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Inspection on 19/11/08 for Barons Lodge Psychiatric Nursing & Rehabilitation

Also see our care home review for Barons Lodge Psychiatric Nursing & Rehabilitation for more information

This inspection was carried out on 19th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

We found that people were generally happy living at Barons Lodge. Comments we received from people who use the service included, "I feel safe here", "I have everything I need", "the food is great" and "I like the people here". One other professional informed us that they felt the service had done well to improve the life of one individual they were involved with. Individuals made positive comments about their rooms and staff are working with people to support them in making their bedrooms more personalised. We saw good interactions between staff and people who use the service. Individuals were seen to be treated with respect and staff dealt with what could have been difficult incidents in a calm and supportive manner. Staff told us they felt well supported by the manager and had seen improvements in the service over the last twelve months. The standards of personal care are good with staff seen to take care to support individuals in a sensitive manner. We found the service has a relaxed atmosphere which was confirmed by people who live there. Individuals felt they had choices in their lives even if staff encouraged them, at times, to become more active.

What has improved since the last inspection?

The service has made good progress in meeting the requirements made at the last inspection. Improvements have been made in the prevention of cross infection through the supply of liquid soap, paper hand towel, disposable cleaning cloths and the safe storage of sharps. Improvements to the environment continue to be made. A new kitchen has been installed. At the time of our visit new fire doors were being fitted to the older part of the building along with new smoke alarms. A number of bedrooms have been redecorated and a stair lift has been fitted to the older building. The manager has made good progress on reassessing the needs of individuals so that the purpose of their living at the service is clear, either rehabilitation or for longer term support. The manager has started the supervision and appraisal process for staff. This will provide opportunities for staff and their supervisor to discuss their work and training needs. Staff are starting to work with individuals in looking at expanding their experiences by taking a holiday and discussing with people where they would like to go. Staff also informed us that they are having more opportunities to work with individuals on a one to one basis which will assist in providing more person centred activities.

What the care home could do better:

Two of the requirements made at the last inspection have not been met. These issues were around the recording of food and water temperatures. These requirements will be re stated. To ensure the health of individuals the recording and management of medication needs further work. Staff must record all medication received into the service and keep accurate records of administration. Staff should continue to work on care planning to make these more individualised and person centred. The recording of complaints needs to be reviewed to make sure that a record of the action taken and outcomes is clearly documented. All staff employed in the service must be provided with training on safeguarding people. All new staff must be provided with induction training. All staff should also be provided with training, appropriate to their role in the service, on supporting people with mental health needs. To ensure the safetyof people who use the service, staff and visitors all staff must be provided with training on dealing with behaviour they find challenging. To ensure the safety of people who use the service staff must not commence work in the service unless appropriate checks have been carried out. All staff must be provided with clear guidance on actions to be taken should the fire alarms be activated. Regular unannounced fire drills should take place to ensure that staff understand what they are to do.

CARE HOME ADULTS 18-65 Barons Lodge Psychiatric Nursing & Rehabilitation 24 Baron Grove Mitcham Surrey CR4 4EH Lead Inspector Liz O`Reilly Key Unannounced Inspection 19th November 2008 11:00 Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.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 Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.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. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barons Lodge Psychiatric Nursing & Rehabilitation 24 Baron Grove Mitcham Surrey CR4 4EH 020 8646 8280 020 8687 0355 baronsadmin@gmail.com Address 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) Genec Limited Mrs Florence Nwanganga Okehie Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (21) of places Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 21 27th November 2007 Date of last inspection Brief Description of the Service: Barons Lodge is a registered care home with nursing for up to twenty one adults with mental health needs. The home is situated in a residential area of Mitcham close to shops and public transport facilities. Accommodation is provided on the ground and first floors of the home. People also have access to communal lounge areas, a dining room, a large garden and the rehabilitation unit. Fees for this service are from £840 to £995 per week. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.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 people who use this service experience adequate quality outcomes. This unannounced inspection was carried out by two Regulation Inspectors. During the visit to the service the inspectors had the opportunity to speak with six people who use the service, four members of staff, one care manager and the registered manager. We received completed surveys from nine people who use the service and four members of staff. The manager completed their own assessment of the service (AQAA) for the CSCI and people who use the service and staff were provided with surveys to complete. We have used the information gained from all of the above sources along with our observations on the day to reach the judgements made in this report. What the service does well: We found that people were generally happy living at Barons Lodge. Comments we received from people who use the service included, “I feel safe here”, “I have everything I need”, “the food is great” and “I like the people here”. One other professional informed us that they felt the service had done well to improve the life of one individual they were involved with. Individuals made positive comments about their rooms and staff are working with people to support them in making their bedrooms more personalised. We saw good interactions between staff and people who use the service. Individuals were seen to be treated with respect and staff dealt with what could have been difficult incidents in a calm and supportive manner. Staff told us they felt well supported by the manager and had seen improvements in the service over the last twelve months. The standards of personal care are good with staff seen to take care to support individuals in a sensitive manner. We found the service has a relaxed atmosphere which was confirmed by people who live there. Individuals felt they had choices in their lives even if staff encouraged them, at times, to become more active. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Two of the requirements made at the last inspection have not been met. These issues were around the recording of food and water temperatures. These requirements will be re stated. To ensure the health of individuals the recording and management of medication needs further work. Staff must record all medication received into the service and keep accurate records of administration. Staff should continue to work on care planning to make these more individualised and person centred. The recording of complaints needs to be reviewed to make sure that a record of the action taken and outcomes is clearly documented. All staff employed in the service must be provided with training on safeguarding people. All new staff must be provided with induction training. All staff should also be provided with training, appropriate to their role in the service, on supporting people with mental health needs. To ensure the safety Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 7 of people who use the service, staff and visitors all staff must be provided with training on dealing with behaviour they find challenging. To ensure the safety of people who use the service staff must not commence work in the service unless appropriate checks have been carried out. All staff must be provided with clear guidance on actions to be taken should the fire alarms be activated. Regular unannounced fire drills should take place to ensure that staff understand what they are to do. 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. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.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 Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.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&4 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Before anyone is admitted to the service a full assessment of their needs is carried out. People who use are offered the opportunity to visit before they make any decision about moving in. EVIDENCE: We looked at a sample of files for individuals who use the service. We found that assessments of their individual needs were carried out before they moved into the service. This ensures that the service understands and can meet the needs of the person and assists in making sure that this is the right place for them. We asked people through our survey if they had been asked if they wanted to move in to the service and all those who responded said they were. Individuals also told us through the survey that “I am happy here”, “I am ok here” and “I think they look after me here”. Individuals we spoke to on the day of our visit told us they had visited before they decided to move in. One person was not feeling very happy at the time of our visit and felt they would like to move on somewhere else. The manager Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 10 and the persons Care Manager were aware of this and were in discussions with them about where the right place might be for them. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 11 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 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Improvements are being made in the care planning process. However care plans could still be more person centred and include more detail. References to individual’s particular needs and goals in relation to all aspects of their lives would assist in producing a more person centred plan. Risk assessments have improved since the last inspection of the service. EVIDENCE: We looked at a sample of care plans and found staff continue to make improvements in working towards a more person centred plan. Information gathered by staff included individual lifestyles and interests and in some instances family and social history. Staff have gathered some information on what individuals enjoy doing but this was not always carried Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 12 forward with information as to how staff would support people to take part in what they enjoy. Important events for the individual were noted but not always the dates, which does not help staff to support people to remember or celebrate such events. We found that staff are working with people on their care plans with some individuals signing that they are in agreement with their plan. Other plans were not signed and consideration should be given to providing an explanation of this. One person we spoke to told us that they do not want to sign documents but do attend meetings and reviews. Care planning could be more person centred with the inclusion of more goals for individuals along with information on the progress being made in meeting these goals. We found a lack of information on the needs of individuals in relation to culture, religion, sexuality and relationships. Where individuals have been seen by other professionals and changes in their individual needs have been noted staff have not always updated the care plan to reflect this. Risk assessments are in place and were seen, on the whole, to be reviewed on a regular basis. One assessment we saw was in need of updating due to changes in the persons needs. We saw people who use the service making their own choices about their daily life throughout our visit. Through our survey, eight out of the nine who responded, told us that they could do what they wanted during the day, evening and at weekends. The new manager has made progress in reassessing individuals to ensure that there is a clear understanding of the reason for their stay at the service. This ensures that individuals know whether they are staying at the service for rehabilitation or on a long term basis. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 13 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, 15, 16 & 17 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People using the service are provided with opportunities to take part in a variety of activities. Improvements have been made in tailoring rehabilitation plans to the needs of the individual. Improvements could still be made in providing a more person centred activities programme within the service. People who use the service enjoy the food on offer. EVIDENCE: An activity plan is produced for each individual. We found these to be written in the first person with comments such as ‘I would like to go out’, ‘I would like to got to church’ and ‘I would like to play bingo’. When we spoke to individuals they confirmed that they were getting opportunities to do these types of things. