Inspection on 06/05/10 for Elwin Lodge Care Home

This inspection was carried out on 6th May 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elwin Lodge Care Home 04/02/10

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Key inspection report Care homes for adults (18-65 years) Name: Address: Elwin Lodge Care Home 58 Fishponds Road London London SW177LG     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Louise Phillips     Date: 0 6 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Elwin Lodge Care Home 58 Fishponds Road London London SW177LG 0000000000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Mark Anthony Peake Name of registered manager (if applicable) Mr Martyn Stace Cooper Type of registration: Number of places registered: care home 2 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 2 The registered person may provide the following category of service only: Care Home only - code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home Elwin Lodge Care Home is situated in a residential street close to Tooting High Street. The home is a terrace house which has been split into two flats, which share the same front door and small entrance area, though have separate lockable doors to each flat. Metered parking is available on the roads around the home. People who live at the home are funded by Wandsworth local authority. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 2 2 0 4 0 2 2 0 1 0 Brief description of the care home The Registered Person informed us that the fees for the service range from £1870.17 to £2659.72 per week Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over one day by two Regulation Inspectors where we met with the manager of the service, area manager and the owner, who is also the Registered Person. We also spoke to one staff member whilst we were at the home. Information was also sent to us following the inspection by the owner, and this has been referred to in the report. Care Homes for Adults (18-65 years) Page 6 of 34 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to information about the home and this must be developed further to give an accurate picture of services provided. The home has recently reassessed the needs of the people who use the service to improve outcomes for them. Evidence: Since the last inspection of the home a new Statement of Purpose (SOP) has been developed for the service and we were given a copy of this at the inspection. The document provides more relevant information about the service though we found that it does not always provide accurate information to people who use the service. For example, it states that it fully conforms to CQC requirements, which is misleading when there are still outstanding requirements and recommendations from the previous inspection. The SOP also states that people who use the service are given information in accessible forms on which to base choices, though this is not in place at the service. Care Homes for Adults (18-65 years) Page 9 of 34 Evidence: Since our last inspection the service has implemented the in-house assessment for the people who use the service, but this should have been carried out prior to people moving to the service to ensure the home could meet each persons needs. However, it demonstrates that peoples care and support needs have been recently reassessed. Care Homes for Adults (18-65 years) Page 10 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are care plans and risk assessments that detail support for people who use the service. Transactions relating to the monies of people who use the service need to be properly recorded and audited. Evidence: Since the last inspection of the service improvements have been made to the information provided in the care plans, with clearer information about each persons health and personal care needs. Information about their social needs or activities are limited, however the manager did demonstrate that this is being worked upon at present, in conjunction with the care manager of both people. The risk assessments for each person are basic and individualised, though now contain more information about risks and hazards that present to both people who use the service. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: Since we visited the home the owner has sent us fire risk assessments and management plans for each person who uses the service. Both of the care files contain a lot of information about the person and Elwin Lodge, such as staff rotas, old information and letters to the CQC. Information not currently relevant to meeting the support needs of the people should be archived to enable easier access to relevant information. The manager is the named person within the corporate appointeeship for the people who use the service. During the inspection the manager informed us that both peoples monies are pooled into the same bank account, which is in the name of one of the people who uses the service. When we looked at the records of transactions relating to both peoples monies we found poor recording, unclear entries, crossings out and incorrect dates. We were also not able to check the monies held for one person, as the manager informed us that the staff member who worked the night shift had taken the key to the money tin home with them. The Statement of Purpose for the service states that the fees paid by the local authority for the people living at the home include all care, food, drink and accommodation costs, however the record of financial transactions for both people do not confirm that this is the case. There were also no contracts at the home for the people who use the service to evidence what the fees cover. Findings from this inspection have raised concerns about how money is managed at the service and we have referred this to Wandsworth local authority to investigate under their safeguarding procedures. Care Homes for Adults (18-65 years) Page 12 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is some evidence to demonstrate that some improvements have been made to increase activities provided by the service. More regular activities need to be in place that are specialist and provide sensory stimulation for the people to engage in. Evidence: At this inspection we noted a number of steps have taken place to improve the activities and quality of life for people who use the service. Upon arrival we were informed that a meeting was due to take place with the social worker, regarding the planning of activities for one person who uses the service, but this was postponed. