Inspection on 04/07/05 for Arthur Lodge

This inspection was carried out on 4th July 2005.

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

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

Other inspections for this house

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 24/10/05

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 08/07/2008.

CARE HOME ADULTS 18-65 ARTHUR LODGE 16 - 18 Arthur Road London N9 9AE Lead Inspector Brian Bowie Announced 4 July 2005 @ 08.30 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Arthur Lodge Address 16 - 18 Arthur Road, London, N9 9AE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8345 5743 Mr Dhenraj Hurdowar Mr Dhenraj Hurdowar PC Care Home 11 beds Category(ies) of LD - Learning disability registration, with number of places ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23 February 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 provides 5 places for respite care and 6 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 G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over one day and lasted 9 hours. The manager and assistant manager were both interviewed and helped with the inspection. The home was looked round and all 8 people at the home on the day of the inspection were seen, with 4 of the permanent 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 providing a good standard of care and has a relaxed family-like atmosphere. However it needs to deal quickly with the challenges it is facing in order to ensure the new respite service meets the needs of people coming to stay at the home. What the service does well: What has improved since the last inspection? The service has been expanded so that the home is now able to provide up to 5 beds for respite care within a very attractive and well furnished living situation. The conversion of the adjoining property has meant that existing residents now have more communal space available and the use of a larger 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 ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 6 the home has also been improved and strengthened with the appointment of an assistant manager. Careplans for residents now indicate clearly what the home is trying to achieve with each resident. The home had responded positively to the last inspection so that 3 of the 4 areas which needed attention had been dealt with. 8 new areas for improvement were identified at this inspection. These concerned: • • • • • • Initial assessments to be made by home on all new referrals Risk assessments about residents to be more detailed Training for staff in giving out medication, adult protection, fire safety and health & safety Garden at rear of 18 Arthur Lodge to be made safe Occupational Therapist (OT) to advise on rear access to premises Fire officer to advise on fire safety measures needed One recommendation is made to improve practice in relation to the administration of medication. The manager at the home emphasised that he was keen to work closely with CSCI to raise standards further at the home in order to be able to provide the best possible quality of life for residents. 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 G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 People moving into the home on a long term basis have their needs and wishes assessed so that the home can be sure that it can meet these needs and wishes. However the home has failed to ensure that the needs of all new people coming for respite care at Arthur Lodge are fully assessed before they come to stay. EVIDENCE: Records for long term residents were looked at. The careplans included detailed assessments by local authority social workers. However the home had not been making its own assessment of new respite care visitors, in addition to the comprehensive assessment provided by Social Services. This had contributed to a couple of inappropriate respite care placements at the home. The home must carry out its own assessment of the needs of any new respite care clients in order that Arthur Lodge is confident that it can meet their needs. The manager said he had now produced his own assessment form which would be used with all future referrals. ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,9 Residents benefit by having careplans which set out clearly and in detail how their needs and wishes will be met by the home. 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 careplans are detailed and cover the key aspects of the resident’s life. These careplans now show clearly what the home is trying to achieve with each resident. Care staff interviewed knew the residents well and were aware of their needs and wishes. As a result residents are benefiting from having staff who are clear about how best to support each resident. Case records included risk assessments for each resident to ensure that any risks identified could be managed by the home. However risk assessments seen were not sufficiently detailed and did not cover situations where the resident might not cooperate with the suggested plan of action. Risk assessments must show in detail how the risk is to be minimised and what ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 10 action is to be taken if the person does not agree with the proposed plan 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 G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,17 Residents are getting a better quality of life because of the good links with the local community and because they take part in a range of stimulating and appropriate activities. Mealtimes are enjoyed by the residents who benefit from having a choice about what to eat. EVIDENCE: Residents take part in a variety of daytime activities, including going to day centres, work projects and college classes. One resident said he enjoyed going to his employment project where he met up with friends as well as developing his work skills. Some of the residents go out to clubs, as well as going to the local shops, parks and cafes. Residents were positive about the food in the home. The lunchtime meal was seen to be very relaxed with residents clearly enjoying the meal. The residents have regular meetings where they discuss with staff what they would like to eat and then meals are provided on this basis. Comments from residents included: ‘The food’s nice- I get what I want.’ Staff interviewed were ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 12 aware of the residents’ preferences and where a special diet was needed for a resident who is diabetic. ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20 Staff are good at supporting residents in a way which makes sure their physical and emotional health needs are met. Record-keeping in relation to the administration of medication is not completely accurate so that residents are not fully protected at all times. EVIDENCE: Interviews with staff indicated that they had a good understanding of the residents’ needs and wishes. This in turn helps the home to provide an individual service to each client. As a consequence there was a lot of positive feedback from residents about how happy they felt in the home. One resident said: ‘I love it here- I don’t want to move.’ The home keeps a record of each resident’s healthcare needs and when they have been seen by health professionals. The community nurse visits the home regularly to make sure residents with special health needs are met. Records seen showed that the home responds to and meets the health needs of the residents. Medication arrangements within the home were looked at. On the day of the inspection the medication administration sheet had not been completed. This sheet must be filled in each time medication is administered. Staff files showed that there was insufficient staff in the home who had had training in ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 14 the administration of medication. The home must ensure sufficient staff undertake this training in order to ensure that at all times there is a member of staff on duty who is competent to administer medication. A recommendation is also made that the home uses blister packs in order to reduce the likelihood of mistakes being made when medication is given out. The manager agreed he would arrange appropriate training for staff and look into the medication being dispensed from blister packs. ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The residents benefit from adult protection procedures which help to ensure that residents are safe and secure whilst at Arthur Lodge. However residents are not fully protected at all times by staff who have had training in adult protection. EVIDENCE: In general the home provides residents with a safe and supportive environment and the complaint record indicated very few complaints having been made in the past year. The home has guidelines and procedures for staff on adult protection. However a recent incident in the home had highlighted this area and interviews with staff and staff files showed that staff at the home needed to have adult protection training so that they are aware of the procedures to be followed and what actions to take in the event of an incident or allegation. The home must arrange adult protection training for all staff. ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,29,30 Residents at Arthur Lodge enjoy an attractive, comfortable and clean living environment which adds considerably to their quality of life. Residents do not have the benefit of a completely safe and accessible home. 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 respite resource has been furnished and equipped to a high standard and looks very attractive. One of the people staying in this part of the house said she was very happy with her bedroom. The rear garden of 16 Arthur Road has had a new lawn put down with attractive borders. However the garden at the rear of 18 Arthur Road had not yet been improved and at the time of the inspection presented some safety issues. These were discussed with the manager who agreed to take immediate action to make the area safe. The home must ensure the rear garden at 18 Arthur Road is safe and carry out a risk assessment to ensure any remaining risks are minimised. ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 17 The access to the rear of the garden is via ramped walkways which are too steep for people with mobility difficulties. The manager must arrange for an OT to assess the situation so that there are appropriate access arrangements in place at the rear of 16 and 18 Arthur Lodge. ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35 Residents benefit from a committed and experienced team of staff. However residents do not get the full benefit of being supported by staff who have undertaken training in all essential areas. EVIDENCE: Care staff were interviewed and said they worked closely with each other in order to meet the needs of residents. Verbal feedback from residents was positive about staff, with typical comments being: ‘I like the staff- they help me when I need help.’ Arthur Lodge has increased its team of staff in order to meet the needs of additional people using the respite service. In addition a part-time assistant manager has been appointed to assist Mr Hurdowar with the day-to-day management and running of the home. Staff have attended a range of relevant courses but had not always attended courses in areas which were essential if they were to work as effectively as required. Care staff therefore need to have training in the administration of medication, adult protection, health & safety and fire safety. ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,42 Residents benefit from living at Arthur Lodge because the home provides a very personalised service to each of the residents in order to meet their needs. 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: The manager and staff work closely together to achieve good standards of care for the home. Feedback from the residents and staff was positive about the way in which the home is run. Comments about the manager included: ‘He’s approachable, he’s a good manager.’ ‘He listens to you and sorts out problems.’ The manager has taken action to increase the staffing levels in the home in order to meet the needs of new people using the respite service. A range of records was looked at, including fire safety and accident reports. These records were detailed, up-to-date and accurate and confirmed that the ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 20 home is being run responsibly with essential checks being made and acted on. However building works to the rear of 18 Arthur had blocked one of the fire exits to the garden. The manager must consult with the London Fire & Emergency Planning Authority about this situation, and any additional safety precautions needed, as well as carrying out his own risk assessment of the situation. The manager must also consult the London Fire & Emergency Planning Authority to determine the appropriate arrangements to be in place when the front door of the home has to be kept locked to ensure the safety of residents. ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x 2 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x x 3 Standard No 31 32 33 34 35 36 Score x x 3 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 ARTHUR LODGE Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 2 x G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 22 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. 2. Standard 2 9 Regulation 14 13 Requirement The registered persons must ensure the needs of any new respite care clients are assessed. The registered persons must ensure risk assessments are detailed. (Previous timescale of 30/4/05 not met) The registered persons must ensure staff undertake training in the administration of medication. The registerd persons must ensure all staff have trainng in adult protection. The registered persons must ensure the rear garden at 18 Arthur Lodge is made safe and a risk assessment made to ensure any remaining risks are minimised. Timescale for action 5/7/05 25/7/05 3. 20 13 30/9/05 4. 23 13 30/9/05 5. 24 13 5/7/05 6. 29 23 The registered persons must 31/7/05 ensure an OT assesses the rear access at the home, and act on the advice given, in order to ensure that there are appropriate access arrangements in place at the rear of 16 and 18 G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 23 ARTHUR LODGE Arthur Lodge. 7. 35 19 The registered persons must 30/10/05 ensure that care staff have training in health & safety and fire safety. The registered persons must 5/7/05 consult with the London Fire & Emergency Planning Authority about fire safety measures needed whilst access to the rear garden is restricted, and act on advice given, as well as carrying out their own risk assessment of the situation. The registered persons must also 5/7/05 consult the London Fire & Emergency Planning Authority to determine the appropriate arrangements to be in place when the front door of the home has to be kept locked to ensure the safety of residents, and act on the advice given. 8. 42 13 9. 42 13 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 20 Good Practice Recommendations The registered persons to consider the use of blister packs in order to reduce the likelihood of mistakes being made when medication is given out. ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London, N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI ARTHUR LODGE G59 S10577 Arthur Lodge V231183 04.07.05 Stage 4.doc Version 1.30 Page 25 - 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. 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