Inspection on 10/01/08 for Hartwood Lodge

This inspection was carried out on 10th January 2008.

CSCI found this care home to be providing an Adequate 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hartwood Lodge 29/06/07

Hartwood Lodge 27/03/07

Hartwood Lodge 12/05/06

Hartwood Lodge 15/02/06

Hartwood Lodge 21/10/05

Hartwood Lodge 20/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Hartwood Lodge 14 Bushwood Leytonstone London E11 3AY Lead Inspector Peter Illes Unannounced Inspection 10th January 2008 09:00 Hartwood Lodge DS0000007249.V357205.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 Hartwood Lodge DS0000007249.V357205.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. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hartwood Lodge Address 14 Bushwood Leytonstone London E11 3AY 020 8518 8988 020 8532 9842 manager.hartwoodlodge@careuk.com 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) Care UK Mental Health Partnership Limited (Arc Healthcare Limited) Karlene Yvonne Palmer Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 17 29th June 2007 & 5th October 2007 2. Date of last inspection Brief Description of the Service: Hartwood Lodge is a private care home owned by Care UK and is registered to provide care and support to seventeen adults with mental health problems. The home is a large converted three storey residential property. The ground floor comprises: the home’s dining room; main lounge; small quiet room; five residents’ bedrooms, four of them grouped in a separate unit for female residents, called the “ladies” area; bath/ shower and toilet facilities; kitchen; kitchenette for residents; laundry; medication room; main office and entrance hall. The first floor contains eight bedrooms and bath/ shower and toilet facilities and the second floor contains four bedrooms and bath/ toilet facilities. All the bedrooms are for single occupancy and contain a wash hand basin. The home also has a pleasant rear garden with two storage sheds and a paved front garden used for car parking. The area is well served by public transport and the home is within walking distance of shops and other community resources. A stated aim of the home is to promote and encourage each individual to achieve his/her level of independent functioning, leading to independence in daily life. At the time of the inspection, the weekly fee was from £650 per week depending on the person’s assessed need. The provider makes information available about the service, including inspection reports, to people living in the home and to other stakeholders. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. At the last key inspection serious shortfalls were identified in the home’s assessment/ admission procedures, care planning procedures and the food served to people living in the home. Following this the Commission issued a statutory enforcement notice regarding these shortfalls to the registered provider under the Care Standards Act 2000. This required compliance and informed them that they may be prosecuted without further notice if compliance was not achieved. A random inspection was undertaken at the home on 5th October 2007 to verify compliance with the statutory enforcement notice and the results of that inspection are reported in the relevant sections of this report. This key unannounced inspection took approximately seven and one half hours with the registered manager being present or available throughout. There were nine people accommodated at the time of the inspection and eight vacancies. The inspection activity included: meeting and speaking with the majority of people living in the home although most chose not to speak to me independently on this occasion; independent discussion with three care staff; detailed discussion with the registered manager; independent discussion by telephone with a placing care manager from the L.B. of Tower Hamlets and independent discussion by telephone with a placing care manager from the L.B. of Waltham Forest. Further information was obtained from: an Annual Quality Assurance Assessment (AQAA) submitted by the home to the Commission prior to the inspection, a tour of the premises and documentation kept at the home. What the service does well: The registered manager and a relatively stable staff group are working hard to review and develop the service offered to residents, some of whom have complex needs and behaviour that can challenge the service. A care manager for one of the placing authorities stated that the home deals with the person he has placed very well and that the home always keeps him informed of any issues. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: A requirement was made at the last key inspection relating to quality assurance. Progress was seen to have been made in this area although some further work is still necessary and this requirement is restated. At this inspection a further eight requirements are made in the following areas: records relating to health care appointments; lockable spaces in residents’ bedrooms; the physical environment; arrangements for residents that smoke; staffing; records relating to staff recruitment and two health and safety issues. Please contact the provider for advice of actions taken in response to this Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 7 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. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Up to date information is available to prospective residents and other stakeholders to make an informed choice about living in the home. The assessment process for people referred to the home has been made significantly more robust to ensure that, if admitted, the home can meet the person’s needs. The reassessment of people’s needs once they are living in the home have also been improved to further assist staff be aware of any changes in these needs. EVIDENCE: At the last inspection a requirement had been made that the registered persons must ensure that the Hartwood Lodge Statement of Purpose reflects fully the level of detail required in Schedule 1 of the Care Homes Regulations 2001. At this inspection I was given a copy of a revised statement of purpose and judged it to be satisfactory. At the last key inspection serious shortcomings in the home’s assessment processes for new people referred to the home were identified in that the home had failed to take adequate steps to ensure the safe and appropriate admission of new residents into Hartwood Lodge. As a result of these shortcomings the Commission issued a Statutory Requirement Notice requiring the home to: Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 10 • ensure that no new people are admitted to Hartwood Lodge unless there has been a comprehensive and current assessment of needs undertaken