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Inspection on 27/11/07 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 27th November 2007.

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 no outstanding requirements from the previous inspection report, but made 11 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

Staff have developed good relationships with people who use the service. We observed good interactions with staff providing support and responding to requests in a friendly and caring manner. Staff were observed to work well with people who were distressed and verbally aggressive. People who use the service told us that "the staff are great", "nothing is too much trouble". Individuals also told us that they appreciated the relaxed atmosphere and felt they had "a good deal of freedom here" and "the home is run to a very high standard and I am very happy here". Care managers felt that staff were "encouraging and positive" in the care they provided. Staff are aware of the need to improve access to community activities and feel this should be one area they could improve in the next year. We observed people in the home who were considering moving in. Staff were seen to take time to make them feel at ease. People who use the service felt they were given plenty of time to make this decision and the opportunity to stay overnight or for a weekend if they wanted to before moving in.

What has improved since the last inspection?

Staff were observed to be interacting in a more positive manner with people who use the service. Staff were also seen to be more engaged in supporting people in the rehabilitation unit and out in the community. The choices available on the menu have improved. Improvements continue with the environment. The new kitchen and wet room will improve the facilities available. The new extension had improved the accommodation available. Staff have made real improvements in the care planning which was seen to be more person centred. Staff records have been improved with evidence of appropriate checks in place to safeguard people who use the service.

What the care home could do better:

Improvements in the care planning needs to be continued particularly around a more person centred approach to rehabilitation programmes. The home owners need to take action to address the issues raised by the health protection nurse which will assist in reducing the risks of cross infection in the service. Further checks need to be made on food stored in freezers to make sure they labelled with what they are and the date they were frozen. Hot water temperatures need to be recorded when anyone is assisted into a bath or shower. This will assist in protecting people from harm.