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 14 Staff have made progress in providing a more person centred programme for one individual who is staying at the service for rehabilitation. We saw staff accompanying individuals out shopping for personal items such as clothing. Individuals told us they enjoyed this type of activity. One person attends a day centre in line with their cultural needs. One person told us they attend a local church every week. A religious service is held in one of the communal lounges each week. Individuals told us that they did not have to attend this, only if they wanted to. The manager informed us that a group of people went on holiday to Bournemouth this year and plans were being made for other destinations next year. The service has a separate building for activities which includes a room with a number of computers, an art room, library and kitchen. The activities on offer in this area could still be more person centred. In our surveys four people said they sometimes made their own decisions about what they did each day. Two people said they always made their own decisions and two people said they usually decided for themselves. However when asked if they could do what they wanted all bar one said yes. Individuals told us, “I can have visitors when I like”, “I have regular visitors” and “having visitors is very important to me”. Staff informed us that there were no restrictions on visiting. People who use the service made very positive comments on the meals. They told us “the food is good”, “we get a choice”, “the food is great”, “lunch was very good” and “I am involved in planning the menu”. The service offers a varied menu which includes two choices and a vegetarian alternative. The cook told us they don’t currently cater for any medical or religious dietary needs but they can if required for individuals. The record of food is a copy of the menu not a record of the diet of individuals. Staff must ensure that a clear record of food is kept. This was discussed with the manager as staff did not appear to understand the record of food which needs to be kept to meet the requirements. We found food to be appropriately stored and labelled. The environmental health officer had visited although the certificate was not displayed due to recent redecoration. We saw records of fridge and freezer temperatures, all within the safe ranges. The cook told us she has completed training in food hygiene. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 15 Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 16 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 & 20 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use the service have good access to health care services. The management of medication needs to be improved to ensure that the health and welfare of individuals is protected. EVIDENCE: The service has good relationships with other health care professionals and we saw evidence that individuals are supported to attend health care appointments. People who use the service attend clinics in the community where they are able. Arrangements can be made for health care professionals to visit the service if needed. Visits are made to individuals by community nurses and consultants as well as their GP if required. We found files contained good information on the health and personal care needs of individuals with information for staff on how these needs should be Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 17 met. Individual files included clear health details with daily and weekly actions for staff to help people stay healthy. People told us they were happy with the way in which they were supported by staff. One person told us “the staff help me to have a bath every day” and another told us “I am very happy for the care I always receive”. One person told us that there were male and female carers but that they did not mind who assisted them. Since the last inspection of the service nursing staff have been provided with up to date information on the administration of injections. Staff have also been provided with disposable aprons, up dated hand washing facilities and the flooring in the area where medication is kept has been up dated. Medication is appropriately stored and staff practices include having the door closed to the area while dealing with medication to ensure that people do not walk in and disturb the process. We looked at a sample of medication records for two people who use the service. We found the record of medication administered was not accurate. We found medication had been signed as given but had not been and another instance where medication had not been signed for but was not in the pack. The medication for one person had been signed for twice a day when it was due to be given once a day. When counting the medication it appeared that the person had been given the medication only once a day and had not been receiving an extra dose each day. Medication for one person had been changed by the GP and staff were breaking a tablet in half. However this had resulted in the person receiving less than the prescribed dose. Records of medication received did not include items received from hospital, making it impossible to audit medications received and administered. These issues were reported to the manager who will carry out their own investigation. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 18 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 & 23 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use the service know how to make a complaint. The recording of complaints needs to be further developed to include outcomes. In order to ensure that all action has been taken to safeguard individuals further work on recruitment and training needs to be taken. EVIDENCE: The service has a clear complaints procedure which is supplied to everyone who uses the service. We found people who use the service knew how to make a complaint. Individuals told us they would also talk to their relatives or care managers as well as staff in the service if they had a concern or complaint. People told us directly and through our surveys the staff always or usually listened to what they had to say and acted on this. Staff informed us that they were aware of their role in reporting on any complaint or concern to a more senior person. We looked at the record of complaints and found four complaints recorded since the last inspection of the service. Two had been