Inspection on 08/04/08 for Arthur Lodge

This inspection was carried out on 8th April 2008.

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 9 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 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

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 Susan Shamash Unannounced Inspection 8th April 2008 02:30 Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arthur Lodge Address 16 - 18 Arthur Road London N9 9AE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8345 5743 020 8345 5743 arthurlodge@googlemail.com Mr Dhenraj Hurdowar Mr Dhenraj Hurdowar Care Home 11 Category(ies) of Learning disability (11), Learning disability over registration, with number 65 years of age (1) of places Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on the 16th May 2006, one service user over the age of 65 years can be accommodated within the home 23rd May 2007 Date of last inspection Brief Description of the Service: Arthur Lodge is a care home for 11 adults with learning disabilities. It was originally registered as a small home for 3 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 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 has a vehicle so that people living at the home can get out and about. Weekly fees as of April 2008 are £650 - £750 and the most recent CSCI inspection reports can be obtained from the home’s office, or the CSCI website at www.csci.org.uk Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place over approximately six hours. The proprietor and manager, Mr Hurdowar, was available to assist me throughout the visit. I spoke to five people living at the home, the deputy manager and two other staff members during the visit, and conducted a tour of the premises and viewed various records and policies. Information provided in the Annual Quality Assurance Assessment for the home was also taken into account as part of this inspection. What the service does well: What has improved since the last inspection? Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 6 As required at the previous inspection a quality assurance audit had been undertaken for the home indicating areas to be addressed in the home’s business plan. The confidentiality of all information relating to people living at the home is now protected by new facilities provided near the deputy manager’s desk and improving the manager’s office so that it is no longer accessible through two residents’ rooms. Improvements have been in the recording of medicines stored for and administered to people living at the home to ensure that they are fully protected. A number of improvements have been made to the home’s environment including a new shower tray in one bathroom, new sofas in the lounge and more hygienic hand-drying facilities in every toilet/bathroom for the comfort and hygiene of people living at the home. As required at the previous inspection records had been maintained of the content of new staff member’s induction training. Some improvements had been made in the arrangements for supporting people with their finances, however further improvement are needed in this area to ensure that residents are further protected from financial abuse. Fire drills are now recorded in greater detail, and fire doors are checked regularly to ensure that they remain effectively self-closing at all times. As recommended the manager had contacted the relevant local authorities for all residents to ensure that people living at the home have at least an annual review with their social workers. Two staff members had undertaken training in person centred planning, and the previous medication records were being maintained on each resident’s care file to aid monitoring. What they could do better: It is recommended that person-centred planning formats be developed for all people living permanently at the home, so that they can be more involved in choosing their support and goals. All people living at the home should be given the option of having their own room and front door keys, and looking after their own monies, following discussion and appropriate risk assessments, to promote their independence as far as possible. A greater selection of activities should be made available for people living at the home, both inside and outside of the home, and during the day, evenings and weekends. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 7 Medication no longer needed by people living at the home must be returned to the pharmacy and this must be recorded to ensure that people’s medication needs are met safely. It is recommended that the deputy manager or the manager should undertake Enfield Local Authority’s adult protection training, and then brief the staff team accordingly to ensure that people living at the home are safeguarded as far as possible, and that the staff team be provided with training in the Mental Capacity Act 2005, to ensure that the rights of people living at the home are respected. It remains required that all staff members involved in the preparation, serving or handling of food at the home, must be provided with current food hygiene training to ensure that the needs of people living at the home are fully and safely met. All staff must also undertake current first aid and fire safety training, for the protection of people living at the home from harm, and a profile of staff training should be developed to highlight any gaps. The findings of the quality assurance audit must be carried forward into the business plan for the home, to ensure a high quality of care and support for people living at the home. It remains required that audits must be undertaken regularly to ensure that records tally with monies stored on behalf of each person, to ensure that residents are fully protected from errors. The Public and Employer’s Insurance Liability Certificate must be displayed prominently within the home and general risk assessments must be carried out regarding all areas of the home. Finally routine safety certificates must be kept up to date for the home. 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. The summary of this inspection report can be made available in other formats on request. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 8 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.V361408.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People considering moving into the home have their needs assessed and their aspirations recognised before moving into the home, to ensure that these can be supported appropriately. EVIDENCE: Seven people were living at the home on a permanent basis at the time of this visit, and there were no people staying there for a respite service. There were no changes in the people living at the home since the previous inspection. I inspected the care records of four people living at the home, including one person staying at the home on a respite basis. The files 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. I also spoke to five people living at the home who confirmed that they had been involved in the assessments from when they moved into the home and had received sufficient information about the way the home is run. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home 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. They can be assured that their confidentiality will be adequately protected within the home. EVIDENCE: Individual plans of care were seen for four people living at the home. These were seen to take a broadly holistic approach to people’s care. The plans were regularly reviewed with any changes being documented. Each had had an annual review by the placing authority 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. As recommended notes were also being kept of the main outcomes of any review meetings with social services, for the interim period before the formal Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 11 minutes are received, to ensure that the needs of people living at the home are met appropriately. Care plans indicated that people are enabled to make choices in their day-today lives, for example on what to wear, what activities to pursue and when to go to bed. Their cultural and religious needs are also 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. These were also being reviewed at least six-monthly as appropriate. Discussion with staff, management and people living at the home indicated that no residents had keys for their own bedrooms, lockable cabinets or the front door of the home, and none of them looked after their own money stored within the home. It is recommended that all people living at the home should be given the option of having their own room and front door keys, and looking after their own monies if they are able to do so (even if extra support will be required for them to accomplish this), following discussion and appropriate risk assessments, to promote their independence as far as possible. 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. As recommended at the previous inspection, to further empower people living at the home, 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 she was in the process of completing one such format for one person living at the home. It is recommended that this work be extended to involve all people in producing their plans so that they can be more involved in choosing their support and goals as far as possible. As required at the previous inspection the storage areas for residents’ care plans, had been reviewed so that they can be locked away as appropriate to protect their confidentiality. The manager’s office had been walled off, so that it is no longer accessible from two residents’ rooms, and further lockable cabinets had been provided at the deputy manager’s work area to store confidential information including care plans for all residents. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. People who use this service experience good outcomes in this area. This judgement has been made using available 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 and are able to eat an appropriate range of meals that meets their nutritional needs. EVIDENCE: The likes and dislikes of people living at the home are recorded with respect to activities available to them. Information was also recorded about people’s cultural needs including religion, preferred language and food preferences. They 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. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 13 People living at the home are 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 when I arrived at the inspection, returning later in the afternoon. However, I noted that for people who were not out during the day, there appeared to be 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 undertaken regularly, with very few activities at weekends and in the evenings. Two people spoken to also advised that they occasionally get bored when at home. It is therefore required that a greater selection of in-house activities be available to people living at the home, in the evenings and at weekends. 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 people’s care plans and those spoken to confirmed that they were encouraged to keep in touch with these contacts. One person told me that they had been on holiday to Cyprus with their family this year. Residents’ meetings take place regularly, and I was able to inspect the minutes of these meetings. As discussed at a previous meeting, a group of residents had enjoyed a holiday in Butlins holiday resort last year. At the most recent inspection residents discussed the Easter break celebrations, activities, shopping and family contact. The manager advised that future day trips were planned for residents to Southend, the West End and a Boat on the Thames. 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 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 food’s nice here’. 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 a relaxed and enjoyable affair. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use this service experience good outcomes in this area. This judgement has been made using available 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 sufficiently rigorous to ensure that people’s health needs are appropriately met. EVIDENCE: People’s 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. Inspection of care files indicated that people’s health needs form an integral part of assessments and care plans. Records are kept of appointments with health professionals, which also serve as a reminder of when new appointments such as check ups with opticians and dentists are needed. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 15 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 self-administer their own prescriptions. Staff who administer medication have had training in uses and side effects. People spoken to during the inspection confirmed that their medication was given at regular times. 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 and appropriate arrangements were in place for the safe storage of medicines. As required at the previous inspection no PRN (as and when) medicines that may affect behaviour, were not prescribed to any resident without their GP providing clear guidelines for when they were to be administered. As required at the previous inspection, medicines received at the home were being recorded as required. However there were several items in the medicine cabinet that had not been needed for several months, and should have been returned to the pharmacy and recorded to provide a clear audit trail. This is required to ensure the protection of people living at the home from inappropriate use of their medication. