Inspection on 15/10/08 for Lancaster Lodge Care Home

This inspection was carried out on 15th October 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 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lancaster Lodge Care Home 15/09/09

Lancaster Lodge Care Home 22/05/08

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lancaster Lodge Care Home 21 Lancaster Park Richmond Surrey TW10 6AB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandy Patrick     Date: 1 5 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Lancaster Lodge Care Home 21 Lancaster Park Richmond Surrey TW10 6AB 02089401052 Telephone number: Fax number: Email address: Provider web address: rffi.mentalhealth@virgin.net Name of registered provider(s): Name of registered manager (if applicable) Richmond Fellowship Foundation International Type of registration: Number of places registered: care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The Registered Person may provide the following categories 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 category: Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 11 Date of last inspection Brief description of the care home Lancaster Lodge is a residential home for 11 people who have mental health needs. The aim of the home is to provide a place for people when they leave hospital to prepare them for more independent living. The home is in Richmond, close to the town centre. There are 9 single bedrooms and 1 bedroom which can be shared. The house is staffed throughout the day and night. The weekly fees are £900 - £1,200 per week depending on individual needs. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 11 Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Two Inspectors carried out this inspection. We visited the service on 15th October 2008, and this visit was unannounced. We met the Manager, the 2 members of staff employed at the home and the consultant supervisor. We looked at records and the environment. No one was living at the home at the time of our inspection. We wrote to the Manager in April 2008 and asked him to complete a quality self assessment. We received this in July 2008 and used the information from it as part of this inspection. We asked the staff to complete surveys about their experiences Care Homes for Adults (18-65 years) Page 6 of 29 working at the home. We inspected the service in May 2008 and found that people living there experienced poor quality outcomes. The overall rating for the service was 0 stars. We took enforcement action in some areas. We visited the home again in August 2008 to make sure they had done the things we told them to do in the enforcement notices. We wanted to see how the service had improved at this inspection. However, no one was living at the home at the time of the inspection and we could not fully assess whether the service had improved. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information to help people who wish to move to the home to make a decision about this. There are procedures for assessing needs. These procedures have not yet been put into practice. Evidence: There is a new Statement of Purpose and Service User Guide for the home. These are designed to help inform people who are thinking about moving to the service. Some of the information on staffing within these documents is inaccurate and this must be updated. No one was living at the home at the time of our inspection. The Manager told us that he was liaising with the local community mental health team so that they could identify people who may be interested in moving to the home. The Manager told us that a number of people had shown an interest in the home and some of them had visited. Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: When we last inspected the home we found that no assessments had been made for the people who were living there at the time. Therefore no one was able to see whether the service could meet their needs. These people have since moved away from the home. We made a requirement that thorough assessments must be made on people before they move to the home. We could not judge whether this requirement had been met at this inspection. However, we saw that there were procedures in place for thorough assessments to be carried out and the Manager showed a good understanding of the importance of this. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems to record peoples needs and to help them to have control over their lives. These systems have not been put into practice yet. Evidence: When we visited the home in May 2008 we found that people living there did not have their needs recorded and there were limited risk assessments. People living at the home told us that they were able to make decisions about their own lives and what they did. No one was living at the home at the time of this inspection visit so we could not assess these outcomes for people. Care Homes for Adults (18-65 years) Page 12 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a planned therapeutic programme but this has not been put into practice yet. Evidence: No one was living at the home at the time of the inspection therefore we could not judge these outcomes for people. The Registered Person must make sure people are given the support through a structured programme which meets individual needs. Care Homes for Adults (18-65 years) Page 13 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medication procedures are in place but need to be further improved to make sure people who move to the service have their medication managed appropriately. Evidence: Because there was no one living at the home at the time of the inspection we could not judge whether people would receive good support with their health. When we last inspected the home people did not get the support they needed in this area. We will look at this when we next inspect the home. There is a medication procedure and this has improved since we last inspected. The procedure covers some areas of storage and administration, however some further improvements are needed. The procedure should say