Inspection on 18/04/08 for Kings Lodge

This inspection was carried out on 18th April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kings Lodge 19/04/06

Kings Lodge 09/01/06

Kings Lodge 11/01/05

Kings Lodge 09/09/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Kings Lodge 47 Kingsway Wembley Middlesex HA9 7QP Lead Inspector Andreas Schwarz Key Unannounced Inspection 18 & 21st April 2008 09:30 th Kings Lodge DS0000017459.V361134.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 Kings Lodge DS0000017459.V361134.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. Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kings Lodge Address 47 Kingsway Wembley Middlesex HA9 7QP 020 8903 0952 020 8902 9611 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) Mr Anil Rawlley Mr Brijendra Sinha Mr Kathirgamu Balendran Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one service user, AA, over the age of 65 years for the duration of his stay. 7th March 2008 Date of last inspection Brief Description of the Service: Kings Lodge is a care home providing care and accommodation for up to 9 adults 18-65 with learning disability. Ablegrange Ltd owns the home. The home has been through a process of transition and used to provide personal care and accommodation for nine older people who have moved to other residential homes. Currently there is one vacancy at Kings Lodge. The home is located in a residential area near Wembley and within reasonable walking distance of two underground stations. A number of bus-routes and Wembley High Street is close by. The home is a converted semi-detached house and was first registered under the Registered Homes Act 1984 in April 1990. Accommodation for the service users is provided on the ground and first floors; all but one of the bedrooms is single occupancy. There is parking at the front of the house and on the street; at the rear there is a good-sized garden and a building, which is the Registered Manager’s office. Information about fees and charges can be obtained from the manager or registered provider. Kings Lodge DS0000017459.V361134.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. We visited the home twice during this unannounced key inspection. The first day of this visit was on the 18/04/08 and lasted eight hours. The second day of this visit was on the 21/04/08 and lasted three hours. The acting manager Mr Alan Moorhead was available on both days of this unannounced key inspection. We have received four completed user surveys and six completed staff surveys. All surveys received did not have any negative comments. All surveys said that care plans are in place, are regularly updated, complaints are dealt with and residents have an understanding whom to complain to We spoke to five residents and three care workers during this key inspection. The home has forwarded a completed Annual Quality Assurance Assessment form within the given timescale to the Commission for Social Care Inspection. We assessed three care plans and various other documents relating to the care and support provided to residents. We would like to thank residents, staff and manager for assisting us and making us welcome during this unannounced key inspection. What the service does well: What has improved since the last inspection? We did a random inspection on 07/03/08, which demonstrated that the home has met fourteen of the seventeen requirements previously made. Areas, which the home has improved on, are staff has received manual handling training and residents are safely transferred. The previous manager has contacted Brent Advocacy concern; referral forms to advocacy are in place. Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 6 Due to the long waiting list referrals are only accepted if the advocacy project sees a need for an advocate. Risk assessments have been updated and reviewed; information is now detailed. During this key inspection all outstanding requirements have been met and issues such as the strong urine smell have been addressed and new flooring has been put into place. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 1 and 2 during this key inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a statement of purpose that is specific to the individual home and the resident group they care for and give prospective residents information about the home. Admissions are not made to the home until a full needs assessment has been undertaken to ensure the home is meeting peoples needs. EVIDENCE: We viewed the homes statement of purpose and service users guide; both documents are compliant with National Minimum Standards. We noted that both documents have not been reviewed since November 2004. It is necessary to review these documents to ensure that any changes in the provision of care and service to prospective residents are captured and recorded. Two of the people living at Kings Lodge were referred as an emergency. We viewed two assessments during this key inspection, and the previous manager has undertaken both assessments. Assessments are detailed and information is transferred to peoples care plans. We viewed three care plan files during this inspection; all files contained a detailed needs assessment undertaken by the Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 9 referring authority. People using the service were not able to tell us about the assessments. Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 6, 7 and 9 during this key inspection. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service understands the right of individuals to take control of their lives and to make decisions and choices. However, this does not always happen in practice as staff has a limited understanding of how to do this effectively. Each individual has a care plan but the practice of involving residents in the development and review of the plan is variable. Care plans are reviewed and updated as required by the National Minimum Standards. Risk assessments are completed but these are basic and mainly focus on keeping residents safe. EVIDENCE: The home told us through the Annual Quality Assurance Assessment that care plans are comprehensive and detailed. We viewed three care plans during this key inspection. Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 11 All care plans have been reviewed and updated where necessary. Care plans have been reviewed monthly. The home is using the same care plan format; with the same care plan objectives for all residents. We discussed this with the manager and advised him to provide more individual care plans, which meets the cultural background of residents. It is required to give staff and residents the opportunity to look at a wider range of objectives as supposed only the ones provided on the standard form provided by the home. Care plans make little or no reference to an individual’s particular needs regarding gender (including gender identity), age, sexual orientation, race, religion or belief or disability, or address any needs identified in a person centred way. The home has two care planning files; one is used for recording daily events and monitoring purposes. The second file includes the care plans, reviews and other necessary documentation about the person. The second file is stored and locked in the managers office and can only been accessed if the manager is around. We recommend looking for alternative space and making care plans accessible 24 hours. One resident told us that he does not know about his care plan; another resident spoken to during this inspection did not confirm this. The home informed us that they have introduced a new key worker system giving staff more responsibilities in care planning. Staff told us that they look forward to do this. The manager told us that he is planning to provide key working and care planning training. This is seen as necessary to make the new key working system work. All residents have access to Brent Advocacy Concern and application forms are made available by the home. Where the home is managing people’s finances records have been of good standard. Income and Expenditure has been documented clearly. A number of residents could be involved more in managing their own finances and the home should look into ways of facilitating this. One resident told us that the family manages his money and he is not aware of how much money he has. We discussed this with the manager and suggested that the home is supporting the person to get this information from his family. The home is not acting as an appointee for any resident; we noted however that the previous manager is still the signatory on one saving account. The home must relinquish the previous managers signatory and discuss with the funding authority and person what the best way forward would be. We observed staff interacting with residents. On one occasion a member of staff approached a resident’s wheelchair from the back, releasing the breaks and pushing the person to the front door. We observed no communication by the member of staff and it was not clear if the resident was able to make a choice. Food and drinks is brought to residents on a tray, as supposed asking them to make their tea independently. Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 12 We asked residents if they are able to make choices, but residents were unable telling us. Surveys section, which relates to choice was ticked to inform us that they are able to make choices. We viewed risk assessments in files assessed during this inspection. The home is assessing risks such as use of hoist, and manual handling. One resident is at risk of developing pressure sores, but risk assessments for this are not in place. Previous inspections asked for a wider range of risk assessments, looking at the environment and peoples activities, but none such risk assessments were in place. Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 12, 13, 14, 15, 16 and 17 during this key inspection. People using the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a limited opportunity for residents to be independent and involved in community activities. Residents are not able to achieve their full potential. Independent living skills are not seen as important and staff does not give time to working with individuals, helping them to learn and develop. It is considered by staff to be much quicker and easier to ‘do’ for residents. Individuals have little choice of what they eat, are not involved in shopping for food, the preparation or serving. EVIDENCE: One resident continued to access a luncheon club after moving in, he told us that he stopped going to this club due to the distance away from the home. The manager told us that he ordered prospectuses from local colleges, which Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 14 he will discuss with residents; none of the residents living at the home is currently attending any college courses. Residents living in the home are not in voluntary or paid employment. We spoke to one resident about this, who told us that he used to work, but unfortunately lost his job. We discussed with the manager to look into employment opportunities for residents. One resident told us that he goes regularly to day centre and enjoys to go there. We observed another resident using community transport to go to a day centre Two residents living at the home access the community independently. We spoke to one resident about this and he told us that he is visiting friends in local shops and café’s. Residents are registered to vote. The home does not use their own transport and residents are encouraged to use public transport or use local taxi firms. The manager told us that the home has good relationships with their neighbours. Staff told us that residents would benefit from more community-based activities such as going to library, cinema, pub, but staffing does make this very difficult. We discussed this with the manager and advised to review staffing levels to enable residents to take part in community-based activities. Residents told us that they have been in Brighton for a day trip, which they enjoyed very much. Two of