Inspection on 02/12/09 for Gothic Lodge

This inspection was carried out on 2nd December 2009.

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

Other inspections for this house

Gothic Lodge 08/12/08

Gothic Lodge 12/02/08

Gothic Lodge 21/04/06

Gothic Lodge 06/12/05

Gothic Lodge 04/07/05

Gothic Lodge 07/03/05

Gothic Lodge 03/09/04

Gothic Lodge 24/03/04

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Ashlong House

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Edenvale

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Gothic Lodge 21 Idmiston Road West Norwood London SE27 9HG     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: Sonia McKay     Date: 0 2 1 2 2 0 0 9 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 39 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Gothic Lodge 21 Idmiston Road West Norwood London SE27 9HG 02087618044 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: gothiclodge@yahoo.co.uk www.larche.org.uk L`Arche Lambeth care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home Gothic Lodge is a large detached gothic style house with three floors. It is located in a residential road in West Norwood close to the organisations workshops, high street shopping and transport networks. The home is registered to provide care and accommodation for six adults with a learning disability. Accommodation is also provided for staff who provide support within the home and to other LArche staff. The house is spacious and is surrounded by a reasonably sized garden. The organisations gardening workshop is adjacent to the home. The home is one of a group of homes managed by LArche Lambeth, an Ecumenical Christian Community that welcomes people of all faiths and people of no stated faith. Strong emphasis is placed on the `community? of staff and service users. Prospective service users receive an information pack about the service and a copy of the most recent Commission inspection report is available on request at the home. Current fees range between £433.60 and £517.39 per week and depend on the Care Homes for Adults (18-65 years) Page 4 of 39 Over 65 0 0 6 6 0 8 1 2 2 0 0 8 Brief description of the care home support needs of individuals placed. Care Homes for Adults (18-65 years) Page 5 of 39 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 was carried out in nine hours over one day by one inspector. I talked with the interim home manager and area manager. I talked with two of the residents and observed how they were spending their time. I looked at records relating to care and how medicines are administered. I looked at staff recruitment and training records. I looked at the information sent to us by the home manager and incidents we had been notified about since the last inspection. Care Homes for Adults (18-65 years) Page 6 of 39 What the care home does well: What has improved since the last inspection? What they could do better: The written information about how staff should support each resident does not cover the full range of areas that would make them fully person centred. There is no standard format for recording the planning of care and current information is hard to locate. Staff may not have a full understanding of peoples care and support needs because of this. Key working is ineffective and annual reviews where residents are consulted about their goals and care are overdue in some cases. Staff seek emergency medical advice when necessary but there is a failure to effectively carry out specific health action plans and to maintain appropriate records about the health and welfare of the residents. Routine health screening and scheduled follow up treatment have been neglected in some cases. Medication administration is unsafe and must improve rapidly. Storage arrangements must also be improved. Systems to safeguard residents from abuse are inadequate and staff are not properly vetted before they start full duties with the residents. Financial records are poor also. Care Homes for Adults (18-65 years) Page 7 of 39 More could be done to ensure good hygiene and infection control. High staff turnover affects staff team training and development plans and key working. Recruitment procedures are not in accordance with good practise and they do not provide the necessary safeguards for vulnerable adults. The home has not had a registered manager for twelve months and interim management arrangements have not been adequate. The home needs clear and consistent leadership as the staff turnover is high. Record keeping is poor and systems for the effective running of the home are not in place. 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 8 of 39 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 39 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been no new admissions but the resettlement procedures in place ensure that the individual needs and aspirations of prospective residents are properly assessed before admission. Evidence: There are no new residents and there are no vacancies at this time. Resettlement procedures have been judged as good at previous inspections which have shown that peoples needs are properly assessed before admission and they are given ample opportunity to get to know the home before they decide whether to move in. Care Homes for Adults (18-65 years) Page 10 of 39 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 is some good written information about how staff should support each resident, although it does not cover the full range of areas that would make them fully person centered. There is no standard format for recording the planning of care and current information is hard to locate. Staff may not have a full understanding of peoples care and support needs because of this. Key working is ineffective and annual reviews where residents are consulted about their goals and care are overdue in some cases. Evidence: I looked at care plans and risk assessments for two people living in the home. Both have lived in the home