Inspection on 01/09/06 for Denron Lodge

This inspection was carried out on 1st September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Denron Lodge 15/05/07

Denron Lodge 28/02/06

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 Denron Lodge 120 Dowsett Road Tottenham London N17 9DH Lead Inspector Karen Malcolm Key Unannounced Inspection 1st August 2006 10:20 Denron Lodge DS0000062333.V303265.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 Denron Lodge DS0000062333.V303265.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. Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Denron Lodge Address 120 Dowsett Road Tottenham London N17 9DH 020 8216 9875 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) Wimbourne House Limited Edem Fiawoo Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th February 2006 Brief Description of the Service: Denron Lodge is a part of Wimbourne Houses Ltd, an organisation that supports service users with mental health disorders in the community. The first home was registered in 1996. Denron Lodge was registered in August 2005 and is able to accommodate up to five service users between ages of 1865 years with mental health disorder. Denron Lodge is a five-bedded house situated in North Tottenham in London. All bedrooms have en-suite facilities and are appropriately sized. The communal areas include a lounge/activity area, kitchen/diner, and a separate bathroom on the first floor, a computer room that is accessed by the front door and a large garden accessible through the kitchen/diner. Denron Lodge is near to Bruce Grove shopping area and Bruce Grove main line station, which runs regular trains to Liverpool Street Station. There are also other good transport links. The other areas of interest close to the home are Bruce Castle Park museum, Tottenham Green sport centre and Tottenham Hotspur football ground. The aim and objective of the home is to ensure an efficient level of work with the service users. All attempts have been made to ensure an effective community rehabilitation of the service users. Service users are encouraged to pursue their interests in relation to social activities, education and hobbies. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. The cost of placements is £750 upwards. There are no other additional costs Following “Inspecting for better lives” the provider must make information available about the service, including inspection reports, to service users and other stakeholders. . Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was completed over approximately six hours. In the home was the manager and four service users. One other member of staff was on duty, but at the time of the inspection they were supporting one of the service users at an appointment. The other four service users in the home from time to time went in and out during the course of the inspection. All the service users are very independent and able to access the community when they please. The inspector was able to speak to four service users independently. They all stated that they were happy with the home and felt the manager was very helpful and knowledgeable. The home supports five male service users with mental health problems. This inspection involved sampling a number of care plans, records, a tour of the building, speaking to four service users and observing the interaction between staff and service users, which was friendly and positive. Feedback was given to the manager at the end of the inspection. The inspector found the manager and the rest of the staff very open and helpful throughout the inspection and would like to thank them for their time and patience. What the service does well: What has improved since the last inspection? At the previous inspection nineteen areas of improvement were made. It was evident at this inspection that fifteen areas of improvement had been addressed. These are: • Healthcare information is now recorded • Records of how a specific individual is supported with regards to their overall healthcare is on file • Dosette trays now have clearly written on the back individual service users medication and personal details • All staff have undertaken medication training • Medication cabinet temperatures are now in place • Service user’s consent to take medication is recorded on their care plan • Copy of the gas certificate was in place Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 6 • • • • Guidelines for care staff are in place when supporting service users on any activity in the community and if any incident occurs The home now employs a part-time cleaner The home now has a fax machine in place for communication The manager now works supernumerary one day a week 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. Denron Lodge DS0000062333.V303265.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 Denron Lodge DS0000062333.V303265.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,5 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. Prospective service users’ are confident that their needs will be fully met by the home because prior to moving in, a comprehensive assessment of needs is completed. However, service users are not confident that the written contract or statement of terms and conditions reflects their appropriate care and support. Therefore service users may not be supported appropriately regarding their care needs. EVIDENCE: Denron Lodge opened in August 2005 with one service user. Since then four other service users have moved into Denron Lodge, the last service user to move into the home was in December 2005. The home is presently fully occupied. All service users are only admitted into the home with a full assessment undertaken by the care manager and the home separately. On the care plans examined this was evident. There are no service users in the home who are self funded or without a named care manager. Each service user’s care plan is based on each service user’s care management assessment, which covers all the areas as set out in Standard 2. Contracts on care plans were also examined. The information recorded mainly pertains to the home’s ‘house rules’. In discussion with the manager it was Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 9 advised that the contracts must cover all the areas as set out in Standard 5.2. The section on ‘house rules’ must also include what the consequences of a service user breaking house rules are, as this information was not clearly highlighted in the document read by the inspector. Denron Lodge DS0000062333.V303265.