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: The manager and the owner of Elwin Lodge informed us of different activities that one person in particular has been involved in, which include trips to a safari park and to the seaside. We also saw photos of these trips on display at the home. They also spoke about increased shorter trips to the local area and drives in the car that the person enjoys. The manager also told us that they had made a referral for the person to have music therapy. We were informed by the manager that the other person who uses the service continues to go to the day centre from Monday to Friday, where they are involved in activities such as cycling and swimming. We were told that they are visited by their family and also stay for the weekend with their family approximately every four to six weeks. The manager told us that the person is now more supported to be involved in domestic activities such as washing the dishes, doing their laundry and ironing their clothes. They said that they also spend time occasionally at another service run by the same organisation, where there are more people for them to see. The service does not have any books, computers, games or videos that either person at the service can be involved in. Similarly, we did not observe any pictures or symbols on display to provide people who use the service with information they may be able to understand. The care plans for the people who use the service indicate that they have high needs, such as specialist communication needs, yet there is no information about any specific support or programmes of care that are aimed at developing peoples skills and quality of life. The kitchen in both flats contain minimal amounts of food, and the manager said that this is because food is purchased on a daily basis by staff taking one of the people who uses the service to the shop to purchase this. The preparation and cooking of the meals predominantly takes place in the top floor flat, with meals being brought down the stairs to the person who lives on the ground floor. It is not clear how people are involved in choosing what foods they would like to eat, and photographic menus and shopping lists should be used to facilitate this for both people who use the service. We did not see any records of foods and meals provided to the people who use the Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: service. Care Homes for Adults (18-65 years) Page 15 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We found improvements have been made to promoting the privacy and dignity of people who use the service. Some improvements need to be made to ensure all health needs are met and that medication is managed properly. Evidence: The rota for the service indicates that people who use the service are supported by staff of the same gender. Since the last inspection we found that the service has taken steps to promote the privacy and dignity of both people who use the service, including replacing a bedroom door and putting opaque screening on a persons bedroom window. Evidence was seen in the care files that care management reviews had been carried out six months after each person had moved into Elwin Lodge. We saw that health action plans have been created for the people who use the service, Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: but these contain limited information and need to be more individualised. They should also include information on specific medication needs, such as covert administration of medication, which we were informed happens with one person who uses the service. We saw that the body map for one person details different injuries and dates of these all on the same chart, and were confusing. We did not see any care plans to accompany the body map records. For one person who uses pads, we did not see a care plan relating to the use of these, nor an assessment by the continence adviser. At the last inspection we made a number of requirements around the medication system, and we saw that steps have been taken to address these, so that medication is being given at the correct times. The manager said that he checks the medication daily, however there is no record of this. We saw that medication is being stored properly, though some improvements are still needed to the medication system. This includes a sample initials and signature sheet of all staff who administer medication and guidelines around administering medication, such as PRN (as required) medication. We also found that there was antihistamine medication for one person which had not been prescribed and did not have label on the packet. Also, the Lorazepam medication for one person did not correspond with the recorded amount received into the home. The Lorazepam to be administered is only half the amount of the tablet provided, and the manager said he does not know what happens to the other half, or how this is