for many years. One resident has a learning disability and a physical disability. She uses a wheelchair. There is some good information about her care and support needs. There is a detailed plan about her daily routines such as support required during personal care and how she is to be supported with some of her chosen activities. This plan were last reviewed in October 2009. The plan is single document covering many areas of care and Care Homes for Adults (18-65 years) Page 11 of 39 Evidence: support with a paragraph of information about each topic. There is a general risk assessment that looks at risk areas at home, for example, in the kitchen and during activities, such as sailing, one of the things that the resident enjoys. This assessment was last reviewed in December 2008 and is due for review this month. A risk assessment about safe moving and handling says that the resident is assisted with transfers by use of a sliding sheet and a hoist. The acting manager says that these mobility aids are not used anymore and the resident uses a steady instead. The risk assessment is incorrect. I note that the risk assessment was last reviewed in July 2000. There is no information about inspections of the residents wheelchair, or who staff should contact if they notice a fault. These plans must be reviewed to ensure that the information about safe moving and handling is accurate and reflective of the residents current need. We have made a requirement about this. Health care plans are in place and these plans tell staff how the resident should be supported to make and attend appointments with various health specialists, for example Orthotics clinic, GP and dentist. There is a guideline about daily physiotherapy exercises she is to be supported to do in the evening. There is no record of how the resident herself was consulted about the plans. I looked at plans for another resident who has a learning disability and some emotional needs. Again, a plan is in place and this gives information about personal care, health care and support with activities. I note that essential guidance has been prepared by a specialist health professional. This guidance tells staff how to support the resident wit her emotional needs. The guidance is not available to staff and there is no risk assessment. This is inadequate because the resident forms strong attachments to individual staff members at times and this can lead to challenging behavior. Staff must have information about how to work with her to avoid this happening. again, although some of the planning contains very good information, the plans do not cover the full range of needs and there is no evidence about how they have been agreed with the resident herself. Plans for the second resident were also mixed together with information hard to locate. Care Homes for Adults (18-65 years) Page 12 of 39 Evidence: The annual quality assurance audit says that residents attend annual review meetings with people that know them from within the LArche community to advocate on their behalf if an independent advocate is not available. After these meetings goals are set and plans are written around these goals. The last recorded internal annual review meeting for this resident is January 2008. So this review is overdue. Information about current care needs is hard to locate because each person has three different files of written information and not all files are accessible to staff on duty. Files contain old and new information and there is no standard system for care planning in place. I also note that some areas of support, for example, cultural needs are not routinely assessed or addressed. Key workers are allocated, but a high turnover in staffing is making the key working system ineffective. There is no evidence of current key working input in the records see during this inspection. Care Homes for Adults (18-65 years) Page 13 of 39 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are part of their local community and they take part in activities of their choosing, but most spend time within the community workshops and groups. Residents are supported to maintain their friendships and relationships with relatives and they are able to take part in the chores around the home if they are able. Evidence: Larche is a faith based community that offers active support to each resident to enable them to develop their faith and spiritual lives. Residents who choose not to attend religious activities of any particular denomination are offered opportunities to engage in art, music and nature. Most of the current residents attend Larche workshops and groups for daytime activities. One person attends a local authority daycentre three days each week and another person, who has increasing dementia needs, has one to one support to stay at Care Homes for Adults (18-65 years) Page 14 of 39 Evidence: home in the daytime if he wishes. He had been attending a regular retirement group within the community but does not want to go out so much anymore. The close proximity of the other Larche homes provides a close community. Residents regularly have supper invitations to see friends living in other homes in the area. Larche Lambeth has been operating for more than 25 years and has developed good relationships with local individuals and organisations. Staff live at the Gothic Lodge with the intention of building a shared community with consistent engagement between the staff and residents. All residents are offered a minimum of two weeks of holiday away from the home in each year, either alone with staff support or as part of a group with shared interest. There is a range of in-house activities available, including television, DVDs, music and musical instruments. Evening and weekend activities in the community and at home are also provided. Personal information held in individual care files contains detailed information about family and friends, their birthdays and family history. This enables staff to support residents to