Inspection on 22/05/08 for Lancaster Lodge Care Home

This inspection was carried out on 22nd May 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 47 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 15/10/08

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

CARE HOME ADULTS 18-65 Lancaster Lodge Care Home 21 Lancaster Park Richmond Surrey TW10 6AB Lead Inspector Sandy Patrick Key Unannounced Inspection 22nd May 2008 09:50 Lancaster Lodge Care Home DS0000070485.V361714.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 Lancaster Lodge Care Home DS0000070485.V361714.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. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lancaster Lodge Care Home Address 21 Lancaster Park Richmond Surrey TW10 6AB 020 8940 1052 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) rffi.mentalhealth@virgin.net Richmond Fellowship Foundation International Manager post vacant Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (11) of places Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 11 This is the first inspection of the service Date of last inspection Brief Description of the Service: 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. Lancaster Lodge Care Home DS0000070485.V361714.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 0 stars. This means the people who use this service experience poor quality outcomes. For this inspection we visited the home on the 22nd May 2008. This visit was unannounced. During our visit we talked to the Manager, a senior manager, staff on duty and one person who was living at the home. We looked at records and at the environment. We also wrote to the people living at the home, staff and visitors asking them to complete surveys about their experiences of the home. Five people returned completed surveys to us. We asked the Manager to complete a quality self assessment form. This was not returned to us at the time of completing this report. In general people were not happy with the service and felt that it did not meet the needs and expectations of those who live there. Some people told us that some of the staff were caring and supportive and that they worked well as a team. Some of the things people said about the home were: ‘Nothing works here.’ ‘The people who live here are not getting the support they need.’ ‘This place does not offer value for money.’ What the service does well: What has improved since the last inspection? The service was registered in October 2007 and this is the first inspection of this service. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 6 What they could do better: We are concerned about the number of National Minimum Standards this new service has failed to meet and we are taking enforcement action where failure to meet Regulations puts people at risk. Everyone living at the home must have their needs assessed. There must be a written plan of care and support to state how the service is going to meet each person’s needs. There must be a structured programme which helps people to meet their needs. Everyone must be registered with a GP and must have access to health care services to meet their needs. There needs to be improvements to the medication procedure. There needs to be improvements to the complaints procedure. There must be a record of all complaints and people should feel confident that their complaints and concerns will be investigated. There needs to be procedures for the protection of vulnerable adults and whistle blowing. The staff need to have training in protection of vulnerable adults. There needs to be improvements to the building to make it safe and clean. The Manager needs to recruit to staff vacancies. The staff need training and support to make sure they can support people. The Manager needs to register with the CSCI. People need to feel confident that they are involved in quality monitoring and continuous improvement of the service. The records, policies and procedures need to be updated and improved. The Manager needs to make sure people are safe from the risk of fire, accidents and injuries. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 7 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. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. There is not enough accurate information to help people make a decision about moving to the home and therefore they cannot make an informed choice. People’s needs are not assessed therefore no one can make an accurate judgement about whether the service can meet each person’s needs. People’s needs are not being met. EVIDENCE: The organisation has created a Statement of Purpose which states the main aim of the home. This statement refers to a service being provided at the home for many years. This is misleading because the current service at Lancaster Lodge is new, registered in 2007. The staff team, management and way in which the home are run are all new. The previous service at the home was managed and run by a completely different organisation. Information on staffing does not accurately reflect the current staffing levels and skills. There is no service user guide. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 10 There were 2 people living at the home when we visited. The Manager said that there had not been that many referrals for places and it had been difficult to fill the places at the home. The 2 people currently living at the home pay privately. People we spoke to said that the fact there was only 2 people made it difficult to create the therapeutic community which is one of the aims of the home. People felt that there was not always the support they needed from a group because there was not enough people living there. People told us that the service they received was not the service they had expected and that their needs were not being met. Lots of people said that they did not feel the people living at the home received the support they needed to get better. People said that the service did not offer value for money. Some of the things people said were: ‘I feel that I have got worse since I have moved here’ and ‘I feel very unhappy here.’ There is no evidence that the people living at the home have had their needs assessed. It is important that thorough assessments of people’s individual needs are made. These assessments will help everyone to make a decision about whether this home is the right place to meet these needs. This breach in Regulations undermines the health and welfare of the people that use the service. The commission is therefore taking enforcement action to ensure compliance and secure better outcomes for people living in Lancaster Lodge. There are copies of signed licence agreements for the 2 people living at the home. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. There is no plan of care or support to tell each person how their needs will be met therefore they are not getting the support they need. EVIDENCE: The staff have recorded some information about each of the people living at the home but there is no care or support plan. The people do not automatically have a copy information held on them, although the Manager said that they could request copies if they wished. We saw that there were no care plans in place that demonstrated how the service planned to meet the needs of each person in respect of their health and welfare. We further noted that there was no structure or plans in place to support people in education or learning new skills or finding employment. People told us that there were no plans of care and there was not specific structure to the support they received. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 12 This breach in Regulations undermines the health and welfare of the people that use the service. The commission is therefore taking enforcement action to ensure compliance and secure better outcomes for people living in Lancaster Lodge. There is a file of information for each person. The records in this were loose and there was no order to the file. Records refer to ‘the client’ and not the name of the person they were about. People who live at the home told us that they did not have a plan of care or support and that there was no specific structure to the support they received. People told us that they were able to make decisions about their own lives and what they did. There is a recorded risk assessment for one person but not for the other. The risk assessment has been dated and signed by the person and two members of staff. Lancaster Lodge Care Home DS0000070485.V361714.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): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to make decisions about their own lives and to do the things they chose. They maintain friendships and relationships with others and use the local community as they wish. However, the service does not support people through a structured therapeutic programme and people are not supported to learn new skills, further their education or find employment. EVIDENCE: The Manager showed us a copy of a planned therapeutic programme for the home which included group and individual therapy sessions, keyworking, group work and staff training. One person told us, ‘the programme is just a fantasy nothing actually happens here’. Another person told us, ‘people are not given the support they need.’ Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 14 People living at the home take part in some group meetings or meet with their key member of staff. However, there is not a lot of structure to the weekly activities at the home. This is partly due to the fact there is such a small group and some of the therapeutic programmes do not work well without larger numbers. But it is also partly due to the way in which the house is organised. The Manager told us that they are hoping to improve this area. At the time we visited people generally planned their own time and activities. One person told us that they did not get the therapeutic support they had expected. There is no structure or plans to support people with their education, learning new skills or finding a job. People are free to use the local community as they wish and to receive visitors when they want. The Manager told us that he hoped to plan a number of events to welcome visitors to the home, such as a garden party and an international day. People are able to maintain friendships and relationships outside of the home and told us that they did so. The Manager said that he is making contact with neighbours so that they could understand what the service was aiming to offer. One person told us that the staff had the wrong contact details for their next of kin. They said that they had informed them about this but the information had not been changed. Everyone helps to chose the menu for the home and people can chose to eat something different from the group if they wish. Everyone is involved in shopping and cooking. One person told us that they had their own supply of food and on occasions other people had taken this without permission. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are not getting the support they need to make sure they stay healthy. The procedures for managing medication do not guarantee that people’s medication will be handled safely. EVIDENCE: The staff do not support people with personal care. The aim of the home is that the staff support people to meet their own physical and mental health needs. The people who live at the home are not registered with a local GP or the community mental health team and the Manager said that there have been problems accessing these services. The staff have a range of different experiences and qualifications but they do not have any medical training. The people living at the home have not been referred to the local community teams. Therefore people are not getting the support they need. Some people have paid for their own private psychiatric care. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 16 One local GP wrote to us and said that they were not willing to prescribe to the people living at the home because they were not being supported by the local mental health team and were seeing private psychiatrists. They also said, ‘I have absolutely no idea how the staff operate and can’t imagine anyone knows’. The staff must make sure the mental health needs of people living at the home are met by the full range of support services available in the area by making appropriate referrals for additional support. One member of staff told us, ‘people are not getting the support they need from services and we have not made any referrals for them to start receiving this support.’ One person told us that they felt staff did not offer them support. They told us about an occasion when they had telephoned the staff to tell them that they were going to hospital. They told us that when they returned to the home the staff did not enquire about this or ask them if they were well. We found that the management of medication was inadequate. Despite two people administering their own medication there were no risk assessments in place to demonstrate safe practice. People did not have a lockable facility in their bedrooms where medication could be stored. The home did not hold a record of medication currently prescribed to the people living there, nor a record of medication received into the home. The medication procedure to guide staff was not readily available but was later sent to us. However this was found to be inadequate and provided insufficient guidance on the receipt, storage, handling and administration of medication in the home. At the time of the inspection there was no medication being held on behalf of people living at the home. There is a medication cabinet, however the door on this was not properly secured. The cabinet was being used for storing paperwork. This breach in Regulations undermines the health and welfare of the people that use the service. The commission is therefore taking enforcement action to ensure compliance and secure better outcomes for people living in Lancaster Lodge. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The complaints procedure is unclear and people do not feel that their complaints will be listened to and acted upon. People are not protected from abuse by procedures and staff do not have enough knowledge or information to make sure people are free from abuse or harm. EVIDENCE: There is a complaints procedure but this does not include timescales for any stages or the completion of the complaint investigation. The procedure does not include contact details for the CSCI and states that the home is registered with the local authority, which it is not. The procedure needs to be updated. There was no evidence that people living at the home had seen a copy of the complaints procedure. There is no record of complaints or concerns. One person told us that they had raised a concern. They said that this had not been investigated to their satisfaction and it had taken a long time to resolve. The staff have not received any training in protecting vulnerable adults. The Manager did not know whether the home held a copy of the local authority protection of vulnerable adult procedure. The staff we spoke to did not know what to do if they received an allegation of abuse or if they suspected abuse. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 18 The Manager must contact the local authority to find out more about local protection procedures. This breach in Regulations undermines the health and welfare of the people that use the service. The commission is therefore taking enforcement action to ensure compliance and secure better outcomes for people living in Lancaster Lodge. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 19 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 & 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People do not environment. EVIDENCE: The home was previously run as a residential home under a different organisation. The Owner took over management of the home and it was registered in October 2007. Some refurbishment has taken place, some rooms had been freshly painted and there are some new carpets. However there are a number of decorative and repair needs which have not been addressed. Some of these present a risk to health and safety. One person told us that they felt the environment was poor and not what they expected for the money they paid. There must be a full audit of the decorative and repair needs and a plan which states how these will be met. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 20 live in a comfortable, clean, well-maintained or safe Work must take place to address the following: The back garden is rather overgrown and needs some attention. We saw the staff working on the front garden to make this more presentable. Kitchen work units and cupboards are cracked, worn and broken in places. There is no TV aerial point in some bedrooms. The window catch in one bedroom is broken. An old TV has been left in the garden. The flooring in one WC was damaged and split. There is broken furniture in some corridors and bathrooms. The kitchen floor is damaged. There is a crack running along one side of the building. This area of the building has suffered from subsidence in the past and the crack has appeared in exactly the same place as before. The organisation must take professional advice on how to address this problem and make sure the building is safe. Work should take place to address the following: Furniture throughout the home does not match and there are old ornaments and Christmas decorations on display. A clock in one communal room was hung upside down and told the wrong time. The washing machine and tumble dryer are old and the lights on the tumble dryer are broken. Windows panes are marked with paint. Drawers and cupboards in unused bedrooms are filled with rubbish. There are no lampshades on some overhead lights. When we visited we found that the house was not sufficiently clean in some areas. One person told us: Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 21 ‘The bathroom is filthy and was when I moved in. clean it myself.’ I have been told I must Another person said, ‘people take my laundry out of the washing machine and leave it on the floor.’ We saw that: The soap tray in the washing machine was filthy and needed to be cleaned out. There were no paper towels or soap in some WCs and bathrooms. All the bathrooms and shower rooms we saw needed to be cleaned. Shower heads had limescale on them, presenting a risk of infection. Extractor fans were dirty. Plug holes in washbasins and baths were dirty. Hand towels in the bathrooms were dirty. There was no toilet paper in one bathroom. The blind in one bathroom was covered in mildew. Some areas of the house had an unpleasant odour. The plants throughout the home are dying and dry. This breach in Regulations undermines the health and welfare of the people that use the service. The commission is therefore taking enforcement action to ensure compliance and secure better outcomes for people living in Lancaster Lodge. Lancaster Lodge Care Home DS0000070485.V361714.