Inspection on 15/05/07 for Denron Lodge

This inspection was carried out on 15th May 2007.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Denron Lodge 01/09/06

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 Peter Illes Key Unannounced Inspection 15th May 2007 09:00 Denron Lodge DS0000062333.V333280.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.V333280.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.V333280.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.V333280.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st September 2006 Brief Description of the Service: Denron Lodge is a part of Wimbourne Houses Ltd, an organisation that supports people 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 people between ages of 18-65 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 a seperate 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 £700 upwards. There are no other additional charges. 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.V333280.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last key inspection of Denron Lodge took place on 1st September 2007. However, a subsequent random inspection took place on the 19th September 2007 when Ms Vashti Maharaj, a CSCI pharmacy inspector, accompanied the lead inspector, Ms Karen Malcolm. The reason for this second inspection visit was to further assess medication handling, training and administration against National Minimum Standard 20 (Care Homes for Younger Adults). The focus of this inspection was on potential interactions between alcohol and prescribed medication. Requirements were made at both inspections and are referred to in the relevant sections of this report. This unannounced key inspection took approximately six and a half hours with the registered manager being present or available throughout. There were five people living at the home at the time of the inspection and no vacancies. One person was in hospital at the time. This unannounced inspection included: discussion with four people living at the home, three of them independently; a brief discussion with two other people that visited the home and who live at one of the provider organisation’s other homes; discussion with the registered manager; independent discussion with the provider organisation’s activities coordinator; a brief discussion with a visiting manager who conducts quality monitoring visits to the home; independent discussion with a support worker and a brief discussion with a second support worker. Further information was obtained from a preinspection questionnaire, a tour of the premises and documentation kept at the home. What the service does well: The home provides a comfortable and domestic scale environment for the five people who live there, all of whom have mental health difficulties and some with needs that are complex and challenging. People living at the home, when spoken to independently, stated that they liked living there and that they received a lot of support from staff, that they appreciated. Staff employed at the home are experienced and have a range of skills. Good quality care plans, risk assessments and other documentation assist staff to address people’s changing needs. The home is well supported by both the provider organisation and by health and social care professionals that visit regularly. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The two requirements that were partially met from the pharmacy inspection and are restated relate to guidance for staff as to whether medication can be administered when people have consumed alcohol and staff training in safe administration of medication. Four new requirements are made at this inspection in the following areas: temperature records for the home’s freezer; records relating to staff training and two areas relating to further improvements in fire safety. One good practice recommendation is made regarding displaying the home’s complaints procedure more prominently. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 8 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.V333280.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home have their needs properly assessed when they first move in to allow staff to assist in addressing these. They also have their needs reviewed once living in the home to ensure staff are aware of any changes in these needs. People accommodated also benefit from clear written information so that they understand their rights and responsibilities that are part of the terms and conditions of them living at the home. EVIDENCE: No new people have been admitted to the home since the last key inspection. The files of three people were inspected and contained a range of multidisciplinary assessment information that had been made available to the home as part of the home’s admission procedure. The files also contained review notes, including minutes of care planning approach (CPA) meetings, that had taken place regularly, including since the last key inspection. Care plans and guidance for staff had been updated and amended where necessary to reflect any changes in an individual’s needs. Evidence was seen from the review meeting minutes that the person concerned was invited to these meetings although on occasion the person concerned declined to attend. This was properly recorded when it occurred and the registered manager stated that the content of the meeting was shared with the person afterwards. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 10 The home has written “house rules” that clearly indicate the rights and responsibilities for living at the home. At the last key inspection a requirement was made that these house rules were amended to include what consequence(s) there may be if a person does not comply with these and this had been complied with. A requirement was also made that the house rules were reflected in the contract/ statement of terms of conditions for living in the house, this had also been complied with. People living in the home who were spoken to independently were clear about the house rules and the potential escalating consequences should they continue to contravene these over a period of time. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are recorded in their care plans to assist staff in meeting these. People are supported to maximise their independence by making as many decisions as possible for themselves within a framework of acceptable rights and responsibilities. People are also supported and guided in relation to taking appropriate risks in their lives to assist them to safely achieve their aspirations. EVIDENCE: Care plans were inspected for three of the people living in the home. These were detailed, broken down into areas of need that reflected current assessment information and gave clear guidance to staff on how to assist address these needs. The care plans were also informed by current risk assessment information. Evidence was seen that people living in the home are involved in writing and reviewing their care plan. The home operates a key worker system and care plans seen were being reviewed and evaluated on a monthly basis. A key worker was spoken to independently and this member of staff was aware of their person’s current needs and how these should be Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 12 addressed. Evidence was also seen on the files inspected that regular one to one sessions are held with people accommodated with notes of the main points discussed. People living in the home are supported to make as many decisions as they can for themselves. It was noted that some people have complex needs and behaviours that the home needs to assist them manage including the use of alcohol and illegal drugs. Those people living in the home are offered structured support by both the home’s staff and external health and social care professionals to assist them in addressing these issues. Some people living in the home indicated that this was restricting their lifestyle choices although in further independent discussion acknowledged that staff did offer them substantial support. Evidence was seen from the files inspected that where restrictions were in place for individuals these were properly documented. The restrictions noted on the files seen were supported by and were consistent with the home’s house rules referred to in the Choice of Home section of this report. Three people manage their own finances and two are assisted to manage their personal allowance by the home. Records relating to this were inspected and were satisfactory. Each file inspected contained detailed risk assessments relating to that individual that were current and subject to periodic review. Three requirements were made at the last key inspection regarding risk assessments: that risk assessments must include all areas of risk and that goals identified must be fully addressed; that the records of one person that had been subject to a court appearance were more detailed including how that person is to be supported by the home in the related area and that an additional photograph of each person accommodated was to be included in the section of their files relating to their profile available to other agencies should that person go missing. Evidence was seen in the documentation inspected that these three requirements had been complied with. The registered manager indicated that given the complex needs of some of the people accommodated that ensuring risk management strategies were current remained a high priority for the home. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are encouraged and supported to participate in a range of activities including within the wider community. They also enjoy contact with relatives to the extent that they wish and with friends who are able to visit the home provided that the house rules are complied with. People are also supported to enjoy healthy and nutritious meals that they like although an additional heath and safety record in the kitchen is needed. EVIDENCE: All the people living at the home can and do travel independently. People spoken to stated that they have freedom passes to use public transport and can come and go from the home independently although need to let staff know when they are going out. One person left the home to visit relatives in another part of London during the inspection. People who live at the home have a range of skills including one person who is keen on artwork. This person showed the inspector some of his drawings and paintings, which the inspector Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 14 thought were impressive. Two of the pictures were displayed in the entrance hall to the home. The inspector was informed that people at the home would be encouraged and supported to develop their varying talents, for example by attending college. People spoken to however confirmed that they were not keen on doing this. People living at the home are from diverse cultural backgrounds. At the last key inspection a requirement was made that the home should consult with them in more detail about their cultural identity and how they would like to be supported. Evidence was seen that the home’s individual equality and diversity monitoring forms had been reviewed as required to evidence this. People spoken to felt that their cultural and religious needs were being met to their satisfaction. The provider organisation employs an activities coordinator who visited the home during the inspection. He stated that he visits the home at least twice a week to assist people living there with a range of activities. These included a BBQ that was planned for later in the month and trips to the seaside in the summer. He stated that visiting the cinema on a weekly basis was a current favourite activity and that he was going with people to a local multiplex cinema that afternoon. He went on to say that people were also encouraged to attend facilities that would assist them to develop skills to assist re future employment but stated that motivation remained an issue. The home has a separate computer room that is linked to the internet. The registered manager stated that it was fitted with filters to minimise the risk of unacceptable material being downloaded and that staff supervised the use of the room. He went on to say that it was difficult to motivate people to use the computer but that staff tried to do this. The home also has a pool table in the lounge that was more popular. Each person had an activities programme that included engaging in daily living skills and activities facilitated by the activities coordinator. The majority of people living at the home have contact with relatives ranging from weekly to annual contact depending on the wishes of the individuals involved. People also have friends, both in the other provider organisation’s homes and in the community although bringing friends back to the home is dependent on compliance with the house rules. Each person living in the home has a key to their bedroom and a key to the house. A record was seen that these had been signed for on the files inspected and people spoken to confirmed that they had the keys and that they used them. Staff were seen to interact positively and appropriately with people accommodated throughout the inspection. People are also appropriately encouraged to undertake daily living tasks to assist develop their independence skills and this was documented in their files. One person living at the home that was spoken to was not enthusiastic about this and expressed the view that cleaning and cooking should be the staff’s job given the cost of the placement. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 15 The home had a specimen weekly menu that showed a range of nutritious meals. The registered manager stated the menu could be amended on a daily basis according to the wishes of individuals on the day. Some people were being supported to prepare and cook some of their own meals. The majority of people spoken to indicated that they liked the food at the home although one person indicated that it could be better given the cost of the placement. One person was being supported to lose weight for health reasons and had an individual healthy eating plan that had been devised with the assistance of a dietician. The inspector was informed that no one else was on any special diet. A range of health and safety checks were being undertaken in the kitchen and records inspected showed that these were generally satisfactory. However the home was keeping daily temperature records for the fridge but not the freezer and this is required. The home had a bought more crockery and cutlery as had been required at the last inspection. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home receive appropriate personal support in accordance with their needs. They also are supported in meeting their physical, mental and emotional healthcare needs. People are protected by the homes procedures relating to medication administration although some further work is still needed to maximise protection in this area. EVIDENCE: People living at the home are independent regarding their personal care although some may require verbal prompts regarding personal hygiene on occasions. People are supported with a range of physical, mental and emotional health needs, some of which are further complicated by excessive use of alcohol and the use of illegal drugs. Satisfactory records of appointments with health care professionals were seen on the files inspected. This included evidence of appointments with GP’s, mental health specialists, general hospital outpatient departments and check ups with a dentist. Evidence was seen on one person’s Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 17 file that they would sometimes refuse to attend appointments made and this was clearly documented. Identified people living at the home receive counselling support from within the provider organisation. Evidence was seen of this on files inspected and confirmed by both staff and people accommodated. The registered manager stated that he and two other members of staff had also undertaken a basic counselling course to national vocational qualification (NVQ) level 4 standard since the last inspection and showed the inspector his certificate to evidence this. At the last key inspection a requirement was made that the records for one person living at the home regarding monitoring their health and dietary care needs and also the record of their weight checks be improved. This was seen to have been complied with. The home’s medication polices and procedures were inspected by a CSCI pharmacy inspector in September 2006, following the last key inspection. The outcome of that inspection is as follows: The homes medication policy, Wimborne House Policy 12, mentions all aspects of medicines handling including self-administration, refusals, and leave medication. Inspection of medication administration records provided evidence that the policy is being followed. All appropriate records are being kept (medicines received, administered, returned). There is evidence that refusal to take medication/missed doses are recorded, and that the appropriate action is taken if medicines are missed for longer than 3 days (GP and CPT notified). Information leaflets are available for each medicine kept at the home, however the critical information should be highlighted, or compiled into a medication profile as the leaflets are not being used at present due to the volume of information they contain. Following on from the last CSCI key inspection in September 2006, the Manager requested information from the GP and Community Psychiatric Teams on any interactions between alcohol and medicines kept at the home however this has not been supplied. This must be documented so that all staff know what to do if a resident has been drinking and medication is due. A medication profile must be completed for each resident, listing: -What their medicines are used for -The likely side effects -Whether there is an interaction with alcohol Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 18 -Whether residents can still take prescribed medication if they have been drinking alcohol -Whether an interval is needed between drinking alcohol and taking medication No residents self-administer their medication. All new residents must be assessed for their ability to self-administer, and the home must encourage and support self-administration particularly for service users who are aiming to move out into less supported accommodation. In order to move out to less supported accommodation, service users must have been managing their own medication for 6 months. Staff have had medication training in-house medication and also by the supplying pharmacist, however the level of training for all staff does not meet that required by the National Minimum Standards. A copy of the Skills for Care Medication Knowledge Set has been supplied, together with a suitable progress log/competence assessment form, which the Manager can use to sign off staff as competent to administer medicines. No staff can administer medicines without appropriate training, and without their training being assessed. Following on from this, any additional training must be provided. Three requirements were made as a result of the inspection by the pharmacy inspector: The registered persons must carry out an assessment for each resident stating whether medicines can be taken if the resident has been drinking alcohol. This had been partially complied with although in the inspector’s opinion this guidance was not detailed enough. This requirement is restated and amended that more detailed guidance is written for staff regarding administering medication to each person living at the home when they have consumed alcohol. Information leaflets for each medicine kept at the home should be used to assist with this. This guidance must then be sent to the prescribing medical practioner for comment stating that if they do not receive a response they will assume that the prescribing medical practioner is satisfied with the guidance. The registered persons must ensure that all staff who handle/administer medicines have had an appropriate level of training. This requirement has been partially complied with although the pharmacist who is providing this training is now unwell and has not completed the training for all staff. This requirement is restated with a revised timescale. It was noted that training for staff had been provided since the last inspection in drug misuse. The registered persons must ensure that medicines supplied to residents to take when away from the home, e.g. when on holiday, must be labelled with Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 19 the drug name, instructions for use and the residents name. This requirement has been complied with. Failure to comply with these requirements within the required timescale will affect the quality rating for the home in this outcome area. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People accommodated are able to express their views and concerns and have these acted on appropriately; the home also takes seriously complaints made by other people. People accommodated are also protected by a satisfactory adult protection policy and procedures that staff are familiar with. EVIDENCE: The home had a satisfactory complaints procedure that was seen and included all the elements specified in the national minimum standards. The registered manager stated that the complaints procedure was included in the information about the home that is given to each person when they are first admitted. However, the complaints procedure was not displayed in a communal area in the home and, given the complex needs of people accommodated, a good practice recommendation is made regarding this. People living at the home indicated that they knew how to raise concerns when they wanted to. The home was dealing with two complaints made by neighbours regarding loud music being played by people living in the home, especially at night. This is an ongoing problem and management action to date has included consultation with the London Borough of Haringey’s Prevention and Options Team that deal with anti-social behaviour including noise. The home has also issued formal warning letters to the people concerned who are aware that if the excessive noise continues this may result in their placements being terminated. It is essential that the home continues to take strong management action over this Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 21 complaint to promote good relationships with neighbours. The inspector was informed that no other complaints have been made to the home. Two requirements made at the last key inspection regarding how complaints were recorded were seen to have been complied with. The home had a satisfactory adult protection policy and procedure that had been amended as required at the last inspection with regard to how staff will be supported if they report an allegation or disclosure of abuse. The home also had a copy of the local authority adult protection policy for the authority in which the home is located. Staff spoken to had received training in adult protection and were aware of the actions that needed to be take should an allegation or disclosure of abuse be made to the home. The registered manager stated that no disclosure or allegation of abuse had been made to the home since the last inspection. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a home that is well maintained, comfortable and that provides an environment that meets their needs. The home was clean and tidy throughout creating a pleasant environment for both those that live and work at the home. EVIDENCE: The home was seen to be suitably decorated and maintained throughout and met the needs of the people living there. The registered manager and a visiting manager from the provider organisation described how ongoing maintenance and renewals of furniture, equipment and decorations were dealt with. Because of the needs of the people accommodated the furnishing and décor in the home needed ongoing monitoring to ensure it remained of an acceptable standard. All of the bedrooms have en-suite facilities with the home also having a separate bathroom/ toilet. The inspector was shown two bedrooms by two of the people living in the home and these were seen to have been personalised by those people. One person told the inspector that the home was ordering them a new bed and carpet for their room shortly. Other people told Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 23 the inspector that they found the home comfortable although one person indicated that it should be furnished to a better standard given the cost of living there. The home had a separate computer room and a pool table in the main lounge. The home was acceptably clean and tidy during the inspection and the inspector was informed that the home employs a part-time cleaner. The home had suitable laundry facilities and had bought a separate tumble dryer to complement the washer/ dryer as was recommended at the last key inspection. This was to provide more flexibility for people in undertaking their laundry. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A competent and qualified staff team supports people living at the home. People also benefit from staff being well trained although a clearer monitoring mechanism is needed to ensure this is up to date and to prioritise planning of future training in the home. People are protected by the home operating a robust recruitment procedure. Staff are properly supervised to assist them further in meeting the needs of people living in the home and in their own personal development. EVIDENCE: Two staff are on duty on each shift including waking night staff. A good practice recommendation was made at the last key inspection that staff have handover sessions at the end/ beginning of each shift, rather than just in the morning. Evidence was seen from a handover book and from staff spoken to that this was now happening. The registered manager stated that all staff had achieved a minimum of national vocational qualification (NVQ) level 2 in care and that some were undertaking NVQ level 3 in care. There was evidence to support this from staff files inspected and from staff spoken to. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 25 No new staff had been employed since the last key inspection. Three staff files were inspected at random and all showed evidence of the documentation required to evidence a robust recruitment procedure. A good practice recommendation was made at the last key inspection that a last employer reference be obtained for a then newly recruited member of staff and this had been obtained. The provider organisation runs a rolling programme of training for staff. Evidence was seen from relevant documentation, including from staff files inspected, that training had been undertaken by staff in the last 12 months including the following areas: drug misuse, basic counselling techniques, fire safety, first aid and management of aggression. It was also noted that from staff files inspected that the home provides documented induction training. Staff spoken to confirmed that the home offers a range of training that is useful. However, at the inspection there was not a clear record of training or other documentation available to evidence when individual staff members had received training and to be able to monitor when refresher training in core skills would need to be provided. A requirement is made regarding this to enable the home to effectively measure what training an individual staff member has undertaken and what their future training requirements are. Staff receive regular 1 to 1 supervision that is recorded and copies of supervision notes were seen on the staff files inspected. Staff spoken to stated that this was useful. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home and staff benefit from the home being managed by a knowledgeable and enthusiastic registered manager. People’s views are sought in different ways to assist monitor and improve the quality of the service provided. Effective health and safety procedures contribute to protecting people living at the home, staff and visitors although some further work is needed with regard to fire safety to maximise this protection. EVIDENCE: The registered manager is qualified and has a range of experienced in working with people who have mental health difficulties. He stated that he had good support from within the provider organisation including peer support from other home managers within that organisation. The inspector’s view was that Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 27 the registered manager had a good insight into the complex needs of people living in the home and had worked hard to address the requirements and recommendations made at the last key inspection. He presented as being enthusiastic about his role and keen to develop the home further for the benefit of people living there. A good practice recommendation was made at the last inspection that the registered manager considered further management training in identified areas given the specific needs of some of the people living at the home. The registered manager stated that this was an ongoing process and that he was currently exploring several options with his line manager within the provider organisation. The provider organisation operates an annual quality assurance survey for people living in each of their homes. This is then analysed and objectives set for the organisation and the homes. Evidence was seen of the 2006 survey and that two of the people living in the home had contributed this. The inspector was informed that the other three people declined to participate on that occasion. Evidence was also seen of the subsequent analysis undertaken by the provider organisation. A manager from the provider organisation undertakes monthly visits to the home to monitor the quality of care. Reports of these visits are written and a copy regularly sent to the Commission as was required at the last key inspection. The home holds regular meetings with people living there to share information and obtain their comments and views. Copies of the minutes of these meetings were sampled and showed that agenda items at recent meetings had included smoking, fire safety, medication and personal hygiene. A requirement and recommendation was made at the last inspection that the home’s policies and procedures were reviewed annually and dated. Policies and procedures were sampled at this inspection and evidence seen of compliance. A range of satisfactory health and safety documentation was inspected including a gas safety certificate, electrical installation certificate and a portable appliance test certificate. The home’s fire log was inspected and this contained a fire plan and fire risk assessment that had been undertaken by a consultant in January 2007 to comply with the latest fire prevention regulations (Regulatory Reform -Fire Safety- Order 2005). The fire risk assessment identified several areas where further fire precaution work needed to be undertaken. The majority of this work had been completed but there were still a few areas where identified work needed to be completed. A requirement is made regarding this. The home also holds fire drills every three months and clear records to evidence this were seen. It was noted however that fire drills had been undertaken at different times of the day and evening but not at night. The home has staff who only work night shifts and it is required that periodic fire drills are held at night when the waking night staff are on duty. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 28 Requirements were made at the last key inspection that: the home’s environmental risk assessment is reviewed annually; the temperature of the hot water is tested fortnightly and that the home develops a written protocol regarding the use of sharp knives to promote the safety of people living at the home and of staff. The inspector was pleased to see that all of these requirements had been complied with. Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 29 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 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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 3 3 2 X 3 X 3 3 X 2 X Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA17 Regulation 13(4) Requirement The registered persons must ensure that the temperature of the home’s freezer is recorded daily to minimise risk to residents. The registered persons must, in order to maximise residents well being, ensure that detailed guidance is available to staff as to whether medication can be administered when people have consumed alcohol. This guidance must then be sent to the prescribing medical practioner for comment stating that if they do not receive a response they will assume that the prescribing medical practioner is satisfied with the guidance (previous timescale of 30/10/06 partially met). The registered persons must ensure that all staff that handle/ administer medicines have the appropriate level of training to maximise protection for residents. (previous timescale of 30/10/06 partially met) Timescale for action 30/06/07 2 YA20 13(2) 30/06/07 3 YA20 13(2) 31/07/07 Denron Lodge DS0000062333.V333280.R01.S.doc Version 5.2 Page 31 4 YA35 18(1) 5 YA42 23(4) 6 YA42 23(4) The registered persons must 30/06/07 ensure that a clear record is kept showing what training individual staff have undertaken, and when it was undertaken, so the home can plan for required refresher training in core and specialist skills. This is to ensure staff skills and knowledge are up to date to address residents needs. The registered persons must 30/06/07 ensure that identified fire precaution work is undertaken to maximise protection for residents. The registered persons must 31/07/07 ensure that periodic fire drills are held at night when the waking night staff are on duty to maximise protection for residents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA22 Good Practice Recommendations The home should display a copy of the complaints procedure in a communal area in the home so that it is more accessible to residents and others. Denron Lodge DS0000062333.V333280.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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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