maintain and develop family relationships. Records of the meals prepared show that a range of meals is served. Food stocks are plentiful and include plenty of fresh fruit and vegetables. Dry goods stored in a pantry are securely stored in air-tight containers. This helps to keep them free from pests. The assurance audit says that one resident requires soft options as has difficulty with swallowing, there is in house training about preparing these soft textured meals. Each resident chooses and helps to prepare an evening meal to the best of their ability and staff and residents eat main meals together at a large dining table, often with friends. Residents also make snacks and drinks without support if they are able. Residents were observed to be engaged in activities of their choosing. The home is getting ready for Christmas and they are putting up decorations. Residents move freely around the home and can choose whether to be alone or in company. I observed some good interaction between with the home manager and Care Homes for Adults (18-65 years) Page 15 of 39 Evidence: some of the residents. The records I looked at for two of the residents had some useful activity support information. However the information had not been reviewed for many years in some cases. Lack of a clear care and support planning system may be a factor. Care Homes for Adults (18-65 years) Page 16 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive support to manage their personal care and this is done in private. Key working is ineffective because of a high staff turnover. Staff seek emergency medical advice when necessary but there is a failure to effectively carry out specific health action plans and to maintain appropriate records about the health and welfare of the residents. Routine health screening and scheduled follow up treatment have been neglected in some cases. Medication administration is unsafe and must improve rapidly. Storage arrangements must also be improved. Evidence: Personal care guidelines are detailed. The manager said that emphasis is placed on inducting new staff on the specific daily routines of each resident. She said that although many staff are new they are settling in and getting to know the personal routines of each resident. A key working system is in place but it lacks consistency and continuity because of frequent changes in staff. All of the residents need some form of assistance with personal care and two need Care Homes for Adults (18-65 years) Page 17 of 39 Evidence: assistance with toileting and continence care. Personal care is provide by same gender staff in the privacy of bedrooms and bathrooms. The manager said that one resident has increasing dementia care needs and she is seeking training for staff. Additional staffing has been arranged and floor covering in a bathroom has been changed because he appeared to be anxious about the colour of the original lino as it was very dark. It has been covered over with a light coloured floor covering which he finds easier. The quality assurance audit says that residents are supported to make good decisions about when to get up or go to be depending on their plans, but that there are no fixed times. Residents were observed to be well dressed in their own styles. Staff help them to select weather appropriate clothing when necessary. It was a cold rainy day and the residents were wearing warm outdoor clothes. The manager assesses that they could improve health care by having clearer information available about each persons health care support needs and how they access that health care. I looked at the health care records for two of the residents and it was difficult to see what health care had taken place because the records are poor. But there is some useful information on file about historical medical treatments. The interim manager, who has only recently taken over the day to day management of the home, helped by looking in house diaries to try and find notes made about appointments attended. The manager assesses that they could improve health care by having clearer information about health care support needs and how they access that support. Each resident has a set of health care plans that record who they should see and how often, for example, the chiropodist, four times each year. One of the residents is meant to see the chiropodist four times each year. Her records show that the last time she had treatment was in August 2008. The home manager said that the chiropodist had visited the home recently and she found an entry in the communal house diary that says the chiropodist planned to visit the home in October 2009. There is no record of this health care. The resident wears orthotic shoes and must have regular checks to ensure correct Care Homes for Adults (18-65 years) Page 18 of 39 Evidence: fitting. A record attached to her orthotics care plan says that she last attended the clinic in December 2008 and that there should be a follow up appointment in five months. There is no record of any such follow up in the last twelve months. There is a health care plan dated April 2009 that says a breast check is needed but the attached record has no record of any action taken about this. There is a physiotherapy care plan in place. It says that the resident should receive physiotherapy at the day centre she attends. The last record of this taking place was in March 2008. The manager is unsure whether this takes place. Elsewhere in this persons records there is good information about the daily physiotherapy exercises that staff have to support the resident with in the evening. There are no records of this happening in the daily notes although the manager assured me that staff induction is focused on the in house routines and that these exercises are still being supported to take place in the evenings and only refusals would be recorded. The resident prefers home visits from the GP as she is a wheelchair user and it easier for her to be examined at home. The manager tries