assessment updated nor was it sufficiently detailed. Risk assessments must show in detail how the risk is to be minimised in order to ensure the home is managing the risks involved in the best possible way and residents are as fully protected as possible. Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 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 the following standard(s): 11,15 Residents benefit from being treated as individuals and are supported to develop their independence skills. They benefit from the opportunity to have regular contact with their families if they want to. EVIDENCE: Residents take part in a variety of daytime activities, including going to day centres, work projects and college classes. Some of the residents go out to clubs, as well as going to the local shops, parks and cafes. One resident had been getting additional one-to-one support to enable them to get out in the community more. Feedback from the outreach worker and staff in the home indicated that this individual had grown in confidence since moving into the home and that they had become more independent and improved their communication skills. Interviews with the residents confirmed that they have in most cases close relationships with their families who they either go to visit, or members of the family come to see them at Arthur Lodge. Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 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 Staff are good at supporting the residents in a way that they are happy with. EVIDENCE: Staff were observed to interact appropriately with residents and in a way that recognised their individual needs and capabilities. A keyworker system is in place so that residents have a member of staff who takes a particular interest in supporting that person. The keyworker for 2 of the residents was interviewed and was able to give a detailed account of their needs and interests. At the time of the inspection a physiotherapist was attending to one of the service users who receives regular weekly physiotherapy. Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 Page 13 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): 22,23 The residents benefit from adult protection measures which help to ensure that residents are safe and secure whilst at Arthur Lodge and by having their concerns listened to and acted on. EVIDENCE: The home has an appropriate complaints procedure and the complaint record indicated very few complaints having been made in the past year. Complaints made had been dealt with appropriately. The environment in the home is an open one and residents are able to express their views to both staff and managers. Residents were observed to interact in a relaxed way with staff in the home. The home provides residents with a safe and supportive environment. The home has guidelines and procedures for staff on adult protection. As previously required staff at the home have had training in adult protection so that they are aware of the procedures to be followed and what actions to take in the event of an incident or allegation. A member of care staff was interviewed who had attended this training and showed that they understood the main issues in relation to protecting vulnerable adults. Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 Page 14 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 Residents at Arthur Lodge enjoy an attractive, comfortable and clean living environment which adds considerably to their quality of life. EVIDENCE: Arthur Lodge is homely and comfortable with plenty of lounge space in the downstairs area so that residents can choose which area to sit in. The new house where respite care is provided has been furnished and equipped to a high standard and looks very attractive. The rear garden of 16 Arthur Road has had a new lawn put down with attractive borders and with a gate separating it from the garden of 18 Arthur Road. There is also a comfortable sitting area outside on the patio which the residents were able to take advantage of in the Summer. The manager is planning to carry out similar improvements to the rear garden at 18 Arthur Road. Access to the rear of the garden at 16 Arthur Road has been improved with the provision of a ramp. Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 Page 15 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): 32,34,35,36 Residents benefit from being supported by a committed and experienced team of staff and by recruitment procedures which safeguard their welfare. However residents do not get the full benefit of being supported by staff who have undertaken training in all essential areas and who are all regularly supervised and appraised by the manager. EVIDENCE: A member of care staff was interviewed who was able to describe clearly the needs of the residents for whom they were the keyworker. Since working at the home this member of staff had attended a range of appropriate training courses so that she could support residents more effectively. Residents themselves said they felt well supported by staff. The member of staff was sensitive to a resident’s need that time was taken when the person had a bath so that the individual did not feel rushed. Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 Page 16 Some staff files were looked at and contained the information needed to make sure that all staff in the home have had the appropriate checks made. These checks included written references and CRB disclosures. Mr Hurdowar is aware that no staff can start working at Arthur Lodge until a satisfactory Criminal Record Bureau disclosure has been received, or in exceptional cases a POVA (Protection of Vulnerable Adults ) First check. A new member of staff had been appointed using the POVA procedures while the home was waiting for their CRB disclosure to be processed. The manager must supply evidence of a satisfactory disclosure for this new member of staff once it is received by the home. Staff have attended a range of relevant courses, including recent training in adult protection and fire safety. However not all of the staff had attended courses in areas which were essential if they were to work as effectively as required. The manager needs to ensure therefore that all care staff have training in the administration of medication and health & safety. As previously required formal one-to-one supervision meetings of care staff are now taking place at least six times a year. These meetings are recorded and help to staff develop their skills so that residents are supported well. In addition a great deal of informal support is provided to staff by the manager who is in the home nearly every day. However in one case a member of staff had not been having regular supervision meetings. The manager must make sure that all care staff have regular recorded supervision meetings at least six times a year. Staff files revealed that staff were not having annual appraisal meetings to discuss their performance in the job and to develop their skills further. The manager must make sure that all care staff have annual appraisals. Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 Page 17 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): 39,42 Residents cannot yet be confident that their views form an essential part of the process at Arthur Lodge for monitoring and reviewing the quality of service provided. In general the home is good at making sure the residents are kept safe and secure whilst living at Arthur Lodge. However fire safety arrangements are not giving the residents the full protection to which they are entitled. EVIDENCE: As highlighted earlier in this report residents’ meeting are not being held regularly and which are an important part of giving residents a voice in the running of the home. The manager also needs to ensure that the process for monitoring and reviewing the quality of care provided by Arthur Lodge incorporates the views and wishes of residents. A range of records was looked at, including health & safety and accident reports. These records were detailed, up-to-date and accurate and confirmed Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 Page 18 that the home is being run responsibly with essential checks being made and acted on. In relation to fire safety a number of issues were identified: • Front door being kept locked in order to minimise risk of to any resident who is not safe to go out from the home unescorted • One fire door being wedged open • Updated fire safety risk assessment of premises needed • Fire safety evacuation plan needed • Fire drills over the course of a year not involving all members of staff The manager must ensure that appropriate arrangements are in place with all of the above and that these arrangements are approved by the LFEPA. Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 Page 19 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 x 2 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X 2 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Arthur Lodge Score 3 X X X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 X DS0000010577.V253730.R01.S.doc Version 5.0 Page 20 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 YA2 Regulation 13 Timescale for action The registered persons must 30/11/05 ensure that individuals having short stays at Arthur Lodge are fully protected by having a risk assessment made before they come to stay. The registered persons must 30/11/05 ensure that residents’ meetings take place regularly. The registered persons must 30/11/05 ensure that risk assessments are detailed and regularly updated. (Previous timescale of 25/7/05 not met) The registered persons must 31/12/05 ensure that evidence of a satisfactory CRB disclosure for the identified member of staff is provided to CSCI once it is received by the home. The registered persons must 28/02/06 ensure that all care staff have training in the administration of medication. (Previous timescale of 30/9/05 not met) The registered persons must 28/02/06 ensure that all care staff have DS0000010577.V253730.R01.S.doc Version 5.0 Page 21 Requirement 2 YA8 24 3 YA9 13 4 YA34 19 5 YA35 13 6 YA35 13 Arthur Lodge training in health & safety. (Previous timescale of 30/10/05 not met) 7 YA36 18 The registered persons must 30/11/05 ensure that all care staff have regular recorded supervision meetings at least six times a year.. The registered persons must 31/01/06 ensure that all care staff have annual appraisals. The registered persons must 31/01/06 ensure that the process for monitoring and reviewing the quality of care provided by Arthur Lodge incorporates the views and wishes of residents. The registered persons must 30/11/05 ensure that fire safety issues identified under NMS 42 are addressed and action taken approved by the LFEPA. 8 YA36 18 9 YA39 24 10 YA42 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Arthur Lodge DS0000010577.V253730.R01.S.doc Version 5.0 Page 22 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. 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