prior to admission and the service confirms in writing to the person that the home is suitable to meet their identified needs. The Notice also informed the registered persons that if they failed to comply within the given timescale they could be prosecuted without any further notice or warning. I subsequently received a response from the responsible individual for the provider organisation outlining the actions the home would take to comply with the statutory notice. This included that a Regional Manager from Care UK would personally scrutinise all referrals and admissions to ensure they met Care UK’s policies and procedures regarding admission. I undertook an unannounced random inspection of the home on 5th October 2007 to test compliance with the Statutory Requirement Notice. At that inspection I was informed that no new people had been admitted to the home since the last key inspection, which took place on 29th June 2007. I saw that a revised assessment system had been put in place at the home and saw relevant documentation to support this. This included a revised referrals and admissions policy for the home. This documentation was satisfactory and I was informed that when new people had been assessed for admission to the home that a letter would be sent to them prior to admission confirming that the home could meet their assessed needs. As no people had been admitted to the home since the last key inspection I informed the registered manager that the admission process and documentation relating to any new admission to the home would be inspected in detail at the next key inspection. At this inspection I was informed that no new people had been admitted to the home although one person had been assessed following a referral being made. The registered manager stated that she had carried out the initial assessment on the person and judged that the home would be unable to safely address the person’s needs. I was shown the completed initial assessment form for this person and also e-mail evidence that the Regional Manager had considered the referral and had agreed the registered manager’s decision not to admit the person to the home. I also inspected the files of four residents at the home. These all showed evidence that the individual’s needs had been reassessed by the home since the last key inspection using the home’s revised assessment system. The reassessments seen were clear and detailed and included evidence that the person concerned had been involved in the assessment process. Evidence was also seen on two plans inspected of reviews having been undertaken by placing authorities and on others of Care Planning Approach (CPA) meetings having recently been undertaken. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. There has been an improvement in how the home agrees and records people’s needs in their care plans to assist staff in meeting these needs. People are supported to maximise their independence by making as many decisions as possible for themselves. People are also more effectively supported and guided in relation to taking appropriate risks in their lives to assist them to safely achieve their aspirations. EVIDENCE: At the last key inspection serious shortcomings in the home’s care planning processes were identified. As a result of these shortcomings the Commission issued a Statutory Requirement Notice requiring the home to: • Ensure all residents have a care plan underpinned by a comprehensive risk assessment, DS0000007249.V357205.R01.S.doc Version 5.2 Page 12 Hartwood Lodge • • Ensure that the care delivered to residents reflect their preferences and this is recorded on the service users care plan, Ensure the service can demonstrate how residents are involved in decisions relating to the assessment and planning of their care. The notice also informed the registered persons that if they failed to comply within the given timescale they could be prosecuted without any further notice or warning. I subsequently received a response from the responsible individual for the provider organisation outlining the actions the home would take to comply with the statutory notice. This included that Care UK would ensure that residents had adequate care plans in place underpinned by a comprehensive assessment of need and specific interventions required to meet these needs. The response also stated that a Regional Manager would personally review every care plan for every resident by 20th September 2007. I undertook an unannounced random inspection of the home on 5th October 2007 to test compliance with the Statutory Requirement Notice. At that inspection I sampled two people’s care plans at random. The assessment of needs for both of these people had been reassessed in August 2007 and each contained a satisfactory risk assessment. Both care plans seen were detailed, covered the areas of need identified in the assessments and had been signed by the person concerned. At this inspection I inspected the care plans for four people living at the home. These were seen to relate directly to current recorded assessment information regarding the person’s needs as outlined in the Choice of Home section of this report. The care plans showed: each identified need, the desired outcome, short term goals and action/guidance needed by the key worker/ staff and action required by the person themselves in order to achieve the agreed goals/ outcomes. The plans also showed evidence of a monthly evaluation of the plan by key workers that showed areas where progress had been made and any changes that might increase opportunities to achieve the desired outcomes. There was evidence that the people living in the home had been involved in their care planning process including the person signing the care plan or else a note on the plan to indicate that the person had refused to sign. People living in the home spoken to independently indicated that they had been involved in drawing up their care plans. The four files inspected all included clear risk assessments that identified risks and gave guidance on how to minimise these. Evidence was also seen that the risk assessments were being regularly reviewed and that the identified risks informed the person’s care plan. Evidence of other general risk management strategies was seen including managing access to knives in the kitchen. Evidence was also seen that staff had received training in care planning and risk management since the last key inspection. Staff spoken to were able to Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 13 explain how they were incorporating elements of this into their roles, including that of key worker. An example of this was one member of staff describing how the home was trying to assist a person with their alcohol consumption without imposing unacceptable limitations. A L.B. of Tower Hamlets care manager for one person with a range of complex needs, including with relation to alcohol consumption, was spoken to independently by telephone. He stated that the home deals with the person very well and always keeps him informed of any issues. It was also noted in each file inspected that the home has introduced a Record Keeping Audit Tool. This is a system that assists managers to monitor recording, including in people’s care plans and risk assessments, to assist in checking that this recording is relevant and up to date. People living in the home are encouraged and supported to make decisions about their day-to-day lives and evidence was seen that they are encouraged to participate in any meetings or discussions relating to them. The home has introduced weekly residents’ meetings and minutes of these were seen. Recent topics discussed included menus and food preferences, how to make a complaint, activities, and preparation for the 2007 Christmas party. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are working hard to encourage and support people living in the home to participate in a range of activities including within the wider community. People living in the home also enjoy contact with relatives and friends to the extent that they wish. People also have their rights respected that they appreciate and they enjoy an improved range of healthy and nutritious meals. EVIDENCE: At the last inspection a requirement was made that the registered person must ensure residents are sufficiently supported to access appropriate activities outside of the home. Staff were seen to be working hard to comply with this requirement although I was informed that the home has difficulty in motivating the majority of people to take part in any activity. The majority of people living at the home can and do travel independently, especially in the local community, and have freedom passes to assist with this. Evidence was also Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 15 seen that some people also travel in the community with the support of staff because of their specific needs and preferences. People were observed leaving and returning to the home independently during this inspection and another person was accompanied out by a member of staff to see a beautician. Three of the current residents are from different ethnic minority communities and their cultural needs and preferences are recorded and acted upon by the home to the extent that those individuals want. People living in the home indicated that that they felt their individuality was respected by staff. Staff also reflect the diversity of people that live in the home and have undergone training in promoting equality and diversity. It was noted that the home’s current assessment of need system includes identifying people’s needs and preferences with regard to culture, sexuality and religion. One person is currently supported to attend church when they wish to attend. Evidence was seen that the majority of people living at the home have contact with relatives and friends ranging from weekly to annual contact depending on the wishes of the individuals involved. The home’s statement of purpose indicates that the home operates an open visiting policy and people spoken to confirmed that visitors were made welcome. All residents are offered a key to their rooms, this is recorded in their care plans and people were seen to use these. One person stated that they did not have a key to their room. The registered manager stated that the person was issued with a key and had probably lost it, she went on to say that this happens quite frequently with some people. The registered manager stated that replacement keys are on order and the identified person would be given another key when they were received. Residents have the opportunity to be with others or be alone as they choose and are able to access the community as they wish. Staff were seen to interact with residents in a friendly and appropriate way during the inspection, including trying to motivate people to engage in meaningful activities. At the last key inspection serious shortcomings were noted in relation to the meals provided at the home. As a result of these shortcomings the Commission issued a Statutory Requirement Notice requiring the home to: • Ensure that people living in the home are provided with adequate quantities of suitable, wholesome and nutritious food. The notice also informed the registered persons that if they failed to comply within the given timescale they could be prosecuted without any further notice or warning. I subsequently received a response from the responsible individual for the provider organisation outlining the actions the home would take to comply with the statutory notice. This included that a comprehensive review of the menu Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 16 provision had been undertaken and implemented and attached to that response was a sample of the proposed menu that the responsible individual stated had been clinically reviewed for nutritional content and appropriateness. I undertook an unannounced random inspection of the home on 5th October 2007 to test compliance with the Statutory Requirement Notice. At that inspection I saw a range of the new menus that were satisfactory and noted that people living in the home had been consulted regarding these. The menus showed a range of healthy and nutritious meals with a choice for each main meal shown. I also saw evidence from an e-mail dated 20th September 2007 from a Community Dietician that the home had consulted that service regarded the menus and had acted upon the comments received. I was also informed that it was the home’s intention to undertake a major review of the menus quarterly and make appropriate seasonal variations, in consultation with people living at the home. I noted that one person living at the home suffers from diabetes and that this person’s G.P. had been consulted separately regarding their diet. I also noted that the home’s nutritional needs policy had been updated and revised and that monthly weight checks were being undertaken for people who there may be concerns about in this area. I visited the kitchen and noted that the home had a sufficient supply of food for that day’s meals that corresponded with the meals shown on the menu for that day. I also briefly spoke to some of the people living at the home who stated that they felt the meals at the home had recently improved. At this inspection I again reviewed the home’s menu and checked the quantities of food stored in the home, both of these were satisfactory. Evidence was seen from both menus and people spoken to that meals that meet people’s cultural preferences are included on the menu and that there is a choice at every main meal. Both records of residents meetings and several people living in the home that were spoken to confirmed that people were being consulted on a regular basis regarding the food served. People spoken to also confirmed that the meals served were more varied and enjoyable than previously. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 17 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 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is working hard to try to provide appropriate personal care to meet peoples’ assessed needs, including involving other stakeholders where appropriate. People are also supported in meeting their physical, mental and emotional healthcare needs although record keeping needs improving to assist staff be more proactive in meeting people’s needs in this area. People are safeguarded by the home’s medication policies and procedures. EVIDENCE: The majority of people living at the home are independent regarding their personal care although some of these may need some verbal prompting on occasion. Identified people need much more direct support from staff in this area, this was the case for one person whose file was inspected and the arrangements for providing this personal care was appropriately recorded. At the last inspection a requirement was made that the registered persons must ensure that the care delivered to residents reflects their preferences and that this is recorded in the person’s care plan. Care plans inspected indicated that this requirement was being complied with. Staff spoken to independently were Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 18 able to describe how they provided personal care in a sensitive way and in keeping with the individual’s preferences. A number of people living at the home indicated that the support that they received with their personal care from staff was delivered in a way that was acceptable to them. At the last key inspection a requirement was made that the registered persons must ensure that all residents living in Hartwood Lodge fall within the service category of registration. The inspector that undertook that key inspection was particularly concerned about one resident that suffered from a physical condition and who was becoming more physically dependent because of this. A second resident also suffered from another physical condition and was also becoming more physically dependent because of this. The more dependent of these two people no longer lives at the home and evidence was seen that the second person had been reassessed by their placing authority. Evidence was seen on that person’s file that the placing authority was seeking a more appropriate alternative placement for this person. However, this person has a diagnosed condition that means their physical needs will continue to increase and that the home will have increasing difficulty meeting these needs. The person’s basic health and safety needs, including in relation to meeting their health and personal care needs, are judged as continuing to be adequately addressed at this inspection although it is clear that an alternative placement is needed to better address and meet their changing needs in this area. The registered manager is aware of the need to continue to press the placing authority as a matter of priority to arrange an alternative placement for this person because of their increasing physical needs. At the last key inspection a requirement was also made that the registered persons must ensure the involvement of specialist professionals in advising on the care arrangements for identified residents. Evidence was seen of referrals to relevant professionals had been made although I was informed that the home was still waiting for input from a physiotherapist and were continuing to request this. Evidence was seen that to comply with another related requirement made at the last key inspection the home had independently commissioned the services of an occupational therapist. This was to assess the needs of the identified people; the environment of the home and to give advice on how the needs of the identified people could be better met. Evidence was also seen that the home was endeavouring to act on the recommendations contained in the occupational therapy assessment albeit that one of the two people is no longer living at the home. Evidence was seen that the home was implementing the occupational therapist’s recommendations for the second person, including the recent supply of an electric profiling bed to make it easier for the person to get in and out of bed. Evidence was also seen that staff had received training to assist them in meeting the needs of people with the physical conditions in question. However, despite this training, it is likely that the identified person’s physical care needs will continue to increase and the home’s physical environment is not conducive to meeting these needs. It is therefore probable that the home will have increasing difficulties meeting this Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 19 person’s assessed needs in the future. Because of this it is important that the managers of the provider organisation continue to impress on the placing authority the need for a more appropriate long-term placement for this person. Given the current situation in relation to this identified person the quality rating for this outcome group can only be judged as adequate. This is because that, whilst the individual’s basic health and personal care needs are being adequately met, more sustained professional input is required, and this is acknowledged by both the manager of the service and the placing authority. Evidence was seen that people are supported with a range of physical, mental and emotional health needs and all people are registered with a GP. Evidence was seen of appointments with health care professionals including: GP’s, mental health specialists and general hospital outpatient departments. However, the home does not keep a clear record of all health appointments that people living in the home attend. Staff informed me that people also saw other health care professionals such as an optician, dentist and chiropodist where necessary although one person living at the home stated they “did not bother with seeing a dentist”. It was not always possible at this inspection to evidence when appointments with healthcare professionals had been offered, whether they had been attended and/ or the frequency and the outcomes from such appointments. A requirement is made that the registered persons must ensure that a clear record is kept of all healthcare appointments that residents attend or are offered, including a summary of the outcome of the appointments attended, to assist staff be more proactive in monitoring and addressing peoples’ ongoing health care needs. The home had a satisfactory medication policy that was seen to have been reviewed in November 2007. I was also pleased to see a range of information leaflets displayed in the home’s lounge regarding medication frequently prescribed to assist people with their mental health needs. These leaflets gave information about the specific medication, what it was generally prescribed for and possible side effects. The registered manager stated that she had introduced these leaflets being displayed for the information of both people living in the home and for staff. Medication and medication administration record (MAR) charts were inspected for three people living in the home. These were current and satisfactory. Evidence was also seen of an annual audit in July 2007 of the home’s medication and related procedures by the dispensing pharmacist and also of random audits of medication and MAR charts being undertaken by the registered manager. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People accommodated are able to express their views and concerns and have these acted on appropriately. The home’s safeguarding adults policy and procedures assist in protecting people living in the home from abuse. EVIDENCE: At the last key inspection a requirement was made that the registered person must ensure that residents’ concerns and complaints are logged as required and a record is maintained for inspection. This was because staff at that time were unable to locate the complaints book that complaints were logged in and as a result the inspector could not evidence that any complaints were robustly dealt with. At the key last inspection a requirement was also made that the registered person must ensure that the complaints procedure is presented in a format that meets the communication needs of residents. Both of these requirements were being complied with. At this inspection a satisfactory complaints procedure was seen along with forms and guidance displayed in communal areas of the home for residents or other stakeholders to use. The registered manager also stated that residents were encouraged to use the home’s suggestion book and evidence was seen from the record of weekly residents’ meetings that the methods of lodging a concern or complaint were regularly discussed. The complaints log was available at this inspection and showed that six complaints had been recorded since the last key inspection and that all of them had been investigated and responded to appropriately. It was noted that three of the complaints were from one person living at the Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 21 home and regarding missing property. Evidence was also seen that the person had been issued a key to their room but was not always locking the room and that means of safeguarding their property had been discussed with the person. A requirement is made in the Environment section of this report regarding a lockable space in people’s bedrooms to further assist people in looking after their property. There have been no other complaints made to the home and no complaints made to the Commission since the last inspection. The home was seen to have a copy of the latest safeguarding adults policy for L.B. of Waltham Forest, the local authority the home is situated in. The home also had an in-house safeguarding adults policy, which referred to the local authority policy, and which had also been reviewed in 2007. Evidence was seen that staff have undertaken training in safeguarding adults and staff spoken to were able to explain the actions that need to take place should an allegation or disclosure of abuse be made to them. There have been no allegations or disclosures of abuse made to the home or to the Commission since the last key inspection. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 & 30 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is adequately decorated and maintained although further improvements are needed in residents’ bedrooms, in where people can smoke and in an identified shower room so that the home may better meet the needs of people who live there. People may also benefit by a review of how the current space in the building is used. People who live in the home, staff and visitors benefit from a generally clean and tidy building. EVIDENCE: The home is a large converted three storey residential property. The ground floor comprises: the home’s dining room; main lounge, that is used as a smoking room; small quiet room; five residents’ bedrooms, four of them grouped in a separate unit for female residents, called the “ladies” area; bath/ shower and toilet facilities; kitchen; kitchenette for residents; laundry; medication room; main office and entrance hall. The first floor contains eight bedrooms and bath/ shower and toilet facilities and the second floor contains Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 23 four bedrooms and bath/ toilet facilities. All the bedrooms are for single occupancy and contain a wash hand basin. The home also has a pleasant rear garden with two storage sheds and a paved front garden used for car parking. At the last key inspection a requirement was made that the registered person must ensure that an assessment of the building is undertaken by a qualified occupational therapist to ensure it is adequately equipped to meet the needs of the residents living there. This requirement was made because of concerns by the inspector undertaking that inspection regarding the needs of two people living at the home at that time, both of whom had increasing physical needs. This requirement had been complied with and an occupational therapist’s report was seen. The occupational therapy report made some recommendations that were being complied with, which are referred to in the Personal Care and Healthcare Support section of this report. At the last inspection a requirement was made that the registered persons must ensure that identified carpet stains are removed by deep cleaning or replacing the carpet and that redecoration takes place where leak damage had occurred. Evidence was seen that the carpet in question had been replace by laminate flooring and that the identified area where leak damage had occurred had been repaired. At the last inspection a requirement had been made that the registered persons must ensure that residents have their care delivered in areas that are safe, hazard free and fit for purpose. This was because of the inspector’s concern that one of the people with increasing physical needs did not have suitable equipment to use the shower facilities safely. Evidence was seen that the home had purchased a shower chair although the identified person is no longer living at the home. During a tour of the