Inspection on 16/01/09 for Cavendish Lodge

This inspection was carried out on 16th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cavendish Lodge 21/01/08

Cavendish Lodge 19/10/06

Cavendish Lodge 01/03/06

Cavendish Lodge 05/05/05

Cavendish Lodge 13/12/04

Cavendish Lodge 05/05/04

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cavendish Lodge 41 Leam Terrace Leamington Spa Warwickshire CV31 1BQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Martin Brown     Date: 1 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Cavendish Lodge 41 Leam Terrace Leamington Spa Warwickshire CV31 1BQ 01926427584 F/P01926427584 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Rethink care home 8 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 8 The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia (MD) 8 Date of last inspection Brief description of the care home Cavendish Lodge is a nursing home for eight people with mental health problems, which is part of the Rethink Organisation (formerly NSF). The Home is situated within walking distance of the town centre and local parks. The home aims to provide a supportive residence in which eight people with enduring mental health problems can have a sense of belonging, be treated with respect and exercise choice in their daily lives. Each individual is encouraged to participate in activities suited to their own needs and wishes, to access local resources and facilities and to manage social and familial relationships beyond the home. Through the long term development of trust between service users and staff, the fostering of hope and focus upon strengths, the home endeavours to enable people to approach their potential and to achieve some recovery Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home in the quality of their lives. The current weekly charge ranges from £910.81 to £960.61 per person. This information was provided by the administrator on 16th January 2009. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report has been made using information that has been accumulated by the Commission for Social Care Inspection. The inspection visit was unannounced and took place on 16th January, 2009, between 10am and 5.15pm. All service users were seen over the course of the inspection, as were staff on both the morning and afternoon shifts. The acting manager was not present. We were advised that he was off sick, and later that he had subsequently tendered his resignation, an event the staff had only just been made aware of. The service manager for the area also visited, as did the manager of a sister home, who had been providing some management support. The administrator was also present, who was now spending more time at Cavendish Lodge. A tour of the premises was made, relevant documentation was looked at, and observations of the interactions between residents, staff and their environment were Care Homes for Adults (18-65 years) Page 6 of 29 made. Policies and procedures, and care records were examined, and three service users were case tracked, that is, their experience of the service provided by the home was looked at in detail. Specific elements of other service users care were also looked at in detail. The Annual Quality Assurance Assessment, containing information about the service, completed by the service, and returned before the inspection, also informed the inspection. All the people living at the home were able to offer views, in varying detail, on the care and support they received. These were broadly very positive. A professional who has close contact with the service was also able to provide views, which, again, were positive. Staff, management and residents were welcoming and helpful throughout. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming to the home can be confident that their needs are assessed and met by competent staff who understand how those needs are best met. The arrangements for ensuring that peoples changing needs are fully met do not ensure that this is acted upon. This means that peoples needs may not all be met. Evidence: There has been one new admission to the service in the past twelve months. This person has been at the home for just over a month, and had come in under the guardianship of the local authority. They were spoken with, and stated they would have preferred to have moved elsewhere, but there was some acknowledgement that current mental health frailties prevented that. They initially said that they had not been to the home and knew nothing about it prior to moving in, but later acknowledged, when reminded by staff, that they had visited a friend at Cavendish Lodge a number of times prior to moving in and were familiar with the home, and liked it. They said they had no complaints about the service itself, and had begun to settle in. The staff are very good was their comment about the service. Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: Most of the information related to care for this person predated their admission, and included information on an application form to move to Cavendish lodge. There were daily recordings, and these, plus staff discussion of the needs of this person, and observations of interactions, showed a good understanding of the needs, and how to meet them. Nevertheless, staff acknowledged that the service should by now be building up a more structured care plan based on his needs as shown by the stay at Cavendish lodge. They advised that this was in the process of being done and forms were in place ready to update assessments. These forms, yet to be completed, were seen. