Inspection on 17/08/05 for Lawrie Park Lodge

This inspection was carried out on 17th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lawrie Park Lodge 26/10/07

Lawrie Park Lodge 21/02/07

Lawrie Park Lodge 20/06/06

Lawrie Park Lodge 09/01/06

Lawrie Park Lodge 22/11/04

Lawrie Park Lodge 25/06/04

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

CARE HOME ADULTS 18-65 Lawrie Park Lodge 27 Lawrie Park Road Sydenham London SE26 6DP Lead Inspector Kate Matson Unannounced 17th August 2005, 10:00am 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 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 Stationary 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. Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lawrie Park Lodge Address 27 Lawrie Park Road, Sydenham, London, SE26 6DP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8778 5388 020 8778 5404 Mr Nundoo Nand Seeboruth Mr Nundoo Nand Seeboruth CRH Care Home PC Care Home Only IN Private 19 Category(ies) of MD Mental Disorder, 19 registration, with number of places Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22ND November 2004 Brief Description of the Service: Lawrie Park Lodge is a large detached house located in a quiet residential road in Sydenham. A bus service passes the door and two railway stations are within walking distance as well as local shops, pubs and community facilities. The home is registered for 19 adults of either gender between 18 and 65 who have experienced mental health related issues. Accommodation is provided over three floors of the house. Communal space is provided on the ground and lower ground floor. The proprietors have extended the communal space with the provision of a large conservatory attached to the dining room on the lower ground floor. The home has an in house activity programme in addition to supporting people to access activities outside of the home. Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over nine hours. The inspection included speaking to eight service users, two staff members, a tour of the premises, and examination of five care plans and other records. Unfortunately the Registered Provider/Manager was away at the time of the inspection but the inspection process was well facilitated by staff on duty and service users. What the service does well: What has improved since the last inspection? What they could do better: Staff did not think information provided to service users had been reviewed as required by previous inspections and documentation was not available for examination. Following the inspection the registered provider confirmed that information had been reviewed following the last inspection. Documentation did not show that service users’ needs were fully assessed before they were offered a place at the home. This must be addressed in order for service users to know that their needs will be met. Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 6 Although all service users had a contract with the home, room numbers had not been included as required by a previous inspection and it was also noted at this inspection that essential information was omitted. Care plans do not cover all areas of need, and cultural and religious needs appeared to be unrecognised in one instance. They were not reviewed regularly enough and daily records do not contain sufficient information about the care provided and progress of service users. Although a weekly community meeting gives service users the opportunity to participate in the running of the home, this has not been developed to encourage fuller participation, or service users provided with suitably detailed and accessible notes of the meetings. There was little evidence to indicate that risks for service users had been identified. Although there is a range of leisure activities provided at the home, service users had not been given individual time with staff on a weekly basis as recommended at a previous inspection. Also service users had not been offered a holiday. Service users have appropriate relationships though the letter of acceptance given to them before they move in must be reviewed to clarify any restrictions on visiting. There are some practices in the home that are restrictive, such as service users not being allowed in the kitchen, the residents kitchen being locked at night, service users not being allowed to smoke in their rooms and having to hand over cigarettes to staff at night. Service users gave mainly positive feedback about the food; one service user said, “The food is nice, you get a choice every day”. However, it was found that meals are served at set times and unless the service user is diabetic, if they miss breakfast they may only have a hot drink. The home is not suitable for people with physical disabilities and one service user who had lived at the home for over three years was having to move out because her physical mobility had decreased and the manager had stated that her needs could no longer be met at the home. It was also noted that although the home has a passenger lift, one service user told the inspector that it is never used and on the day of the inspection it was full of cleaning equipment and materials. Staff meeting minutes are not adequately recorded and at the meeting where staff hand over information from one shift to the next staff records were not used or taken. This practice is likely to lead to information getting missed. Although recruitment records were not available on the day of the inspection, it was found that a new staff member had started employment before a new check with the criminal records bureau and a check against the list of people considered unsuitable to work with vulnerable adults had been made. This practice potentially leaves service users at risk of abuse. The homes induction training process does not meet National Minimum Standards. Service users had not been supported to access their care plans and contribute to day-to-day recording as required at the previous inspection. The home’s recording of accidents, service users’ money and property and the format of Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 7 some files must be reviewed and improved in order to safe guard the rights and best interests of service users. The health, safety and welfare of service users are generally protected though records of fire alarm testing were not up to date, the certificate of electrical appliance safety inspection was out of date and evidence of food temperature testing was not available. A serious concern letter was sent to the registered provider following the inspection to ensure that electrical appliances were safe and evidence of this was sent to the inspector as required. 