that the medication, dose and frequency needs to be recorded on administration records. It needs to include an area to provide description of tablets. The procedure must explain what to do in the event of medication error. The Manager should add information about recording administration to the procedure. There needs to be a procedure regarding people taking medication out with them, and when they go on leave. There needs to be Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: information about dispensing (if staff will be doing this for people who self-medicate eg. filling dossett boxes). There needs to be a procedure for if someone refuses medication. There should be procedures for collecting prescriptions and medication and a homely remedies policy and procedure. There are risk assessment formats to be used for people who administer their own medication. These must be used for people when they move to the home and the service needs to develop spot check forms so that they can monitor these assessments. Care Homes for Adults (18-65 years) Page 15 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are procedures for people to make complaints and to help protect them. Staff recruitment practices need to be improved to make sure people supported by the service are in safe hands. Evidence: Since the last inspection the complaints procedure has been reviewed and updated. The Manager told us that copies of this will be given to people when they move to the home. The procedure still refers to the home being registered with the local authority, which it is not, therefore this should be amended. A book to record complaints and concerns has been created. There are procedures on abuse and whistle blowing and there is a copy of the local authority procedure at the home. Some of the staff have attended protection of vulnerable adult training but some staff still need to attend this. We looked at staff recruitment files. These did not contain sufficient evidence of thorough checks on the staff,s suitability to work with vulnerable people. Care Homes for Adults (18-65 years) Page 16 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been improvements to the environment and cleanliness. There needs to be further work to make sure people move into a safe place. Evidence: There have been improvements to the environment since the last inspection. These include improvements to the kitchen, garden and cleanliness. Throughout the home there is a mixture of old and new furniture and some of this is worn and dirty. People moving to the home must be able to choose the way their bedroom is decorated and must be given opportunities for personalising their rooms. People must be given clean and undamaged furniture. The stairs leading from the first to the second floor have a window at leg height which could pose a health and safety risk if someone were to slip or fall on the stairs. Specially toughened glass should be installed. At the base of one of the stairways there is a crack on the wall that needs to be addressed. The fire exit leading from kitchen is cluttered with garden furniture, broken furniture and rubbish. At the end of this there is a gate that is stiff to opening the other Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: direction there is a cupboard completely blocking the pathway, as well as overgrown ivy. This blocks an escape route from the garden. The garden has two potential escape routes, the one which is blocked and on the other side is a gate that is locked with a bicycle chain. The house is regularly cleaned and was clean and odour free on the day of our visit. There were no paper towels in the bathroom and there needs to be to help prevent the spread of infection. Care Homes for Adults (18-65 years) Page 18 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a small staff team who are trained and supported. There needs to be further recruitment, training and more thorough recruitment procedures to make sure people who move to the home have the support they need. Evidence: The Manager and two members of staff were employed at the time of the inspection. The Manager told us that staff vacancies were being recruited to. He told us that he had interviewed a potential member of staff on the day of our visit and that they had advertised for other staff. The consultant supervisor employed by the organisation visits the home each week. He offers training to the staff group every fortnight on team building and therapeutic communities. A psychologist from a local organisation offers staff group training about mental health issues every fortnight. The Manager told us that thorough checks were made on all staff before they were employed. However, we looked at the 3 recruitment files for all of the staff employed at the home and found that evidence of some checks were missing. For example one Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: file did not contain evidence of references or criminal record checks (CRB). This member of staff told us that they were waiting for receipt of their criminal record check. Another staff members file only had one reference and their CRB had been obtained after they had started work at the home. The Managers file did not have any recruitment documentation and he told us that this was at head office. All staff files must contain evidence of thorough recruitment. Staff should not be employed before receipt of satisfactory references and criminal record checks. We saw evidence of recent staff training in health and safety, food hygiene, fire safety and medication. Some staff need training in other areas including protection of vulnerable adults. All the staff needed training in first aid. The Manager told us that this training had been organised. A new induction training programme has been organised. The staff members told us that they felt this induction had been helpful in explaining their role. The staff members told us that they had regular individual and team meetings with their manager and we saw evidence of team meetings and individual supervision for one member of staff. There was no