disposed of. Care Homes for Adults (18-65 years) Page 17 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are appropriately recorded by the service. Staff have not received training in safeguarding vulnerable adults. Evidence: We looked at the complaints log book and there is a record of complaints and concerns received, actions taken and the outcome of these. Since the last inspection a safeguarding issue has been raised about the service, and this was investigated under Wandsworth local authority safeguarding procedures. In response to this the home has made changes at the service, involving staff training in managing challenging behaviours and better recording of incidents, to ensure that this issue does not arise again. At the previous inspection we required that all staff receive training in safeguarding of vulnerable adults. At this inspection the manager told us that no training (apart from that highlighted above) had been undertaken or arranged for the staff. He said that he is in consultation with Wandsworth local authority to provide this, though there was no evidence to support this. Care Homes for Adults (18-65 years) Page 18 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is modern for the people who live there. However, improvements are needed to ensure that cleaning is carried out routinely for the safety of the people who use the service. The layout of the home should be more homely for the people who live there. Evidence: Elwin Lodge Care Home is a terrace house on a residential street that has been converted into two flats. One flat is on the ground floor, whilst the other is spread over the first and second floor. Each flat has a bedroom, bathroom, kitchen area and lounge or conservatory. The top flat has a staff sleep-in room. Since the last inspection the manager is now based full time at the service. However, there is not a designated office area, and the lounge of the top flat is used as an office. The manager and owner informed us about plans for him to be based in the kitchen area of the top flat. We recommend that the staff sleep-in room be re-arranged and also used as an office. The person who lives in the top flat also does not have their own private bathroom facilities as this is used by the staff, manager and any visitors to the service. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: The staff are responsible for cleaning the flats, and the owner visits approximately three times a week to address any maintenance issues. We saw that maintenance issues that we raised at the last inspection have been, or are in the process of being addressed. During this inspection we observed a number of cleanliness issues that need to be seen to, including the cleaning of the greasey filter above the oven in the top flat and also the bathroom of the top floor flat, as this is dusty. There was also no hand soap or facilities for drying hands in this room. There were no curtains installed in the top flat bathroom to promote the privacy and dignity of the person using this. The windowsill in the top flat bedroom was also seen to be dusty and in need of a clean. We found that the door to this bedroom had been replaced and also the doors to the top cupboards. We saw that the sofas in the top flat lounge had been replaced, as well as new curtains installed to the ground floor flat windows. The service needs to ensure that these are all fire retardant and maintain evidence of this. The trailing wires that lead from the television in this lounge need to be made safe We were informed that COSHH (Control of Substances Hazardous to Health) products were being stored in a locked cupboard and did not observe any in the living areas of both flats. We noted the skylight on the second floor to be dirty and having mould spots on it. The fire doors are not self closing, and this needs to be addressed by the service to ensure the safety of the people who live there. Care Homes for Adults (18-65 years) Page 20 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service must demonstrate that appropriate recruitment checks take place to minimise risks to people who use the service. New staff must also be properly inducted to their work and all staff must have full training for the work they do. Evidence: The home is staffed throughout the 24 period, with one member of staff supporting each person on a one-to-one basis throughout this time. Following findings from the last inspection we made a requirement that a minimum of two staff must be working in the building at any one time throughout the 24 hour period to meet the challenging needs of the people who use the service. We made the requirement to not only support the member of staff should an incident happen, but also support the person who uses the service, should a lone staff member be injured. At this inspection we were informed that there is a minimum of two staff in the home throughout the week. However, we were told that this is not always the case, and this was evidenced in the staff rota we saw for the recent Bank Holiday weekend, as there was only one staff member working in the home throughout this time. The owner said that they will ensure that cover is in place, so that there will always be Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: a minimum of two staff in the building at all times. Since the last inspection of the service one member of staff has been recruited. There are improved recruitment checks that have taken place prior to the person being employed, yet the home did not keep a written record of the interview, and the staff member has not yet received an induction, despite the rota showing that they have already worked two shifts on their own with a service user. There is also no