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. Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 5 Copies of the statement of purpose and service user guide were not available. There was little information available to show that service users needs are assessed before admission to the home. Each service user has a contract with the home but information needed to protect their rights is missing. EVIDENCE: Previous inspections had noted that the statement of purpose and service user guide had required information missing and it was recommended that both documents were reviewed in consultation with service users and accessible copies supplied to service users. At this inspection the registered manager was away on holiday and the staff member in charge did not know whether the documents had been reviewed or not. There were no copies of either document available. Following the inspection the registered provider confirmed that information had been reviewed following the last inspection. Information must be available to both existing and prospective service users in addition to any visitors to the home. Five service users files were examined and they contained little information to evidence an assessment was completed prior to them being offered a place. One service user had been admitted from another home but there was no information available to show that an assessment had been completed and the reason for the change of home. The service user admitted very recently had only very scant information available including a hospital discharge summary from two years previously. The needs of service users must be fully assessed Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 10 and documented prior to admission to show that the home is able to meet their needs. Previous inspections had noted that the service user contract excluded the room number to be occupied. At this inspection it was noted that this had been added to some contracts but was missing from others. Continued noncompliance with this requirement may lead to enforcement action being taken. It was also noted that some other key information was omitted from the contract such as details about the support, facilities and services provided, rights and responsibilities of both parties, and arrangements for reviewing needs and progress. This must be added in order to protect service users rights. Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 8 and 9 Care plans do not cover all areas of need, and cultural and religious needs appeared to be unrecognised in one instance. They were not reviewed regularly enough and daily records did not contain sufficient information about the care provided and progress of service users. A community meeting gives service users the opportunity to participate in the running of the home, but this has not been developed to encourage fuller participation, or service users provided with suitably detailed and accessible notes of the meetings. There was little evidence to indicate that risks for service users had been identified in order for them to be addressed within a risk management framework. EVIDENCE: Previous inspections had noted that more was needed within the plan of care to ensure it represents a more comprehensive picture of the individual and the introduction of clear objectives with clear targets; actions, timescales and responsibilities, would assist the monitoring and evaluation of progress and development. At this inspection the care plans examined did not cover all needs, for example the newest service user only had care plans around continence, personal hygiene and finance. Continued non-compliance with this requirement may lead to enforcement action being taken. Also none of the care plans included cultural and faith needs, including a service user who speaks very little English and it was unclear what was being done to Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 12 support this man with his communication and cultural needs. Also staff were unable to inform the inspector of his religious background indicating he is not being supported to practice a faith if he wishes to. Some care plans had not been reviewed for over a year, rather than at least six monthly to ensure that changing needs are recognised and addressed. It was also noted that although a daily record is completed for each service user, this does not detail all activity relating to that service user, for example one service user had been given notice to quit but there was no evidence on the file to explain this. It was also noted that although service users had regular reviews under the Care Programme Approach, the minutes of these reviews were not always available. It is recommended that the registered manager write to the community mental health team to request minutes when they have been unacceptably delayed. The home has a weekly “community meeting” to promote a sense of community and offer service users the opportunity to give and receive information and take part