evidence of supervision meetings for one member of staff. The staff working at the home told us that they were happy there but they were eager for people to move to the service so that they could start supporting them. Care Homes for Adults (18-65 years) Page 20 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management has worked hard to improve all areas of the service. This improvement needs to continue and be maintained so that people who move to the home can feel confident that they will receive quality care and support. Evidence: The Manager has been in post since May 2008. He has applied to be registered with the CSCI. The consultant supervisor makes monthly quality inspections of the service and writes a report making recommendations for change. The organisation is reviewing all policies and procedures and has created and updated some since the last inspection. A copy of policies and procedures is available in the home. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: There have been improvements in record keeping making records more accessible and organised. There are regular recorded checks on health and safety, including fire safety. We saw evidence of electrical appliance testing. Fire exits and escape routes must be clear and free from hazards. Care Homes for Adults (18-65 years) Page 22 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 33 18 The Registered Person must support staff to achieve an appropriate qualification which is recognised by Skills for Care as equivalent to NVQ Level 2. 30/06/2009 Care Homes for Adults (18-65 years) Page 23 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 The Registered Person must 31/12/2008 make sure no one is admitted to the home unless there is an assessment of needs detailing how the home is a suitable placement for this person. At the last inspection there was no evidence of assessments for the people living at the home. This requirement has not been met. 2 6 15 The Registered Person must make sure any person using the service has a written care plan, which details how their needs in respect of their health and welfare are to be met. 31/12/2008 no care plans were in place 3 7 12 The Registered Person must 31/12/2008 make sure, unless otherwise impractical, that every person using the service is Care Homes for Adults (18-65 years) Page 24 of 29 consulted about the service they are offered. people were not being consulted 4 9 13 The Registered Person must make sure there are recorded risk assessments for each person. no risk assessments were in place 5 19 13 The Registered Person must make sure people receive the healthcare services they need. The staff must make referrals so that people can start accessing these services. people did not have access to health care services 6 20 13 The Registered Person must develop spot check forms to monitor peoples ability to self medicate. So that people who self medicate can be monitored and kept safe. 7 20 13 The Registered Person must 31/12/2008 ensure the appropriate recording, handling, storage, administration and disposal of medications received into the home. 31/12/2008 31/12/2008 31/12/2008 medication was not being handled appropriately 8 20 13 The Registered Person must make sure there are adequate procedures in 24/11/2008 Care Homes for Adults (18-65 years) Page 25 of 29 place that detail the recording, handling, storage, administration, disposal and management of medicines. medication proc needs additions 9 22 22 The Registered Person must make sure everyone has a copy of the complaints procedure. The Registered Person must make sure each complaint is fully investigated within agreed timescales. The Registered Person must make sure there is a copy of all concerns and complaints and details of the action taken to investigate these. people had not had copies of the procedure, complaints had not been investigated or recorded 10 23 13 The Registered Person must make sure all staff receive appropriate training in relation to safeguarding vulnerable adults. not all staff have been trained 11 24 23 The Registered Person must 31/12/2008 make sure people moving to the home are able to choose the way their bedroom is decorated and must be given opportunities for personalising their rooms. 31/12/2008 31/12/2008 Care Homes for Adults (18-65 years) Page 26 of 29 People must be given clean and undamaged furniture. broken furniture and unpersonalised rooms 12 30 13 The Registered Person must make sure there are paper towels and liquid soap in WCs and bathrooms to help reduce the spread of infection. there were no paper towels in the WCs 13 34 19 The Registered Person must make sure staff records evidence thorough pre employment checks. files missing CRBs and reference checks 14 35 18 The Registered Person must ensure all staff employed in the home receive appropriate training in first aid. staff have not done FA training 15 39 24 The Registered Person must make sure people who live and work at the service are involved in the day to day running and reviewing the quality of the service. The Registered Person must develop a quality monitoring system which measures success in meeting the aims of the service. minimal QA system in place 31/03/2009 31/12/2008 28/11/2008 14/11/2008 Care Homes for Adults (18-65 years) Page 27 of 29 16 42 13 The Registered Person must 14/11/2008 make sure all fire exits are unobstructed and people are able to open them and escape if they need to. fire exits blocked and obstructed Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Registered Person should make sure the staff information in the Statement of Purpose and Service User Guide is accurate. The Registered Person must make sure there is a record of the action taken to investigate the reappearance of a crack where there was subsidence in the past. The Registered Person should repair the crack on the wall. The Registered Person should consider replacing the glass of the window on the stairwell with specially toughened glass. 2 24 3 4 24 42 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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