CARE HOME ADULTS 18-65 Barons Lodge Psychiatric Nursing & Rehabilitation 24 Baron Grove Mitcham Surrey CR4 4EH Lead Inspector Liz O`Reilly Unannounced Inspection 27th November 2007 10:00 Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.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.V356654.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.V356654.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 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 Dementia - over 65 years of age (2), Mental registration, with number disorder, excluding learning disability or of places dementia (21), Mental Disorder, excluding learning disability or dementia - over 65 years of age (1) Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home can admit one named service user over 65 years of age. As agreed on 25th July 2006, two named service users over the age of 65 years, with dementia, can be accommodated. The CSCI must be informed if either of these service users no longer reside at the home. As agreed on the 03/05/2006, one named service user (male)over the age of 65 with a Mental Disorder can be accommodated within the home 28th August 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.V356654.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one regulation inspector on 27th November 2007. The inspector was accompanied by a Lead Health Protection Nurse who carried out an audit of the service. The inspector had the opportunity to talk to people who use the service and staff members. Questionnaires were provided for people who use the service, staff and care managers. The manager had previously provided their own assessment of the service for the CSCI. All of the above sources and observations made at the time of this visit have been used to produce the judgements made in this report. What the service does well: What has improved since the last inspection? Staff were observed to be interacting in a more positive manner with people who use the service. Staff were also seen to be more engaged in supporting people in the rehabilitation unit and out in the community. The choices available on the menu have improved. Improvements continue with the environment. The new kitchen and wet room will improve the facilities available. The new extension had improved the accommodation available. Staff have made real improvements in the care planning which was seen to be more person centred. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 6 Staff records have been improved with evidence of appropriate checks in place to safeguard people who use the service. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4 People who use this service receive good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. People are given the opportunity to spend time in the home before making any decision about moving in. Each person is provided with information on the service through the Service User Guide. EVIDENCE: Records showed that assessments are carried out before anyone moves into the home. This ensures that the service can meet the needs of the person and staff are provided with some information about the person before they arrive. The information gained from the pre admission assessments is used to set up the initial care plan. People who use the service told us that they were given a choice about moving in and that they had enough information about the service. One person told us they visited the home twice before making their mind up about moving in. During this visit someone was looking round the home prior to making their decision. Staff were seen to take time to assist the people looking round and answer any questions they had. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 9 The organisation is aware that the Statement of Purpose and Service User Guide need to be up dated once decisions have been made about the management of the service. A copy of the up dated documents should be provided to the CSCI. The statement of purpose and service user guide needs to be up dated Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.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 People who use this service receive adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Each person has a care plan and improvements have been made in this area. However the care planning relating to rehabilitation still needs to be more person centred. Risk assessments are completed and have been improved but mainly focus on keeping people safe. EVIDENCE: We found improvements in the care planning with some care plans set out in the first person with the person using the service stating what they needed or wanted and what was important to them. This more person centred approach should be continued across the service. It was noted that the decisions and comments made at the review of the placement were not always followed up in the care planning. One person expressed boredom with activities among other things but there was no evidence that these had been followed up. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 11 Improvements have also been made in the risk assessments which should be used to support people to live a more independent lifestyle. However in one instance the risk assessment indicated that an individual would be safe making tea in the kitchen but the recorded outcome stated they should not do this. Staff need to take care that outcomes reflect the assessment. As noted in previous inspection reports the rehabilitation element of the care plans still needs further work to provide a more individualised, personal plan. We observed staff supporting people to make choices about their day to day activity. People who use the service told us that they make their own choices about day to day issues. Comments from a Care Manager indicated that their client was happy with the level of support and choice they were given. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.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, 15, 16 & 17 People who use this service receive adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People using the service are given the opportunity to take part in activities within the home and in the community. The community involvement and variety of activities could be improved. The variety of food on offer has improved. EVIDENCE: People who use the service told us that they make their own decisions about joining in group or individual activities outside the home. Individuals told us they enjoyed going out for walks, shopping, going to the pub and out for meals. One person told us they enjoyed an outing to Hastings. We observed individuals assisting with some domestic activities such as clearing or setting the table at meal times. One person is doing voluntary work in a charity shop two to three times a week. Staff told us that one of the Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 13 aims over the next year is to access more community work or activity opportunities for people using the service. Staff support individuals to maintain family relationships with some individuals visiting and staying with relatives for short periods. We found people who use the service are supported to meet their religious needs and wishes. Individuals go out to church services of their choice and visits are made to the home every second week from a Baptist church group for bible readings. People told us that they made their