premises at this inspection it was noted that the grouting and sealant in one of the first floor shower rooms was black with mould. A requirement is made the registered persons must ensure that the identified grouting and sealant is replaced to maximise protection to residents and to provide a more pleasant environment to shower in. It was also noted that most of the residents smoke and that the lounge was used as the home’s smoking area. This had a fan although did not have self-closing doors as required by the Health Act 2006, Smoke-Free (Premise & Enforcement) Regulation 2006, which came into effect in July 2006. Records of a recent residents’ meeting showed that an enforcement officer from L.B. of Waltham Forest’s Environmental Health Department had attended a meeting to discuss the legislation with residents and give guidance on how it would be enforced. The registered manager informed me that previous to this residents were allowed to smoke in various parts of the building and it had been difficult to persuade them to restrict smoking to just the lounge. She went on to say that the provider organisation had subsequently made a decision that the entire building was to be made smoke free by June 2008 and that this had been discussed with the Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 24 enforcement officer. The registered manager also stated that staff were actively preparing residents for this date although the decision was very unpopular with many residents. Given the particular needs of the current residents a requirement is made regarding complying with the smoking legislation within a negotiated timescale. The registered persons must ensure that the home fully complies with current legislation regarding smoking and its implementation within registered care homes. Some residents’ bedrooms were seen during this inspection although some residents did not want me to look in their rooms. Those rooms seen were adequately furnished and personalised and residents that did not want me to see their rooms indicated that their rooms met their needs and preferences. However, it was noted that although residents had access to keys to their rooms, most rooms did not contain a lockable space for people to keep their personal possessions within the rooms. Given that the home had received three complaints from one resident regarding safekeeping of property within their room, a requirement is made that the registered persons must ensure that each resident has a lockable space within their bedroom in order to assist safeguard their property. Although the building was being adequately maintained there is limited communal space to undertake different therapeutic activities, especially as and when the number of residents increase. In the December 2007 report of an unannounced monthly provider visit to the home the following comment is noted under the section “Physical Condition of Property”: the home does not possess sufficient rehab space and resources – too many bedrooms and a lack of independent living resources (training kitchen, lounges etc) Layout of home would lend itself to the creation of separate rehab flat; and later in the same report: the building would benefit from redesign of layout and reduction in bedrooms to facilitate better resources. A good practice recommendation is made at this inspection that the use of the existing spaces in the home are reviewed to better meet the needs of the residents. The home was reasonably clean and tidy during the inspection. The home had suitable laundry facilities and an infection control policy that was seen to have been reviewed and re-issued by the provider organisation in September 2007. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A staff team with a range of competencies, in sufficient numbers, support people currently living in the home. However, it is important that staffing ratios are kept under review to ensure people’s needs continue to be met. The implementation of the home’s recruitment policy assists the protection of people living in the home although further documentation is needed in the home to evidence this. People are supported by staff who have access to appropriate training and formal supervision to assist in further meeting the needs of people living in the home and in their own personal development. EVIDENCE: At the last key inspection there were seventeen residents at the home and at this inspection there were nine. At the last inspection a requirement was made that the registered persons must undertake a review of the roles and levels of staff on duty and ensure that there are consistently enough staff on duty to meet the assessed needs of residents. At the time of the last key inspection there were three care staff on duty on both the early and the late shift and that remained the same at this inspection. Evidence from records seen, staff Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 26 spoken to and residents spoken to indicated that the current staff levels were sufficient to meet the needs of the current residents. The home currently deploys staff as follows: three care staff on the morning and afternoon shift, one of whom is either a senior or designated shift leader and two waking night staff. The home has a deputy manager who was until recently in addition to the rota’d care staff. However, when the number of residents fell to nine the deputy was then included in the main rota. A current rota was seen and reflected the staff that were on duty on the day of the inspection. The registered manager is in addition to the rota as is a handy person and a cleaner post although the latter post was vacant at the time of this inspection. The registered manager stated that the cleaner post was in the process of being recruited to. Although the current staff to resident ratio is judged to be sufficient to meet the needs of the current residents this will continue to need to be kept under review as and when the numbers of residents increase. A new requirement is made that the registered persons must keep the staffing ratio at the home under review and must be able to demonstrate that enough staff are deployed at the home at all times to meet the assessed needs of all residents as and when the number of residents increases. Of the ten care staff employed four had completed the national vocational qualification (NVQ) level 2 in care and three were working towards this qualification. The registered provider stated that one care staff was working towards NVQ level 3 in care. At the last key inspection a requirement was made that the registered persons must ensure that no staff are employed to work in the home unless there satisfactory pre employment checks undertaken as detailed in Schedule 2 of the Care Homes Regulations 2001. This was