to arrange this and has made a note of issues to be discussed at the next appointment, which has yet to be arranged. There is a record that she saw a dentist in September 2009 for a dental check and no treatment was required. Staff support the resident with dental hygiene. The resident was admitted to hospital with severe constipation earlier this year. The manager said that this is now better controlled by monitoring of her bowel function, use of laxatives and a better diet with more fibre. The resident is not keen on drinking much fluid, but she enjoys soft jelly so this is being encouraged because of the fluid content. There is a record of concern recorded in March 2009. A member of staff noticed that the resident had bruises on her arm and hand and a swollen knee. There is a record that she saw the GP. There is no body chart to show the areas of injury. The homes coordinator had arrived at the inspection and he had been managing the home at that time. He said that the record of concern had been sent to the local authority care manager but there is no record of any investigation or outcome of this referral. He said the bruises were most likely caused whilst the resident moved around the building in her wheelchair. The Commission was not notified of the unexplained bruising at the time. Care Homes for Adults (18-65 years) Page 19 of 39 Evidence: Staff complete a daily diary making a brief note about the general welfare of the resident. These notes are not kept consistently and there are many days where there is no record of any care and support provided. We have made a requirement about this under record keeping. On Th July 2009 there is a diary entry that says the member of staff noticed scratches on the residents arm. The scratches were bleeding. The member of staff did not know how it had happened but noted that it was definitely something in house and staff should watch out. Again there is no body chart to identify the injury. The resident has communication needs. There is no accident record and no notification was made about this. There is no record that the local authority was notified either. There is no record of how this unexplained injury was followed up or of any first aid provided. This has safeguarding implications. The last record of this residents weight was made in 2008. This legally required information must be recorded regularly as weight changes may be as a result of an underlying health condition. The manager said that staff had noticed a weight gain prior to an emergency hospital admission earlier this year. We have made a requirement about this under record keeping. Health care records for the second person were also difficult to locate. Again a health action plan for chiropody says hat the resident should see a chiropodist four times each year but there are no records since November 2008. We have made a requirement about this. The last recorded GP appointment was in December 2008. A dental record has an entry in March 2009 that says a follow up appointment should be made for April 2009. There is no record of whether this appointment was made and there are no further records. We have made a requirement about this. The resident has had two operations this year. These surgeries have been to correct her eyesight. There is a record of this health care. There are guidelines for managing physical aggression but these are not date and there is no record of when the information was last reviewed. There is a support guideline for taking the resident to have her ears syringed but no Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: record of when this should be arranged. There are gaps in the daily records of the residents wellbeing and information recorded does not include a record of care provided. We have made a requirement about this under record keeping. I looked at how medicines are handled. Medication is stored in a small locked room in a set of lockers. One locker for each person. Medication administration records are kept in the room for easy reference. There is a photograph missing. This must be added to the record so that staff are reminded of who the medication is for when they are preparing to administer. Bowel monitoring charts are kept with the records so that staff can reference them whilst deciding on the appropriate laxative treatment required for one of the residents. The resident is prescribed many creams and the directions on the charts do not specify when and where the cream is to be used. We have made a requirement about this. The directions for the use of one cream, diprobase, say that it should be used twice each day. This direction has been amended by hand to say once a day. It is not clear whether the prescriber had authorised this change of dose. We have made a recommendation about recording changes and a requirement about ensuring medicines are given as prescribed. A prescribed shampoo with directions that it is to be used twice each week was used on nineteen consecutive days. This was picked up by the acting manager last week and the shampoo has been used as directed since then. A requirement is made about this. One cream says that it should be used as required but it is being used very day. There is no direction about where it is to be applied and when it is should be used. We have made a requirement about this. A recent medication administration records has a sticker applied to the directions area. This is bad practise. The manager was not sure if this had been done by the pharmacist or a member of staff. We have made a recommendation about this. Directions for the use of an as required analgesic, paracetamol are incomplete. There is no record of the strength of tablet being administered. This as required medication Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: is being administered daily but there is no record of why. We have made a requirement about this. The manager assesses that the home could improve by making clear the reasons why medication is prescribed and