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): 32, 33, 34, 35 & 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There are staff vacancies and this has an impact on the service which people receive. The staff have not had training in key areas to make sure they can keep people safe. There is no evidence at the home to show that the staff recruitment procedures make sure people are safe. EVIDENCE: There are four support staff and a Manager employed at the home. Two of the staff were due to leave shortly after we visited. This would leave the home short of staff. The Manager said that he was holding interviews to recruit new staff. The staff we spoke to were worried that staff shortages would have a detrimental impact on the level of service they provided. Staff told us that they did not feel they were doing the job they were employed to do. One person told us, ‘I am not doing anything like my job description’. People living at the home told us that some of the staff were kind and supportive but they felt some of the staff did not have the experience, Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 23 expertise or qualifications to give them the therapeutic support they had expected. There are not individual staff recruitment records at the home. Some information on staff recruitment, including records of some staff interviews and staff CVs were stored in a single folder in a cabinet which is accessed by all staff. The file also contains information on people who do not work at the home. The Manager said that other staff recruitment records were stored at the organisation’s head office. The staff told us that they had had face to face interviews, criminal record and reference checks before they were employed. A consultant employed by the organisation is meeting with the staff every fortnight to offer training on group work and building a therapeutic environment. Some other professionals from a private hospital offer fortnightly training for staff around mental health needs. Some of the staff said that this training had been useful. There was no information on the content of this training and should be. The staff told us that they had not had an induction and there was no record of any staff inductions. There is no record of staff training. There are no individual staff training profiles. The staff told us that they had not had any training except the group training provided by the consultant and professionals who visited the home fortnightly. The staff have not taken NVQ training. The Manager said that he is looking at what would be the most appropriate professional qualification for staff to undertake. He should contact Skills for Care to make sure this is considered equivalent to NVQ training. The staff have not received training in protection of vulnerable adults, food hygiene, fire safety, medication or first aid. This breach in Regulations undermines the health and welfare of the people that use the service. The commission is therefore taking enforcement action to ensure compliance and secure better outcomes for people living in Lancaster Lodge. There are weekly team meetings and regular individual supervision meetings for staff. Some staff told us that they felt supported through these formal meetings. Others said that they would like more support informally as well. Lancaster Lodge Care Home DS0000070485.V361714.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): 37, 38, 39, 40, 41, 42 & 43 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People do not feel confident that the service is well managed and that they can contribute their ideas and opinions about the running of the home. People are put at risk by serious risks to their health and safety. EVIDENCE: The Registered Manager left shortly before the inspection. A new Manager has been employed. This person has not yet applied to be registered and must do so. The certificate of registration and liability insurance were not on display. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 25 People who live and work at the home said that the service was very disorganised. The staff said that they did not feel supported on a day to day basis. Lots of people said that they did not feel the people living at the home received the support they needed to get better. Shortly before we visited a consultant was employed on a short term contract to give the Manager and staff support and training. This person is experienced at managing therapeutic communities. We met this person. They spoke about their role in the organisation offering support and supervision and working with the Chief Executive. This person hopes that if their role is a success they may continue to work for the organisation on a more permanent basis. We feel that it is important and the Manager and staff have someone in this role offering them support to develop the service. The consultant has started to make monthly quality inspections which will identify areas where the service needs to improve. Copies of these inspections should be forwarded to us. There has not been any other form of quality monitoring. The people who live and work at the home told us that their feedback and comments were not listened to. The records at the home are disorganised and information was difficult to locate. Not all files are labelled. Some information is not dated. Some information is out of date. The Manager was unable to find several documents we requested. Records were stored in different places including the medication cabinet. Some files were not properly labelled and information was not properly secured within these. Some information on staff was not held at the home and other confidential information was stored in a place accessible to all staff. Information on residents was poorly organised and unclear. There were no care plans. There was a range of different files containing different policies and procedures. Some of these were old, including some information which was