Inspection on 19/02/07 for First Care Lodge Limited

This inspection was carried out on 19th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

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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 First Care Lodge Limited 9 Beryl Avenue Beckton London E6 5JT Lead Inspector Nurcan Culleton Unannounced Inspection 19 February 2007 10:30 th First Care Lodge Limited DS0000067805.V328207.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 First Care Lodge Limited DS0000067805.V328207.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. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service First Care Lodge Limited Address 9 Beryl Avenue Beckton London E6 5JT 020 8586 7895 020 8586 7895 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) First Care Lodge Limited Mr Satyatah Rumnah Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Sleep-in staff must not sleep in any communal area of the home. There must be separate private sleeping facilities for any sleep-in staff. The home`s documents must clearly indicate to any Commissioning Agent and prospective service users the period of the Tenancy before admittance or placement. Initial Inspection Date of last inspection Brief Description of the Service: First Care Lodge Limited is a small residential care home registered to provide support to three service users aged 18 to 65 years with enduring mental health needs. First Care Lodge provides short, long term or permanent placement, providing one to one support and twenty-four hour care with waking night staff. Service users who present an active serious risk to themselves or others are excluded. First Care Lodge Limited is an older style terraced house, located in Beckton and situated close to buses, trains and local amenities. The home was registered in September 2006 and is managed by the proprietor who also runs another similar three bedded residential home in East Ham. Currently fees start from £700 per week and are variable depending on level of needs. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 19th February 2007. The Registered Manager was present to assist with the inspection. As the home was registered in September 2006, the home is a newly established one and there are two service users resident and one vacancy. Both service users were in the house at the time of inspection. Staff who assist in the home are the same staff who work in the manager’s other registered home in East Ham. Their records were recently checked at their recent inspection. The home policies and procedures are also shared with the other home’ and were seen at that inspection. s records and documentation, including both service users files. Currently, there are and policies and procedures and minutes of staff and service users’ meetings. During this inspection, the inspector interviewed the manager, both service users, examined their files and other records and health and safety certificates necessary for inspection and toured the premises. What the service does well: What has improved since the last inspection? What they could do better: The Service User Guide needs to state accurately the numbers of staff in the home. Care plans could be expanded further to take into account service users’ broader support needs rather than their main need. The manager needs to ensure that the water system in the home is safe to protect against Legionnaires Disease. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 6 There is a plumbing issue in the shower room which needs attention. Some recommendations are given regarding staff records to be accessible in this home; for service user files to be audited; for a quality assurance system to be developed to assess and improve the quality of the service on an ongoing basis and for a risk assessment to be completed for the lack of window restrictors in the house for health and safety reasons. 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. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have sufficient information to make an informed choice about the home. Needs are appropriately assessed prior to admission. Service users are aware of their terms and conditions. The home has shown its capacity to provide a service which responds well to individual service users’ needs. EVIDENCE: The Statement of Purpose and Service Users’ Guide examined were satisfactory, except that the Service User Guide needs to be amended to specify that there is one staff member on duty during the day and not two. Referrals to the service are received from the Care Coordinator from the Community Mental Health Team. Assessments and risk assessments are sent with referrals. The Registered Manager visits the service user and confirms the information on the assessments using a further admission/assessment form. Both service users had the opportunity to have trial visits including overnight stays prior to their admission, though one service user liked the placement and admitted himself following his visit. Following the service users’ admission to the home and observation of the service user’s needs, the manager then completes a risk assessment form. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 9 Assessments were seen in both service users’ files examined and comprehensively outlined service users’ needs. Signed contracts were seen in service users’ files including fees, terms and conditions. The home has shown its capacity to meet individual service users’ needs. First Care Lodge (FCL) Referral forms include service users’ language, religion, spiritual and cultural needs and are taken into consideration to assist with service planning. One service user is English and the other is from a Caribbean background, though he is English speaking. The manager had a good awareness of the service users’ needs and through the assessments available to him and the good relationships he had developed with the service users, he was confidently able to state that presently neither of the service users have specific cultural, ethnic or religious needs. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ are consulted about their care plans though their care needs could more comprehensively be outlined. There is a positive approach to risk taking to enable service users to live independent lives. EVIDENCE: FCL service users’ care plans outlined service users’ main needs. They also identified objectives associated with the need and action required by service user and key worker. However the home was advised that the care plans could be expanded to be more holistic to include service uses’ needs for which staff offer support which may not solely be the service users’ primary needs. For example, supporting service users with their finances, prompting with household tasks, if relevant and where identified, and in one service users’ First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 11 case, the need for wake-in staff during the night for a newly admitted service user who initially requires this level of monitoring. Care plans were signed by the service user and reviewed by the home. The home follows the review system governed by the Care Programme Approach and care plans are reviewed six months to a year. Review meeting notes were seen dated 09/01/07. Service users are consulted about their care plans. Records seen and discussion with service users showed that service users are involved in assisting with meals in the home, shopping and with doing their own and other household chores. Risk assessments are comprehensive and outline levels of risk from low, medium to high and review dates entered. As the home encourages service users’ to live independent lives, there is a positive attitude towards risk taking. Service users therefore have freedom of movement in and out of the house and have a high degree of control and choice over they decisions make which affect them. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff play a key role in supporting service users to live fulfilling and independent lives. Service users’ are supported to make individual choices about their day time activities. Service users’ choices are valued and respected in the home. EVIDENCE: One service user has been resident since November 2006 and attends a rehabilitation centre for alcohol and drug dependency on a daily basis. He had friends who visited however he chose to stop their visits as he felt they were detrimental to him. The other person has been referred to Day Opportunities, a centre for people with mental health difficulties. He has minimal contact with his mother. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 13 He attends Stratford shopping centre, buys his personal shopping and clothes and both service users were assisted to become familiar with the area to access amenities as they choose. Both have keys and go in and out of the house independently. Both service users have a level of independence with meal preparation and also eat out. Staff assist service users to cook a meal in the evening. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. 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. Service users are pleased with the support they receive from their support workers. The home works well within a multi-disciplinary approach to meeting service users’ mental, emotional and physical health needs. EVIDENCE: Both service users informed that they liked living in the home and that the staff were supportive. One service user said he was very happy in the home and specifically mentioned that he liked the staff and high standards in the home. Records seen in service users’ files showed that they have access to their local community health services, including regular appointments and reviews with professionals from the Community Mental Health Team. All service users must have regular reviews to monitor their mental and physicall health progress and actions required as arranged by the Care CoOrdinator according to their level under the Care Programme Approach. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 15 The manager of the home and service user are present at these review meetings. Service users are monitored when taking their own medication on a daily basis and medication records were accurately recorded. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is (excellent, good, adequate or poor) This judgement has been made using available evidence including a visit to this service. Service users views are listened to and respected by staff leading to a high level of satisfaction with the home and lack of complaints. Service users know how to complain should they need to. EVIDENCE: The service users have not been resident over three months and there have been no complaints so far. The service users informed that they were aware of the complaints procedure and how to complain. Staff previously spoken to informed that they had received relevant training on adult protection. An adult protection policy is in place. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 17 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, 25, 26, 27, 28, 29, 30 Quality in this outcome area is (excellent, good, adequate or poor) This judgement has been made using available evidence including a visit to this service. The home is suitable for its stated purpose. It is bright, comfortable, pleasant and homely in style and provides a safe environment for service users. EVIDENCE: The premises is suitable for the stated purpose of the home and needs of its service users. The home is clean, pleasant and has a good standard of decoration and comfortable in its appearance. Each service user has a single bedroom containing a washbasin. Service users had personalised their rooms with their own effects such as photographs, pictures and other items such as their own bedding. Service users are encouraged to maintain their own rooms. On the ground floor is a kitchen, communal lounge, shower room/toilet and one service users’ room. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 18 On the first floor is another large pleasantly decorated and furnished lounge, bathroom and toilet and two bedrooms. There is currently no specialist equipment for service users with disabilities in the house. The homely feel to the house adds to the service users’ sense and experience of living independently with support in the community. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 19 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): 31, 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. Service users benefit from receiving support from a home which has a robust recruitment procedure and by living in a home which is committed to the development and training of staff. EVIDENCE: The manager informed that the staff who assist the service users are shared between this house and the other FCL residential home. The manager explained that the service users’ are usually out during he day but inform the manager of their movements and when they will return. It is mostly the manager who is on site, or any other staff member to offer support when service users return home. This has been working well so far according to the manager and service users spoken to. Neither of the service users require escorting or support when they are out or one to one supervision. However there is a wake-in staff member during the night to ensure that one recently admitted service user is adequately observed during his settling in period. There is a sofa bed in the office should there be a need for sleep-in staff. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 20 Staff records were checked at the other First Care Lodge home’s recent inspection and there has been no change in staffing since then. Staff files were generally in good order and contained all necessary documentation. The manager is currently engaged in merging systems and procedures with the new home. The manager was informed to keep separate copies of records related to all staff working in the home, such as their personnel records, training and supervision notes for the purpose of inspection. The inspector was satisfied at the last inspection that all staff have a minimum NVQ Level 2 qualification and that all staff receive supervision. The manager informed that they have recently subscribed to a system called WAN which assists to put together a staff training needs analysis profile of all staff. This will assist the manager to develop an individual staff or group training plan. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 21 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, 38, 39, 40, 42, 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager provides good leadership and management of the home. This is beneficial to staff who are effectively supporting service users and service users benefit from a receiving a good service. Some health and safety practises could improve. EVIDENCE: The manager is a qualified nurse and has shown that he has sufficient management skills and leadership to run the home effectively. This is evident in the accounts given by service users of their experience in the home and in the support they receive as well as in the quality of files, records and documents seen. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 22 Health and safety certificates and records were checked and were up to date and in order. Window restrictors were not in place. The manager informed the health and safety officer assessed that this was acceptable. However in view of the needs of the service users and their vulnerability to variable mental states, it is recommended that the manager undertakes a risk assessment regarding the need for or against the use of window restrictors. The manager must also ensure that he meets his legal obligation to ensure the safety of his water systems against Legionnaires Disease as a water safety certificate to evidence this was not available. During the tour of the premises it was observed that the tap in the ground floor shower room made a loud noise when switched on. This needs to be attended to. A requirement is given to ensure all opened foods in the fridge are labelled. It is recommended that the manager puts in place a quality assurance and monitoring system to seek the views of service users, family members or representatives and multi-disciplinary professionals associated with the quality of the service, as outlined in National Minimum Standard 39. In addition it is recommended that the manager puts in place a system to audit service user files to ensure that the quality of records are maintained. First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 23 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 2 2 3 3 3 4 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 x 3 1 3 First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard YA1 YA6 YA42 Regulation 5 15 13 (3)(4) Requirement The Service User Guide needs to be amended to accurately reflect the number of staff on duty. Care plans must be expanded to include all service users’ identified support needs. The manager must also ensure that he meets his legal obligation to ensure the safety of his water systems against Legionnaires Disease. The manager must ensure that all opened foods in the fridge are labelled. The plumbing issue affecting the tap in the ground floor shower room needs attending to. Timescale for action 15/04/07 15/04/07 15/04/07 4 5 YA42 YA42 13 (4) 13 (4) 15/04/07 15/04/07 First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 25 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 YA39 Good Practice Recommendations It is recommended that the manager puts in place a quality assurance and monitoring system to seek the views of service users, family members or representatives and multi-disciplinary professionals regarding service quality. It is recommended that the manager puts in place a system to audit service user files to ensure that the quality of records are maintained. It is recommended that the manager undertakes a risk assessment regarding the need for or against the use of window restrictors. 2 3 YA39 YA42 First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection East London Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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. Extracts may not be used or reproduced without the express permission of CSCI First Care Lodge Limited DS0000067805.V328207.R01.S.doc Version 5.2 Page 27 - 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. 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