what potential side effects may be. The manager said that staff are trained in the safe administration of medicines and in house procedures during induction and they do not administer medications until they have been trained. There is no list of trained staff in the file and there is no sample signature record. This is good practise as it identifies who has administered a medication. This is recommended. As required in the previous inspection report there is regular stock checking of the medications. This prevents stock running out and monitors if medications are being administered correctly. There is now a note of the reason for any discrepancies in the quantities of medicine in stock, for example if a medication was disposed of. Method of disposal is not recorded as it should be. There are no controlled drugs in use. There is no controlled drugs storage available and this is now a requirement, in case any are prescribed. Care Homes for Adults (18-65 years) Page 22 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities to make complaints and raise concerns. However, systems to safeguard them from abuse are inadequate and staff are not properly vetted before they start full duties with the residents. Financial records are poor also. Evidence: There is a poster in the kitchen with photographs of people who can help residents with making a complaint and there is a complaints procedure. A record is available but there are no complaints recorded. The manager assessed that there had been no formal complaints this year. There are regular house meetings and the manager says that the complaints procedure is brought to the attention of the residents during these meetings so that they have a chance to raise any concerns and have them addressed quickly. During case tracking I saw that staff are not clear about what action to take when they find that residents have unexplained injuries. There is no procedure in place for recording the injuries, for example use of a dated body chart form, or record of any follow up, which may include notifying the appropriate authorities. A house visitors book is in place and is being used. Care Homes for Adults (18-65 years) Page 23 of 39 Evidence: There are four new members of staff. I looked at records for two. Neither had an enhanced criminal records check but both had applied and both had the early vetting of a POVA check. I checked records of when the staff had started working in the home and both had started before the pova check had been completed. This is unsafe. Both were undertaking full duties, including personal care, before their enhanced criminal records check had been completed. This is unsafe. I spoke with the home manager. She was unaware that full checks were not in place and I spoke with the human resources officer for Larche and she was not clear about restrictions on staff with only an initial check in place. I looked at how the home looks after peoples money and valuable and how they support them to budget. there are no individual financial support plans to record the type of support required for each person in regards to managing their finances, saving and budgeting. Small amounts of cash are store in a lockable cabinet. The manager has recently revised the system so that she has more control. I looked at records and did a spot check on valuables held for one person. The resident had seventy one pounds in a wallet and the record says she should have only forty four pounds. I asked the manager about this and she said that there had been a period of significant error and when records were recently audited by the Larche finance officer the discrepancy was discovered. I looked at the records and a number of receipts. Staff had kept receipts but not completed or signed a record on many occasions. The records were not audited at all between July and November 2009. Financial transactions should be recorded properly and should be signed by two members of staff. The records and receipts should be checked regularly. I found foreign currency, one hundred and forty Euros, and a passport held in safekeeping but with no record. I found a piece of paper with a handwritten note that said the residents bank book had been sent to the benefits agency in January 2009. The manager said she had been looking for the bank book. We made a requirement about this at the last inspection and the requirement has not been addressed. There is no inventory of the residents possessions and furniture. Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: This evidence of failure to ensure systems are in place to protect residents from abuse. Care Homes for Adults (18-65 years) Page 25 of 39 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 reasonably well maintained and homely. Most commual areas are accessible and it is close to shops and transport links. More could be done to ensure good hygiene and infection control. Evidence: The home is a large, gothic style house with many original features. It is in keeping with other homes in the area and is comfortable, welcoming and reasonably well maintained. Although the home is registered for people with a physical disability one of the communal areas, the kitchen, including the facilities, is not readily accessible to wheelchair users. There are large cracks in the walls of the kitchen. The manager said that surveyors had recently attended and said it was safe. These cracks, and any underlying problem, will need repair. The home is a short walk from high street shopping and public transport networks. Bedrooms are located on the ground floor and the first floor of the home. All bedrooms Care Homes for Adults (18-65 years) Page 26 of 39 Evidence: are single occupancy. A profiling bed with a window view is available in the ground floor bedroom of a resident with a mobility need. Bathroom aids and adaptations are in place where needed and there are a sufficient number of bathrooms and toilets available. Assessment of a ground floor bathroom to meet the needs