Inspection on 30/04/08 for Laglin Lodge

This inspection was carried out on 30th 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Laglin Lodge 07/10/05

Laglin Lodge 13/01/05

Laglin Lodge 28/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Laglin Lodge 7 Eardley Road Streatham London SW16 6DA Lead Inspector Louise Phillips Key Unannounced Inspection 30th April 2008 11:30a Laglin Lodge DS0000035525.V363660.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 Laglin Lodge DS0000035525.V363660.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. Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laglin Lodge Address 7 Eardley Road Streatham London SW16 6DA 020 8769 8655 020 8265 8340 laglinlodge@tiscali.co.uk 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) Mrs Patricia Elizabeth Modile Mr Hussain A Modile Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Laglin Lodge DS0000035525.V363660.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 (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 6 19th July 2006 Date of last inspection Brief Description of the Service: Laglin lodge is a registered care home for up to six adults with mental health needs. The home is a three-storey house and each resident has single room accommodation and there are spacious modern communal areas consisting of a lounge, conservatory and kitchen/ dining area. There is a small car parking area to the front and a large garden to the rear of the house that has a patio and lawn. The home is close to bus and rail links that provide access to the shopping areas of Streatham, Tooting and Mitcham. Laglin Lodge DS0000035525.V363660.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. This inspection took place over one day and included a visit to the service by a Regulation Inspector. When we visited we spoke to the people who work at the home and the manager. We also looked at records, observed what was going on and looked at the environment. Surveys were received back from three people who live at the service, and three staff who work there. What the service does well: What has improved since the last inspection? 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. Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 6 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 Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 7 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): 2 and 4 Quality in this outcome area is good. New residents are appropriately assessed to ensure the service can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care file for the newest resident was looked at. This contains relevant information about the referral and assessment prior to them moving to Laglin Lodge, with details about their mental health, social needs and any personal care issues, etc. A risk assessment has also been drawn from the assessment information, and updated where necessary. New admissions to the home are planned with the resident. These take place through day visits and overnight stays. A care plan is developed for this process and is reviewed after each visit, where the new resident is assessed and their mental state monitored, particularly when interacting with existing residents at the home. Good records are kept of each visit to the home, including what the resident has done, who they have spent time with, meals eaten, whether they were anxious or settled, etc. Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 8 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 and 9 Quality in this outcome area is good. Resident’s needs are met by the service, and any risks to their safety are minimised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care files for two residents were looked at. These continue to be very much ‘working files’, providing up-to-date information about the residents needs, interests and how the staff support with promoting the independence of each resident. Care plans focus on the individual needs of each resident, where some have particular support needs around daily living skills such as personal hygiene or domestic skills, whereas the care plans for other residents have been developed around their more towards their moving to less supportive accommodation. Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 9 Feedback from residents is that they are treated well by the staff and their privacy is respected. Staff comment that they also feel that they have built up good relationships with the residents. Where necessary, any significant mental health needs of the resident has been incorporated into their care plan, along with any particular areas of risk or safety needs of the resident. These include risk management plans around self neglect or support when outside of the home. Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 10 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 and 17 Quality in this outcome area is good. The service is flexible to the needs of the residents, to support them to gain maximum independence in their life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On arrival at the home most of the residents were out of the service, and some were still getting ready for the day. The staff said that one resident was out visiting friends, another was at a hospital appointment, whilst another was at a day centre. Feedback from residnets is that they are able to choose what they want to do each day. The care plans detail different activities that residents do during the day, and the role of staff in encouraging them to maintain these and utilise community resources, such as the day centre or music session workshops. Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 11 The manager spoke about a recent holiday that most of the residents went on to Brighton, and plans to have ‘long-weekend’ trips away once or twice a year. Feedback from staff is that they feel the service is good at letting the residents choose what they want to do, where to go out and what they would like to eat. Residents are able to prepare their own breakfast and lunch from the food provided in the kitchen. The evening meal is cooked by staff with the involvement of residents in the preparation of this. There was seen to be a range of foods, fresh, frozen, tinned and dry goods to ensure that balanced meals are provided by the service. However, some residents said that they would like to have more fruit available to eat. Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 12 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 and 20 Quality in this outcome area is adequate. Staff support residents to maintain their own health needs. Some improvements are needed to the medication system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most of the residents are independent in their personal care, and staff support is by way of encouraging and prompting only. The care files record that residents are encouraged to attend regular appointments with their psychologist or psychiatrist as necessary. Residnets at Laglin Lodge are assessed and supported to self-medicate, and manage taking their own meidcation. At present one resident self-medicates, with their ‘dossett box’ being filled up weekly by staff. The staff say that they check the the resident is taking this correctly by carryin out ‘spot checks’ throughout the week. The checking is not currently recorded and it is Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 13 recommended that a form is implemented to record all spot checks carried out. Taf. The medication system was looked at and a number of discrepancies were identified and pointed out to the manager at the time: • For one resident the Clozapine medication, the label on the packet stated it as a regularly prescribed medication, whereas the Medication Administration Record (MAR) chart stated it to be given as a ‘PRN’ (as necessary) medication. For another resident, the label on the Procyclidine medication says for one tablet to be given twice a day when necessary, though on the MAR chart this was recorded as being given daily, dating back to at least the past four weeks. Also, the MAR chart for another resident their Clozapine medication was recorded on the MAR chart to be given 100mg (1 tablet) at night, whereas the label on the box states 200mg (2 tablets) to be taken at night. • • A requirement has made to ensure that these medication errors are rectified. The manager must implement a system to audit the medication weekly, to ensure the MAR chart records correspond with the labels on the medication packs and the original prescription. Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 14 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 and 23 Quality in this outcome area is good. There are appropriate procedures for addressing complaints and ensuring that risks to clients are minimised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a satisfactory complaints procedure and format for the logging of complaints. No complaints have been received since the last inspection of the service. Residents say that they know who to talk to if they are not happy about something, and that they know how to make a complaint. The training records for staff indicate that they have received recent training in Safeguarding of Vulnerable Adults (SOVA). There are also policies and procedures in place regarding abuse awareness and what to do in the event of this. The abuse policy needs some further work, to include guidance about informing the CSCI and local authority, who will be responsible for investigating any SOVA issues. Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 15 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, 27 and 30 Quality in this outcome area is good. Laglin Lodge is comfortable, spacious and homely for the residents. Some improvements are needed to ensure the health and safety of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Laglin Lodge continues to be a modern and homely environment, that is kept clean and hygiene by the staff. It was noted that improvements have been made to the office areas, with an additional room now being used as the manager/ administrators office. It is recommended that some shelves are installed in this area to house the numerous files that are piled up on the floor and surfaces. Some other areas were noted as needing to be addressed, including the provision of a hand towel in the toilet areas and the replacement of the linoleum in the first floor bathroom, as this had become raised and is a trip Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 16 hazard. It was also noted that the top of the lightshades need to be cleaned as they are dusty and could be a health and safety risk. Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 17 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, 34 and 35 Quality in this outcome area is good. This staff receive training that is relevant to their role, and appropriate recruitment checks are carried out. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two staff files were looked at and seen to contain relevant recruitment information. This includes a completed application form, Criminal Records Bureau (CRB) check, two references, copy of identification, photograph and a record of their interview. Training records indicate that staff have undertaken recent training in medication awareness, SOVA and basic life support. There is a written plan for training to be taken over the coming year, with all staff due to receive training in mental capacity, dealing with aggressive behaviour and learning about depression. A number of staff have, or are close to completing their NVQ level two or three, with plans to commence newer staff on this course later in the year. Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 18 Feedback from staff is that they feel well supported, appropriately trained for their work and that they are kept up-to-date with relevant information. Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 19 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 and 42 Quality in this outcome area is good. The manager is competent and understands the responsibilities of their role. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is also the owner of the home. He demonstrates a good understanding of what is needed to maintain the service at a good level, and uses feedback constructively to continue to develop the service. The service carries out an annual survey with the residents, to seek feedback about different areas around the home, such as food quality, approach of staff, facilities and management. The manager said that any issues raised are discussed with the residents and used to develop the service. Residents are Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 20 also able to raise concerns at the monthly residents meeting, or by approaching the staff or manager. Appropriate health and safety checks are carried out around the home, with records to demonstrate that up-to-date checks had been done on the electrical installation, gas safety and fire system. Regular Portable Appliance Testing (PAT) needs to be carried out at least every year, and certificates maintained to evidence this. Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 21 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 X 2 3 3 X 4 3 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 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X 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 3 2 X 3 X 3 X X 2 X Laglin Lodge DS0000035525.V363660.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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 YA20 Regulation 13(4) Requirement The Registered Persons must ensure that all the medication errors listed under ‘personal healthcare and support’ are addressed. Timescale for action 30/06/08 2. YA20 13(4) The Registered Persons must 30/06/08 implement a system to audit the medication weekly, to ensure the MAR chart records correspond with the labels on the medication packs and the original prescription. The Registered Persons must replace the linoleum in the first floor bathroom. The Registered Persons must ensure that: - a handtowel is provided in each toilet area - that the top of the lightshades are cleaned regularly. 31/07/08 3. YA27 23(2)(b) 4. YA30 23(2)(d) 30/06/08 5. YA42 13(4) The Registered Persons must ensure that Portable Appliance Testing (PAT) is carried at least DS0000035525.V363660.R01.S.doc 30/06/08 Laglin Lodge Version 5.2 Page 23 annually. 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 YA20 Good Practice Recommendations The Registered Persons should develop a form to record the ‘spot checks’ carried out on residents who selfmedicate. The Registered Persons should develop the Abuse policy to include guidance about informing the CSCI and local authority, who will be responsible for investigating any SOVA issues. It is recommended that some shelves are installed in the office areas to put the files on. 2. YA23 3. 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