Inspection on 08/09/06 for Carmen Lodge

This inspection was carried out on 8th September 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 5 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 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 Harun Rashid Unannounced Inspection 8th September 2006 10:00 Carmen Lodge, DS0000007243.V310404.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.V310404.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.V310404.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.V310404.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2006 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. A number of 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.V310404.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on a weekday morning 08/09/06. The registered manager was present during the inspection process. The inspector interviewed three members of staff and five service users. A tour of the premises is conducted during the inspection. 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.V310404.R01.S.doc Version 5.2 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.V310404.R01.S.doc Version 5.2 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): 1,2,3 and 5 The quality in this outcome area is good. This judgement had been made using available evidence including a visit to this service. The home is able to meet service users’ assessed needs with input from health professionals. All service users are provided satisfactory contracts. EVIDENCE: The home has developed a satisfactory Statement of Purpose, which set out the aims and objectives of the home. The Service Users’ Guide included all information regarding the service delivery. Since the last inspection no service user was admitted to the home. However, the registered manager who is a qualified nurse carried out previous preadmission assessments prior to the admissions. The home also received copies of the health professional’s assessment of needs and those were available in the service users’ care files. Six care files examined in random selection confirmed that if any specialist needs were identified, specialist services advice were sought, such as Community Psychiatric Nurse (CPN) and Psychiatrist. The inspector interviewed members of staff and service users expressed their satisfaction with the standards of care provided. 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. Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 Page 8 Six service users files examined in random selection contained contracts, which were signed by service users/family members and the management of the home. The contracts found to be satisfactory and those included a statement of terms and conditions between the home and the service users. The contracts also included the rooms to be occupied by individual service users. Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 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): 6,7,8 and 9 The quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. Staff completed a detailed strength and needs list for service users, however, their care plans must be reviewed on a six monthly basis and minutes of the meetings must be available for inspection. Although service users have risk assessments, however, service users who have psychiatric input must have their risk assessments reviewed with input from CPN. EVIDENCE: Care files examined confirmed that staff completed a detailed ‘strength and needs list’ for service users. Service users have individual recording books, which staff complete on a daily basis. This demonstrated how service users identified needs were met. However, it was evident that service users review meeting minutes were not available for inspection. The management must ensure that service users’ six monthly reviews take place on time and the minutes of review meetings are available for inspection. The registered manager informed in writing on 30/3/07 that ‘’it is the responsibility of the placing authority and the designated social worker to hold Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 Page 10 six monthly reviews on time and to make minutes available to the home’’. The manager has requested for the review reports to be sent but not arrived. Staff interviewed demonstrated that they respect service users’ right to make decisions about their lives by providing information and assisting them with managing finances and supporting them with cooking meals. Service users attend monthly resident’s meetings and minutes suggest that service users were able to choose menus, decoration of their bedrooms and suggest the venues for day trips. Service users were given information in order to access advocacy services like North East London Advocacy (NELA). Evidence suggests that service users are consulted on and they participate in the day-to-day activities of the home. Service users attend residents meetings on a regular basis and a member of staff minutes the outcome of the meetings. The minutes were viewed which confirmed that service users had opportunity to discuss various issues. The management has reviewed service users risk assessment recently. The risk assessments enable service users to take responsible risks, for example they are encouraged to travel in the local community for shopping, visiting friends and family members. However, the registered manager informed that for five service users who are receiving support from their Community Psychiatric Nurse (CPN) their risk assessments would be reviewed with input from CPN at the next review meetings. The registered manager informed that on 27/9/06 he has written to CPN for their input in developing risk assessments. Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 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 The quality in this outcome area is good. This judgement had been made using available evidence including a visit to this service. Service users have opportunities for developing further education and they are encouraged to access local amenities. Choices of menus are offered and service users have opportunities to cook meals. EVIDENCE: Some of the service users of Carmen Lodge attend various activities for developing further education within their capacities. Three out of five service users interviewed informed the inspector that they no longer want to attend any day centre or courses at college. One service user currently doing a voluntary work at Whips Cross hospital. This service user works in the post room and sort out letters and delivers these to various wards. On the day of inspection a service user informed the inspector that she is attending a job interview in a voluntary centre at Walthamstow. Service users activity plans were displayed on the notice board and they attend various activities in the community, for example, visits to cinema, bowling, and church and travelling to the local shopping centre. Staff also provide Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 Page 12 information and advice regarding available local activities offered by specialist organisations. Staff also ensure service users’ have access to public transport for example, advice is provided on how to obtain a taxi card and freedom pass for travelling. Service users of Carmen Lodge are able to travel by bus, rail and underground. Service users of Carmen Lodge are able to maintain family links and friendships inside and outside the home. Families and friends visit service users in the home and service users also visit them in their homes. 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 opportunity to cook meals with staff supervision. Staff develop weekly menus in discussion with service users. It was clear from the examination of weekly menus that the home provides meals of their choice (minimum choices of two meals) and these were varied and balanced. Member of staff assist service users to prepare snack. All service users are able to make sandwiches and hot drinks. Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 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 quality in this outcome area is good. This judgement had been made using available evidence including a visit to this service. Staff seek specialist support in order to meet service users complex assessed needs. Staff are provided training on medication administration. EVIDENCE: Staff ensure 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. Majority of service users required minimum supervision with personal care and some of them are able to shower/bath independently. 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. Five service users are currently receiving support from CPN. Three of the service users are able to attend some of the medical appointments. An elderly service user who had bilateral hip replacement and had reduced mobility is transferred to a care home for elderly people. Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 Page 14 It was clear from discussion with staff and viewing care files that none of the service users are able to self-administer medications. It was observed that staff administer medications to all service users and 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. Since the last inspection staff attended ‘treatment of Anti-psychotic and taking good care of medicine’ seminar on 14/06/06. This was conducted in accordance with guidance recommended by the National Minimum Standards (NMS). Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 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 quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. The home follows its complaint procedure. The responsible individual is required to seek advice from five service users placing authorities for the management of their finances. EVIDENCE: The complaint book was seen. A record of complaints was kept in a complaint book including details of investigation and action taken by staff. The complaint procedure of the home was displayed on the notice board for the attention of service users and relatives. The adult protection policy and procedure contain guidance for staff to enable them to protect service users from abuse. Staff interviewed were aware of the adult protection procedure. The registered manager informed that five service users finances are managed by the responsible individual and other five service users finances are managed by service users family members and service users themselves. Staff keep records of all financial transactions. During the inspection it was observed that when service users collected their personal allowances they and staff have signed on financial record sheets. Although the responsible individual has written to the DSS that she no longer wish to act for five service users appointee, she is required to seek advice for those five service users placing authorities to manage their finances in accordance with Regulation 20 of the Care Homes Regulations 2001. Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 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): 25 and 30 The quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. The home is suitable for its stated purpose. Its is bright, clean and free from offensive odour. However, the registered provider must replace the partly worn carpet in the lounge and the old oven in the kitchen. 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. Following the requirement of the previous inspection report, the worn out sofas in the service users lounge is replaced. The carpet of the first floor landing was also replaced. However, during the tour of the premises it was noticed that the carpet of service users’ lounge is worn out. The decorative stain glass of the front door is broken and the old oven in the kitchen is required to replace. The registered manager must ensure that the carpet in the lounge, the front door stain glass and the old oven is replaced. The manager informed that replacement of lounge carpet has been completed. Replacement of old oven has been done. Repair to decorative stain glass of the front door has been done. Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 Page 17 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. Staff supervise service users with laundry tasks. The laundry room was found to be cleaned and tidy. The kitchen was also clean and tidy, staff support service users to keep kitchen clean after cooking a meal. Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 Page 18 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): 31,32,33,34,35 and 36 The quality in this outcome area is good. This judgement had been made using available evidence including a visit to this service. Carmen Lodge provides various staff training including NVQ level 2 training in care for its staff development. Staff are receiving regular supervision. The management carry out all relevant checks on staff before appointment. EVIDENCE: Six staff files were examined all contained job descriptions and staff signed contracts with the management. Three members of staff interviewed were aware of their roles and responsibilities. Staff have read the code of conduct and practise set by the General Social Care Council. Staff files examined confirmed that seven staff have completed NVQ level 2/3. Therefore, the home met this standard in full. Three staff interviewed confirmed that they have already completed their NVQ level 2 training in care. The home employs 11 (full and part-time) members of staff. At the time of the inspection two members of staff were on duty in addition to the registered manager. The home is currently accommodating ten service users. All service users communicate verbally and staff are able to communicate with them verbally in an appropriate manner. Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 Page 19 The management operates a thorough recruitment procedure based on an equal opportunities policy, which reflects on their staff recruitment. Six files were examined which contained all relevant checks including CRB disclosures, two reference letters, and Photocopies of staff passports. Staff attended fire safety, first aid, food hygiene, treatment of anti-psychotic and taking good care of medicine and NAPPI (Non Aggressive, Psychological and Physical Interventions) training. Five members of staff recently attended health and safety, care plan and writing reports training with the City and Guild. Certificates of those training were shown to the inspector. Staff interviewed confirmed that they are receiving regular supervision and records of supervision notes were available in staff files. Staff interviewed informed that staff meeting take place once a month. They all have opportunities to attend staff meetings and discuss issues if they wish to. Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 Page 20 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 The quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. There is a quality monitoring system in place to measure the success in achieving the aims and objectives of the home. The home ensures service users health, safety and welfare. However, the management must ensure that the inspection of the electrical main wiring is conducted without delay. 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. Following the requirement of the previous inspection report, the registered manager’s hours of duty were included in the staff rota. The registered manager was available during the unannounced inspection. Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 Page 21 The home’s quality programme involves service users and seeks their comments on the service. The manager showed evidence of completed quality questionnaires forms, which were completed by service users. The responsible individual sends regulation 26 visits’ reports to the CSCI. Staff interviewed confirmed that they have attended health and safety training. 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. However, the management must ensure that the inspection of the electrical main wiring is conducted without delay. The home displayed a valid insurance certificate against loss or damage to the business. Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 Page 22 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 3 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 3 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 2 3 3 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 3 x 3 x x 2 X Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13 Requirement The management must review service users risk assessments with input from the health professionals. (This is an outstanding requirement must be me within new timescale). The management must ensure that service users’ six monthly reviews take place on time and the minutes of review meetings are made available for inspection. The responsible individual is required to seek advice from service users placing authorities for the management of their finances. The registered manger must ensure that the carpet in the lounge, the front door stain glass and old oven is replaced. The management must ensure that the inspection of the electrical main wiring is conducted without delay. Timescale for action 31/03/07 2. YA6 15 31/03/07 3. YA23 20 31/03/07 4. YA24 23 31/12/06 5. YA42 23 30/11/06 Carmen Lodge, DS0000007243.V310404.R01.S.doc Version 5.2 Page 24 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.V310404.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London IG1 4PU 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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