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. There is a clear consistent care planning system in place to provide staff with information pertaining to each service users care. However, this is not consistently updated. Therefore service users may be at risk, because their care needs may not be appropriately met by the home. EVIDENCE: Three care plans were examined. The information recorded on each service users care plan addresses individual’s: admission needs, illicit substances/alcohol abuse, physical condition, finance, occupation/education needs, management of identified risks, legal issues and missing person/unexplained absences. On examining the service users files it was clear that each service user has a comprehensive risk assessment, addressing and identifying needs and behaviour management. This was impressive as this ensured that each service users’ individual needs are addressed and managed appropriately by the home. However, upon further reading of the two care plans, it was evident that the information presented on both files covered the same risk areas and outcome Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 11 of needs for each service user. In discussion with the manager it was evident that each service user had different support needs with regards to risk. The inspector sampled a third care plan. It was also evident that the individual risk and management strategies were the same. Upon reading another service user’s care plan, information presented related to a court hearing and fine. However, there was not much information pertaining to this. The manager stated that the individual did have a court hearing and was supported by the home. While the manager also informed the inspector the outcome of the hearing, none of this information was recorded on the individual’s file. It was advised that a record of the outcome of the court proceedings, the action taken by the court must be recorded on file. Further discussion highlighted that the individual service user had a number of risk areas that had also not been addressed in the individual’s care plan under risk management. These areas related to the individual’s behaviour, medication, and relationships with other service users in the home, their age, drugs and alcohol, the army and other activities. It was clear from the discussion with the manager that although risk assessments have been completed, that these were not completed properly taking into account individual risk areas which are in the opinion of the inspector deemed to be high. Therefore, it was not evident that service users are appropriately supported in the home because of this. The manager completes the daily records for each service user. These were found to be comprehensive and clear. However, appointments, incidents and treatments were not always recorded in the notes. The manager stated that this is usually recorded in the monthly summaries; upon examination of these it was evident that this was the case. It was recommended as good practice that healthcare information and treatment should be recorded in the daily records. Missing person profile information did not include pictures of the individual service users. It was advised that a recent picture of all the service users regards missing person information must be on individual files. The service users are very independent and are able to inform the manager and staff of their needs and wants. Service users manage their own finances, but if they need support with finances the home is able to support them too. Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 12 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 & 17 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. Service users engage and benefit from a social lifestyle and are offered other activities provided by the organisation. Service users are offered a wide range of various meals. Service users are able to have appropriate family and personal relationships. Therefore service users are happy and fulfilled with their life. EVIDENCE: All service users have their own key to the front door and their bedrooms. The organisation has an activity co-ordinator who visits the home once a week. A timetable of activities provided by the organisation is displayed on the notice board situated in the hallway. During the inspection, the activity co-ordinator arrived. The co-ordinator informed the inspector that at times it has been difficult to organise and motivate the service users to participate in activities as individuals keep changing their minds. However, there have been some successful activities such as a trip to Brighton and a BBQ party at one of the other organisations homes. Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 13 Service users were able to wander in and out of the home independently; on the day of the inspection none of the service users had any planned activities. The manager stated that this was their choice. Service users rights are respected in the home, as individuals are able to make informed choices and are very independent. Most of the service users have a good family connection. Service users either contacted their next of kin by phone; some visit or the service users visit them. One service user has no family contact. The meals are prepared in the home. The menu plan showed that the meals provided are wholesome, nutritious and balanced. Service users spoken to stated that they are happy with the meals provided. All service users are from a different cultural or religious background. The manager stated that this has not been an issue in the home with regards to preparing meals as none of the service users have a strict religious regime regarding their diet. Service users are offered choices of meals daily and this varies from day to day. One of the service users requested mutton to be cooked. However, they were not willing to go and buy the meat at the butchers and requested that one of the staff buy it on their behalf. This was undertaken by one of the care staff on duty. During the tour of the kitchen area, it was evident that there was a limited amount of plates and cutlery for service users to use. It was advised that this is reviewed regularly. Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 14 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 & 20 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. Service users know that their healthcare needs are being addressed within the home. However, this is not always consistently monitored or reviewed when any changes occur to an individual’s health. Therefore service users can be placed at potential risk with regards to their overall care. The home’s has a good medication policy and procedure administered by competent and trained staff. Therefore service users know that they are safe and protected. However, service users may be at risk, as at times medication may not be administered safely. Therefore the home has failed to improve their procedures for administering medication, placing service users at risk and harm. EVIDENCE: All service users are independent and able to manage their personal hygiene. The manager informed the inspector that the all the service users who live at Denron Lodge have varying complex social and health issues, which may at sometime have included drugs and alcohol and in some cases this is a continuing pattern. The manager also stated that the organisation provides an in-house counselling service for the service users. However, this is limited, as Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 15 the counsellor is also a manager of another project. Evidence of counselling advice sessions were documented in individual’s care plans. The last recorded counselling session received by a service user was on 11/01/06 and this lasted 15 minutes. Further discussion with the manager highlighted the discussion whether the counsellor is appropriately trained and whether this service continuing. The manager also stated that he has obtained advice, leaflets and further guidance from Haringey Advisor Group on Alcohol. While appointments were made with individuals to see the counsellor, the service users refuse to attend. On the care plans examined there was no evidence of this documented. It was advised that although this was good practice to obtain advice from the advisory group, evidence of this must be recorded on file. Primary health care needs of service users are identified and in most cases addressed. Records show that service users have access to GP’s and dentists. Service users, if they so wish, are accompanied to attend any healthcare appointments. One service user has an ulcerated leg and this is dressed several times a week by the district nurse. On the day of inspection, the specific service user was at the clinic, accompanied by one of the carers. The manager stated that they have a constant battle with this specific service user with regards to taking advice on eating healthily and managing their weight to aid the healing process of their leg. On the healthcare notes, information and advice given by the nurse after each visit was recorded and has been repeated after each visit. The manager was able to give the inspector a full account of how the home supports the specific service user, however this was not documented. It was advised that all healthcare needs pertaining to this specific individual’s health must be recorded and monitored by the home appropriately; evidence of this must be kept on file. At the last inspection it was required that all details of specific service user’s healthcare issues are documented on file. It was evident at this inspection that this is partially met. The inspector was able to speak to the specific service user and their healthcare issues was discussed. The specific service user stated that the advice given by the nurse was helping, and the ulcer is getting better; nevertheless, healthy eating and losing some weight will improve the healing process even further. The specific service user also stated that foods such as fruits are not their favourite and this is an issue for them. The medication policy and procedures were examined. Four of the five service users have prescribed medication kept in the home. All service users have a monthly dose of depot injection administered by their allocated Clinical Psychiatric Nurse (CPN), records of this was on file. At the last inspection the following was required: • that dosette trays have the correct information of the specific service user whose medication is in the tray, written on the back of the box • that all staff to have comprehensive medication training • that the temperature of the areas where medication is stored is monitored Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 16 • that consent to take medication from each service user is recorded on file At this inspection the above matters were checked and found to be in good order. The issue regarding service users continuing to take drugs and alcohol whilst on prescribed medication was also discussed. It was advised that further advice is needed with each of the service user’s Consultant or GP to ensure that the medication administered is not having an adverse effect on the individual’s health or the medication being administered. This issue was raised because one specific service user, who was given their medication late morning was slightly confused and agitated. The manager informed the inspector that the individual had been drinking. Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 17 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 & 23 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. Service users know how to complain and appropriate policies are in place. However complaints or concerns are not always consistently recorded or monitored, therefore service users and their relatives cannot always be confident that their views will be listened to or acted on appropriately. Service users are protected by policies and procedures pertaining to abuse. EVIDENCE: No records of complaints were on file. However, during the inspection one service user complained to the manager about another service user. The issue raised aggravated the service user, and during the outburst the manager didn’t respond to the individual. Due to this the service user then called the police in the presence of the manager and the inspector. The service user also stated to the manager that they had reported this yesterday after the incident. From the conversation, it was evident that the police were to follow-up the complaint with a visit to the home later that evening. This calmed the situation down. The complaint was addressed with the manager during the feedback session at the end of the inspection. It was the opinion of the inspector that the manager could have handled the situation better. The manager stated that similar complaints had occurred in the home, with the same service user on different occasions and he found the best way to handle the situation was to listen to the individual and make no comment, as this calms the situation down and another factor was that the individual had been drinking. The specific service user’s care plan was examined. No information regarding managing the individual’s challenging behaviour was recorded on their individual care plan. Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 18 It was also advised that a clear account of the complaint and any follow-up action is to be recorded. It is also advised that the manager must record the strategies he has in place regarding handling a volatile or challenging situation to ensure that these strategies are shared within a staff team and discussed and changed if needed. During the inspection one of the service users was playing their music loud in their bedroom. The manager informed the inspector that one of the neighbours had complained about the noise level on several occasions. The outcome was that the neighbour then complained to the local authority noise unit, who visited the home. They then issued a Notice to the specific service user. However, the manager stated he has not seen the written notice since being issued. Following this a meeting was held the day before this inspection, with two service users, the registered provider and the manager. The outcome of the meeting was that each night at 10.30 pm care staff would turn off the electric in these specific service users bedrooms to ensure the noise level is reduced at night. This was discussed at length with the manager. It was advised that the manager must cease this practice and find alternative ways of sorting out this situation, as this action has health and safety implications. Prior to this report being written the manager rang the inspector and stated that this practice has now ceased and an alternative programme is to be put in place. During the feedback session, it was reminded that the one of the ‘house rules’ should relate to noise levels. At the previous inspection it was required that the adult protection procedures must be in place and the home obtains a copy of the local procedures. A copy of the local procedure and a policy pertaining to adult protection was on file. However, the policy does not make any referral to how care staff are supported relating it to the whistle blowing policy and grievance procedures. Therefore it is recommended that the adult protection policy should be amended to ensure that carers are protected if they alert to an adult protection issue. Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 30 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. The standard of décor has improved greatly therefore providing service users with a pleasant, warm and inviting environment in which to live. The home is well lit, clean and tidy. EVIDENCE: The home consists of five single bedrooms with en-suite shower facilities. One bedroom is situated on the first floor, three bedrooms on the first floor and one bedroom on the top floor. There is a bathroom on the first floor and a separate toilet on the ground floor. The communal areas are a lounge/activity area, kitchen/dining area, and a garden and computer room, which is accessed via the front door. The manager’s office is situated on the first floor. The home provides a TV with SKY programmes listing and pool table in the lounge area. It was observed during the tour of the building that one of the service users was watching the TV and two service users were playing pool. Two service users refused the inspector access to their bedrooms during the inspection. However, the inspector could see whilst discussing with individuals whether or not they were going to let the inspector view their bedroom, that Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 20 their rooms were not tidy and needed a thorough clean. The manager stated this is a problem and having the cleaner has helped. The home was found to be reasonably clean. Since the last inspection, a domestic cleaner has been employed to cover 6 hours of cleaning a week. The laundry area was examined and was found to be in good order. The washer/dryer is positioned near the stairs. It was advised that the home should purchase a separate washing machine and dryer as a combined washer/dryer restricts the usage of the machine at anytime, considering there are five service users in the home. The other issue is in the winter this could be an unmanageable problem. Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. Staffing levels in the home have improved. Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and trained by a competent and qualified staff team. EVIDENCE: Two staff are rota’d on each shift each. The manager is now supernumerary on Thursdays to ensure that supervision and other management issues are completed. The home now employs a part time cleaner. The manager informed the inspector that all staff with the exception of two have completed their NVQ level 2 and above. Handovers are only completed in the morning. It was advised that it is good practice to complete a handover after each shift change over, to ensure the events of the day are handed over appropriately to each shift leader. Three staffing personal records were examined. All information required was in place. One staff member’s references did not refer to the individual’s last employer; it was advised that it is good practice to ensure obtaining a reference from the staff member’s last employer. Training undertaken by staff were in the areas of health and social care, NVQ, anti psychotic, managing aggression, manual handling, basic first aid and adult Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 22 protection. The organisation has a rolling programme of the training provided to all staff working in the home. Supervision notes were examined. Although in place, it was evident from the individuals notes on file that training and development needs, support and guidance, and key-working roles are not discussed or if discussed, not documented. Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 23 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, 40 & 42 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. The management of the home is satisfactory and overall the records are well managed. Service users’ are assured that their health and safety is promoted and protected. Therefore service users’ health, safety and welfare is always fully promoted and protected. However, this is not consistently reviewed, therefore service users may be at risk from harm. The home is run in the best interest of the service users, as the management and staff ensure service users’ needs are utmost in the day to day running of the home. EVIDENCE: The manager has been in post since the home opened in August 2005. It was observed that service users and staff respect the manager. It is the opinion of the inspector that the manager may need to take further training with regards to management, as it was evident throughout the inspection that the manager was not confident in making decision in the home and kept on referring to needing to discuss it with the provider. This was discussed with the manager at the time of the inspection. Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 24 Service users and family and friends have completed the home’s qualitymonitoring forms. ‘Equality and diversity’ monitoring forms were also in place. These forms clearly state the organisation will meet the individual’s cultural, ethnicity, sexual, religious, and disability needs. However, documented under one form examined is that the individual likes West Indian food and nothing else was mentioned about how this is obtained, who would cook it, the culture and the ethnicity of the individual and what other needs they had other than food. It was advised by the inspector that the manager must explore this further with each of the service users and a detailed account of the findings is to be in place. The home has a range of policies and procedures. However, it was not evident from reading a number of the documents, as to the aim and objectives of them. It was advised that each policy must have an aim and objective, (guidelines to assist the person/s reading it and what they should do in event of). It was also advised that it is good practice to date policies once reviewed and amended. A range of satisfactory health and safety documentation was inspected that included: gas safety certificate, fire alarm and fire extinguisher servicing and regular fire drills. Evidence was seen that a requirement made at the previous inspection had been complied with regarding the manager completing an environmental & fire risk assessment. However, the assessment completed was not clear, as to whether an assessed risk was low, medium or high risk. It was advised that the manager should re-visit the document and ensure that the risks areas are properly assessed according to risk. At the previous inspection it was required that temperature of the hot water outlets must be recorded and the bath must be fitted with an appropriate tamper proof, pre set, fail safe, thermostatic mixer device, so that hot water cannot exceed a safe temperature. At this inspection the thermostatic mixer device was in place, however, no records of water temperature had been made. Therefore this requirement is partially met and restated in this report. Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 25 Sharp knifes are kept in the office. Upon request the manager gives knifes to service users and staff. It was advised that a proper knife protocol must be put in place, as the current system is inconsistent. It was evident that not all staff have undertaken training in manual handling, food hygiene and infection control and those who have their certificates on file are currently out of date. It was advised that where relevant staff must undertake this training along with the current training programme for the organisation. It was also advised that at least one person on each shift should be a qualified first aider. This should be a HSE (Health and Safety Executive) approved course. Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 2 2 X 2 X Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 27 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 YA18 Regulation 13(1b) & 17 Sch3m Requirement The registered person must ensure that on one specific service user’s care plan, the individual’s health and dietary care needs are recorded. This must be monitored and reviewed regularly. (Previous timescale 30/04/06 partially met) The registered person must ensure that the specific service user’s weight chart has guidance in place, regarding the individual’s target weight and the reason why the individual is on a healthy eating plan. The registered person must amend the adult protection procedure to ensure that it support and informs staff on what to do if they have a suspicion or allegation of abuse of a service user. The procedure must be written in line with the local authority’s procedures. (Previous timescale 30/04/06 partially met) The registered person must establish and maintain a system DS0000062333.V303265.R01.S.doc Timescale for action 30/10/06 2. YA23 13(6) & 17 30/10/06 3. YA39 24 30/10/06 Denron Lodge Version 5.2 Page 28 4. YA42 13(4) 5. YA42 13(4) 6. YA5 5(1)(b) 7. YA9 14(2)(a) for reviewing at appropriate intervals the quality of care being provided by the home. Evidence of this must be available. (Previous timescale 30/04/06 partially met) The registered person must ensure that the temperature of hot water from all outlets in the home (other than the kitchen sink) are tested at least fortnightly, with any necessary action taken to ensure that it does not exceed 43’C. (Previous timescale 30/05/06 partially met) The registered person must complete and amend the environmental risk & fire assessments to ensure that the risk levels are properly graded. This is to be reviewed at least once annually. (Timescale of 30/04/06 is partially met.) The registered person must amend the home’s ‘house rules’ document to include all the areas as set out in Standard 5.2, which refers to a contract/statement of terms and conditions. The section regarding the ‘house rules’ should include what actions are to be taken by the home if a ‘house rule’ has not been followed appropriately. The registered person must ensure that all the service users risk assessments are updated appropriately, ensuring that all areas of risks and goals identified are fully addressed. This is to be done in consultation with the specific service user and evidence of this must be kept on file. DS0000062333.V303265.R01.S.doc 30/09/06 30/10/06 20/11/06 30/10/06 Denron Lodge Version 5.2 Page 29 8. YA9 17(1)(a) Sch 3.(j) 9. YA9 17(1)(a) Sch 3.2 16(g) 10. YA17 11. YA20 13(2) The registered person must ensure that the specific service user who had a court appearance, has on file a detailed account of what happened, the action taken and how the individual is being supported by the home. The registered person must ensure that on each service users missing person profile has a current photograph in place. The registered person must provide sufficient and suitable crockery and cutlery for service users to use on a daily basis. The registered person must ensure that the in-house counsellor is appropriately trained to support service users with drug and alcohol problems. Evidence of this must be kept on file. Records of any advice and support given to service users must be recorded appropriately in the individual service users file. The registered person must seek professional advice from either the GP or a Consultant with regards to service users who may take their medication with either drugs or alcohol. Records of this must be kept. The registered person must ensure that the specific service user’s recent complaint is logged appropriately and that details recorded include the action taken. A record of all complaints received must be kept. The registered person must make a record of the meeting held with, the two service users, the provider and the manager DS0000062333.V303265.R01.S.doc 30/10/06 30/10/06 30/10/06 30/10/06 12. YA20 13(2) 30/10/06 13. YA22 22 30/10/06 14. YA22 13(4) & 17 30/09/06 Denron Lodge Version 5.2 Page 30 15. YA39 12(3) 16. YA40 17 17. YA42 13(4) regarding the noise level in the home. The registered person must ensure that the appropriate course of action regards addressing the noise level in the home is in place, including the action taken and that this is reviewed and monitored appropriately. The registered person must consult with service users appropriately about their cultural identity and how they would like to be supported. A record of this must be kept on the individual’s file. The registered person must ensure that all the home’s policies and procedures are reviewed and amended accordingly, in line with current relevant legislation. The registered person must develop a written knife protocol that promotes the safety of staff and service users. 30/10/06 30/11/06 30/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard YA20 YA42 YA37 YA30 YA31 Good Practice Recommendations It is recommended and that the registered person should have a list of all the side effect of medication administered to individual service users on their file. There should be a qualified first aider on duty at all times. The registered person should ensure action made at the previous Regulation 26 visit are addressed in the following report. It is recommended that the registered person should consider purchasing a separate tumble dryer for the home. It is recommended that consideration be given to having a handover sessions at the end/beginning of each shift, DS0000062333.V303265.R01.S.doc Version 5.2 Page 31 Denron Lodge 6. 7. 8. YA34 YA37 YA40 rather than not just in the morning. The references sought for a carer should be that carer’s most recent employer. It is recommended that consideration be given to the added value of further management training for the registered manager. It is recommended that all policies are dated, and signed and dated on review to evidence that a review has taken place at least annually. Denron Lodge DS0000062333.V303265.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Denron Lodge DS0000062333.V303265.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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