own choices about joining with this group or going out to religious centres. We found that the rehabilitation programme still needs to be more person centred. We did find that staff from the home were much more engaged in supporting people in the rehab unit but the programme is repetitive and does not reflect the individual needs of people who use the service. This was commented on as the one area which could be improved in surveys returned from care managers. Boredom with the rehab programme was also recorded in the review of the placement for one individual. A weekly menu meeting is held with people who use the service. We found the menu had improved with more choice available. Comments on the food were positive and included “I like the food here”, “it’s very nice” and “I am never hungry”. The cultural needs of people living at the service are partly met with some alternatives on offer. In order to fully meet cultural needs an additional menu with choices should be considered. A record of food sufficient to evidence that each person is provided with a well balanced diet was not available. This needs to be in place. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.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 & 20 People who use this service receive 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 access to health care services both within the home and in the local community. Staff have not been following current good practice on administering injections and the safe disposal of sharps. Hand washing facilities are not adequate in the clinical area. EVIDENCE: People who use the service felt they were well supported in accessing health care services. Staff have contacts with other health care professionals including, community psychiatric nurses, GP’s and psychiatrists whom they can call on for advice or further assessment. The improvements made in the care planning assists in ensuring that people who use the service get the support they need in the way they wish. This could be further developed to include more detail. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 15 Medication was seen to be safely stored and well managed. Issues raised by the health protection nurse need to be addressed. These include supplying disposable aprons in the clinical room, changing the lay out and flooring to the clinical area. Wall mounted liquid soap and paper towels must be provided in the clinical area. Bowls and kidney dishes used for clinical procedures were found to be cleaned with water. To ensure that these items are cleaned thoroughly these need to be cleaned with detergent and water. Staff were not aware of current good practice guidance on administering injections. This needs to be provided. Staff informed us that when carrying out injections they carry the syringe and needle to individual rooms, re sheath the needle and return this to the clinical area for disposal. This practice risks the health and safety of staff and people who use the service. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.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 & 23 People who use this service receive good 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 complaints procedure is supplied to everyone living at the home and on display. Policies and procedures for Safeguarding Adults are available and staff know when and who they should report any concerns to. Clear information on staff training in this area needs to be available. EVIDENCE: We found systems in place to record any complaint with details of actions taken and outcomes. The majority of people we spoke to and received surveys from told us that they knew who to go to if they had any concerns or complaints. The complaints procedure was seen to be on display. Staff were found to have an understanding of their responsibilities to report any concerns or allegations of abuse. Copies of the local authority procedure for safeguarding adults are available. Evidence that all staff have received training to an appropriate level to their role was not available on the day of inspection. This needs to be addressed by the registered person. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 17 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, 28 & 30 People who use this service receive good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Improvements to the environment continue to be made. Shared areas provide a choice of communal space with opportunities to meet with visitors in private. The organisation needs to take action on the issues raised by the health protection nurse regarding prevention of cross infection. EVIDENCE: People who use the service are provided with a large lounge/dining room, plus two more large lounge areas one of which is the designated smoking area. A small domestic style kitchen is also usually available in the main building. This was being used by the cook on the day of this visit as the main kitchen was not accessible. The rehabilitation unit at the back of the rear garden includes a computer room, art and crafts room, library and small kitchen. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 18 A significant amount of refurbishment is continuing. Since the last inspection a small extension has been completed to the rear of the building this provides two more en suite bedrooms. On the day of this visit the main kitchen and shower room on the ground floor were in the process of being refurbished. One of the bedrooms on the first floor of the original building was being redecorated. The home owners need to take into account the issues raised by the health protection nurse which included providing a larger sink in for domestic staff in the laundry room, removing the toilet from this area and changing the clinical area. People who use the service told us that they felt the home was mostly kept clean and tidy. However comments were received about toilets not being so clean during the night. We found all areas of the home seen to be clean and tidy despite the disruption of the building work. A flood had occurred and had brought down a corner of the ceiling in the lounge/dining room. This was repaired and replastered during our visit. Domestic staff were not using disposable cleaning cloths and mop heads were not being cleaned appropriately at the end of each day. This poses a risk of cross infection. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 19 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 & 35 People who use this service receive good 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 confidence in the staff that support them. There are sufficient staff on duty to meet the needs of the present group living at the home. Pre employment checks assist in protecting people who use the service. The record of staff training needs to be better maintained. EVIDENCE: There are sufficient staff on duty to meet the needs of the present resident group. At the time of this visit thirteen people were using the service. The management of the service are aware of the need to increase the numbers of staff including qualified staff once the service is running at full capacity. We found staff files well maintained with evidence of checks being carried out, including Criminal Records Bureau checks, before people start work at the home. References were in place in each file we examined. People who use the service told us that staff “look after me very well” and that “they listen to what I have to say”. Other comments included “I like the staff”, Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 20 “these people work very hard” and “they have a lot of patience”. Only one person made negative comments and felt that certain staff were “plotting against” them. This information has been passed to the care manager. We observed staff interacting in a positive and supportive manner even when being faced with challenging behaviour from one person. We found staff were provided with opportunities for further training. The management need to organise training records to ensure that individuals receive the training they need. A regular training needs analysis would address this issue and make sure that all staff are provided with statutory training and on going training on mental health needs at a level appropriate to their role in the home. Staff records were found to be well maintained with the appropriate checks, to safeguard people using the service, carried out before staff start work. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 21 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 receive adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The arrangements for the management of the home in the absence of the registered manager are appropriate. Further work needs to be done to complete the quality monitoring to produce a review of the care provided and an annual development plan. The health and safety checks do not cover key areas, in particular hot water temperatures, the storage of food and uses and disposal of sharps. EVIDENCE: The registered manager for this service has not been able to attend work for some time. The organisation has taken appropriate action to make sure that a temporary manager has been available during this time. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 22 The organisation has consulted with people who use the service, families and care managers to gain their opinions on the service provided. The quality assurance and monitoring process has not been completed to produce an annual review of the service taking into account these views. We found staff were carrying out regular checks on the building and services to ensure the health and safety of people who use the service and visitors. However a few areas were found to need further attention. We found a large amount of meat stored in a freezer without any information about what the meat was or when it had been frozen. This poses a risk to the health of anyone eating in the home. Staff are not keeping a record of the water temperatures when assisting people with a bath or shower. This also poses a possible risk to people who use the service. The organisation needs to look at providing wall mounted liquid soap and paper towels in en suite facilities so that staff can wash their hands which will assist in reducing the risk of cross infection. The disposal boxes for sharps were found to be inappropriate, not stored safely and not collected frequently for disposal. This needs to be addressed to ensure the health and safety of people who use the service, staff and visitors to the home. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 23 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 2 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000019074.V356654.R01.S.doc 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 2 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 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement To ensure that people who use the service are provided with information on the support they receive, care plans must include information for people on their individual rehabilitation programme along with the estimated duration of the programme. (Timescale of 06/02/07 not met) 2. YA6 15 To make sure that people who 01/03/08 use the service are provided with the support they need care plans must be updated following any review including those reviews carried out by placing authorities. 12(1)(2)(3) To ensure that people who use 01/03/08 the service are provided with the support they require rehabilitation programmes must be designed to meet the needs of individual residents. Timescale of 30/01/07 not met. Timescale for action 01/03/08 3. YA13 Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 25 4. YA17 17(2) Schedule 4 (13) 13(2) 13(4) 7. YA20 8. YA20 13(2) 13(4) 9. YA30 13(4) 10. YA42 13(4) 11. YA42 13(4) 12. YA42 13(4) 13. YA42 13(4) To ensure the health and welfare of people who use the service a record of food must be maintained for each individual. In order to protect the health and welfare of staff and people who use the service staff must be provided with up to date guidance on administering injections and the safe disposal of sharps. In order to protect the health and welfare of staff and people who use the service disposable aprons, adequate hand washing facilities and cleaning products must be provided in the clinical area. To protect the health safety and welfare of people who use the service staff must be provided with disposable cleaning cloths to be disposed of daily and mops which can be cleaned at the end of each shift. To ensure the health and safety of people who use the service staff must ensure that any food stored in fridges or freezers is labelled with the content and the date of opening or freezing. To ensure the health and safety of people who use the service staff must take and record the temperature of all baths and showers before supporting individuals to use them. In order to ensure the health and safety of people who use the service, staff and visitors appropriate sharps disposal boxes must be provided and collected at appropriate times. In order to protect the health and safety of people who use the service, staff and visitors wall mounted liquid soap dispensers, paper towels and DS0000019074.V356654.R01.S.doc 01/03/08 01/03/08 01/03/08 01/03/08 01/02/08 01/02/08 01/03/08 01/03/08 Barons Lodge Psychiatric Nursing & Rehabilitation Version 5.2 Page 26 bins must be provided in en suite bathrooms. 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 YA30 Good Practice Recommendations To ensure the health and safety of people who use the service the home owners need to take into account the issues raised by the health protection nurse which included providing a larger sink in for domestic staff in the laundry room, removing the toilet from this area and changing the clinical area. It is recommended that individuals are more involved in the care planning process and are requested to share with staff some of their life history and their views on their previous experiences. 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. Risk assessments should be reviewed to ensure that they are used to support people to live as independent a life as they are able. The record of training should be improved to ensure that the training needs of each individual are met. The quality assurance and monitoring system should be further developed to produce an annual review of the care provided and development plan. 2. YA6 3. 4. 5. 6. YA14 YA9 YA35 YA39 Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V356654.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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.V356654.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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