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home feel their views are important to the operation of the home. Complaints are handled appropriately and staff training and policies on protecting vulnerable adults ensure 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, but three complaints prior to this had been dealt with appropriately. 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. The home has a policy on the protection of vulnerable adults. As required previously it had been updated to include the relevant London borough’s policy and procedure. Inspection of staff files showed that staff had received 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. It is recommended that the deputy manager or the manager should undertake Enfield Local Authority’s adult protection training, and then brief the staff team Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 17 accordingly to ensure that people living at the home are safeguarded as far as possible. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use this service experience good outcomes in this area. This judgement has been made using available 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: I found the premises to be homely, 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, 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. As required at the previous inspection the registered provider had replaced the shower base in the downstairs shower room. A new set of sofas had been provided in the lounge area, near the entrance to the home, providing residents with greater comfort. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 19 Soap and hand-washing facilities were available in all bathrooms and toilets, and as required at the previous inspection, paper towel dispensers had been provided in all these facilities. This is an improvement on the previous use of shared hand towels in these areas, so residents are now better protected from the spread of infection. As noted under Standard 10, the storage of care files for people living at the home had been improved to protect their confidentiality. As recommended an additional lockable cabinet was placed near to the deputy manager’s desk, for the storage of confidential information relating to people living at the home. The manager’s office had also been closed off as a separate room, rather than being opened into directly from two of the resident’s rooms. The manager advised that he was also planning to create a games room in the garden area, for the use of people living at the home. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. People who use this service experience adequate outcomes in this area. This judgement has been made using available 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. However people living at the home are not protected sufficiently by regular staff training in safety updates 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. Five 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 Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 21 allowed to work at the 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. As required at the previous inspection, staff files now provided evidence that induction training had been provided, and the areas covered in this area. I saw evidence in the form of certificates held on staff files that various training courses had taken place since the last inspection. A newer staff member still had a range of training to undertake, however the majority of longer-serving staff members had undertaken mandatory courses including first aid, adult protection, fire safety, epilepsy and manual handling. However I was concerned to note from staff certificates on file that several of these staff had not undertaken updates in food hygiene training within three years of taking the original training course, and therefore were not adequately trained in this area within the last year. Discussion with the manager and staff members preparing or serving food on the day of the inspection confirmed that this was the case. A requirement was made about this at the previous inspection and this requirement is restated. Shortly after the inspection the manager wrote to the CSCI to advise that two staff members would be undertaking food hygiene training on 2nd May 2008. The manager is aware this training needs to be undertaken by other members of the staff team who have not had this training within the last three years. I was also concerned to note that the majority of staff files inspected showed that staff did not have current training in first aid and fire safety, and this is required for the protection of people living at the home from harm. A profile must be developed including all the training undertaken by each member of the staff team, and highlighting when updates are due or training has not yet been undertaken, so that appropriate action can be taken. It is recommended that the staff team should also be provided with training in the Mental Capacity Act 2005, 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. However I advised the manager that the deputy manager should also receive regular supervision sessions and these should be recorded. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is generally well run so that people living there can be confident that their welfare is promoted and protected. They can be confident that their views will be taken into account in determining the support that they receive. However their finances and health and safety are not sufficiently protected by the home’s procedures, and self-monitoring. 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 told me that it was his intention that the deputy manager would complete these qualifications and then apply to be registered as the Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 23 manager of the home. He confirmed that the deputy manager is in the process of undertaking the Registered Manager’s Award at NVQ level 4. 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. As required at the previous inspection a quality assurance audit had been carried out including feedback from people living at the home and other stakeholders. A detailed self-audit had also been undertaken of each area of the home’s performance, and the manager had provided the CSCI with a copy of the findings. The findings of this audit should now be incorporated into the business plan for the home, to ensure that the home is proactive at monitoring the quality of the service it provides. 