over 30 years old and applied to services previously managed by the organisation. Some policies and procedures were not dated. Some referred to other services rather than Lancaster Lodge. We were told that these were being reviewed and that clearer and more up to date information would be available. We were sent some copies of new procedures. However, when we visited the information was hard to locate and neither the staff nor the Manager were able to locate procedures or to tell us whether there were certain procedures we asked to see. There was no evidence that the Manager or staff had read and understood the procedures. A file containing information on health and safety is old and was created by the organisation who previously ran the service. There was no up to date file of information. There is no evidence of checks on health and safety, although Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 26 one member of staff said that these did take place. We observed a high number of health and safety hazards which put people at risk. Fire doors throughout the home were wedged open in a way which prevented them from closing automatically. We found that some of the doors, including the kitchen door did not shut automatically even when the wedge was removed. This means that in the event of a fire the fire would not be properly contained and people would be at risk. There is no evidence of checks on fire safety equipment or fire drills. The staff said that they were not aware of any fire drills being held. The staff have not had training in fire safety. Information suggested that a fire risk assessment had taken place in July 2007. However, there was no copy of this assessment at the home. The Manager was not aware of the risk assessment. The last recorded check on fire extinguishers was in August 2006. There was no evidence that electrical appliances had been tested. Therefore any faulty electrical equipment could not be identified and people are put at risk. The last recorded service of the boiler was in September 2006 when the service was run by a different organisation. The casing around the boiler had been bent and damaged. Sellotape had been used to hold the boiler casing together. A sign stated ‘do not place anything on top of the boiler.’ A pile of towels had been placed on top of the boiler. There are no locks on cupboards to hot water storage tanks and no risk assessment had been made regarding this. There are no locks on windows and no risk assessments have been made regarding this. Radiators have not been covered and no risk assessment has been made regarding this. There were cleaning products, including bleach, left in bathrooms and WCs and no risk assessment had been made regarding these. The data information sheets on cleaning products were not for the products used in the home but were copies of sheets used in another service. Hot water pipes are exposed and present a risk. pipe is at the height of a handrail on a stairway. Lancaster Lodge Care Home In one area the hot water DS0000070485.V361714.R01.S.doc Version 5.2 Page 27 There is a number of breaches to health and safety Regulations and these are of a serious nature. The level of monitoring has been poor and people are put at risk. This breach in Regulations undermines the health and welfare of the people that use the service. The commission is therefore taking enforcement action to ensure compliance and secure better outcomes for people living in Lancaster Lodge. Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 28 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 2 2 1 3 1 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 2 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 X 2 2 2 1 2 1 2 Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No – this is the first inspection of the service. 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 4 Requirement Timescale for action The Registered Person must 31/08/08 produce an accurate Statement of Purpose which complies with Schedule 1 of the Care Home Regulations. The Registered Person must 31/08/08 provide each person a Service User Guide for the home. The Registered Person must put 25/07/08 in place arrangements to ensure all potential service users have an appropriate assessment of needs undertaken prior to admission. The Registered Person must 25/07/08 ensure that no service user is admitted to the home unless an assessment of needs detailing how the home is a suitable placement for the service users and that it can meet the service user’s needs in respect of their health and welfare. DS0000070485.V361714.R01.S.doc Version 5.2 Page 30 2. YA1 5 3. YA2 14 4. YA2 14 Lancaster Lodge Care Home 5. YA3 12 The Registered Person must 30/06/08 make sure the service meets the needs of the people who live there. The Registered Person must 25/07/08 ensure all service users have a written care plan, which details how their needs in respect of their health and welfare are to be met. The Registered Person must 25/07/08 ensure, unless otherwise impractical, that service users or their representatives are consulted as to how the service will meet the service users health and welfare needs. The Registered Person must 30/06/08 make sure there are recorded risk assessments for each person. The Registered Person must 31/07/08 make sure people are given the support through a structured programme which meets individual needs. The Registered Person must 30/06/08 make sure people are registered with a GP of their choice. The Registered Person must 30/06/08 make sure people receive the healthcare services they need. The staff must make referrals so that people can start accessing these services. DS0000070485.V361714.R01.S.doc Version 5.2 Page 31 6. YA6 15 7. YA6 15 8. YA9 12 13 15 9. YA11 12 10. YA19 13 11. YA19 12 13 Lancaster Lodge Care Home 12. YA20 13(2) The Registered Person must 25/07/08 ensure there are adequate procedures in place that detail the recording, handling, storage, administration, disposal and management of medicines. The Registered Person must 25/07/08 ensure the appropriate recording, handling, storage, administration and disposal of medications received into the home. The Registered Person must 31/07/08 make sure the complaints procedure is accurate, clear and up to date. Each person must be given a copy of this and this must be evidenced. 