photograph of the person in their file, and they do not have a contract of work. We looked at the recruitment files of staff who had been recruited previously, before our last inspection. We could see that an attempt for one person has been made to obtain references, that had not previously been in place. However, much more work is needed in this area, to ensure that the service complies with Schedule 2 of the Care Homes Regulations 2001. There is no staff recruitment policy or procedure at the home. The manager said that staff meetings at the home take place regularly, although was unable to evidence any records of these having taken place, apart from one that took place in February 2010. Since the last inspection we saw that staff files now contain completed induction forms, though not for the newest member of staff. There is no staff training and development policy at the service. At the last inspection we made a requirement for all staff to receive training in the work that they are expected to do, plus statutory training such as fire safety, first aid, basic life support and food safety. The manager stated that no training, apart from managing challenging behaviours had been provided to staff since our last inspection of the service. He said that he is looking at some training to be provided but that nothing had been confirmed yet. At the last inspection we also recommended that staff receive regular supervision to support them in their work. In two of the four staff files we looked at we saw that two staff had received one supervision each since they started work, whilst the other staff had received none. All staff should receive a minimum of six supervision sessions a year, at regularly Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: spaced intervals, and a record maintained of these. Care Homes for Adults (18-65 years) Page 23 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to provide better outcomes for the people who use the service. However, the service must adopt a proactive approach and implement robust quality assurance processes to show that it is self-monitoring and making progressive improvements to the service. Record keeping needs to improve so that the home can clearly evidence how it operates in the best interests of the people who use the service. Evidence: Since the last inspection of the service we have been informed that the manager is now based at the service from Monday to Friday each week, and this is reflected on the rota for the home. The service does not have a policy on quality assurance. We asked the manager about the quality assurance processes in use at the service. He said that they have spoken Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: to someone about this for addressing this with people who have specialist communication needs. They said that they had also received input from a Mental Capacity advocate. There was no recorded evidence to support this. The area manager told us that the service does not have any quality assurance processes that currently take place. We found no evidence of any quality monitoring processes, like those described in the Statement of Purpose, or of any audits that are carried out by the service, apart from the reports of two monthly visits carried out by the Registered Person (in accordance with Regulation 26 of the Care Homes Regulations 2001). There was no evidence to demonstrate that people who use the service are consulted about any aspects of the service. Throughout the inspection we found that some records and information about the service were not available, such as staff meetings minutes, menus, staff contracts and input from relevant professionals. All records relating to the service must be held on site. The manager told us that there are no policies and procedures at the service, as these are being reviewed at another service run by the same organisation. We looked at the health and safety practices in use at the service. We found that not all the staff have received training in moving and handling, or in fire safety. The fire log book records that different call points around the service are being checked weekly, and a fire system service took place in October 2009, with a certificate to evidence this. We observed that the fire blanket and extinguishers have been re-situated in the home to enable easier access for staff. Since the inspection the owner has provided us with individual fire risk assessments for each person who uses the service. The fire risk assessments state that the home does not carry out fire drills due to the reactions of the people who use the service. However, there is no risk assessment in place to detail how people will be supported should there be a fire, and one must be developed to minimise risks to people who use the service. The home also needs to demonstrate that staff practice fire drills, and this could be done without sounding the fire alarm. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: It is recommended that the service seek the advice and guidance of the local fire authority to ensure that the service is appropriately equipped to deal with any fire emergency, and regarding the fire assessments and procedures of the home. There are certificates to evidence that external contractor checks have been carried out on the gas and electrical systems. We also saw that water testing has been carried out for Legionella in March 2010. The report of this states that in the ground floor kitchen the levels were higher than preferred, and the home needs to demonstrate how this is being managed. We also saw that regular records are kept of the temperatures of the fridge and freezers at the home, and of the temperature of water dispersed from the taps. The manager confirmed that the service does not have any risk assessments in place for any health and safety and safe working practices at the service. These must be implemented to cover all hazards identified at the service. This must include a risk assessment for the use of the microwave oven in the ground floor kitchen, which is at least five foot above the ground. There is a current Employers Liability Insurance certificate on display at the service. Care Homes for Adults (18-65 years) Page 26 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 23 13 All staff must receive training 31/03/2010 in safeguarding vulnerable adults. To minimise risk to people who use the service. 