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect the needs of those living in the home and are reviewed regularly. Clearer presentation of personal aspirations may help residents focus on positive goals. Residents are encouraged to take decisions and risks within a supportive environment, by staff who are familiar with them and their needs. Evidence: Care plans, known as Recovery Plans, covered areas such as emotional well being, healthy eating, hygiene, shopping, social events, and finances. Those looked at showed review dates of November 2008 and January 2009, and showed involvement by the people concerned, as well as health professionals and relatives. A sample of three individual care plans were looked at. Care plans tended to focus on needs, and less on individual aspirations. It was not clear from looking at care plans what individuals liked doing, hoped to do, or had enjoyed in the past. People spoken with on such matters tended to focus on whether they wished to remain at Cavendish Lodge, or move elsewhere. Most said they liked it, and wished to stay. One person was clear Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: they wanted to move. Staff were supporting this person to realise that aim, with a prospective destination having been identified, and individual support in respect of further developing individual living skills. Residents spoke about their lives at Cavendish Lodge in positive terms, appreciating both the freedom and the support available when needed. Staff spoke of, and were seen to offer, a balance between motivating residents towards desirable aims such as developing self-help and social skills, and allowing them to make decisions. Residents were supported in taking risks in terms of living an independent life style. Some restrictions were noted in the use of the kitchen, where individuals had to ask for access to locked cupboards and fridges and freezers, because of the risk of some individuals using foods inappropriately. Similarly, some implements were locked away. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported in a variety of activities and enjoy good food, and opportunities to develop cooking and food preparation skills at their own pace. Evidence: Residents came and went during the day, either independently, or with staff support, according to perceived needs. For those who needed staff support, period of double staff cover in the afternoon provided an opportunity for one or two to be supported in individual activities, such as shopping. One person living at the home talked of the allotment he works, in better weather, with outside support, and what he likes to grow there. Residents spoken with were happy with the level of staff support for activities and socialising. One noted that they went out less in the winter, but more in the summer. The issue of going out in group Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: trips was raised. Some residents liked to go out as a group, others preferred not to. It was clear that if joint trips are arranged, and some do not wish to go, they have to go to another home, as Cavendish does not have the staff to enable them to remain at home. One staff argued that large trips are now outdated, and that smaller, more individual trips are preferable, and less stigmatising. Residents spoke of using local restaurants, coffee shops and sports centres. One resident spoke of shopping trips, and attending an Art group. Two residents spoke of enjoying an individual break at a holiday camp. They enjoyed it, but were conscious that they could afford it, whereas others who had not budgeted could not. One person commented that they would like to get out more. One person had culture needs highlighted with arrangements to meet someone from a similar background. Staff spoken with were knowledgeable concerning the needs of this person, and to what extent and in which areas help was appreciated. Where meals are prepared by staff (usually the evening meal) this is done, usually without the help of residents, for safety reasons, the staff explained. Residents spoke of enjoying the food, with several appreciative comments regarding the cooking and quality of food. Residents tend to be assisted to make individual meals and snacks more in the day, according to individual wishes and developing abilities. Two residents were noted as developing their cooking skills, one of whom spoke keenly of moving to a more independent setting. The fridge is currently locked, as items were going missing. Residents spoken with accepted this, if the alternative was losing some of their food. The freezer, and other cupboards are also locked, with access on request, for safety reasons. Again, residents understood and accepted the reasons for this. Staff showed a good awareness of hygiene and safety risks in the kitchen, and of the need to balance those with encouraging and facilitating independence for individual residents. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home receive good personal and health care support, but the service needs to ensure that the arrangements for dispensing medication are improved, to enable everyone to be fully confident that they are receiving their medication as prescribed at all times. Evidence: Good personal support was shown being offered to residents, with concerns being listened to and reassurance and helpful advice being offered. Residents were supported in a calm and effective way, with potential areas of stress and conflict being defused very early on. An outside health professional spoken with viewed the service very positively, saying that the well-being of people living at the home had improved greatly during their stay there. They felt that the home has some people with particularly complex and challenging needs and had done well to help and support them in the community and keep them out of hospital. This person felt that for many of the people living at Cavendish Lodge, it was the most secure and stable setting they had known for a long time, or even ever. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: Records were seen of visiting health professionals, showing that contacts with such as opticians are facilitated and supported, whilst not denying individual choice. Medication continues to be stored suitably, with a lockable fridge available for use if needed. Individual medication records had photographs of the person concerned. One person self medicates, receiving their supply a week at a time. When checked, records matched the stocks for this medication. This person also had when required medication, which they requested when they felt they needed it. This was observed during the inspection, and gave the staff member opportunity to talk sympathetically to the person as to why they needed the medication. Most medication is dispensed from blister packs. These were dated as starting from a Monday, but were actually received from the pharmacy on a Wednesday, leading to some confusion about starting days. When they were checked, all medication was found to have been recorded and administered accurately. Staff were strongly recommended to ensure that the starting day on the blister packs tallied with the day they were received from the pharmacy, to minimise potential confusion and errors. Non-blistered medication was looked at. The majority were in foil-wrapped packets. These were all counted and stock control records all tallied with amounts remaining. One medication was dispensed in a bottle. The amount remaining in this bottle did not tally with records. Staff acknowledged that these were more difficult to regularly count and consequently stock control, and agreed that these would be better dispensed either in blister packs or in foil packaging, and agreed to action this with the pharmacist. There was no returns book in evidence. Staff spoken with advised that no medications have been returned recently, and that any that were would be receipted by the pharmacist, but acknowledged that that there should be a returns book, to note all these properly. An outside health professional spoken with felt that medication was administered appropriately and in accordance with instruction and guidance. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures and the open, listening culture in the home help to protect people living there against abuse. People living in the home would be more confident that their concerns were listened to and acted upon if there was a clearly labelled complaints log available. Evidence: We have received no complaints concerning this service since the last inspection. All those spoken with during the inspection said they had no complaints, and were particularly complimentary about the staff. I asked staff if there was a complaints log. They produced a small green book with nothing in it, and no title on it. They acknowledged that it this needed to be clearly labelled, and would action this. When asked what would they do if they were unhappy about something, or if they had something they wished to complain about, people living in the home said that they would speak to staff. Staff were seen listening to, and advising people with problems and individual concerns. There is a complaints notice, but staff agreed it was not very eye catching, and one staff said she would happily draw up another, more colourful, eye catching version. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: Records showed that staff have received training in respect of helping protect vulnerable adults. Procedures and policies in relation to the protection of vulnerable adults are in place. Staff spoken with were aware of what to do in the event of any abuse being alleged or suspected. Residents now have control over their monies. Staff will sometimes, at their request, hold some monies for them, often to support them in saving. Staff, and some residents, acknowledged that it was now more difficult for some to save for more distant goals such as holidays, but felt, on the whole, people were managing to budget well, with staff advice and support, on a weekly basis. Records of where staff held monies for those living in the home were seen to be satisfactory. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are benefiting from a much improved and more homely environment. Continuing refurbishment and redecoration should continue to improve the environment for them. Evidence: The main dining room and lounge is now much more pleasant, with new dining furniture and leather sofas. The people who live at Cavendish were clearly pleased with the new furniture, saying that they thought it was very nice. Repainting has been taking place. One person who lives at Cavendish Lodge advised that the windows had been repaired and rot cut out. The other lounge, used for smoking, has an extractor, and is sparsely furnished, in keeping with its function as purely a smoking room. People went in there to smoke, but did not linger once they had finished. The downstairs bathroom, which was previously in poor condition, has been refurbished, with the floor awaiting attention. The laundry floor has been repaired. The walls have paint flaking on them. The laundry was otherwise tidy and clean. Redecoration is continuing. During the inspection, a man arrived to look at three bedrooms that are to be decorated. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: The cellar area has been further improved and made safe from flood damage to be used for administrative and other office work. Where there are hazards, such as hazardous materials, these were securely locked away. The kitchen continues to be spacious and well-maintained, with locks on some cupboards to keep individuals foods secure. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a skilled, consistent, and knowledgeable staff team who are able to meet their needs. To enable residents to be confident that all staff have been safely recruited, the service should ensure that it has a clear record within the home that all staff have had appropriate checks. Evidence: There are two staff on duty on each shift, with at least one being a nurse, and the other a care assistant. There is an overlap of staff during the afternoon, which allows individual work, such as shopping or appointments, to take place. Rotas showed that this was the normal pattern. The home does not use agency staff, but has a number of bank staff who fill in where there are gaps in the rota. All those living at Cavendish Lodge were very positive about the staff, saying that they were always helpful, and very good. Good positive interactions between staff and residents were observed throughout the inspection. Staff were re-assuring and calming whilst giving optional medication at the request of a resident. Information passed on at the daily handover showed a good knowledge by staff of those who lived at the home. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: One resident was keen to know what staff were on duty the following day. The staff member was able to provide this information. Staff said they enjoyed good support by the organisation in getting necessary training. Training records looked at showed mandatory training taking place. Criminal Records Bureau details are recorded on files. There was no information about a Criminal Records Bureau check recorded against one staff member. This was raised with the administrator, who explained that all details were kept centrally by the Human Resources of the organisation, who provided details of the Criminal Records Bureau number when requested. In this instance it had not been requested. It was promptly requested, and the organisations Human Resources were able to confirm the Criminal Records Bureau and its issue date. All other files looked at, including that of the most recent recruit, had Criminal Records Bureau details in place. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents generally benefit from positive outcomes from this service. The service needs to ensure that management arrangements are fully in place so that residents can enjoy a safe and well-run home. Evidence: At the last inspection, there was an acting manager, who was to register. We have received no record of an application to register a manager over the past year. The home advised that the manager had recently been off sick, and subsequently tendered their resignation. Some frustration was evident by staff at things within the home that had not been done, ranging from a proper complaints log being in place, to a gas maintenance check, which had only recently been done, after being several months overdue. There was evidence of regular water checks. These were however, badly worded, with the advice that temperatures should be over 50C. Staff acknowledged the error and Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: had this changed promptly. Records showed that two showers had recorded temperatures of over 50C. Staff acknowledged that this was unsatisfactory, and advised that they to have new mixer valves put in place. They advised that the two showers concerned were in individual bedrooms, and were not used by those individuals, but acknowledged that they should still only operate within safe limits. Surveys filled in by people living at the home were seen. These were generally positive. Some indicated individual grievances, such as one person feeling that they did more chores than others. One person had written that they felt that staff should tell residents off more if they misbehaved. Regular recorded visits by other representatives of the organisation continue to take place. The most recent of these highlighted areas of improvement, as well as areas that still needed to be improved on. There were records of regular residents meetings, with issues of concern being raised. However, it did show issues raised at previous meetings had been resolved, enabling residents to see a clear connection between issues being raised and them being acted upon, and actions fed back. The area manager visited during the inspection, and the manager of a nearby home run by the organisation has also been providing support to the home. Both were keen to address shortcomings highlighted by the inspection. The administrator, who works throughout the organisations three homes in the area, is now concentrating on work in Cavendish for the time being. Staff expressed the view that the home had suffered in recent years from a lack of stable management. One comment was: Staff would like a settled system, adding every time we get used to a system, it changes. An examination of the Fire log showed fire drills and alarm checks undertaken regularly. Staff spoken with were clear on fire procedures. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The service must be able to demonstrate that if any medications have been returned, they are clearly recorded. This is so that it is clear that medicines no longer needed are disposed of properly, have been accounted for, and are not being misused. 27/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The service should ensure that it assesses the needs of residents and how they are to be met within a reasonable time of their admission, rather than relying on information gathered prior to their admission. If group outings continue to be arranged, the service should ensure that sufficient staff are available to allow anyone who does not wish to go to remain at Cavendish Lodge, rather than have to go to a nearby sister home. It is recommended that all non-blistered medication is stored in packets, rather than bottles, to ensure that it is Page 27 of 29 2 16 3 20 Care Homes for Adults (18-65 years) accurately counted, to ensure proper stock control, to be confident that people living at the home are always receiving the correct medication. 4 22 The complaints log should be clearly labelled as such, so that staff are clear where to record any complaints or concerns. Notices informing people of the complaints procedure could be more user friendly, so that people are more aware of how to complain if they are not happy with something. Information in the home regarding all staff working at the home should clearly refer to a satisfactory Criminal Records Bureau check having taken place, so that those living there can be confident that staff have all been appropriately approved for working with vulnerable adults. It is strongly recommended that the service appoints a permanent, registered, manager to oversee the development of the service and ensure that small but potentially significant shortcomings are quickly overcome. Resident meetings should clearly show how issues raised at previous meetings have been resolved. Gas checks should be completed within appropriate time scales, to ensure the safety of the service is not compromised. All water temperatures should be within safe limits. 5 22 6 34 7 37 8 9 39 42 10 42 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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