of one resident with increasing dementia care needs is required, as temporary flooring of a colour he is able to see properly and walk on, may present a trip hazard after time. The manager said further adaptations are planned. There is level access to all communal areas of the home, which are all situated on the ground floor, including access to the large garden. The home is clean and satisfactory arrangements are in place for the disposal and handling of clinical waste, although there are no regular checks for pests or vermin being done. I observed yellow bags of clinical waste being stored by a bin in the back garden. This is poor hygiene. The manager said that this was only temporary whilst the clinical waste shed was being reorganised. Automatic door closure devices, that shut the door automatically if the fire alarm goes off, are fitted to the fire doors in the ground floor hallway. This means they can be safely left open during the daytime to enable a resident who uses a wheelchair to move around the building more easily. Risks posed by having unguarded surfaces, such as central heating radiators, have been assessed and a radiator cover fitted in a bedroom as a result. There are damaged areas of carpet on the first floor communal hallway floor. This was a trip hazard at the last inspection and a requirement was made for the carpet to be repaired or the floor covering replaced. A temporary repair involving strips of durable tape is in place. This will not last for long and the strips may present a hazard if not repaired properly or the carpet replaced soon. The ground floor hallway carpet and lounge carpet have been replaced. The manager assesses that a newly introduced individualised laundry system was now in place and working well. A new washing machine that can wash at appropriately high temperatures is also in place. This helps with infection control. Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: The manager assesses that the home could better promote the need for regular hand washing and there are plans to do that in the next twelve months. A chest freezer has damaged seals and residents cannot access the contents easily. The freezer seals should be repaired and when the freezer is replaced a more accessible design would be preferable. Care Homes for Adults (18-65 years) Page 28 of 39 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. High staff turnover affects staff team training and development plans and key working. Recruitment procedures are not in accordance with good practise and they do not provide the necessary safeguards for vulnerable adults. Evidence: In the Larche community of homes in the area, the care staff are called assistants. There are two or three assistants on duty each day and two assistants are appointed to be available, if needed, during the night. Most assistants live on premises. There is no waking cover at night. If there is a vacant post this shortfall is filled by Larche assistants from neighbouring homes in the Larche community or by agency carers. A record is kept of which assistants were on duty on each day. The Larche community also has a team of assistants who staff day services. These are based at workshops or shared interest groups. There is also a small team who focus on involving people in community based activities. There are seven staff at Gothic Lodge. Five members of staff have left and been replaced in the last year. Care Homes for Adults (18-65 years) Page 29 of 39 Evidence: None of the staff have attained a vocational qualification in care although four are undertaking a learning disabilities qualification. The manager assesses that the home must improve in analysing the training needs of the team against the training dictated by the specific care needs of the residents. She aims to do this in the next twelve months. There is a staff training and induction programme in place staff and staff. High staff turnover means that residents have to share their home with, and get to know, new staff frequently. The turnover also reduces the impact of the training and development plan. Most staff are from overseas and visa restrictions mean that staff often leave after completing the first years foundation training. There are four new members of staff. I looked at records for two. Neither had an enhanced criminal records check but both had applied and both had the early vetting of a POVA check. I checked records of when the staff had started working in the home and both had started before the pova check had been completed. This is unsafe. Both were undertaking full duties, including personal care, before their enhanced criminal records check had been completed. This is unsafe. I spoke with the home manager. She was unaware that full checks were not in place and I spoke with the human resources officer for Larche and she was not clear about restrictions on staff with only an initial check in place. A requirement is made about this. Care Homes for Adults (18-65 years) Page 30 of 39 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. The home has not had a registered manager for twelve months and interim management arrangements have not been adequate. The home needs clear and consistent leadership as the staff turnover is high. Record keeping is poor and systems for the effective running of the home are not in place. Evidence: The post for registered home manager is vacant since December 2008. The area manager was providing interim management cover with a key member of staff until recently, when a registered manager from another Larche home assumed the responsibility. The acting manager has lived and worked in the community for many years and knows the residents well. There are regular monthly inspection visits conducted by representatives of the registered provider. Copies of reports from recent inspections are maintained at the home and these indicate that the inspections are now happening each month. This is a way for the registered provider to monitor the