Inspecting for better lives Random 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: The rating was made on: 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Susan Shamash Date: 3 0 0 9 2 0 0 8 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 11 Over 65 1 Conditions of registration: 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 as of April 2008 are 650GBP - 750GBP and the most recent CSCI inspection reports can be obtained from the homes office, or the CSCI website at www.csci.org.uk Care Homes for Adults (18-65 years) Page 2 of 13 What we found:
This unannounced inspection lasted approximately four hours, and I was assisted by the registered manager and deputy manager during the visit. I also had the opportunity to speak to two support workers during the visit, and five people living at the home. Seven people were living at the home on a permanent basis, and one person was staying for a respite break, at the time of my visit. A tour of the building was conducted and five residents records were inspected in addition to maintenance and other general records for the home. Appropriate assessment information was available in the four care files inspected for permanent residents, including information regarding cultural needs and lifestyle preferences. People that I spoke to including the resident on a respite stay, confirmed that they had had received adequate information about the home and had opportunities to visit and stay at the home before moving in. I examined five care plans indicating that appropriate support plans and risk assessments continue to be in place for people living at the home. The plans were regularly reviewed with any changes being documented. Each had had an annual review by the placing authority as appropriate. Care plans indicated that people 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. As recommended previously, two staff members had undertaken training in personcentred planning, and the home had commenced producing detailed person-centred plans as appropriate. People living at the home, including the person on a respite stay, advised that they were generally able to make their own decisions about their lifestyles and felt that they were receiving adequate support from the staff team. However I was concerned that there was little current assessment information for people who stayed at the home on a respite basis, other than information provided by social services. The likes and dislikes of people living at the home are recorded with regard to activities available to them. Information was also recorded about peoples cultural needs including religion, preferred language and food preferences. Discussion with staff, management and people living at the home indicated that no residents had keys for their own bedrooms, or the front door of the home, although each kept a float of their own money in their rooms, so that they are encouraged to be more involved in their own finances. People have 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. Approximately half of the residents were out at day care services when I arrived at the inspection, returning later in the afternoon. As required Care Homes for Adults (18-65 years) Page 3 of 13 at the previous inspection records and staff and residents spoken to confirmed that there had been an improvement in the number of activities provided to people who did not attend day care services outside of the home. Activities undertaken included a drum circle, dancing, football training, walks, swimming and td a recent trip to the Paradise Wildlife Park. 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 peoples care plans and those spoken to confirmed that they were encouraged to keep in touch with family members. A holiday was being planned for all residents to go to Hastings in October 2008. Residents meetings take place regularly, and minutes showed that they are consulted about activities as appropriate. My observations indicated that where able, people are encouraged to participate in the running of the home and to carry out tasks such as keeping their rooms tidy, making drinks etc. The manager and staff were seen to show respect to people living at the home during the inspection. All people spoken to, spoke positively about the food served. One person, discussing the food, told me the foods nice. Stocks of food seen on the day of the inspection were sufficient including fresh vegetables and cultural alternatives, and were related to the menus seen during the inspection. 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 relaxed and enjoyable. People 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. Records are kept of appointments with healthcare professionals indicating regular check ups with opticians and dentists etc. as needed. The home operates a monitored dosage system of medicine administration. Most people living at the home take some form of medication and none self-administer their own prescriptions. Staff advsed that those who administer medication have had appropriate training. The 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, however staff were not recording the administration of eye drops to a particular resident, and these were not secured safely (within the refrigerator in the kitchen). Clear guidance must also be readily available regarding the administration of PRN (as and when) medicines. It was also noted that the practice of writing out the instructions for administration of medicines on MAR charts involves an additional risk of human error, and that without descriptions from the pharmacy, it is not possible to record the medicines received into the home in blister packs accurately. The home has an appropriate complaints policy and and adult protection procedures in place. 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 Care Homes for Adults (18-65 years) Page 4 of 13 unhappy about something at the home. All staff have undertaken adult protection training, however the manager and deputy manager advised that they had not yet undertaken the Enfield safeguarding adults training, due to the courses being full, but they remain on a waiting list to do so. The homes premises were clean and comfortably furnished and decorated, with the bedrooms of people living at the home 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 were carried out swiftly. The need for the replacement of a bath mat and plans to replace the carpet on a stairway, were the only issues that appeared to need addressing. 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. No new staff had commenced work at the home since the previous inspection, and staff files were not inspected on this occasion. I saw evidence in the form of certificates that staff had undertaken current training courses in first aid, food hygiene and fire safety as required at the previous inspection. Staff are also due to undertake training in working with non-verbal people. The deputy manager is in the process of undertaking the Registered Managers Award at NVQ level 4. She confirmed that she was receiving regular supervision sessions from the manager. Staff and residents spoken to said that they had a good relationship with both the manager and deputy manager. Inspection of staff meeting minutes indicated that there had been some recent issues raised between the staff and management, and the deputy manager advised that these had been addressed. No new quality assurance audit had been carried out since the previous inspection. Although the Annual Quality Assurance Assessment for the home had been completed and returned to the CSCI as appropriate. The manager holds money for safekeeping for a number of people living at the home. Since the previous inspection he had provided each resident with a float of their money, so that this would be more easily accessible to them. However, although the monies kept by the manager were now accurately recorded as required at the previous inspection, the monies kept by residents did not tally accurately with records kept. One staff member has been allocated the