the residents informed us that they would like to go on an annual holiday this year. Activities records show that people play cards, read newspapers, colour books and go for walks to the local park. The home has an activity book to record people’s participation. It was recorded that on the 16/04/08 two residents went to the local park for a walk. We spoke to residents about this who told us that they have not been to the park for a long time; staff confirmed that nobody went to the park on the 16th April. We discussed this with the manager informing him that records and actual activities do not match up. The manager informed us that he would investigate this and inform the Commission for Social Care Inspection of the outcome of this investigation. People’s families are involved in their lives. One resident told us that he will be visited by his nephew and join him for his engagement party this weekend. The home informed us that they do not have a sexuality and relationship policy, which is required. People using the service told us that they could have visitors in their room if they choose to. Residents told us that they don’t have a key to their room and rooms cannot be locked from the inside. We spoke to the manager about this who informed us to look into this and find appropriate mechanisms to lock doors. We observed mail been given to residents unopened. Residents were seen moving around freely in the home. One of the kitchen cupboards was locked; staff explained that this is done due to one person living in the home drinking excessively. We felt that the home should not limit access to all residents due to one persons behaviour. The home must find alternatives in protecting one person from excessive drinking, without limiting the rights of all other Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 15 residents. We observed one resident making a cup of tea for him; staff informed us that residents are involved with some household tasks such as clearing the table. None of this was observed during this visit. We noted in one care plan that a resident likes cooking, when speaking to this person he told us, “The coking is done by staff here”. When asked if he licked to do more cooking he replied, “Yes”. We recommend involving residents more in household routines. Lunch was prepared by staff and brought on a tray to people using the service. The home told us in their Annual Quality Assurance Assessment form that the menu has changed following a discussion with residents. The home has a three weekly menu displayed. Over the three-week period the same meals are provided on different days of the week. We noted that on the weekend a roast should be cooked, the actual recording however showed cottage pie. We looked back over the past three weeks and the home did not cook a Sunday Roast for that period. The manager informed us that the finance manager purchases food. The freezer was fully stocked with value meals purchased from a local supermarket chain. We observed lunch during one of the two inspection days. Lunch was chicken nuggets with frozen vegetable. One of the residents prefers his meals to be pureed. The home is mixing all ingredients together and putting this in the food processor. Residents spoken to told us that they like curries, which was reflected on the menu. Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 18, 19 and 20 during this key inspection. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have access to health care services both within the home and in the local community. Health needs are monitored and appropriate action and intervention taken. There is evidence in the care plan of health care treatment and intervention, and a record of general health care information. The home has a medication policy which is accessible to staff. Medication records are generally up to date for each resident Medication systems do not always follow good practice or safe practice guidelines and has needed action. EVIDENCE: We viewed personal care records in three care plan files during this inspection. One was developed in June 2006 and one was very basic giving little information in how to support the person. The home must review and update all personal care guidance to ensure people are supported appropriately. One person using a wheelchair is not able having a bath, previous inspections were Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 17 asking the home to look into alternatives, which is still recommended. We observed people getting up when they choose to, during both days of this inspection. People were dressed appropriately and we overheard the manager talking to one resident about the clothes, which recently have been purchased. The home is using a hoist for one of the people living at the home; the hoist has been serviced regularly. The home can access clinical support from Brent Learning Disabilities Partnership; a continence advisor was visiting the home during the afternoon of the second day of our visit. The home has introduced a key working system recently, staffs training needs in regards have been discussed with the manager and requirements have been made earlier in this report. Residents are registered with a local General Practitioner. Visits to dentists, opticians, and chiropodist are recorded in the daily records file. Staff supports residents in accessing health care facilities. The previous manager has updated the epilepsy protocol, guidance and some staff Epilepsy training provided. Staff asked demonstrated understanding of what to do if residents suffer from Epilepsy. Medication is stored in an area near the kitchen. A lockable metal cabinet is securely fixed to the wall and the key was with the shift leader when we asked for it. The home is using a local dispensing chemist and staff is checking medication once picked up from the pharmacist. The manager informed us that he keeps medication, which is to be returned to the Chemist, is locked in the safe. There were no records of medication returned to the chemist available, which is required. When assessing Medication Administration Sheets, we noted gaps. The home has a medication policy in place, which was judged as compliant during previous inspections. Staff has received medication training, which was provided internally. We discussed this with the manager, and informed him that care staff must receive accredited training. Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 18 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): We assessed National Minimum Standards 22 and 23 during this key inspection. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. The complaints procedure is supplied to everyone living at the home. Residents and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made. The home understands the procedures for safeguarding adults and will attend meetings, but not all staff have received adult protection training. EVIDENCE: We viewed the homes complaints policy, which is compliant with National Minimum Standards. Residents spoken to informed us that they would complain to the manager if they were unhappy with anything. The home did not receive any complaints since the random inspection in March 2008. The home told us in the Annual Quality Assurance Assessment that they are planning to display the complaints procedure in people’s rooms. A previous abuse allegation has now been resolved and actions are implemented by the home. Staff demonstrates good understanding of reporting and recording allegations of abuse. Some staff have received adult Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 19 protection training provided by the local authority. The home must ensure that all staff receives Protection of Vulnerable Adults training. The deputy manager informed us that she did not receive Protection of Vulnerable Adults training since commencing employment. The manager informed us that this is ongoing training and newly recruited staff will attend this training. Staff will be informed during their induction of safeguarding adult’s procedures. The home has a abuse policy in place and local as well as funding authorities abuse procedures are available in the managers office. Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 20 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): We assessed National Minimum Standards 24, 26, 28 and 30 during this key inspection. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that meets the specific needs of the people who live there. Residents can personalise their rooms. The home is generally clean and tidy. EVIDENCE: The home is spacious and meets space requirements as stated in National Minimum Standards. During the random inspection in March 2008, we discussed with the manager and registered provider, the need to create a more homely environment. Furniture in the lounge consists of single chairs similarly to homes who provide care for the elderly. Pictures are chosen by the previous manager and don’t reflect resident’s cultural background. The manager informed us that the registered provider is planning to repaint the communal Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 21 areas and replace the carpet, which is uneven in some areas and could lead to people trip or fall. During our random inspection we noted a strong smell of urine from two of the residents room. The home has replaced one of the carpets with linoleum flooring and is planning to replace the other carpet on the weekend after this key inspection. There is a patio area and wellmaintained garden, which can be accessed through the lounge. There is an Annexe in the garden. The manager’s office, laundry room and one spare room is in the Annexe. The manager told us that he is planning to use the spare room as an activity room for people living in the home. One of the residents invited us to see his room; the room is decorated and furnished to acceptable standard. The resident brought some furniture and his own TV when moving in. We noted that one wardrobe is used to store linen for everybody living at Kingslodge. We told the manager that he must look for alternative space to store items and remove them from the person’s room. People using the service informed us that they don’t have a key to lock their rooms; this has been addressed earlier in this report. The lounge is spacious and has a separate dining area attached. Residents can smoke outside. The laundry room is located in the Annexe and a domestic dryer and washing machine is provided, both machines were working during this key inspection. The kitchen is clean overall, we noted however that the filter in the extractor fan over the hob was very dirty and needs replacement. The broken drawer near the sink must be repaired. The manager told us that he plans to replace the fridge freezer. During this key inspection the premises were clean and staff have been observed cleaning during the morning of the first day. Laundry facilities are located outside the main building and soiled clothes do not get in contact with food area. Toilets and bathrooms have hand washbasins; soaps and paper towels are provided. The home has an infection control and Health and Safety policy in place. The home has a cleaning schedule in place for the manager to monitor if regular cleaning is undertaken. The home has addressed the strong smell of urine coming out of two residents rooms, by removing the carpets and replacing it with linoleum flooring. Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 22 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): We assessed National Minimum Standards 32, 33, 34, 35 and 36 during this key inspection. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager is aware that there are some gaps in the training programme and plans to deal with this. There is limited understanding of the person centred way of delivering care and support. The service has a recruitment procedure that meets statutory requirements and the National Minimum Standards. EVIDENCE: During this key inspection we observed staff interacting with residents. On one occasion staff moved a person sitting in a wheelchair without communicating to the person where she is going. This seems not distress the person, but it raises concern if staff demonstrates clear understanding of supporting people with respect. The manager informed us that staff receive training in their induction, but more in depth training in this area is recommended. Staff spoken to demonstrate good understanding of people’s needs and relationships between staff and residents is professional. The home does not employ trainees under the age of 18. The Annual Quality Assurance Assessment Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 23 informed us that 100 of care staff work or hold their National Vocational Qualification in Care. The three staffing files and care staff we have spoken during this inspection confirmed of having achieved their National Vocational Qualification in Care. We observed residents in the lounge for approximately fifteen minutes on the first day of this key inspection without any staff present. When discussing this with staff we have been told that they were busy with cleaning of the home. The rota shows that the home has two staff during morning, two staff during afternoon and two staff during night shifts in place. Evidence from the last inspection suggests an increase in nighttime staffing numbers. The home has admitted more residents since the last inspection and we recommend reviewing staffing levels and suggest providing a day shift. We sampled four staffing records randomly. All relevant documents such as Criminal Records Bureau checks, references, application form, proof for the right to work in the United Kingdom, passport photo and health questionnaires were in place. Staff told us that they are aware of the General Social Care Councils Code of Conduct. The home has a recruitment policy in place, which has been followed. The manager showed us a training and development plan, which stated that the deputy manager has attended Protection of Vulnerable Adults training; the deputy manager however did not confirm this. We discussed with staff how the previous manager Mr Balendran provided the training. Staff told us that they were given a DVD, which they watched at home and than discussed with the manager what they have learned. Following this they had to fill out a test and were issued the certificate and judged as competent. The temporary manager raised this with us and told us that he is currently assessing staff training needs and is planning to retrain all staff in areas such as medication, manual handling, adult protection, Health and Safety, Fire and First Aid. There is a general training and development plan for 2008 in place. Staff did not receive the minimum of six planned supervisions per year. None of the assessed staffing files documented any supervision. Records as well as staff spoken to confirmed this. Staff told us that they feel well supported by the Acting Manager. The Acting Manager informed us that the new manager will provide regular supervisions to staff. Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 24 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): We assessed National Minimum Standards 37, 39 and 42 during this key inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has the necessary experience to run the home, but must be registered with the Commission for Social Care Inspection. Regular random Health and Safety checks take place to ensure staff work towards it. Staff is appropriately managed to support people using the service safely. EVIDENCE: Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 25 The previous manager Mr Balendran has left the home following allegation made by staff about his conduct. The acting manager informed us that the organisation has appointed a new manager who will start on the 28/04/08. The new manager has management experience and holds a National Vocational Qualification in Care Level 3. We informed the acting manager that the new manager has to register with the Commission for Social Care Inspection without delay. Staff provided us with good feedback about the support they have received from Mr Moorhead since the registered manager has left. Residents told us that they like the acting manager and that he listens to what they have to say. The home has undertaken resident surveys on 06/02/07 and the last residents meeting was held and recorded on the 04/02/08. Records show that the home is having six residents meetings per year. Staff attend residents meetings as well. Feedback from resident and staff surveys send out by the Commission for Social Care Inspection were positive, but no comments were made. The home has a business plan and annual development plan for 2008 in place. All sections of the Annual Quality Assurance Assessment were completed and the information gives a reasonable picture of the current situation within the service. The Annual Quality Assurance Assessment gives us some limited detail about the areas where the service still needs to improve on. The ways that the service is planning to achieve this is explained briefly. We viewed certificates such as Portable Appliances Test Certificate, Landlords Gas Safety Certificate, Electrical Installation and Legionella check. All certificates were current and in date. The home has an emergency plan in case of a fire and the fire risk assessment is up to date. The fire alarm was serviced on 29/02/08. A current Control of Substances Hazardous to Health assessment is in place and cleaning materials are stored safely. Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 26 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 1 14 2 15 2 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 3 X X 3 X Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 27 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 6(a) Requirement The registered person must review the statement of purpose and service users guide, to ensure new prospective people using the service are given the current information about the home and services provided. Timescale for action 01/06/08 2. YA6 18(1)(c)(i) The registered person must provide care planning and key working training to make the new key worker system work and provide staff with the necessary skill and knowledge to support residents taking part in the key working process. 