because there was only one employment reference instead of two on one of the staffing files inspected at that time. This requirement was seen to have been complied with and no new staff had been employed at the home since the last key inspection. At this inspection the files of another two staff were inspected at random. These contained all the required documentation including a record that the provider organisation had undertaken an enhanced Criminal Records Bureau (CRB) check on the staff members before they commenced work at the home. However, the record did not specifically indicate whether a Protection of Vulnerable Adults (POVA) check was included with the CRB. A requirement is made that the registered persons must ensure that there is a record kept in the home to evidence that the provider organisation has included a POVA clearance with the CRB check undertaken before a member of staff starts work in the home, to maximise protection to residents in this area. At the last key inspection two requirements were made regarding staff training: one regarding all staff receiving training in dealing with challenging Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 27 behaviour, health crises and emergencies in the home; the second that the staff team receive training to meet the changing care needs of residents particularly around delivering personal care practices. These requirements were seen to have been complied with. Evidence was seen that the following training had been undertaken since the last key inspection: first aid, managing challenging behaviour, dementia awareness, multiple sclerosis awareness, meeting the needs of people with diabetes and Parkinson disease awareness. In addition the home’s training matrix showed that staff had also undertaken training in fire safety, safeguarding adults and food hygiene in 2007. In addition to this a trainer undertook a ½ day training session in health and safety at the home on the day of the inspection. The trainer was spoken to and stated that he undertook a range of training with staff at the home and with the provider organisation generally. The registered manager stated that infection control training was booked for later in January 2008 and that she and the deputy manager were booked on Mental Capacity Act training in February 2008. Staff that were spoken to independently confirmed that they had undertaken a range of the above training and had found it useful in addressing residents’ needs, especially those needs in addition to mental health needs. At the last inspection a requirement was made that the registered persons must ensure all staff receive regular supervision. At this inspection I saw a supervision plan with dates for monthly supervision for all staff. Staff spoken to confirmed that they received individual supervision and that they found this useful. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are benefiting from an improvement in the management systems in the home. The views of people living in the home are sought regarding the quality of life in the home although further work is still required to obtain the views of external stakeholders. Health and safety procedures generally assist in protecting people living at the home, staff and visitors although further work is needed in this area including, as a priority, to ensure that the electrical wiring in the home meets the required standard. EVIDENCE: The registered manager has been in post for approximately twelve months and has taken a range of action to try to address identified shortcomings in the home, which had been identified at the last key inspection and inspections before that. The registered manager is a registered nurse and has a range of Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 29 experience in management and of meeting the needs of people with mental health needs. The registered manager presents as being committed to improving the service offered by the home and has been proactive in addressing requirements made at the last key inspection. I spoke independently by telephone to a care manager from the L.B. of Waltham Forest’s mental health services. She stated that she had noted a significant improvement in the care and support of her client who had lived in the home for a number of years, she was also particularly complimentary about the improvements in the home since the registered manager has been in post. The registered manager stated that in June 2007 a deputy manager was appointed to the home and that this appointment has assisted in addressing outstanding shortfalls in the service. At the last key inspection a requirement was made that the registered manager must detail to the Commission her plans to obtain her NVQ4 in management award. Evidence has been received that both the registered manager and the deputy manager are both currently undertaking their Registered Manager’s Award. At the last key inspection a requirement was made that the registered provider must ensure the learning gaps are identified in the newly formed senior team and training is planned accordingly. Evidence obtained throughout this inspection indicates that this was being addressed. In the provider organisation’s response to the Statutory Requirement Notice issued following the last key inspection the responsible individual stated that a Regional Manager would personally scrutinise all new referrals and admissions to the home. At this inspection evidence was seen that this was happening; see the Choice of Home section of this report. When I undertook the random inspection to test compliance with the enforcement notice the registered manager was also receiving significant support from a provider organisation Clinical Governance Manager. At this inspection I was informed that the both the Regional Manager and the Clinical Governance Manager were both in the process of moving on and that different people would be undertaking both of those roles. In my judgement it is extremely important that the registered manager continues to be effectively supported by the provider organisation as the home must continue to have sufficient senior management support and resources to meet people’s needs, especially if the number of people living at the home is to increase. At the last key inspection a requirement was made that the registered persons must ensure all stakeholders are included in the review of the service and this is reflected in the home’s development plans. Evidence was seen at the last key inspection, and at this inspection, that residents were being actively consulted about the quality of care in the home. At this inspection this included seeing a catering satisfaction survey undertaken in October 2007 and a revised overall satisfaction survey that was due to be given out to residents later in January 2008. Evidence was also seen that the registered manager had organised a meeting for relatives that was due to be held in November 2007. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 30 However, only one relative confirmed that they would attend the meeting and that person cancelled at the last minute. Evidence was also seen of weekly residents’ meetings and of monthly monitoring visits by the provider organisation. Advice was given to the registered manager about trying to obtain further feedback from external stakeholders, including relatives and health and social care professionals, including by using postal satisfaction surveys. Given the previous concerns about the service it is my judgement that it remains important for the home to obtain feedback from external stakeholders to continue to be able to develop the quality of care the home offers; therefore the requirement is amended and restated. The registered persons must ensure that external stakeholders are included in the review of the service and this is reflected in the home’s development plans. During the inspection a range of health and safety temperature records were sampled for the fridges and freezers in the home and were generally satisfactory. However, it was noted that the temperature records for the fridge in the residents’ kitchenette were reading very high. I inspected the fridge with the registered manager and it felt very cold although the thermometer in the fridge was showing a warm temperature, 10º C. It appeared that the thermometer was malfunctioning although staff had recorded an unacceptably high reading in the temperature record book on a daily basis for at least three days and had apparently not reported the anomaly. It was noted that there was a range of drinks in the fridge but no food although presumably, as it was a residents’ fridge, they could have placed food in the fridge. A requirement is made that the registered persons must ensure that the fridge in the residents’ kitchenette is maintained at an appropriate temperature and that the daily record of the temperature reflects this, to maximise health and safety in this area. A range of satisfactory health and safety documentation was inspected. This included the home’s fire log, gas safety certificate, portable appliance testing and evidence that the home’s water storage system had been checked to minimise the risk of legionella. However, the home’s electrical installation certificate was dated 23rd February 2006 and stated that the installation was unsatisfactory. Evidence was seen that some remedial work had been undertaken on 22nd February 2007 but the record of this indicated that there was still outstanding work required on the wiring to the home’s boiler. An engineer called at the home to look at the home’s boiler on the day of the inspection but it was not clear as to whether this was to attend to the outstanding work regarding the wiring. Given the needs of the residents, the age of the building and the fact that the required work appears to have been outstanding for over 22 months a requirement is made regarding this. The registered persons must ensure that outstanding work to the home’s electrical installation is completed by a person competent to do so, that a satisfactory electrical installation certificate is obtained by the home and that a copy of the certificate is sent to the Commission to evidence the electrical installation in Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 31 the home is satisfactory. This requirement is made to promote the health and safety for all in the home. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 32 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 2 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X X 2 X Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA19 Regulation 13(1) Requirement The registered persons must ensure that a clear record is kept of all healthcare appointments that residents attend or are offered, including a summary of the outcome of the appointments attended, to assist staff be more proactive in monitoring and addressing peoples’ ongoing health care needs. The registered persons must ensure that each resident has a lockable space within their bedroom in order to assist safeguard their property. The registered persons must ensure that the identified grouting and sealant is replaced in an identified first floor shower room, to maximise protection to residents and to provide a more pleasant environment to shower in. The registered persons must ensure that the home fully complies with current legislation regarding smoking and its implementation within registered DS0000007249.V357205.R01.S.doc Timescale for action 08/02/08 2. YA26 16(2) 08/02/08 3. YA27 13(4) 08/02/08 4. YA28 13(4) 30/06/08 Hartwood Lodge Version 5.2 Page 34 care homes. 5. YA33 18(1) The registered persons must keep the staffing ratio at the home under review and must be able to demonstrate that enough staff are deployed at the home at all times to meet the assessed needs of all residents as and when the number of residents increases. The registered persons must ensure that there is a record kept in the home to evidence that the provider organisation has included a POVA clearance with the CRB check undertaken before a member of staff starts work in the home, to maximise protection to residents in this area. The registered persons must ensure that external stakeholders are included in the review of the service and this is reflected in the home’s development plans (previous timescale of 20/09/07 not achieved). The registered persons must ensure that the fridge in the residents’ kitchenette is maintained at an appropriate temperature and that the daily record of the temperature reflects this, to maximise health and safety in this area. The registered persons must ensure that outstanding work to the home’s electrical installation is completed by a person competent to do so, that a satisfactory electrical installation certificate is obtained by the DS0000007249.V357205.R01.S.doc 08/02/08 6. YA34 19(5) 08/02/08 7. YA39 24(3) 29/02/08 8. YA42 13(4) 08/02/08 9. YA42 13(4) 08/02/08 Hartwood Lodge Version 5.2 Page 35 home and that a copy of the certificate is sent to the Commission to evidence the electrical installation in the home is satisfactory. This requirement is made to promote the health and safety for all in the home. 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 YA24 Good Practice Recommendations The use of the existing spaces in the home are reviewed to better meet the needs of the residents. Hartwood Lodge DS0000007249.V357205.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Ilford 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. 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