2 32 18 Staff must receive specific 31/05/2010 training to meet the needs of the people who use the service. So that people who use the service receive the right support to meet their needs. 3 35 18 All staff must receive training 30/04/2010 in the work that they are expected to perform, and all statutory training, including fire safety, first aid, basic life support and food safety. So that people who use the service are supported by properly trained staff. 4 39 24 A robust quality assurance 31/03/2010 system must be implemented at the service to ensure close selfmonitoring of the service takes place, and appropriate actions taken. So that the service monitors itself and makes necessary Care Homes for Adults (18-65 years) Page 27 of 34 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action improvements. Care Homes for Adults (18-65 years) Page 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The Registered Persons must ensure that the Statement of Purpose accurately details all the services to be provided, and updated as necessary. To provide relevant and accurate information about the service. 30/06/2010 2 19 15 The Registered Persons must demonstrate that all the health needs of people who use the service are properly assessed and planned for. So that people receive the right support for their needs. 30/06/2010 3 20 13 The Registered Persons must ensure they hold accurate records of the administration and disposal of medicines into the home. So that medication is given safely and correctly. 30/06/2010 Care Homes for Adults (18-65 years) Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 20 13 The Registered Persons must ensure that a system of robust auditing of medication is consistently and regularly undertaken To demonstrate that the home is carrying this out, and to minimise risks to people who use the service. 30/06/2010 5 23 13 13(6) Make stringent and transparent arrangements that will ensure no service user is placed at risk of financial abuse. Statutory Requirement Notice 07/07/2010 6 23 13 13(6) Ensure all staff receive 07/07/2010 training in the various types of abuse of vulnerable adults and their role in the prevention of abuse Statutory Requirement Notice 7 30 16 The Registered Persons must make suitable arrangements for maintaining satisfactory standards of hygiene in the home So the service is clean and hygienic 30/06/2010 8 34 19 The Registered Persons must ensure information 30/06/2010 Care Homes for Adults (18-65 years) Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action held in respect of persons working in the home includes a recent photograph So that full information is maintained about the staff 9 35 18 The Registered Persons must ensure all staff receive a structured induction. So that staff are inducted properly to their work 10 39 24 24(5) Ensure that 07/07/2010 appropriate methods of communication are employed to consult all service users accommodated and this consultation is reflected in the evaluation of the quality of the service Statutory Requirement Notice 11 39 24 24(1) Implement a system 07/07/2010 for evaluating the quality of the service provided in Elwin Lodge Statutory Requirement Notice 12 41 17 The Registered Persons 30/06/2010 must ensure that full records relating to the service are kept at the home at all times 30/06/2010 Care Homes for Adults (18-65 years) Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To demonstrate that the service is being run in the interests of the people who use the service. 13 42 23 The Registered Persons must ensure that a detailed fire risk assessment is developed for the service. To minimise risks to people who live and work at the service Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 30/06/2010 1 2 1 7 The Statement of Purpose should be provided in a format that is accessible to the people who use the service. The Registered Persons should ensure the monies of people who use the service are not pooled into one account, and each person must have their own bank account. The service should consider the provision of a sensory area, and sensory stimulation for people who use the service The service should ensure that only fire retardant furniture and furnishings are provided at the service, and maintain evidence of this. Separate shower facilites for sleep-in staff should be provided at the service A minimum of two staff should be in the building at all times throughout the 24 hour period. Staff should have a minimum of six recorded supervisions sessions a year, at regularly spaced intervals Service specific policies and procedures must be developed Page 32 of 34 3 4 11 24 5 6 7 8 28 33 36 40 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations for the home to cover all aspects of running the service 9 42 It is recommended that the service seek the advice and guidance of the local fire authority to ensure that the service is appropriately equipped to deal with any fire emergency. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 34 of 34 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!