reported by people who Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 19 use the service, one from the community mental health team and one from the local authority. The record of complaints needs to include more detail particularly around actions taken and outcomes. Where information on actions and outcomes is held elsewhere for privacy reasons information on the record needs to indicate where this is held. This record will then show that the appropriate actions have been taken and outcomes are satisfactory to the person making the complaint. We found the record of money held on behalf of people using the service was up to date and well maintained. Individuals who use the service told us they “feel safe here”. Staff informed us that they knew what to do if they suspected anyone of being abused. However we found no evidence on file that new staff have been provided with information through the induction process on their role or responsibilities in relation to safeguarding people. At the time of the last inspection of the service evidence that staff had been provided with safeguarding training was not available. At this inspection we found not all staff have been provided with this training. Although staff may feel confident on their ability to recognise and report abusive behaviour the lack of evidence of training in this area is of concern. When we examined staff records we found that staff were starting to work in the service without either a Criminal Records Bureau Check or a check of the Protection of Vulnerable Adults (POVA) List. The minimum requirement before staff commence work in a service is a check of the POVA list. The lack of appropriate pre employment checks puts at risk the safety of people who use the service. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 20 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 & 30 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Improvement to the environment continue to be made. People who use the service feel happy with their individual and communal rooms. The service is clean and free from offensive odours. EVIDENCE: Individuals made positive comments about the environment. People told us, “my room is comfy”, “I have a splendid room”, “my room is very nice”, “I have a shower and toilet in my room” and “staff always clean my room when I get it a bit messy At the time we were visiting the service new fire doors were being installed. Since the last inspection of the service a new kitchen has been completed and the manager reported a number of bedrooms have been redecorated. Staff are working with individuals to personalise their own rooms. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 21 The home owners are working on the laundry area to provide a separate laundry and two toilets. A stair lift has been fitted and new flooring has been laid in the area where medication is administered. Liquid soap dispensers and paper towels have been installed to assist in reducing the risk of cross infection. Everyone who completed a survey told us that the environment was always clean and fresh. Domestic staff have been provided with more appropriate cleaning equipment which also assist in reducing the risk of cross infection. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 22 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, 33, 34 & 35 People who use this service experience poor quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The checks carried out before people commence work in the service are inadequate. The records of training do not give clear information and evidence that staff are receiving induction training, training on safeguarding, moving and handling or supporting people with mental health needs. EVIDENCE: At the time of this visit to the service sixteen people were using the service, two of who were at that time in hospital. The service can accommodate up to twenty one people. We found the staffing levels sufficient to meet the needs of the individuals using the service at the time of this visit. However the staffing levels must remain under review particularly if the numbers increase. The only nurse on duty at the time of this visit was the registered manager. The practice of the registered manager being the only nurse on duty should be reviewed. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 23 The staff training records available indicated that new staff to the service had not started any induction training. Not all staff were seen to have completed training on safeguarding people, moving and handling, person centred care and planning, or working with people who may express challenging behaviour. The manager informed us that recent training had been provided on challenging behaviour and Schizophrenia. Discussions had also taken place during staff meetings on infection control, privacy and clothing. Staff informed us that they were supplied with opportunities for training but felt they would benefit from more training on working with people who may present challenging behaviour and on safeguarding. At the time of the last inspection of the service we reported that the management of the service should organise training records to ensure that individuals receive the training they need. We could find no evidence that this had been actioned. All staff must be provided with training on safeguarding people. In order to meet the needs of the people using this service staff should be provided with on going training on mental health needs at a level appropriate to their role in the service. We looked at a sample of staff files. We found that although applications were being made for Criminal Record Bureau checks staff were being allowed to work in the service before these had been returned and without a check on the Protection of Vulnerable Adults (POVA) List having been carried out. This practice does not meet present legislation and does not safeguard people who use the service. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 24 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 & 42 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Good progress has been made to meet the requirements made at the last inspection in relation to health and safety. Staff and people who use the service feel well supported by the manager. The staff response to fire alarms going off in one instance is of concern. EVIDENCE: A new registered manager has been appointed since the last inspection of this service. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 25 People who use the service expressed confidence in the manager to deal with any concerns they may have and told us they felt well supported by the manager. Staff told us they are kept well informed with the changing needs of individuals who use the service through daily handover meetings, shift plans and regular staff meetings. A record of staff meetings is kept. Staff felt well supported by senior staff through individual supervision and on the job discussions. The manager has started the process of implementing a staff supervision system where each person is provided with one to one supervision from a more senior member of staff. Once fully up and running this will assist in ensuring that all staff are working towards and in line with the aims and objectives of the service. Supervision will also provide opportunities to ensure that individual staff are receiving the training they need to meet the needs of the service. The manager provided us with an Annual Quality Assurance Assessment on the service. This document provided a basic outline of the service. However under the sections requesting information on what the service could do better and plans for improvement in the next twelve months a number of entries read ‘maintain continuity’ and ‘continue to maintain’. We are aware that as part of their own quality monitoring and assurance systems the service provides people who use the service and others involved with surveys to provide feedback. The system needs further work to complete this process with an annual review of the service leading to an annual development plan. People who use the service told us they were consulted through regular “resident meetings” and weekly discussions about the menu. Good progress has been made in improving the environment and equipment available to reduce the risk of cross infection in the service. Staff informed us they had been provided with training on food hygiene and the new kitchen has been inspected by officers from the environmental health department. Sharps are now stored safely and the manager informed us that staff have been provided with up to date guidance on giving injections. We looked at a sample of the records kept on health and safety checks. These were mostly up to date and accurate. At the time of the last inspection of the service a requirement was made for staff to record the temperature of any bath or shower before they assist people into them. It appears that staff have not understood this requirement. This was discussed with the new manager and will be re stated. We found a record of the fire alarms being activated in the early hours of the morning on one day in September. The record stated that the night staff then checked all the rooms and found there was no fire. It is of concern that staff took time out to check all the rooms in the service without first calling the fire Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 26 brigade. Staff must be provided with clear instructions on the actions to be taken should the fire alarms go off. Regular unannounced fire drills must be carried out to ensure that all staff are aware of their role and responsibilities. A record of the guidance provided to staff must be copied to the CSCI and a record of all fire drills along with the time, date and who from the staff group were present must be kept. Risk assessments must be produced for any person who uses the service who may not respond to the fire alarms. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 27 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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 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 2 33 2 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000019074.V372040.R01.S.doc 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 2 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Barons Lodge Psychiatric Nursing & Rehabilitation Score 3 2 2 X 3 X 2 X X 2 X Version 5.2 Page 28 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 YA17 Regulation 17(2) Schedule 4 (13) Requirement To ensure the health and welfare of people who use the service a record of food must be maintained for each individual. Timescale of 01/03/08 not met To protect the health of people who use the service staff must ensure:• A record of all medication received into the service is kept. • The record of medication administered is up to date and accurate. • People who use the service must be provided with the dosage of medication as prescribed. The record of complaints must include clear information on actions taken and outcomes. To ensure the safety of people using the service all staff must be provided with training on safeguarding people. To safeguard people who use the service the organisation must ensure that, where a full up to date Criminal Records Bureau DS0000019074.V372040.R01.S.doc Timescale for action 10/02/09 2. YA20 13(2) 05/01/09 3. 4. YA22 YA23 22 13(6) 10/02/09 01/03/09 5. YA34 19 05/01/09 Barons Lodge Psychiatric Nursing & Rehabilitation Version 5.2 Page 29 6. YA35 18 (c) (i) (CRB) check has not yet been obtained staff must not commence work unless a check on the Protection of Vulnerable Adults List has been carried out. To ensure that staff have the skills and knowledge to meet the needs of people using the service. • A clear record of individual training must be kept. • All staff must be provided with training, appropriate to their role in the service, on supporting people with mental health needs. 01/03/09 7. YA42 13(4) All staff must be provided with training on dealing with challenging behaviour. To ensure the health and safety 05/01/09 of people who use the service staff must take and record the temperature of all baths and showers before supporting individuals to use them. Timescale of 01/02/08 not met. To safeguard people who use the service, staff and visitors staff must be provided with clear guidance on their role and responsibilities should the fire alarms be activated. Regular unannounced fire drills must be carried out to allow all staff to practice these procedures. 05/01/09 • 8. YA42 23 (4)(d)(e) Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 30 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 Staff should continue to provide more person centred care planning. Consideration should be given to the inclusion of more personal goals along with the progress made in meeting these goals. The needs of individuals in relation to their culture, religion, sexuality and relationships should be included in the care planning process. A review of the mix of structured and recreational activities taking into account the needs and wishes of individuals and the purpose of their placement. The use of the registered manager as the only qualified nurse on duty should be reviewed to allow for time to carry out management duties and develop the service. The quality assurance and monitoring system should be further developed to produce an annual review of the care provided and development plan. 2. 3. 4. YA14 YA33 YA39 Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V372040.R01.S.doc Version 5.2 Page 32 - 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. 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