Inspection on 14/02/06 for Carmen Lodge

This inspection was carried out on 14th February 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carmen Lodge 31/01/08

Carmen Lodge 08/09/06

Carmen Lodge 01/09/05

Carmen Lodge 01/03/05

Carmen Lodge 26/04/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Carmen Lodge, 13 Bushwood Leytonstone London E11 2AY Lead Inspector Harun Rashid Unannounced Inspection 14th February 2006 10:00 Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 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 Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 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. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Carmen Lodge, Address 13 Bushwood Leytonstone London E11 2AY 020 8532 9789 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) Ms Jennifer Khan Mr Paul Wright Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (11) of places Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st September 2005 Brief Description of the Service: Carmen Lodge is a privately run care home for 11 adults with Mental Health problems. The home was first established in May 1993. The home is situated in a quiet residential area at 13 Bushwood, Leytonstone, in the London Borough of Waltham Forest. The home has easy access to Leytonstone underground. Most of the current service users are living there as long-term residents in the home since their discharge from psychiatric hospital. Accommodation is on two floors, with kitchen, lounge and dining room on the ground floor and single bedrooms for the service users on both floors. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place on a weekday morning of 14/02/06. The Inspector was able to speak to three members of staff including the registered manager. The Inspector also spoke to four service users. They all expressed their satisfaction with the standard of care provided in the home. What the service does well: What has improved since the last inspection? 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. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 6 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 Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4 and 5 The service carries out a pre-admission assessment prior to a new admission to the home. The home can demonstrate that service users’ assessed needs are met adequately. EVIDENCE: The registered manager who is a qualified nurse carries out pre-admission assessments. The home also receives copies of the health professional’s assessment of needs. Copies of assessments were available in the service user’s care file. From discussion with staff members, service users and examining care files it was evident that staff can demonstrate if any specific needs are identified, specialist advice is sought, such as Community Psychiatrist Nurse, psychiatrist. All nursing input required by service users is provided through the Primary Care Team or through the Community Psychiatric Nurse (CPN). From the discussion with the manager and staff it was clear that a newly admitted service user was given opportunity for a one week trial period during the daytime and one week overnight stay in the home afterward. Service user, family members and social worker are also encouraged to visit the home prior to the admission. The home has a policy of three months settling period. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 8 Service users’ contract letters were updated. The updated contracts have included a description of rooms to be occupied by the individual service users in the home. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 All service users have care plans, which are reviewed on a six monthly basis. Staff respect service users’ right to make decisions about their lives. All service users have risk assessments, however, these are required to be reviewed with input from health professionals. EVIDENCE: Evidence from care files suggest that staff completed a detailed ‘strength and needs’ list of all service users, which included service users personal, social, leisure, educational, health, emotional and communication needs. The care plans had been developed with involvement of service users, their family members and professionals. It also identified how the assessed needs of the service users will be met and by whom. Staff review service users care plans on six monthly basis. All service users have a yearly review, which is attended by psychiatrist, and community nurses. All staff had attended Non-Abusive Psychological and Physical Intervention (NAPPI) training and staff were confident to deal with any aggressive behaviour with positive planned interventions. Staff respect service users’ right to make decisions about their lives by providing information and assisting them with managing finances. Service Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 10 users were given information in order to access advocacy services like North East London Advocacy (NELA). All service users have risk assessments. Service users are supported to take responsible risks as part of their independent lifestyle and are enabled to take decisions about their lives. Staff encourage service users to travel independently in the community within the risk assessment framework. However, the Inspector advised the management at the last inspection that, service users’ risk assessments to be reviewed with input from health professionals. The registered manager of Carmen Lodge informed that the consultant psychiatrist informed the home that service users who do not have ongoing psychiatric problems would receive health support from their G.P. instead. Therefore, all service users no longer receive support from Community Psychiatric Nurse (CPN). However, at present five service users are receiving support from their CPN. Therefore, the management must ensure that for service users who have psychiatric input risk assessments are reviewed with input from relevant professionals. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Service users have opportunities for developing further education within their dependency levels and they are encouraged to access local amenities. Family and friends are welcomed in the home. Choices of menus are offered and service users have opportunities to cook meals. EVIDENCE: Service users of Carmen Lodge take up opportunities for developing further education within their capacities. One service user is currently attending various courses in a local college and another service user is doing voluntary work in Quest where he assists older people with serving tea. Another service user is doing unpaid administrative work in a clubhouse. Staff are proactive to help service users to find and take up opportunities for further education and training. All service users have structured activity plans, which were displayed on the notice board. Service users attend various activities in the community, for example, visits to cinema, bowling and travelling to the local shopping centre. Staff also provide information and advice regarding available local activities Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 12 offered by specialist organisations. Staff also ensure service users’ have access to transport for example advice is provided on how to obtain a taxi card. Staff support service users to maintain family links and friendships inside and outside the home. Families and friends are welcomed, and their involvement in daily routines and activities is encouraged with the service users’ agreement. Service users can choose whom they see and they see visitors in their bedroom in private. Daily routines and house rules promote independence; individual choice and freedom of movement, subject to restrictions agreed in care plans. Service users are offered bedroom keys, however some of them choose not to hold keys by themselves. Service users have opportunities to choose when to be alone or in company, and when not to join an activity. Staff do not open their mail without their agreement. From viewing weekly menus and discussion with service users it was clear that the home provides meals of their choice (minimum choices of two meals) and these were varied and balanced. At the time of the inspection it was observed that a member of staff assisted a service user to prepare a snack. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The home can demonstrate that service users health needs are met adequately. Staff seek specialist support in order to meet service users assessed needs. Staff are provided training on medication administration. EVIDENCE: Care files demonstrate that specialist support and advice is made available to service users who would benefit from this. Individual working records set out the preference routine, likes or dislikes of service users. Health care needs of service users are assessed and recognised and there is a procedure in place to address any issues. Service users are accompanied to outpatients and other medical appointments by staff or family members. For service users able to attend some of the medical appointments staff encourage them to do so. It was evident from the examination of care files and discussion with the manager that, an elderly service user who had bilateral hip replacement and has reduced mobility will require nursing care. The management is liaising with the placing authority to find a suitable placement (nursing care) for her. It was clear from discussion with staff and viewing care files that none of the service users are able to self-administer medications. Staff administer Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 14 medications to all service users. Medication Administration Record sheets were completed after medications were administered. Staff keep records of medication received from chemist and disposed of to ensure that there is no mishandling. The manager seeks information and advice from the pharmacist who supplies the medications to the home. All staff attended in house medication administration course conducted by the pharmacist and aware of the policy and procedures for safe administration of medication. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The complaint policy and procedure of the home is simple, clear and was made available to all relevant parties by displaying on notice board. The adult protection policy and procedure contain sufficient guidance for staff to enable them to protect service users from abuse. EVIDENCE: The home provides a simple and clear complaint policy and procedures for service users, their family members and for other relevant parties by displaying on the notice board. A record of complaints was kept in a complaint book including details of investigation and action taken by staff. The complaints received were minor in nature and those were investigated and resolved accordingly. Staff attended adult protection training. The adult protection policy and procedure contains sufficient guidance for staff to enable them to protect service users from abuse. The registered manager understands his responsibility to refer staff who harm service users in their care to the POVA list. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The home is suitable for its stated purpose. Its is bright, clean and free from offensive odour. However, the registered provider must replace worn carpets on the first floor landing and stairs and sofas in service users lounge. EVIDENCE: The home is a no-institutional building, similar to a large family house. This is suitable for its stated purpose. The home offers access to local amenities and local transport. However, during the tour of the premises it was evident that three of the sofas in the service users lounge were worn out. The carpet of the first floor landing was also worn out. The registered provider must ensure that the worn out sofas and carpets are replaced for the safety and comfort of service users. At the time of the inspection the home was clean, hygienic and free from offensive odour throughout the building. The washing machine has the specific programming ability to meet disinfection standards. The kitchen was clean and tidy, staff support service users to keep kitchen clean after cooking a meal. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36 The deployment of staff and current number of staff was sufficient to meet service users current assessed needs. The home provides training for staff development. Staff receive a minimum of six supervision sessions in a year. EVIDENCE: A wide range of training has been taking place, some of which is arranged inhouse, using the skills of the staff team and others in the community. All staff received equal opportunities training; training and development are linked to the home’s aims and objectives. The manager advised that four of the care staff have completed their NVQ level 2 qualifications in care and a further two are undertaking their NVQ level 2qualifications in care. The management of Carmen Lodge operates a thorough recruitment procedure based on equal opportunities and ensures the protection of service users. Two written references were available in the staff files. The management carried out Criminal Record Bureau checks prior to the staff appointments. The home has a training and development plan and training budget. All newly appointed staff received a structured induction and this is linked to the aims and objectives of the home stated in the Statement of Purpose. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 18 From the examination of supervision notes and discussion with member of staff it was clear that the registered manager ensures that all staff receive a minimum of six supervision sessions in a year as required by the National Minimum Standards. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 There is a quality monitoring system in place to measure the success in achieving the aims and objectives of the service. The home ensures service users health, safety and welfare. The registered manager’s hours of duty must be included on staff rota to ensure when he would be available for guidance and supports. EVIDENCE: The registered manager is a RMN and RGN nurse. He also completed RNMH qualifications. He has BSc in Health Studies and a certificate in Health Management and Health promotion awarded by the University of London. The manager has completed diabetic specialist nurse training. The manager is qualified and experienced to meet the home’s stated purpose. At the time of the inspection it was noticed that the registered manager’s hours of duty were not included in the staff rota. The registered manager must ensure that his hours of duty are included on the staff rota for the reason that staff and service users would be aware when he would be available for guidance, advice and support. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 20 There are various systems, which ensure that close monitoring is maintained on all of the home’s services and procedures. The home’s quality programme involves service users and their relatives and seeks their comments on the service. At the time of the inspection the manager showed evidence of completed quality questionnaires forms, which were completed by service users/ relatives. The management ensures, so far as is reasonably practical, the health, safety and welfare of the service users and staff. The management ensures safe working practices, including staff training for fire safety, first aid, food hygiene, infection control, treatment of anti-psychotic illness and taking good care of medicine, adult protection and NAPPI (Non Aggressive, Psychological and Physical Interventions). Staff test fire alarms on a weekly basis and carry out fire drills in every three months. The management ensures that all appliances for example, gas and electric are regularly checked. The manager carried out a fire risk assessment for the premises to identify the risk areas of the home and how to eliminate/minimise those risks. The home displayed a valid insurance certificate against loss or damage to the business. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 3 4 3 5 3 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 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 3 x x x 3 Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13 Requirement The management must review service users risk assessments with input from the health professionals. The registered provider must replace worn carpets on the first floor landing and stairs. To replace worn out sofas in service users’ lounge. The registered manager’s hours of duty must be included on staff rota. Timescale for action 31/07/06 2. YA24 23 31/07/06 3 YA37 18 28/02/06 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 YA19 Good Practice Recommendations The management to liaise with the placing authority for accommodating an elderly service user to a nursing home, as her present placement is unable to meet all care needs adequately. Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carmen Lodge, DS0000007243.V283438.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!