job of recording all transactions from residents cash boxes, and she keeps the keys for their boxes, when not on shift. Records for monies kept on behalf of two residents, did not exactly match the amounts recorded, indicating that the exact monies going in and out from each cash box is not being recorded. The required procedures for recording finances were discussed with the manager, deputy manager, and staff member with responsibility for the cash boxes. The main reason given for the discrepancy in records was due to insufficient change available at the time of the most recent transactions. However as noted at the previous inspection, this is not acceptable, as it relies upon one persons memory, with no record being kept of how much money each person still Care Homes for Adults (18-65 years) Page 5 of 13 owes or is owed, and therefore does not sufficiently safeguard residents finances. As recommended the Public and Employers Insurance Liability Certificate was displayed prominently within the home as required by legislation. I was concerned to learn that the incident of a respite service user going missing whilst resident in the home in September 2008 had not been notified to the CSCI. The manager advised that this was due to this being an expected pattern of behaviour for this person from previous placements, and doubts as to whether this incident needed to be reported. Where there is any doubt, any relevant incidents should be reported to the CSCI. The majority of health and safety records were available for the home including current service certificates for fire equipment, weekly fire alarm tests and regular fire drills. 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 had been undertaken about all areas of the home including security, infection control and kitchen safety as required at the previous inspection to ensure the safety of people living and working at the home. Current electrical installation and gas safety certificates were also available for the home, as required for the protection of people living and working at the home. However no current portable electrical appliances testing certificate was available. What the care home does well: What they could do better:
The service needs to improve the recording of current information about some respite residents who return to the home, and people would benefit from the monitoring of goals within their person centred plans. Residents should be offered keys for their bedrooms and the front door of the home, with appropriate risk assessments in place, to ensure that people are encouraged to develop their independent living skills. Some improvements are needed in the recording of the administration of medicines to people living at the home and storage of medicines requiring refrigeration, to ensure that peoples medication needs are met safely. Care Homes for Adults (18-65 years) Page 6 of 13 The management should undertake the local authoritys own safeguarding adults training, and a selection of staff members should also undertake Mental Capacity Act training, and pass on relevant information to staff working at the home, for the protection of people living at the home. A quality assurance audit needs to be undertaken for the home, at least annually, to ensure that standards of support are monitored appropriately. More accurate records must be maintained of monies kept for safekeeping on behalf of people living at the home, to improve the financial protection of people living at the home. The CSCI must be notified regarding any serious event affecting a person living at the home or on respite stay, so that peoples comfort and safety can be monitored. Finally all portable electrical appliances must be tested at least annually to ensure the safety of people living and working at the home. 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 2. Care Homes for Adults (18-65 years) Page 7 of 13 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 13 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 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 2 20 13 The registered person must 31/10/2008 ensure that staff sign for the administration of eye drops, or other medicines that are not administered orally. A secure facility must be in place for the storage of medicines requiring refrigeration, and guidance must be readily available for the administration of PRN (as and when) medicines, to ensure that peoples medication needs are met safely. 3 24 23 The registered person must ensure that the bath mat in an identified bathroom is 14/11/2008 Care Homes for Adults (18-65 years) Page 9 of 13 replaced, and that a schedule is in place for the replacement of the carpet on the homes stairway where it is worn, for the comfort of people living at the home. 4 39 24 The registered person must 12/12/2008 ensure that a quality assurance audit is undertaken for the home, at least annually, including consultation with all relevant stakeholders, and that the findings are taken forward into the homes business plan. A summary of the results of this audit must be sent to the CSCI London regional office, to evidence that there is adequate monitoring of the standards of care and support provided to people living at the home. 5 41 37 The registered person must 22/10/2008 notify the CSCI regarding any serious event affecting a person living at the home or on respite stay, without delay, so that peoples comfort and safety can be monitored. The registered person must 07/11/2008 ensure that more accurate records are maintained of monies kept for safekeeping on behalf of people living at the home, including double signatures for all transactions, records that tally to the actual amounts stored for each person, clear records of any monies lent to residents 6 41 17 Care Homes for Adults (18-65 years) Page 10 of 13 by the provider, and at least weekly checks that the amounts stored are accurate. A record must also 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. 7 42 13 The registered person must 21/11/2008 ensure that all portable electrical appliances are tested at least annually (PAT testing) with a current certificate maintained on file, and the specific fire call points tested each week on the weekly fire alarm tests, should be recorded. To ensure the safety 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 6 It is recommended that person centred plans be updated to include goals for individual residents, and dates for when these will be reviewed and evaluated, to ensure that people are supported to address their goals as appropriate. It is recommended that residents should be offered keys for their bedrooms and/or the front door of the home, in addition to development of other independent skills, with appropriate risk assessments in place, to ensure that people are encouraged to develop their independent living skills. 2 11 Care Homes for Adults (18-65 years) Page 11 of 13 3 20 It is recommended that pre-printed medication administration records (MAR sheets) or duplicate stickers which can be included on the MAR sheets should be used for recording the administration instructions of each medicine, to reduce the risk of recording errors. The pharmacy should also provide a description of each medicine provided in blister packs for people living at the home, so that staff at the home can check and record the receipt of all medicines at the home accurately. It is recommended that the manager and/or deputy manager should undertake the local authoritys own safeguarding adults training, and disseminate any relevant information to staff working at the home, for the protection of people living at the home. It is recommended that the management and some staff members working at the home undertake Mental capacity Act training, to ensure that they protect peoples rights in line with the latest best practice. 4 23 5 35 Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) 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. Care Homes for Adults (18-65 years) Page 13 of 13 - 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!