in decisions made about the running of home. At the last inspection it was required that the format of the meeting must be developed to ensure that service users can more fully participate and that a more detailed and accessible record be kept of the meeting to ensure that those not present at the meeting can be clear about what was discussed and agreed. The record should be in an accessible format with copies posted on the service users notice board or provided individually to service users. At this inspection, it was found that the meeting minutes were still recorded in a bound book as previously and one service user stated that if a meeting was missed there was no mechanism for being updated. Continued noncompliance with this requirement may lead to enforcement action being taken. It was also noted that there was no continuation between meetings and some issues discussed were not followed up at subsequent meetings. The minutes did not evidence much contribution from service users and one service user stated that the purpose of the meeting is “to let you know what’s going on”, and another said “Everyone wants to get it over and done with”. It is recommended that consideration be given to reviewing the regularity of service user meetings as participation may increase if the meeting is held less often. Also service users should be supported to contribute to the agenda in advance of the meeting. None of the service users files examined included a risk assessment and these must be in place to ensure that risks are identified and managed safely and to evidence why any restrictions may be in place. Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 14, 15, 16 and 17 The home provides service users with opportunities for personal development through its’ in house activities programme, though this should be reviewed to ensure that it meets their needs and preferences as far as possible and service users should be offered opportunities for one-to-one time with staff. Appropriate leisure activities are also offered at the home, though few service users had been given the opportunity of an annual holiday. Service users have appropriate relationships though the acceptance letter must be reviewed to clarify any restrictions on visiting. There are some practices in the home that are restrictive. Service users mainly enjoyed their meals but meal times are also restrictive. EVIDENCE: The home has a weekly programme of activities that are reportedly well attended. The activities include, relaxation therapy, social skills, cookery class, art and craft, budgeting and planning, assertiveness and outdoor activities. Most service users were happy with the activities offered, but one commented that the activities had never changed and were a bit boring. It is recommended that in consultation with service users the activities programme be reviewed to ensure that it meets their needs and preferences as far as possible. It was Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 14 previously recommended that service users be offered the opportunity for designated individual social and leisure activity time once per week. At this inspection, only one of the service users spoken with felt that one to one activity would be available if required. In addition to the therapeutic activities on offer at the home it was noted that arts and crafts, cookery, beauty therapy and exercise were also offered and at previous inspections that bingo, barbeques, and parties were offered. The previous requirement and recommendation under Standards 6 and 11 state that the home gathers more detailed information about what is important to each service user and the interests they would like to pursue. This information should be used to develop individualised activities with designated time being made available to each service user. It was also recommended that the manager consider how to provide all service users with the option of an annual holiday. At this inspection all but one of the service users spoken to, had not had the opportunity of a holiday and this must now be addressed, as it is usual for most people to take an annual holiday. Several service users have regular contact with their family and one stated that visitors are welcomed at any time and he may take his girlfriend into his room for privacy. However in the letter of acceptance that is sent to service users before moving in, it states, “communal areas are to be used for visitors, and female acquaintances are not encouraged in bedrooms”. This statement is restrictive and sexist and must be reviewed. Although service users were seen to come and go freely from the home and move around freely within it, there were some restrictions in place such as not being allowed in the main kitchen and the residents kitchen being locked at 10.30 pm. In addition service users are not provided with a front door key. Any restrictions must be individually assessed and documented in service users personal files. It was also found that service users are not allowed to smoke in their bedrooms and at nighttime must hand over their cigarettes to staff. This blanket policy does not recognise the individuality of service users and is very restrictive. The registered manager must review the no-smoking policy and if it is still believed to be necessary a risk assessment must be carried out for each service user. Service users property must not be kept by the home without records of their consent (or a risk assessment) and signed records of each handover between staff and service users. Service users gave mainly positive feedback about the food; one service user said, “The food is nice, you get a choice every day”. The inspector was invited to sit with the service users whilst they had lunch and the choice of two meals provided looked appetising and nutritious. As already stated there are some restrictions in place such as service users not being allowed in the kitchen and the service users kitchen being locked at 10.30 pm. Also it was found that meals are served at set times and unless the service user is diabetic, if they miss breakfast they may only have a hot drink. This must be addressed to ensure that service users are provided with food at times that suit them. Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards was examined at this inspection. They were all considered met in the previous inspection year. EVIDENCE: Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Few service users had made complaints but they would be helped to feel that their views were taken into account in developing the service if expressions of dissatisfaction and comments about care received were also recorded. EVIDENCE: Previous inspections had noted that there was a clear complaints procedure in place. At this inspection there were no complaints recorded and all but one of the service users spoken to stated they had never made a complaint. The service user who had, stated that this was dealt with properly at the time. It was recommended at the previous inspection that a record should be kept of significant issues, expressions of dissatisfaction and comments about the care and report received. This had not been implemented and should be so that service users can feel that their views are taken into account. Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 29 and 30 The home offers a good standard of accommodation to service users. It is homely, comfortable and safe. Service users’ rooms had been personalised but there was no records of consultations where service users had refused certain items. Service users on the top floor cannot easily open their windows and blinds. The home is not suitable for service users with physical disabilities and the lift is not always available for service users. The home is clean and hygienic. EVIDENCE: The home is located in a residential area on a main bus route for the shops, facilities and other transport links in Sydenham. The home offers a good standard of accommodation for service users. All of the accommodation is in single rooms and all of the rooms have en-suite toilets. There is a range of communal space, including a large lounge on the ground floor with satellite TV, a dining room in the basement and a conservatory at the rear of the property. There is a large garden at the rear of the property that is reportedly used for barbeques in the summer. The home is clean and well maintained and it is decorated and furnished in a comfortable and homely way. Carpeting on the stairs and upper floor corridors had been replaced and corridor walls decorated as required at the last inspection. Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 18 Previous inspections had noted that some service users did not have all of the required items, for example two comfortable chairs and although some service users had individualised their rooms with personal items, some rooms contained only basic items and lacked a homely feel. At this inspection the inspector was informed that service users had been encouraged to do this but some did not want anything additional in their rooms, however this had not been documented as required. It was noted on the top floor that service users had opening skylight windows with blinds, however one service user stated that he couldn’t reach to open and close the window or blind without standing on his bed. Service users must be provided with a safe and easy means of opening and closing windows and blinds on the top floor. The home is not suitable for service users with physical disabilities and one service user who had lived at the home for over three years was having to move out because her physical mobility had decreased and the manager had stated that her needs could no longer be met at the home. It was also noted that although the home has a passenger lift, one service user told the inspector that it is never used and on the day of the inspection it was full of cleaning equipment and materials. The manager must ensure that the lift is available for use and that it is kept clear of all items. The home was clean on the day of the inspection and there were no offensive odours. Laundry facilities are conveniently and appropriately located away from areas where food is prepared and eaten. The washing machines have programming facilities to meet disinfection standards. Cleaning products and other chemicals were stored appropriately. Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35 and 36 Recording of staff meeting minutes and staff duty handovers do not ensure an effective staff team. An element of the home’s recruitment practice potentially places service users at risk of abuse. The home’s induction training process does not meet National Minimum Standards. Supervision and support could not be examined at this inspection and a previous requirement regarding frequency of supervision remains in place. EVIDENCE: The inspector was informed that there are three staff on duty during the day and at night one waking and one sleeping staff. There is also a cook and a cleaner. The staffing level appears to be sufficient to meet the basic needs of service users though as noted under Standard 11 there should be sufficient staff to allow designated time for each service user on a weekly basis. It was noted at the previous inspection that staff meetings were not taking place at least six times per year and that minutes of meetings were only very brief. At this inspection it was noted that the meetings were now taking place every two months, however the minutes had not been done for the previous two meetings and staff were not provided with a copy. Continued noncompliance with this requirement may lead to enforcement action being taken. The