service being provided, although there is failure to identify significant failure in record keeping and financial accounting. Care Homes for Adults (18-65 years) Page 31 of 39 Evidence: Regular house and community meetings are held to ensure that residents are involved and consulted about the running of the community and planning home life. There is no defined quality assurance system in place and there is a need for wider consultation, for example surveying the views of all stakeholders. There is evidence throughout this report that interim management arrangements have been inadequate and the home has failed to maintain many important records. Requirements are made about this. There have been significant changes in all senior positions in the Larche community and the new manager is also yet to decide whether to stay at this home or return to the home she was managing elsewhere in the community. Staff conduct regular health and safety checks of the premises and record the outcomes. An environmental risk assessment is reviewed annually. Fire evacuation drills take place regularly and the manager said that fire evacuation procedures,a fire risk assessment in light of the increasing needs of some of the residents, and an up to date building floor plan are complete. The Commission issues a certificate providing details of the type of service that the home is registered to provide. As required in the last inspection report, both pages of the certificate are now displayed but the certificate is out of date because it does not reflect changes in both the manger and registered provider. A new certificate was sent out and must be displayed. An Employers liability insurance certificate is displayed. Care Homes for Adults (18-65 years) Page 32 of 39 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 17 The registered person must 11/05/2009 ensure that there is a record of all money and valuables held in safe-keeping on behalf of any resident. To protect residents from financial abuse. Care Homes for Adults (18-65 years) Page 33 of 39 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 17 The registered provider shall 31/01/2010 maintain in respect of each service user a record of information specified in Schedule 4. Records are not being kept when money and valuables are held in safe keeping. Records are not kept of personal possesions like items of furniture. 2 9 13 Risks assessments relating to moving and handling plans must be up to date at all times. To ensure the health and safety of the residents. 31/01/2010 3 19 13 The registered person must ensure that adequate arrangements are in place for residents to receive where necessary treatment, advice and other services from any health care professional. 31/01/2010 Care Homes for Adults (18-65 years) Page 34 of 39 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 ensure that health care needs are addressed. 4 20 13 Medication storage must allow for the storage of a controlled drug. There is inadequate storage at this time. 5 20 13 Medication administration 31/01/2010 records must contain accurate directions for use and what dose of medication is to be given. To ensure the health and safety of the residents. 6 20 13 The registered person must ensure that residents receive their medication as prescribed. To ensure the health and safety of the residents. 7 23 13 The registered person must make adequate arrangements, by training staff, or by other measures, to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. Safeguarding procures are lacking in areas of recruitment, accounting for personal possessions and 31/01/2010 05/01/2010 01/03/2010 Care Homes for Adults (18-65 years) Page 35 of 39 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 accident and incident recording. Staff need additional training. 8 30 13 Clinical waste must be stored corectly. For infection control. 9 34 19 The registered person must 31/12/2009 not employ staff to work in the home unless satisfactory information, and documents in accordance with Schedule 2 of the Care Homes Regulations 2001 are in place and available for inspection. Staff have been fully employed and working in the home before adequate checks have been made. 10 41 17 The registered provider shall 31/01/2010 ensure that all records are kept up to date and are available for inspection. There are inadequate records about accidents and injuries. There are inadequate records about the condition of the residents and what health care has been provided. 31/12/2009 Care Homes for Adults (18-65 years) Page 36 of 39 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 11 41 17 The registered provider shall 31/01/2010 maintain in respect of each service user a record of information specified in Schedule 3. There are inadequate records about accidents and injuries. There are inadequate records about the condition of the residents and what health care has been provided. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 There should be a standard format for care plans so that the staff, who change frequently, know what areas of care and support to review and plan for. Care plans should be in place for all areas as listed in National Minimum Standard two, which covers needs assessment. Activity support plans should be reviewed regularly and amended when needs change along with other areas of care planning. Changes in the directions of use for any prescribed medicines, for example dose or frequency of administration, should be properly recorded with account of who has authorised the change and when. Handwritten entries should be signed. There should be a sample list identifying the staff signatures used on the medication administration records. This maintains a record of who has administered the medication. Page 37 of 39 2 6 3 12 4 20 5 20 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 Care Homes for Adults (18-65 years) Page 38 of 39 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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