Inspection on 31/01/08 for Carmen Lodge

This inspection was carried out on 31st January 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carmen Lodge 08/09/06

Carmen Lodge 14/02/06

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 3AY Lead Inspector Peter Illes Unannounced Inspection 31 January 2008 09:30 st Carmen Lodge, DS0000007243.V351934.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 Carmen Lodge, DS0000007243.V351934.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. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carmen Lodge, Address 13 Bushwood Leytonstone London E11 3AY 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) Mrs Jennifer M E 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.V351934.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th September 2006 Brief Description of the Service: Carmen Lodge is a privately operated care home registered to provide care and support to eleven adults with mental health problems. The home is a large converted two storey residential property. The ground floor comprises: four residents’ bedrooms; kitchen; staff office; a large lounge/ dining room and an adjoining television lounge, which leads out to a large attractive garden; there are seven further bedrooms on the first floor. There are sufficient toilet and bathroom facilities on both floors. There is an outhouse in the garden that is used as a smoking room and another large outbuilding that accommodates the home’s laundry facilities, a second office, staff shower and a storeroom. The area is well served by public transport and the home is within walking distance of shops and other community resources. A stated aim of the home is to provide its residents with a secure, relaxed and homely environment in which their care, well being and comfort are of prime importance. At the time of the inspection, the weekly fee was from £650 per week depending on the person’s assessed need. The provider organisation makes information available about the service, including inspection reports, to people living in the home and to other stakeholders. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection took approximately seven hours with the registered manager being present or available throughout. There were eleven people accommodated at the time of the inspection and no vacancies. The inspection activity included: meeting and speaking with the majority of people living in the home, four of them independently; independent discussion with two care staff; discussion with the registered manager; discussion with the registered provider who visited the home during the inspection; independent discussion with a Community Psychiatric Nurse (CPN) who visited the home during the inspection; separate and independent discussions by telephone with social workers from the L.B. of Barking Community Mental Health Team (CHMT), the L.B. of Romford CHMT the L.B. of Waltham Forest CMHT and a social worker from Whipps Cross hospital, the local general hospital. Further information was obtained from: an Annual Quality Assurance Assessment (AQAA) submitted by the home to the Commission prior to the inspection, a tour of the premises and documentation kept at the home. What the service does well: What has improved since the last inspection? At the last inspection five requirements were made and I was pleased to find that these had all been complied with. These requirements were in the following areas: Reviewing of risk assessments; reviewing of care plans; residents’ finances; identified maintenance issues and an identified health and safety issue. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Carmen Lodge, DS0000007243.V351934.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 Carmen Lodge, DS0000007243.V351934.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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Current information is available to prospective residents and other stakeholders to make an informed choice about living in the home. People have their needs properly assessed when they first move in to the home to assist staff in addressing these. People also have their needs reviewed once they are living in the home to ensure staff are aware of any changes in these needs. EVIDENCE: The home has a satisfactory statement of purpose and service user guide; copies of both were given to me for information. Two new people had been admitted to the home since the last key inspection although one of these two had subsequently been discharged from the home following an admission to the Whipps Cross hospital. The registered manager stated that he had made the decision that the home was unable to continue to meet this person’s changing and increasing health needs and judged it was not safe to have the person back in the home. The registered manager had informed the Commission of this decision at the time. However, a social worker from Whipps Cross hospital was spoken to independently by telephone and did not feel that the way the home had dealt with this situation was appropriate, Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 9 especially by not being prepared to accept the person back from Whipps Cross hospital while alternative placements could be considered. The file of the other new resident, who had moved from another residential home earlier in January 2008, was inspected and contained a range of up to date assessment information undertaken by the home including an up to date risk assessment. The assessment information included a strengths and needs list to assist the home understand the person’s needs. The file also contained information about the person’s needs from health and social care professionals. I spoke to a care-coordinator from L.B. of Barking Community Mental Health team (CMHT) who has involvement with this resident and who felt satisfied with the care provided by the home, including arrangements made for the transition. The files of three other people that had lived at the home for a longer period were also inspected. These showed a range of assessment information about the person with evidence that it is reviewed on a regular basis to allow staff to be aware of any changing needs the individual might have. A social worker from the CMHT based in Romford stated that the home continued to provide a good service to the person she placed who has particularly complex needs. She went on to say that previously it had been difficult to find a placement to meet the person’s needs and felt that part of the reason the current placement was successful was because the home “accepted the person for who (s/he) is”. Carmen Lodge, DS0000007243.V351934.