inspector was invited to attend a handover meeting where staff going off duty, inform staff starting duty of any significant issues relating to each service user. It was noted that no records were used to hand over Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 20 information and staff starting duty did not take any notes. Whilst the inspector was impressed by the capacity of staff to store information, this practice is likely to lead to information getting missed and does not make staff accountable for information passed on. Although recruitment records were not available on the day of the inspection due to the manager’s absence, a new staff member was asked about recruitment practices. It was found that they had started employment before a new check with the criminal records bureau and a check against the list of people considered unsuitable to work with vulnerable adults had been made. This practice potentially leaves service users at risk of abuse. Previous inspections had noted that individual training needs were discussed and recorded in supervision sessions but there were no separate training records for the year. Effective individual and group training and development plans were yet to be established. Induction recording was too brief and generalised and did not provide sufficient evidence of training provision, which was in line with the Sector Skills Council specification. At this inspection training records were not available but a new staff member was asked about the induction they had completed. It was found that they had undergone a week’s induction but nothing had been recorded. This does not meet the requirement that induction is completed within six weeks of employment and covers all of the areas identified by the National Training Organisation. Continued non-compliance with this requirement may lead to enforcement action being taken. It is recommended that the manager contact the local office of the National Training Organisation, “Skills for Care” for advice about training. It was noted at the previous inspection that although staff were supervised individually these meetings did not take place at least six times per year and that staff were not provided with a copy of the notes. At this inspection supervision records were not available due to the manager’s absence so will be examined at the next inspection. Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 41 and 42 Service users were not confident that their views underpin review and development by the home. The home’s record keeping policies and procedures do not safe guard the rights and best interests of service users. The health, safety and welfare of service users are generally protected though some evidence of equipment and food safety testing was not available. EVIDENCE: Previous inspections had noted that although service users had been surveyed the home needed to implement an effective system for inviting and recording the views of staff, service users relatives and visiting professionals and for documenting internal monthly audits. It was required that the manager implement a more formal, preferably professionally recognised, quality assurance system, which would enable an improved overview of whether the home is achieving its aims and objectives. It was also recommended that the survey form be redeveloped with a view to eliciting more useful and detailed feedback on a variety of issues, including inspection requirements and recommendations. At this inspection the inspector was informed that service users had completed a questionnaire a couple of months previously though the Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 22 views of service users representatives or visiting professionals had not been sought and the results were not available as required. As the manager was unavailable the Standard could not be fully examined however blank or completed surveys were not available and staff were not aware of any developments in terms of the development of a quality assurance system. The requirement and recommendation will be carried forward to the next inspection. It was required at the previous inspection that all service users are supported to access their care plan and contribute to day to day recording and recommended that service users are made aware of their rights in relation to accessing records and direct support should be offered to ensure service users are able to participate in record keeping if they wish. The inspector was informed that this was discussed at a service users meeting however there was no record of this and four of the seven service users asked were not aware that they could see their records. None of them had been offered the opportunity to participate in record keeping. Continued non-compliance with this requirement may lead to enforcement action being taken. The records of service users care plans, accidents and incidents, complaints, food provided, visitors, service users money, fire drills, inspection and testing of fire equipment, and gas and electrical safety were examined. Concerns about recording in service users files are discussed under Standard 7. The inspector was informed that there was no book to record staff accidents and it was noted that service users accidents were recorded in a bound book, which has been deemed unacceptable in terms of confidentiality. Single sheets must be used in order to maintain confidentiality. There is a book available from the Health and Safety Executive specifically for this purpose. Eight service users have assistance from the home in managing their money. Money is kept in individual pouches in a safe and records were available to record transactions. It was not clear whether service users had purchased things themselves or whether staff had made purchases on their behalf as there were receipts available for both