15 The registered person must have a more person centred care plan approach. 01/06/08 3. YA6 01/06/08 4. YA7 16(2)(m) The registered person must 01/06/08 & 12(4)(a) ensure that residents are treated with respect and choices are offered when going out, having a drink, etc. 13(4) The registered person must provide a wider range of risk assessments to ensure people DS0000017459.V361134.R01.S.doc 5. YA9 01/06/08 Kings Lodge Version 5.2 Page 28 are protected. 6. YA9 13(4)(c) The registered person must ensure that people who are at risk of developing pressure sores appropriate risk assessments and guidance must be provided to minimise the risk. The registered person must review staffing levels to enable people using the service accessing the community more often and live a more active life. The registered person must ensure that staff only record activities that have actually happened. 01/06/08 7. YA13 16(2)(m) 01/06/08 8. YA14 17(3)(a) 01/06/08 9. YA15 Appendix 2 The registered person must 01/07/08 develop a policy on sexuality and relationships to ensure people using the service are aware of their rights and responsibilities. The registered person must 01/06/08 ensure, that food and drinks are not locked away unless there is a medical or behavioural reason, this however should not affect the rights of all people using the service. The registered person must provide mechanisms to lock doors safely ensuring peoples privacy. 01/06/08 10. YA16 12(3) 11. YA16 12(4)(a) 12. YA17 12(2)(i) The registered person must 01/06/08 involve people using the service in the preparation and purchasing of food if they choose to develop more independence skills. The registered person must review and update all personal DS0000017459.V361134.R01.S.doc 13. YA18 17(3)(a) 01/06/08 Page 29 Kings Lodge Version 5.2 care guidance to ensure people are supported appropriately and changing needs are met. 14. YA20 13(2) The registered person must to protect peoples safety ensure that all residents are administered their medication as prescribed by the General Practitioner 01/06/08 15. YA20 13(2) The registered person must 01/06/08 ensure that only staff who have received accredited medication training administer medication to people using the service. This is to ensure residents are protected from medication not administered appropriatly. The registered person must ensure that all staff receives Protection of Vulnerable Adults training, which is relevant to the levels of their responsibilities; to ensure people using the service are protected appropriately from abuse and are safe to make any allegations of abuse. The registered person must ensure that the furnishing provided is of domestic nature and a comfortable as well as homely environment must be provided. The registered person must ensure that no communal items are stored in resident’s rooms as this invades their personal space. The registered person must ensure that the dirty filter in the extractor fan above the hob must be replaced to ensure it is working properly. DS0000017459.V361134.R01.S.doc 16. YA23 13(6) 01/06/08 17. YA24 23(2)(h) & 16(2)(c) 01/08/08 18. YA26 23(2)(l) 01/06/08 19. YA28 23(2)(c) 01/06/08 Kings Lodge Version 5.2 Page 30 20. YA28 23(2)(c) The registered person must ensure that the broken kitchen draw is repaired to enable residents using it for storage. The registered person must ensure that training records reflect what actual training staff has taken part in. The registered person must ensure that all staff receives a minimum of six planned supervisions per year pro rata. The registered person must ensure that the new manager is registering with the Commission for Social Care Inspection without delay to ensure fitness to manage a registered care home. 01/06/08 21. YA35 17(3)(a) 01/06/08 22. YA36 18(2) 01/06/08 23. YA37 8; 9 01/08/08 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. 2. 3. Refer to Standard YA6 YA7 YA7 Good Practice Recommendations The registered person should look for more appropriate and easier accessible storage of care plan files. The registered person should find ways in involving people using the service more in their finances. The registered person should try to support one person to obtain information about his finances, which are currently taken care of by his family. The registered person should together with the placing DS0000017459.V361134.R01.S.doc Version 5.2 Page 31 4. YA7 Kings Lodge authority discuss who should sign for resident’s savings accounts, if they are unable doing it independently. 5. 8. 9. 10. YA12 YA17 YA17 YA17 The registered person should explore employment opportunities for people living at Kings Lodge. The registered person should review the weekly menu involving the residents in choosing their own meals. Choices made by residents on the weekly menu should be followed. The registered person should try to purchase better quality food and provide a wider range of fresh vegetable to ensure peoples diet is healthy, varied and nutritious. Food should be purred individually to be able tasting individual flavours. The registered person should consider ways in how residents with mobility problems can have regular assisted baths. The registered person should provide staff with in-depth training around issues such as respect, dignity to provide better understanding and more sensitive support to people using the service. The registered person should review the current staffing levels and consider a middle shift. We recommend that the registered person is referring the registered manager who was recently dismissed to the Protection of Vulnerable Adults list. 11. 12. YA17 YA18 13. YA32 14. YA33 15. YA37 Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kings Lodge DS0000017459.V361134.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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