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 experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from their needs being recorded on their care plans, including how staff are to assist them to meet these. People also benefit by being supported to undertake appropriate risks in their daily lives. However, the home needs to be able to evidence more robustly that it is fully involving people in important decisions that are made about them. People are supported to maximise their independence by making as many decisions as possible for themselves. EVIDENCE: The files of four people were inspected, three for people that had lived at the home for some time and one for a person that had just been admitted to the home. Evidence was seen that a care plan was being formulated for the new resident, including assessing the person’s ability to travel independently into the community to access their existing day service. The files of the three longer standing residents all contained a care plan that had been reviewed by the home in the past six months. The care plans were seen to have been Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 11 informed by current assessment information and gave guidance to staff on how to meet the identified needs. Staff spoken to independently were able to demonstrate a satisfactory knowledge of residents’ needs and how they were being addressed by the home. However, it was noticed that some care plans had been signed by the resident and others had not. The registered manager stated that all residents were involved in discussion regarding reviewing their care plan although some people refused to sign the plan to evidence this. This is the same as for reviewing risk assessments and a requirement in relation to this is made later in this section of the report. At the last inspection a requirement was made that the registered person must ensure that residents’ six monthly reviews take place on time and the minutes of review meetings are made available for inspection. This was because the inspector that undertook that inspection was unable to evidence that external health and social care professionals had input into the reviews. The registered manager stated that this was problematic as not all residents had six monthly reviews by health and social care professionals and, when they did, it was sometimes difficult obtaining minutes of these meetings in a reasonable time. Evidence was seen that the registered person had written to identified health care professionals regarding this as a result of the requirement. There were minutes of external professional’s meetings on some people’s files inspected, including minutes of a recent meeting with a consultant psychiatrist on one person’s file. However, the registered manager went on to say that staff did usually attended such meetings with the resident although the outcomes of these meetings did not appear to have been recorded on the person’s file by the staff member that attended the meeting. A new requirement is made that the registered persons must ensure that, where staff attend meetings with health and social care professionals about residents, a record of the outcome of such meetings must be recorded on the person’s file. This requirement is made to facilitate sharing of up to date information between staff about residents’ needs and includes staff attendance at both review meetings and at medical appointments. I was pleased to note that since the last inspection the home has introduced a system whereby the key worker writes a monthly summary of the work undertaken with the relevant resident. This was to inform and assist the home when reviewing the person’s care plan. Daily notes regarding residents were also sampled and were generally satisfactory. People living at the home indicated that they were able to make decisions about their daily lives. People were seen to get up at times they prefer and to travel independently in the community if they wished to do so. One resident stated that they would talk to their key worker if they had any difficulties in their day-to-day life. Another resident stated that they had agreed to the home holding their cigarettes and issuing them with a daily allowance. This was as a way of helping the person to manage their smoking and this restriction was recorded on their file. Evidence was also seen of regular residents’ meetings with recorded discussion on areas including: smoking, personal hygiene, confidentiality and access to a chiropodist. I was also informed that residents Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 12 of Carmen Lodge were invited to attend a talk given by a local advocacy service at another of the provider organisation’s home’s situated a few doors away in the same road. One resident spoken to independently confirmed this and information about the advocacy service was seen displayed in the home. At the last inspection a requirement was made that the registered persons must review residents’ risk assessments with input from relevant health professionals. Evidence was seen that the home has worked hard to comply with this requirement including writing to health care professionals requesting their input into risk assessments and review meetings. However, the registered manager stated that the home had experienced the same difficulties with this as with the requirement about reviewing care plans, in that not all the residents had a health or social care professional allocated to them who was able to undertake this task. Evidence was seen that risk assessments were regularly reviewed by the home and that they were also reviewed at multidisciplinary review meetings when these were held. Both the registered manager and residents spoken to confirmed that residents were involved in reviewing their risk assessments. There were up to date risk assessments seen on all the files inspected and these included guidance to staff on minimising the identified risk. However, some of the risk assessments seen had been signed by both the registered manager, who undertook the review, and also by the resident to evidence their involvement in this process, on other risk assessments seen only the registered manager had signed. The registered manager stated that all residents were asked to sign reviewed care plans and risk assessments although some people refused to sign. A requirement is made that the registered persons must ensure that where a person refuses to sign a revised care plan and/ or risk assessment, that this is recorded on the document including noting that the document had been discussed with the person. This requirement is made to show clear evidence that the home has made all reasonable efforts to involve the resident in reviewing their progress and in any important decisions or limitations that are made about them. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are encouraged and supported to participate in a range of activities including within the wider community. They are also supported to enjoy contact with relatives and friends to the extent that they wish. People enjoy healthy and nutritious meals that they enjoy. EVIDENCE: People living at the home can travel independently and have freedom passes to facilitate this. One person works part-time as a volunteer at a local general hospital, which they enjoy. Another person also works as a volunteer and attends the Waltham Forest Black Peoples Mental Health Association (WFBPMHA) day service, which again they enjoy. Evidence was seen that other people had attended external day services and local education facilities since the last inspection but were choosing not to participate in some of these activities at the time of this inspection. Staff spoken to indicated that it was sometimes difficult to motivate some residents to take part in structured activities although evidence was seen in key worker notes sampled that staff Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 14 do try. Residents spoken to, who were home during the inspection, indicated in various ways that they preferred to do what they wanted to and did not want to attend structured activities. One resident spoken to independently was quite clear that they liked their privacy and were happy travelling in the community as they wished and liked spending the majority of time in their room when they were at home. A placing social worker from the L.B. of Waltham Forest CMHT for one resident was spoken to independently by phone. She stated that the person she had placed had settled well at the home and had lived there for a number of years after an unsettled history including episodes of sleeping rough on the streets. The social worker stated that a number of previous placements had broken down and, in her opinion, it would be unwise to put too much pressure on the person to participate in structured activities as this may jeopardise the placement. Staff spoken to stated that they endeavoured to engage residents in activities within the home such as helping to develop their daily living skills and also with recreational activities such as board games. Evidence to support this was obtained from documentation in the home and from discussion with some residents. Approximately half of the residents at the time of the inspection were White European in ethnic origin and the other half were Black Caribbean. People’s cultural needs and preferences were recorded in their file including their religious and dietary needs and preferences. Residents are supported to attend their preferred place of worship and currently one person attends a Church of England church and another is supported in their faith as a Jehovah’s Witness. Some residents were assessed as being sexually vulnerable and this was recorded in their files. One member of staff stated that residents were advised and supported regarding promoting their sexual health and some evidence to corroborate this was seen on individual’s files. Residents are supported to maintain and develop relationships with family members with a number of residents having regular contact, including some who visit and stay with relatives. One relative was spoken to independently when they visited the home during the inspection. The relative stated that he was pleased with the progress the person had made while living in the home and went on to say that the home always keeps them informed of any relevant issues and makes them welcome when visiting the home. Residents are also supported to make and develop personal relationships and are supported with this, especially those that may be sexually vulnerable. Staff were seen to interact positively and appropriately with people accommodated throughout the inspection. People are also appropriately encouraged to undertake daily living tasks to assist develop their independence skills and this was documented in their files. This included people being able to cook meals with appropriate level of staff supervision. People living in the home have a key to their bedroom and several people were seen to use these when showing me their bedrooms. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 15 The home’s menu was seen and showed a variety of nutritious meals with evidence obtained from documentation in the home and discussion with both residents and staff, that residents were involved in the choice of meals. Staff cook the main meal of the day in the middle of the day, the main meal on the day of the inspection was mince beef and pasta with residents being able to choose an alternative of their choice if they did not want the beef and pasta. Residents are supported by staff to make their own breakfast, supper and also to make drinks and snacks during the day. I was informed that one resident told an external review meeting before the last inspection that they did not always get their preferred choice of meal at the home. Since that time the home have kept a separate menu book for that person that was seen. The registered manager stated that the process of individually consulting with that person and demonstrating to the person that the home kept a separate menu book for them satisfied the person albeit they could have had their own choice of meals without this. The home can provide meals to meet a range of health needs or cultural needs and people living at the home stated that they enjoyed the meals provided. The home had sufficient food that was stored appropriately on the day. The kitchen was clean and tidy with satisfactory and current health and safety records. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home receive appropriate personal support in accordance with their needs. They also are supported in meeting their physical, mental and emotional healthcare needs although some recordkeeping needs to be more robust to assist maximise this support. People are protected by the home’s policies and procedures regarding safe administration of medication, which are being kept under review. However, the home now needs to comply with a recent change in regulation in relation to controlled drugs. EVIDENCE: The registered manager stated that all of the people living at the home are independent regarding their personal care although some need varying degrees of verbal prompting on occasion. People’s support needs regarding their personal care were recorded on the files inspected and staff spoken to independently were able to describe how they provided that support in keeping with the individual’s preferences. Residents spoken to independently were clear that they did not need physical assistance from staff regarding their personal Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 17 care but one person did acknowledge that they sometimes discussed issues such as health and hygiene when they talked to their key worker. People are supported with a range of physical, mental and emotional health needs and all people are registered with a GP. Evidence of appointments with health care professionals was seen on the files inspected. This included evidence of appointments with GP’s, mental health specialists, general hospital outpatient departments, dentist and a chiropodist. Although records of the dates of the actual appointments were seen on people’s files, on some records seen there was no indication of the outcome of these appointments, including any differing levels of support the person may need following these appointments. A requirement is made in the Individual Needs and Support section of this report that the home must ensure that, where staff attend meetings with health and social care professionals about residents, a record of the outcome of such meetings is recorded on the person’s file. This requirement applies to medical appointments to assist the home monitor and support residents in addressing their health care needs. A Community Psychiatric Nurse (CPN) was spoken to independently when she visited the home during the inspection. She stated that she visited the home regularly and felt that the care and support provided to residents was good. She went on to say that the staff would discuss any issues with her and accepted and acted on advice when given. Ten of the eleven people living at the home take prescribed medication. I was informed that the home encourages people to be as independent as possible with their medication but that currently all ten people were currently being assisted by staff with its administration. In September 2007 the home had changed its previous dispensing pharmacist and is now receiving medication in a monitored dosage system (MDS), this is where medication is supplied in individual blister packs for each person for 28 days at a time. However, the registered manager stated that he was not very happy with the service being received from the current dispensing pharmacist and was keeping the system under review, including considering changing pharmacists again. It was noted that staff had received up date training in August 2007 regarding safe administration of medication in preparation for the change to the MDS system. Medication and medication administration record (MAR) charts were inspected for three people living in the home and were found to be satisfactory. The regulations regarding the safe storage of medication in registered care homes has recently changed and new professional guidance to care providers was issued by the Commission in January 2008. This can be found on CSCI Professional, the Commission’s website for care providers. The change in regulation includes that all registered care homes must now have a controlled drugs cupboard in place, the specification of which meets the regulations. This is the case for all registered care homes, whether they have residents that are currently prescribed controlled drugs or not. The home currently does not have a controlled drug’s cupboard and a requirement is made that the registered Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 18 persons must fit a controlled drugs cupboard in the home to comply with the recent change in statutory regulations. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has satisfactory procedures for dealing with complaints and people living at the home felt confident that any concerns raised would be properly dealt with by the home. People living at the home are protected by an up to date Safeguarding Adults policy and procedures that the registered manager and his staff are familiar with. EVIDENCE: The home has a satisfactory complaints procedure that was seen and a summary of this was also seen displayed in the lounge area for the information of residents and visitors to the home. People living at the home indicated that they knew how to raise concerns when they wanted to and that these were listened to and acted upon when raised. However, the home had no recorded complaints since the last inspection. This was discussed with the registered manager as, in my experience it was unusual that no one had raised any significant concerns with staff, given the length of time since the last inspection and the needs of the people living in the home. The registered manager was reminded that records of how concerns and complaints were dealt with were a good way of providing evidence to contribute to the home’s overall quality monitoring systems. The Commission has not received any complaints about the home since the last inspection. The L.B. of Waltham Forest had updated and re-launched its Safeguarding Adults policy in November 2007 and the registered provider had attended the Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 20 re-launch event. The home had subsequently reviewed and revised its Safeguarding Adults policy and procedures in the light of this. Evidence was also seen that the home had prioritised a rolling programme for staff training in this area, including attending training provided by the L.B. of Waltham Forest. Staff spoken to were able to describe what they needed to do should an allegation or disclosure of abuse be made to them. There have been no allegations or disclosures of abuse made to the home or to the Commission since the last inspection. At the last inspection a requirement was made that the registered persons were required to seek advice from residents’ placing authorities for the management of their finances. This was because the inspector that undertook that inspection was concerned that the registered provider had been the appointee for some residents’ benefits. However, the inspector acknowledged at that time that the registered provider had written to the Benefits Office stating that she no longer wished to undertake that role. Evidence was seen that this requirement had been complied with. Either residents undertook that role themselves or else relatives, placing authorities or other stakeholders had been asked to act as appointee for any resident that could not manage their own finances. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 21 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, 26, 27, 28 & 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is generally comfortable, well decorated, well maintained and that meets their current needs. People who live in the home, staff and visitors benefit from the building being kept clean and tidy. EVIDENCE: The home is a large converted two storey residential property. The ground floor comprises: four residents’ bedrooms; kitchen; staff office; a large lounge/ dining room and an adjoining television lounge, which leads out to a large attractive garden; there are seven further bedrooms on the first floor. There are sufficient toilet and bathroom facilities on both floors. There is an outhouse in the garden that is used as a smoking room and another large outbuilding that accommodates the home’s laundry facilities, a second office, staff shower and a storeroom. The home is suitably decorated and furnished and I was informed that the home had the use of a handyperson to undertake routine maintenance tasks. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 22 I undertook a tour of the building and several residents also showed me their bedrooms, which were seen to be suitably furnished, personalised to the tastes of the person occupying in it and were generally comfortable and homely. One resident who showed me their room stated that they liked to spend most of their time in it when they were in the house preferring not to spend too much time in the company of the other residents. They had their own door key and went on to say that the room contained everything they needed and appeared to be quite proud of the room. Overall the bedrooms and communal areas in the home are pleasant, comfortable and meet the current needs of the people that live there. At the last inspection a requirement was made that the registered persons must ensure that the carpet in the lounge, the front door stained glass and an old oven were replaced. This requirement was seen to have been complied with. The home was generally clean and tidy during the inspection and the registered manager stated that people living in the home were encouraged and supported by staff in keeping their rooms clean. The home had suitable laundry facilities and an infection control policy that met the needs of the current residents. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. A stable staff team with a range of qualifications and competencies and in sufficient numbers, support people living in the home. The home’s recruitment policy assists in protecting people living in the home although the home must be able to demonstrate that it has received all the required documentation to evidence this. People are supported by staff who have access to a range of appropriate training although a more robust system to monitor this is required. Staff receive regular formal supervision to assist in further meeting the needs of people living in the home and in their own personal development. EVIDENCE: At the time of this inspection the home employed a registered manager, a senior support worker and eleven support workers, a number of whom worked part time. Of the eleven support workers five had completed the national vocational qualification (NVQ) level 2 in care and three were working towards this qualification. The registered provider stated that two support workers were currently undertaking NVQ level 3 in care. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 24 Two support workers are deployed on the morning shift, two support workers on the afternoon/ evening shift and two waking support workers are deployed at night. The registered manager’s hours are in addition to this. Records show that support workers often work double shifts from 8am to 8pm and the night staff work from 8pm to 8am. Staff spoken to independently confirmed that working long shifts suited them and felt that it worked to the homes benefit by maintaining more continuity of care throughout the day. A copy of the rota was seen and accurately recorded the staff on duty during the time of the inspection. People living at the home benefit from a relatively stable staff group with only one new member of staff being employed since the last inspection. This support worker’s file was inspected and indicated that the home operates a generally robust recruitment policy. This file contained: a copy of the staff member’s proof of identity including a recent photograph, evidence of entitlement to work in the U.K. and evidence that the person had a current Criminal Record Bureau (CRB) clearance and Protection of Vulnerable Adults (POVA) check that was undertaken by the provider organisation and received before the person started working at the home. The file also contained a recruitment checklist indicating that two references had been applied for and satisfactorily received although only one reference was physically present in the file. The registered manager was very clear that two satisfactory references had been obtained and apologised that the second reference could not be located at that time. I inspected another staff member’s file at random and this included all the required documentation including two references. The registered manager stated that he was clear about the need to operate a robust recruitment procedure to assist safeguard people living in the home. However a requirement is made regarding staff references, as it is important that the home can evidence that it is complying with the updated Care Home Regulations 2001 regarding staff recruitment. The registered persons must ensure that a copy is kept of all the documentation relating to staff recruitment required in the updated Care Homes Regulations 2001, including a copy of two references, to evidence residents are being properly protected through the home’s recruitment procedures. Evidence was seen in documentation kept in the home, and from staff spoken to independently, to indicate that the home provides a range of training, including refresher