13. YA20 13(2) 14. YA22 22 15. YA22 22 The Registered Person must 30/06/08 make sure each complaint is fully investigated within agreed timescales. The Registered Person must 30/06/08 make sure there is a copy of all concerns and complaints and details of the action taken to investigate these. The Registered Person must 15/08/08 ensure all staff receive appropriate training in relation to safeguarding vulnerable adults. The Registered Person must 15/08/08 Version 5.2 Page 32 16. YA22 22 17. YA23 13(6) 18. YA23 13(6) Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc ensure there is an appropriate, accessible adult protection procedure in place, which is in line with local authority safeguarding protocols. 19. YA24 23 The Registered Person must 23/08/08 ensure all flooring in kitchens and bathrooms are intact and undamaged. The Registered Person must take 31/07/08 steps to have a professional assessment on the building where there is subsidence. They must make sure people in the building are safe and take steps to address the problem. The Registered Person must 23/08/08 ensure all kitchen work units are repaired or replaced. 20. YA24 13 21. YA30 23 22. YA42 23 The Registered Person must 23/08/08 ensure and provide evidence to demonstrate all electrical equipment used in the home is safe and in good working order. 23. YA42 23 The Registered Person must 23/08/08 ensure that all areas including bathrooms, toilets and kitchens are clean and free from malodours. The Registered Person must 31/08/08 make sure records of staff recruitment are in place and these evidence thorough pre employment checks. This DS0000070485.V361714.R01.S.doc Version 5.2 Page 33 24. YA34 19 Lancaster Lodge Care Home information securely. 25. YA35 18 should be stored The Registered Person must 31/08/08 make sure there are individual staff training profiles and a record of all staff training. The Registered Person must 30/09/08 ensure all staff receive an appropriate induction at the commencement of their employment. The Registered Person must ensure all staff employed in the 15/08/08 home receive appropriate training in first aid, food hygiene and the management of medication. The Registered Person must ensure the service maintains 15/08/08 evidence of training provided including details of the content of training provided. The Registered Person must 30/06/09 support staff to achieve an appropriate qualification which is recognised by Skills for Care as equivalent to NVQ Level 2. The Registered Person must 30/06/08 make sure the Manager applies to be registered with the Commission for Social Care Inspection. The Registered Person must 30/06/08 make sure there is appropriate liability insurance and the certificate is displayed. DS0000070485.V361714.R01.S.doc Version 5.2 Page 34 26. YA35 18 27. YA35 18 28. YA35 18 29. YA33 18 30. YA37 8 9 31. YA43 25 Lancaster Lodge Care Home 32. YA38 12 24 The Registered Person must 30/09/08 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 30/09/08 develop a quality monitoring system which measures success in meeting the aims of the service. The Registered Person must 31/07/08 make sure records are appropriately maintained, accurate and up to date. The Registered Person must 31/10/08 make sure the home’s policies and procedures are up to date, accessible to staff and are followed. The Registered Person must 30/06/08 make sure there are regular checks on health and safety which identify hazards and record the action taken to address these hazards. Checks must be recorded. The Registered Person must 23/08/08 ensure there is a current fire risk assessment in place, which is available for inspection. 33. YA39 12 24 34. YA41 17 35. YA40 17 36. YA42 13 37. YA42 23 38. YA42 23 The Registered Person must 23/08/08 ensure staff receive training in DS0000070485.V361714.R01.S.doc Version 5.2 Page 35 Lancaster Lodge Care Home fire safety and that fire drills take place at regular intervals. 39 YA42 23 The Registered Person must 23/08/08 ensure staff receive training in fire safety and that fire drills take place at regular intervals. The Registered Person must 23/08/08 ensure that all fire fighting equipment and alarms are appropriately tested and maintained. The Registered Person must 23/08/08 ensure all fire doors are not wedged open and close as required to restrict the spread of fire and smoke in the event of fire. The Registered Person must 23/08/08 ensure the removal of any broken or damaged furniture from corridors and bathrooms. The Registered Person must 31/08/08 make sure the boiler is safe and has a service. The Registered Person must 31/07/08 make sure there are recorded risk assessments on hot water storage tanks, pipes and radiators and that action is taken to make sure people are safe. The Registered Person must 31/07/08 make sure there is a recorded risk assessment on window safety and that this is reviewed each time a new person moves DS0000070485.V361714.R01.S.doc Version 5.2 Page 36 40. YA42 23 41. YA42 23 42 YA42 23 43. YA42 13 44. YA42 13 45. YA42 13 Lancaster Lodge Care Home into the home. 46 YA42 13 The Registered Person must 31/07/08 make sure there is a recorded risk assessment on COSHH products, including data information sheets. This assessment must be reviewed when a new person moves to the home. The Registered Person must 31/03/09 make sure the AQAA is completed and returned to the CSCI within agreed timescales. 47. YA1 24 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 YA15 Good Practice Recommendations The staff should make sure they have accurate recorded information on each person’s next of kin and their contact details. The staff should make sure people feel that their personal supply of food will be safe and will not be taken by others. The staff should make sure people feel supported with all their health needs and take a genuine interest in their wellbeing. The staff should make sure people’s laundry is treated with respect and not placed on the floor. 2. YA17 3. YA19 4. YA30 Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Lancaster Lodge Care Home DS0000070485.V361714.R01.S.doc Version 5.2 Page 38 - 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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