Inspection on 31/10/05 for Camden Lodge Residential Care Home

This inspection was carried out on 31st October 2005.

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

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

Other inspections for this house

Camden Lodge Residential Care... 09/01/07

Camden Lodge Residential Care... 06/06/05

Camden Lodge Residential Care... 06/10/04

Camden Lodge Residential Care... 16/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Camden Lodge Residential Care Home 137 Palmerston Road London N22 8QX Lead Inspector Jackie Izzard Unannounced Inspection 31st October 2005 12:30 X10015.doc Version 1.40 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 Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 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 Older People. 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. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Camden Lodge Residential Care Home Address 137 Palmerston Road London N22 8QX 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 8829 9438 020 8829 9439 Mr Munundev Gunputh Ms Eleni Constantinou Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2005 Brief Description of the Service: Camden Lodge is registered to accommodate twenty four people over the age of sixty five who may also have dementia. The registered provider also owns other homes in North London. The home is purpose built and has a shaft lift and garden for residents’ use. There are three floors and all bedrooms are single with their own en suite toilet and washing facilities. Residents spend their day in one large lounge/dining room. The home is situated in a residential street on the borders of Haringey and Enfield, near to the amenities of Green Lanes. The aims of the home includes “to offer a warm welcome, which combines comfort with the support of caring professionals.” Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and lasted for four and a quarter hours. The inspector looked at records, looked around some of the ground floor rooms and spent time talking to twelve residents and observing the way that staff were looking after them. The inspector also met privately with a relative of a resident to obtain her views of the care provided at the home. The inspector talked to the manager at length and followed up on the requirements made at the previous inspection to see what progress had been made in the home since June 2005. New requirements were made and discussed with the manager at the end of the inspection. What the service does well: What has improved since the last inspection? At the last inspection of the home in June 2005, the inspector made seven requirements and one recommendation. The requirements were actions that the registered persons needed to take in order to meet national minimum standards for care homes for older people. Six of the requirements had been completed by the time of this inspection which is very positive. Staff have received more training to help them with their work. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 6 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. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Residents can be assured that their needs have been assessed by the manager and that their needs will be addressed in the home. EVIDENCE: The inspector looked at two residents’ files and discussed their needs with the manager and also discussed a third resident with his/her next of kin. These three residents had their needs assessed before moving to the home and had their needs reviewed as they had become more dependent. The manager was able to give detailed information about residents’ needs. This standard was met. Camden Lodge does not provide intermediate care so standard 6 is not applicable to the home. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 Residents’ needs are clearly set out in a plan of care to ensure that staff have clear guidance on how to meet their needs. The registered persons need to ensure that these plans are reviewed on a monthly basis, so that residents can be assured that their changing needs will be recognised and met. The home needs to take further action to reduce the risk of residents falling over and injuring themselves. EVIDENCE: Standards 7, 8, 9 and 10 were assessed in June 2005 and three requirements were made. Two have been fully met. One requirement regarding meeting the needs of a resident who had a hearing impairment is restated. This resident had no hearing aid and although the inspector was told that s/he had a communication book where staff communicated with her/him in writing, it was observed that staff were not always using this method of communication. The inspector was informed that the resident had been waiting a long time for an appointment at the audiology clinic. The resident told the inspector s/he was “fed up” and s/he appeared to be isolated in the home. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 10 The inspector looked at a sample of care plans and found the content to be good. The care plans gave a clear description of the resident’s needs. One plan had no evidence of a review since June 2005. It is a requirement that plans are reviewed every month. A requirement is made that this takes place every month and the inspector advised that staff record each month that no changes have been made to the care plans if this is the case. Although none of the residents that the inspector spoke to knew that they had a care plan, all said that that they felt well looked after and that staff were meeting their needs. One resident said that staff were busy and she did not like to trouble them. Staffing levels were looked at and are addressed later in this report. The inspector looked at the number of accidents there had been in the home during the two months prior to this inspection. In September there had been seven falls recorded, of which three led to minor injuries and one a serious injury. In October, there were eight falls recorded, of which five led to minor injuries. A requirement is made to devise a falls prevention plan in the home to look at the circumstances in which residents fall and what action is needed to reduce the risk of further falls. The manager was advised to contact a falls prevention advisor for guidance. A copy of this plan must be sent o to the CSCI. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Residents do not currently have enough stimulation or activities offered to them to ensure that their social and recreational needs are met. EVIDENCE: All the above standards were assessed in June 2005. A requirement was made to address the wishes of particular residents regarding their social interests. Improvements have been made and this requirement was met for those residents. One has just started attending church appropriate to his/her cultural background the day prior to this inspection. One resident has been attending a culturally appropriate social club but is currently not doing so for health reasons. There is a fortnightly entertainer in the home and the manager explained that staff carry out indoor activities in the afternoons. These were Bingo, ball activities, dominoes, snakes and ladders and singalongs. The inspector observed staff playing a game with a small group of residents after lunch. However, the majority of residents had no activity and spent the afternoon sitting in chairs. Some people have high care needs due to dementia or physical disability and they had limited opportunity to engage in any activity. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 12 Now that the home is registered to take people with dementia, activities suitable for these people need to be provided. Two residents told the inspector they were “fed up” and had nothing to do. Two appeared to be upset when asked about their interests and how they spent their time and, although this may not have been due to having nothing to do, there were not enough staff to attend to these residents by talking with them and offering emotional support. This is addressed in the staffing section. The manager had good ides for further activities but limited resources. From discussion with residents, it was clear that there is little opportunity to go out of the home even to local shops, parks or cafes and those people who are not taken out by relatives may not leave the building at all other than attending medical appointments. A requirement is made to produce an activity programme for the home which includes a variety of interesting activities that residents have been consulted on and send a copy to the CSCI. The registered provider will need to ensure that enough money is available to provide meaningful activities including trips out of the home and to ensure staffing levels are sufficient to support residents. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Residents know how to complain and consider the manager to be responsive to their complaints and concerns. Residents benefit from being looked after by staff who are trained in adult protection. EVIDENCE: Since the last inspection, there had been one complaint were a relative complained that resident was not escorted by staff when sent to hospital. The manager said that it had not been possible at that time to provide an escort. No further action had been taken. The manager said that normally residents are escorted to hospital. The inspector asked a relative and two residents if they knew how to make a complaint and all said they did and that the manager was very responsive to any complaints or suggestions. A requirement to ensure staff attend training in adult protection has been met. The inspector checked a sample of staff files to see if they contained certificates of this training and found them to be in place. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Residents live in a clean and comfortable environment which is generally hygienic and well maintained. They would benefit from the lounge/diner being made more homely as they spend all their time in one room. EVIDENCE: The inspector looked at a small sample of rooms on this occasion. These were ground floor toilets and bathroom, lounge and one bedroom. All rooms were clean, suitably furnished and comfortable. The lounge carpet needed replacing as part of it was a trip hazard to residents. A requirement is made to replace this carpet, though the manager said that this is already in hand. Three residents were asked for their comments on cleanliness in the home and their rooms. All three said they were satisfied and had no complaints or suggestions to improve the environment. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 15 The inspector did note that the dining area had limited space and some people sat in the same chair for lunch that they had been in all morning and would remain in for the afternoon. A requirement regarding providing an activity programme may improve this situation. It would be better for the residents of the seating were arranged in a more homely way as it does appear somewhat institutional for twenty four people to be sitting in one room. The ground floor of the home appeared to be safe, clean and hygienic. There was a cleaner working at the time of the inspection. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Residents are at risk of not having all their needs met due to inadequate staffing levels in the afternoons. Recruitment practice regarding CRB disclosures must be improved in order to fully protect residents. The manager’s commitment to training staff should lead to further improvements in the quality of care provided to residents. EVIDENCE: The manager told the inspector that staffing levels had recently increased for one hour a day between 8 and 9am to assist residents when getting up. A total of twenty-two staff including part time staff and domestic staff are employed. Staffing levels at the time of this inspection, as confirmed by inspection of the rota and discussion with the manager, were four staff on duty 8am to 2pm, three between 2 and 5pm and four from 5 to 8pm. At night there are two staff awake on duty. Due to the high care needs of some of the residents as observed during this inspection, the inspector made a requirement that four staff must be on duty at all times during the day and that staffing levels need to be reviewed. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 17 The inspector looked at a sample of six staff files to see if the process by which they had been recruited was satisfactory. All had a photograph of themselves, an employment history and a statement regarding their health as required. All but one had the required two references and the one who didn’t was recruited five years ago. Three files were checked for evidence that a previous inspection requirement to seek confirmation of why staff left previous employment with children or vulnerable adults was met. None of the staff whose files were chosen had worked in a care capacity before so this requirement was not fully checked. The manager said that this is taking place for new staff who have worked in a care capacity in their previous post. It was noted that one member of staff had started work in February 2005 when his/her CRB was not received until March. This is not acceptable. Another staff member had no CRB check in his/her file, although the manager did locate and send this to the inspector after the inspection. Two others were seen to have started on receipt of a POVA first check (check that the person is not on the list of people unsuitable to work with vulnerable adults) before a full CRB disclosure was received. It was the view of the inspector that during the afternoons when staffing levels are minimal, it is not practical for staff with no CRB to be supervised at all times. An immediate requirement was made to ensure that any staff with no CRB are supervised at all times and have no unsupervised access to any resident and that the registered person must ensure all future staff have a CRB disclosure in the home before starting work. The manager showed a commitment to staff training. There has been improvement in staff training since she has been in post at the home. The manager had devised a training plan for the home. Fourteen staff have attended training in dementia awareness and adult protection. Four currently have NVQ 2 training and one has NVQ 3. The manager said that the plan is for 50 of staff to achieve this training (NVQ 2) by July 2006. It is important that the registered provider ensures that this is completed. The manager is undertaking the Registered Managers Award and the deputy plans to start this training in January 2006 which is positive. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 Residents at this home benefit from a manager who is experienced, has a good knowledge of their needs and who carries out her management responsibilities fully. EVIDENCE: The manager is studying for the Registered Managers Award. She has prior experience of managing a care home and an understanding of dementia which is beneficial to the residents. Three residents and a relative praised the manager. One said “you couldn’t ask for a better manager.” The manager demonstrated a high level of knowledge regarding residents’ individual needs during this inspection. The manager has also made improvements in the standard of care provided by ensuring staff are inducted and trained. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A 2 X X X X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 STAFFING Standard No Score 27 2 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 20 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 OP8 Regulation 12(1)(a)( b) Requirement The registered persons must ensure that the hearing needs of a named resident are addressed. This requirement is restated. Previous timescale of 6/9/05 not met. The registered persons must carry out a risk assessment looking at the circumstances in which residents are likely to fall, and make a plan to reduce the number of falls in the home. A copy of the falls prevention plan must be sent to the CSCI. The registered persons must ensure that residents’ care plans are reviewed by staff at least once a month and updated to reflect changing needs. The registered persons must consult residents and devise a programme of activities, including activities out in the community, and provide the necessary staffing levels and finances to implement this activity programme. A copy of the activity programme must be sent to the CSCI. DS0000010654.V258653.R01.S.doc Timescale for action 01/12/05 2 OP8 13(4)(c) 28/02/06 3 OP7 15(2)(b) 28/02/06 4 OP12 16(2)(m) 31/03/06 Camden Lodge Residential Care Home Version 5.0 Page 21 5 OP19 13(4)(a) 6 OP27 18(1)(a) 7 OP29 19(1)(b) sch 2 (7, 8) The registered persons must ensure the lounge carpet is replaced or made safe so that residents cannot trip on it. The registered persons must provide four staff on duty at all times during the day and evening and carry out a review of staffing levels in the home due to the high needs of current residents. The registered persons must ensure that any staff with no CRB are supervised at all times and have no unsupervised access to any resident, and that all future staff have a CRB disclosure in the home before starting work. This is an immediate requirement. 15/03/06 01/12/05 01/11/05 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 OP19 Good Practice Recommendations The registered persons should review the seating arrangements in the lounge to make a more homely environment. Camden Lodge Residential Care Home DS0000010654.V258653.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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