training, in the core skills and knowledge required by staff. This included evidence of training since the last inspection in the following areas: safeguarding adults, safe administration of medication, food hygiene, breakaway techniques and dental/ oral hygiene. Evidence was also seen that fire safety training was booked for February 2008 and staff spoken to confirmed that they were booked on this and had undertaken a range of other training in the past year. Evidence was also seen that the home operates a satisfactory induction procedure for new staff. However, it was not possible for the registered manager to show me a documentary overview of the training each member of staff had received and when refresher training was due. A Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 25 requirement is made that the registered persons must develop a staff-training matrix or similar system to allow them to effectively monitor training staff have undertaken and to assist them to arrange new training and refresher training when required. This requirement is made to ensure that staff remain up to date with the required skills and knowledge to effectively address residents needs. The registered manager stated that all staff were supervised at least two monthly and both documents sampled and staff spoken to provided evidence of this. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service People living at the home benefit from the service being managed by a qualified and experienced registered manager. The views of people living in the home and of staff are sought and acted on regarding the quality of life in the home although the views of external stakeholders are now needed to develop this process further. Health and safety procedures assist in protecting people living at the home, staff and visitors. EVIDENCE: The registered manager of the home is a registered nurse for people with mental health needs (RMN) and has a range of other nursing and management qualifications. The registered manager also has a range of appropriate skills and experience to enable him to undertake his role effectively. Feedback from Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 27 residents, staff, relatives and some stakeholders was generally positive about the home, the registered manager and the outcomes for residents. The home monitors the quality of care it provides in a number of ways: satisfaction surveys had been sent out to residents in August 2007 and the results of these have been collated into a summary that showed areas of strength and identified areas that could be improved; the home has developed a staff satisfaction survey that is currently being implemented; the home is using a key worker system to assist in better understanding people’s wishes and preferences and the registered provider undertakes regular visits to the home and provides monthly reports of these to the registered manager. Although the views of residents and staff are being sought as part of the home’s quality monitoring system this system now needs to be extended to other stakeholders including involved relatives, health and social care professionals. A requirement is made that the registered persons must seek the views of external stakeholders regarding the quality of care the home offers including from involved relatives and health and social care professionals. This requirement is made to promote and develop further the quality of care and support offered to residents. A range of health and safety documentation was inspected. A requirement was made at the last inspection that the electrical wiring at the home was inspected. This had been complied with and a current electrical installation certificate was seen. Satisfactory documentation was seen at this inspection regarding gas safety and portable appliance testing. Evidence was also seen from the home’s fire log that the home’s fire fighting equipment had been serviced and of a current fire plan and fire risk assessment. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 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 2 2 X 3 X 2 X X 3 X Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 YA19 Regulation 15(2) & 13(1) Requirement Timescale for action 29/02/08 2. YA6 YA9 15(2) & 13(4) The registered persons must ensure that, where staff attend meetings with health and social care professionals about residents, a record of the outcome of such meetings must be recorded on the person’s file. This requirement is made to facilitate sharing of up to date information between staff about residents’ needs and includes staff attendance at both review meetings and at medical appointments. The registered persons must 29/02/08 ensure that where a person refuses to sign a revised care plan and/ or risk assessment, that this is recorded on the document including noting that the document had been discussed with the person. This requirement is made to show clear evidence that the home has made all reasonable efforts to involve the resident in reviewing their progress and in any important decisions or limitations that are made about them. Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 30 3. YA20 13(2) 4. YA34 19(4) 5. YA35 18(1) 6. YA39 24(3) The registered persons must fit a controlled drugs cupboard in the home to comply with the recent change in statutory regulations. The registered persons must ensure that a copy is kept of all the documentation relating to staff recruitment required in the updated Care Homes Regulations 2001, including a copy of two references, to evidence residents are being properly protected through the home’s recruitment procedures. The registered persons must develop a staff-training matrix or similar system to allow them to effectively monitor training staff have undertaken and to assist them to arrange new training and refresher training when required. This requirement is made to ensure that staff remain up to date with the required skills and knowledge to effectively address residents needs. The registered persons must seek the views of external stakeholders regarding the quality of care the home offers including from involved relatives and health and social care professionals. This requirement is made to promote and develop further the quality of care and support offered to residents. 30/04/08 29/02/08 29/02/08 29/02/08 Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carmen Lodge, DS0000007243.V351934.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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