instances. This must be clearly stated in the record in order to fully protect service users interests. It was also found that daily amounts of money were kept for service users but there were no records for these, leaving service users vulnerable to financial abuse. Personal files of service users and the file for maintenance and inspection certificates were poorly organised and the manager must conduct a filing audit and ensure that files are sorted into sections and properly indexed. At the previous inspection it was noted that the home had systems in place to ensure the health, safety and welfare of service users though fire drills were not taking place at least 4 times a year as required. At this inspection it was noted that three had taken place since November 2004 and provided another was undertaken before November 2005 the requirement would be met. Other records of inspection and testing of fire equipment, gas and electrical safety were seen to be up to date though fire alarm tests had not been completed for over a month and portable electrical appliance tests had not been inspected for over two years. Also a recommendation made by the Environmental Health Officer in October 2004 had only partially been implemented. This was to Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 23 check temperatures of the fridge and food as it is being cooked. Records of fridge temperatures were available but there were none of food temperature testing. A serious concern letter was sent to the registered provider following the inspection to ensure that electrical appliances are safe and evidence of this was sent to the inspector as required. Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 24 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 1 x x 1 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 x 2 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 2 x x 1 3 Standard No 11 12 13 14 15 16 17 3 x x 2 2 1 2 Standard No 31 32 33 34 35 36 Score x x 2 1 1 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lawrie Park Lodge Score x x x x Standard No 37 38 39 40 41 42 43 Score x x x x 1 1 x G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4 and 5 Requirement The Registered Person must ensure that the statement of purpose and service users guide contains all of the information required by the care homes legislation and the national minimum standards (previous timescales of 30/09/04 and 31/03/05 not met) The registered provider must ensure that copies of the statement of purpose and service user guide are available in the care home. The registered provider must ensure that thorough assessment of the needs of service users is undertaken prior to admission to the care home, in order to ensure that those needs can be met and ensure that documentation supporting this assessment is available in the service users file. The Registered Person must ensure that the number of the room occupied by individual service users is noted on service users’ contracts (previous timescales of 30/09/04 and 31/03/05 not met) Timescale for action 31/12/05 2. 1 4 and 5 31/12/05 3. 2 14 (1) 30/11/05 4. 5 5 (1) (c) 30/11/05 Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 26 5. 5 5 (1) (c) 6. 6 15 7. 6 12 (4) (b) 8. 6 15 (2) (b) 9. 6 17 (1) (a) 10. 8 12 11. 9 13 (4) (b) and (c) 12. 14 12 (1) (a) The registered provider must ensure that the service user contract covers all of the areas listed under NMS 5. The Registered Manager must ensure that all needs are detailed on individual care plans so that they are more easily accessible and so that monthly reviews can be recorded clearly (previous timescales of 30/08/04 and 31/03/05 not met) The registered provider must ensure that the linguistic, cultural and religious needs of service users are assessed and addressed. The registered provider must ensure that care plans are reviewed at least every six months. The registered manager must ensure that the daily record gives an accurate overview of all activity relating to the service user, including action taken in response to concerns and contact with other professionals. The Registered Manager must develop the format of the residents meeting to ensure service users can more fully participate. Service users to be provided with a suitably detailed and accessible copy of the notes (previous timescale of 31/03/05 not met) The registered provider must ensure that brief risk screens are undertaken for each service user and where risks are identified a more detailed assessment and plan of management is developed and recorded. The registered provider must ensure that service users have as part of the basic contract price the option of a minimum 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 31/12/05 Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 27 13. 15 12 (4) (a) 14. 16 12 (3) 15. 16 17 (1) (a) Schedule 3 (3) (q) 16. 17 16 (2) (i) 17. 26 23 (2) (f) 18. 26 16 (2) (c) seven-day annual holiday outside the home, which they help choose and plan. The registered provider must review the acceptance letter given to service users to ensure that it accurately reflects rules of the home. The registered manager must review the need not to allow smoking in service users bedrooms and if it is still believed to be necessary a risk assessment must be carried out for each service user. Property of service users must not be kept by the home without records of the service users consent (or risk assessment) and signed records of each handover between staff and service users. The registered manager must ensure that where restrictions are in place, (such as the use of the main kitchen, the residents kitchen door being locked at night or service users not being given the keys to the front door) the need for the restriction is regularly reviewed and documented in the personal files of all those affected by the restriction. The registered provider must ensure that service users are provided with food at times that suit them. The Registered Manager must ensure that where necessary service users are encouraged and supported to personalise bedrooms and give them a more homely feel. Details of the consultation and decision must be recorded in their care plans (previous timescales of 31/10/04 and 31/03/05 not met) The registered manager must 30/11/05 30/11/05 30/11/05 30/09/05 30/11/05 30/11/05 Page 28 Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Schedule 4 (10) 19. 