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. As recommended, previous medication records were being maintained on each resident’s care file to aid monitoring procedures. The manager holds money for safekeeping for a number of people living at the home, and procedures were generally found to be appropriate to ensure that their monies are protected, with records of all transactions recorded and use of a safe to store monies. As required at the previous inspection, the use of pin numbers held on behalf of some residents, had ceased, as this placed them at an increased risk of financial abuse. However, although it was required at the previous inspection, the monies kept on behalf of one out of three residents that I checked, did not tally with the records kept on their behalf being over by £3. The manager advised that this was because on the day of this visit he had needed to take money out for them at short notice and therefore did not have the necessary change to take out the exact amount needed, and would correct this when the change was available. This is not acceptable, as it relies upon the manager’s memory with no record being kept of how much money each person still owes (due to insufficient change) and does not sufficiently safeguard residents’ finances. It remains required that audits must be undertaken regularly to ensure that records tally with monies stored on behalf of each person, to ensure that residents are protected from error in the management of their finances. The home’s policy on the management of people’s finances must also be updated accordingly. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 24 It is recommended that the Public and Employer’s Insurance Liability Certificate must be displayed prominently within the home as required by legislation for the protection of people living in or working at the home. The majority of health and safety records were available for the home including portable appliances testing, 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. As required that records maintained for fire drills had been improved, to specify the time, staff and residents involved as well as any relevant issues that arise. 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. It is required that general risk assessments about all areas of the home including security, infection control, kitchen safety etc. are undertaken and reviewed at least six-monthly to ensure the safety of people living and working at the home. I was concerned to note that there were no current electrical installation and gas safety certificates available for the home at the time of the inspection, as required for the protection of people living and working at the home. These certificates were provided within a week of the inspection, following visits from contractors that took place shortly after the inspection. However it is of concern that the home’s management had not noticed that these certificates were due, through its own self-monitoring procedures. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X 2 2 X Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 YA9 Regulation 12(2) Requirement The registered person must ensure that all people living at the home are given the option of having their own room and front door keys, and looking after their own monies where this is possible, following discussion and appropriate risk assessments, to promote their independence as far as possible. The registered person must ensure that a greater selection of activities are available for people living at the home, both inside and outside of the home, and during the day, evenings and weekends, so that people living at the home are provided with more options for activities. The registered person must ensure that medication no longer needed by people living at the home is returned to the pharmacy and that this is recorded, to ensure that people’s medication needs are met safely. The registered person must ensure that all staff members DS0000010577.V361408.R01.S.doc Timescale for action 13/06/08 2. YA14 16(2mn) 30/05/08 3. YA20 13(2) 09/05/08 4. YA35 18(1ci) 27/06/08 Arthur Lodge Version 5.2 Page 27 5. YA35 18(1ci) involved in the preparation, serving or handling of food at the home, have undertaken current food hygiene training to ensure that the needs of people living at the home are fully and safely met. (Previous timescale of 10/08/07 not met). The registered person must 25/07/08 ensure that all staff working at the home have undertaken current first aid and fire safety training, for the protection of people living at the home from harm. 6. YA39 7. YA41 A profile must be developed including all the training undertaken by each member of the staff team, and highlighting when updates are due or training has not yet undertaken. 24 The registered person must ensure that the findings of the quality assurance audit are carried forward into the business plan for the home, to ensure a high quality of care and support for people living at the home. 17(2) Sched The registered person must 4(9) ensure that audits are undertaken regularly to ensure that records tally with monies stored on behalf of each person, to ensure that residents are protected from financial error. (Previous timescale of 29/06/07 not met). The home’s policy on the management of people’s finances must also be updated accordingly. The registered person must DS0000010577.V361408.R01.S.doc 13/06/08 09/05/08 8. YA42 13(4) 13/06/08 Page 28 Arthur Lodge Version 5.2 9. YA42 23(4ac(iv)e) ensure that general risk assessments about all areas of the home including security, infection control, kitchen safety etc. are undertaken and reviewed at least six-monthly to ensure the safety of people living and working at the home. 13(4) The registered person must 09/05/08 ensure that current electrical installation certificates and gas safety certificates are available for the home, for the protection of people living and working at the home. These certificates were provided for visits that took place shortly after the inspection. 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 YA6 Good Practice Recommendations It is recommended that person-centred planning formats be developed with each person living at the home on a DS0000010577.V361408.R01.S.doc Version 5.2 Page 29 Arthur Lodge 2. YA23 3. 4. YA35 YA41 permanent basis, so that they can be more involved in choosing their support and goals. It is recommended that the deputy manager or the manager should undertake Enfield Local Authority’s adult protection training, and then brief the staff team accordingly to ensure that people living at the home are safeguarded as far as possible. It is recommended that the staff team be provided with training in the Mental Capacity Act 2005, to ensure that the rights of people living at the home are respected. It is recommended that the Public and Employer’s Insurance Liability Certificate must be displayed prominently within the home as required by legislation for the protection of people living in or working at the home. Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Arthur Lodge DS0000010577.V361408.R01.S.doc Version 5.2 Page 31 - 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!