26 16 (2) (c) 20. 29 23 (2) (c) 21. 33 12 (5) (a) and 18 (2) 22. 33 12 (1) (a) 23. 34 19 (1) (b) 24. 35 18 (1) (a) 25. 36 12 (5) (a) and 18 (2) discuss with service users whether they would want any of the standard items of furniture not currently provided and if so these must be supplied. Details of the consultation and decision must be recorded in their care plans (previous timescales of 30/09/04 and 31/03/05 not met) The registered provider must provide service users with a safe and easy means of opening the windows and blinds on the top floor. The registered provider must ensure that the lift is available for use and that it is kept clear of all items. The Registered Manager to ensure staff meetings take place at least six times a year. Staff to be provided with a copy of the notes (previous timescale of 31/03/05 not met) The registered manager must ensure that records are kept for handover purposes and staff sign the record on shift handover. The registered provider must not allow any staff to commmence employment in the home until new checks have been completed including a POVA check. The Registered Manager must introduce a more formal induction programme, which meets TOPPS specifications (previous timescale of 31/03/05 not met) The Registered Manager must ensure individual staff supervision meetings take place at least six times a year. (This could not be examined at this inspection. Previous timescale was 31/03/05) 30/11/05 30/11/05 30/11/05 31/10/05 30/09/05 30/11/05 30/11/05 Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 29 26. 39 24 27. 41 15 (2) (a) 28. 41 17 (1) (b) 29. 41 16 (2) (l) 30. 41 17 31. 42 23 (2) (c) 32. 33. 42 42 23 (4) (c) (v) 16 (2) (j) The manager must ensure that there is an effective quality assurance and monitoring system in place at the home to measure success in achieving its aims and objectives.(This could not be fully examined at this inspection, previous timescales were 30/04/04, 30/08/04 and 31/03/05) The Registered Manager must ensure all service users are actively supported to access their care plan and contribute to day-to-day recording (previous timescale of 31/03/05 not met) The registered provider must ensure that accidents are recorded on single sheets in order to maintain confidentiality. The registered provider must ensure that records are kept for all transactions of property kept for service users including cigarettes and daily money. Records must also indicate whether purchases are made by service users or on their behalf. The registered provider must conduct a filing audit and ensure that files are sorted into sections and properly indexed. The registered provider must ensure that all electrical appliances are safe and certificates of electrical safety of appliances are sent to CSCI SE London Office by 24 August 2005 (This was an immediate requirement and evidence was received by the given date) The registered provider must ensure that fire alarms are tested weekly. The registered provider must ensure that advice given by the Environmental Health Officer is implemented. 30/11/05 30/11/05 30/11/05 30/09/05 31/12/05 24/08/05 30/09/05 30/09/05 Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 6 8 8 Good Practice Recommendations It is recommended that the registered manager write to the Community Mental Health Team regarding the delayed receipt of CPA meeting minutes. It is recommended that previous meeting minutes and matters arising are discussed at each meeting to ensure that issues get followed up. It is recommended that consideration be given to reviewing the regularity of service user meetings as participation may increase if the meeting is held less often. Also service users should be supported to contribute to the agenda in advance of the meeting. It is recommended that service users be offered the opportunity for designated individual social and leisure activity time at least once a week. It is recommended that in consultation with service users the activities programme be reviewed to ensure that it meets their needs and preferences as far as possible. The Registered Manager should keep a record detailing significant issues, expressions of dissatisfaction and comments from service users about the care and support received. It is recommended that the manager contact the local Skills for Care office for advice and support regarding for the homes training programme. The Registered Manager should redevelop the service user quality assurance questionnaire with the aim of eliciting more useful and detailed feedback. The Registered Manager should ensure all service users are aware of their rights in relation to accessing records. Direct support should be offered to ensure service users are able to participate in record keeping, if they wish. It is recommended that a new format accident and incident book is obtained from the Health and Safety Executive. 4. 5. 6. 11 11 22 7. 8. 9. 35 39 41 10. 41 Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 31 Commission for Social Care Inspection Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 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 Lawrie Park Lodge G02-G52 S25630 Lawrie Pk Lodge V242341 170805 Stage 4.doc Version 1.40 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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