Inspection on 19/06/07 for Little Heath Lodge

This inspection was carried out on 19th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Little Heath Lodge 04/01/08

Little Heath Lodge 06/06/06

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

CARE HOME ADULTS 18-65 Little Heath Lodge 68 Little Heath Charlton London SE7 8BH Lead Inspector Maria Kinson Unannounced Inspection 19th June 2007 10:55 Little Heath Lodge DS0000064562.V339037.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 Little Heath Lodge DS0000064562.V339037.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. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Heath Lodge Address 68 Little Heath Charlton London SE7 8BH 020 8317 7542 020 8317 7534 enquiries@cognithan.com 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) Cognithan Ltd Ms Emilia N Endeley Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th April 2007 Brief Description of the Service: Little Heath Lodge is registered with The Commission for Social Care Inspection to provide nursing care for five male or female service users, aged 18 to 65 years of age, with a mental health disorder. The home is located on a main road, in Charlton, which is served by several bus routes and within 10 minutes walk of a train station. The property consists of a large Victorian terraced house with five single bedrooms, dining room, kitchen, laundry, office/meeting room and lounge. The fees charged by the home start from £900 per week. This information was forwarded to the commission on 24.05.06. Further information about this home can be obtained by requesting a copy of the Statement of Purpose or by sending an email to enquiries@cognithan.com Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 19th and 26th June 2007 and was unannounced. The inspection took two days to complete, as the agency nurse that was on duty did not have access to some records. On 19th June two inspectors spent four and a half hours in the home. The inspectors met and spoke with three service users, three members of staff and one health care professional. One of the service users showed an inspector around the home whilst the other inspector examined some of the records that were maintained by staff. On 26th June the inspector was assisted by the deputy manager to view health and safety and staff recruitment and training records. Comment cards were sent to four service users, four relatives and eight health care professionals. The commission received one comment card back from a relative and one from a service user. The information provided by service users, relatives and other professionals forms part of this report. There were three people living in the home at the time of this inspection and one person was in hospital. The commission has visited this home on three occasions since the last key inspection to undertake random and pharmacy inspections. The reports from these visits are available from the office listed at the back of this report. What the service does well: This service provides a stable and pleasant environment for people with a mental health disorder. The home was clean and tidy and all of the communal areas were comfortable. People could choose how and where they spent their time in the home and were able to go out when they wanted. An occupational therapist worked with service users to establish a regular programme of activities. For some people this included completing daily living tasks such as cooking, cleaning and shopping or learning new skills by undertaking voluntary work in the community. A health care professional said staff had supported his client to gain new skills and achieve a more independent lifestyle. The people living in the home were satisfied with the choice and quality of food provided. Service users said staff were usually helpful and supportive. One person said “I like it here, I want to stay”. A relative said staff were able to meet their family members needs and usually kept them informed about significant issues. Staff had a good understanding of abuse and said they would report concerns or allegations to senior staff. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The manager had updated the Statement of Purpose to include additional information about the service. Information about the admission procedure and range of needs the home could meet. Staff must obtain adequate information about a persons needs before allowing a person to move into the home. This includes a copy of the care needs assessment and CPA plan. This information will assist staff to make a decision about whether they can meet the person’s needs and will enable them to provide appropriate support for the person on admission. The manager must write to the service user to confirm if the home is able to meet their needs once she has assessed the information provided by the funding authority and undertaken her own assessment. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 7 Staff must use the information that they have obtained from the funding authority to develop a care plan to meet the persons needs and to develop clear strategies to minimise the risk of harm to the service user or others. Staff should encourage service users to assist with the day to day running of the home by assisting staff to purchase shopping and to prepare, serve and clear up after a meal. Staff should support service users to attend regular health checks. The management of medication had improved but changes were not properly recorded. Some of the people living in the home did not have a key to their room or the front door. The reason for this was unclear and was not recorded in the person’s records. The homes complaints procedure did not provide adequate information about what a person could expect to happen if they made a complaint or what they do if they were not satisfied with the response from staff. It was not clear in the whistle blowing procedure who staff could contact if they had any concerns about the home. The records maintained by staff about people’s personal money were not maintained to a satisfactory standard. It was not always clear what money was spent on and who had authorised the use of the money. Adequate documentation was not obtained for some of the new staff that were working in the home. There was no evidence that the manager had checked if one of the nurses was registered and able to practice and if the references provided were genuine. The training provided for new care staff did not cover all of the recommended topics. Staff recorded accidents on a form and in the person’s notes and in some instances in a book. This showed that some staff were not fully aware of the correct procedure for reporting accidents. The front door was locked from the inside. The inspectors were concerned that this could hinder the evacuation of staff and service users from the home if there was a fire. Some staff had attended training about the safe use of chemicals in the home but there were no written assessments for staff to refer to. The home was maintained to a satisfactory standard overall but some work was required to make the decking in the garden safe and to provide adequate privacy in the bathroom. There were no hand washing facilities in the lower ground floor toilet. The manager had introduced some quality monitoring tools but there was little evidence to show if the information obtained during audits was used to improve the service. The manager should consider developing or purchasing a quality assurance tool that would assist her to monitor compliance with the Care Homes Regulations and National Minimum Standards. Please contact the provider for advice of actions taken in response to this Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 8 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. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 9 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 Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 10 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 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information that was obtained about prospective service users needs was not always sufficiently robust to prepare staff for the person’s admission to the home. EVIDENCE: The registration certificate was displayed in the office on the top floor of the home. The manager should consider moving the certificate to a prominent position where people that visit the home can see it. Both pages of the certificate should be displayed. The inspector was unable to locate any records to confirm what written information was supplied to service users before they moved into the home. There was no evidence of a Statement of Purpose or Service User Guide in the bedrooms visited and the people spoken with were unable to confirm receipt of such information. The deputy manager said this information was provided but had probably been mislaid. The Registered Person should consider placing a laminated copy of the Service User Guide in the communal areas for people to read. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 11 The homes Statement of Purpose was revised in June 2007 and a copy was supplied to the commission. Although this document includes all of the information required, details about the range of needs the home intends to meet and the admission criteria were a little vague. The Registered Manager should address this issue. Two people were selected for case tracking. As part of case tracking the inspector met and spoke with both of the people chosen. The records for one of the people chosen indicated that the person was admitted to the home in 2007. The inspector was not able to identify if this person was under CPA procedures as there was no reference to this in the documentation. The Care Programme Approach [CPA] is intended to form the basis of after care for people with serious mental health needs. The assessment consisted of an admission sheet, a registration form, a clothes inventory and an admission checklist. There was a form headed “ patient contract”, this was limited in content and mainly outlined the house rules, but it was not signed or dated and a fax from the local hospital, which included a brief outline of potential risks and a discharge summary. This form provided information about the person’s background, diagnosis and cognitive functioning. There was a multi disciplinary assessment form, which indicated the person required 1:1 assistance, this was not observed during the visit. The homes pre-admission assessment form included general information and contact details. Parts of the form such as the sections about personal history and psychiatric history were incomplete. The inspector was unable to locate CPA information or a community care assessment in this file. There was no evidence that the manager had written to the person to confirm that the home was able to meet their needs. See requirement 1 and 2. The second file indicated the person was admitted to the home whilst under Section 3 of the Mental Heat Act. This home is not registered to care for people that are detained under Section 3 of the Mental Health Act. A letter was sent to the provider about this issue. The file also contained the home’s own referral form dated 13/11/06, which included medical and therapy information, a tick box risk assessment and identified the persons needs. Two serious risk areas were identified but there was little information for staff about what they could do to minimise or manage the risks. The form stated that the information would be reviewed once a month but this had not taken place since 28/2/07. See standard 9. A ‘preliminary assessment’ form provided information about the person’s psychological and social history. The file also included information from the funding authority such as a copy of the CPA plan, a risk assessment and a letter from the persons Psychiatrist. It was not possible to establish from the records if people had visited the home before making a decision to move in but one person said they had visited the home with a relative. Staff should ensure that this information is recorded. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The records maintained in the home did not always provide adequate information about the support that was required to maintain peoples safety and meet their needs. People said they could make decisions for themselves. EVIDENCE: The care plan for one person identified three areas of need including medication and restlessness. The plan did not provide adequate information for staff to support the person with these issues. The person was visiting the toilet very frequently but there was no reference to this issue in the care plan. The deputy manager said the person was undergoing some tests to establish the cause of the problem. There was no evidence that the person had agreed or was consulted about their support plan and the inspector could not establish if the plan was based on the CPA plan. The file did not include a crisis or contingency plan for staff to follow in emergency situations. See requirement 3. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 13 The second care plan appeared to address all of the persons needs and interventions were clearly recorded. The plan was reviewed regularly and the record was signed and agreed by the service user. The plan was based on the CPA plan but included more information about how the home would support the service user to meet their goals. There was no evidence of CPA reviews. The files did not include a photograph of the service user. See requirement 4. Service users said they were able to make decisions about what they did during the day, in the evening and at weekends. During the inspection one person went out to visit a relative, the remaining people spent their time in their rooms or the communal areas. Staff had completed a risk assessment, which had the following headings: identified risks, current risk setting and factors that could increase the risk. There was limited information recorded on the form and strategies to minimise risks were not always very clear. One area, which required more detail, was information about the action that staff should take to minimise the risk of people becoming physically aggressive. There was no evidence that the risk assessment was discussed with the service user. See requirement 5. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 14 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, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were supported to establish a regular programme of activities to meet their needs but staff did not always encourage people to participate in the day- to- day running of the home. Some people did not have a key to their room and were not able to get out of the home without assistance from staff. EVIDENCE: All of the people that were living in the home were spoken with during the inspection. People were asked about activities, meals and privacy and dignity. One person had a voluntary office job, which they attended twice a week and staff were looking for day care facilities for another person. The home employs a part time Occupational Therapist. The Occupational Therapist visited the home once a week to develop an individual activity programme for each Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 15 person and to support people to learn new skills. Some people had prepared meals with support from the Occupational Therapist and had started to develop basic computer skills. One health care professional said that staff had spent a lot of time finding out about his clients interests and personal goals and were very supportive. The inspectors did not see any activities taking place during the inspection but one person was due to attend an appointment later in the day with support from staff. Interaction between staff and service users was limited. One person was rather restless but staff did not enquire if there was a problem or use any techniques to distract the person. Feedback from a visiting health care professional indicated that staff usually had a good understanding of peoples needs and communicated effectively. There was very little food in the refrigerator when the inspectors arrived. The freezer contained some bags of chipped potatoes and meat. The deputy manager said food was purchased on a daily basis to avoid waste. People said the food was satisfactory and usually met their needs and tastes. A member of staff purchased food for lunch from the local shops and prepared and served the meal. The people living in the home were not engaged in any of these activities, all of which are essential parts of rehabilitation and would reinforce the work that the Occupational Therapist was undertaking. See recommendation 1. One person had a key to their bedroom but none of the people living in the home had a front door key. One person that did not have a key to their room felt their privacy was compromised because of this. There was no evidence in the records to indicate why some people had not received a key. See recommendation 2. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff worked in partnership with other professionals to meet people’s health and social needs. The management of medication had improved but staff must ensure that adequate records are maintained when a person’s medication regime changes. EVIDENCE: One person required some prompting with personal hygiene. On the day of the inspection this person was supported to have a bath, which they said they enjoyed. There was evidence that staff were flexible and tried to accommodate people’s preferences about when they took their morning medication. There was little reference to health care appointments in the plans viewed but some information was recorded in the daily notes and diary and some of the files included letters from various professionals. It was not clear if people were encouraged to attend regular health checks, dental check ups or eye tests. The manager should consider introducing a form to record this information. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 17 This will enable staff to see at a glance when the person was last seen. The records indicated that one person should be weighed once a week. The last weight recorded was on 18/5/07. See recommendation 3. The home used the Boots monitored dosage system and supporting medication administration charts (MAR) sheets. In the front of the medication file there was a list of staff initials. Three medication charts were examined. There were no photographs on the charts but all of the people in the home could identify themselves. Good records were maintained about medicines that were received in the home or sent for disposal and storage facilities were satisfactory. The instructions on the label for two medicines indicated the medicine should be administered ‘when required’ but the chart indicated the medicine was administered three times a day. The deputy manager said the frequency of administration was increased following consultation with the persons GP. There was no evidence to support this change of treatment on the chart. See requirement 6. The label on one medicine stated it was to be given once every three weeks. There was no information on the chart about when the medicine was last given or when it was due. The inspector was shown a separate file that contained this information on the second day of the inspection. The manager should consider storing this record with the persons MAR chart so that all staff, including agency staff have access to it. There was overstocking of some medication. This issue had been addressed by the time the inspector returned to the home. Some of the people living in the home attended a local clinic for some of their medication. The records showed that staff monitored this issue very closely to ensure that people were receiving their medication. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The complaints procedure did not provide adequate information for service users or their representatives. Staff had a good understanding of the procedure for protecting vulnerable adults but did not take adequate steps to safeguard people’s personal money. EVIDENCE: The complaints procedure was kept in a file in the office. The procedure did not provide information about the timescale for investigating concerns, did not state if there were different stages that the complainant could follow if they were dissatisfied with the initial response and did not include contact details for the commission. The procedure made frequent references to abuse although there was a separate procedure for staff to follow about allegations of abuse. See requirement 7. The home had not received any complaints during the past year. The people living in the home said they knew who to speak to if they were unhappy but one relative said they had not been informed about the homes complaints procedure. The homes adult protection procedure stated that concerns should be reported to the manager who would then contact social services or the police, depending on the nature of the allegation. The procedure referred to the Registered Homes Act, which was repealed several years ago. Staff demonstrated a reasonable knowledge about adult protection procedures but one member of staff was not aware of the homes whistle blowing and restraint Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 19 procedures. The whistle blowing procedure indicated that staff could contact the chief executive if they had any concerns about the service. This service does not have a chief executive. Several people are required to restrain a person in a safe manner. The manager should consider adopting a no restraint policy because there were a number of shifts when there was only one member of staff on duty in the home. See recommendation 4. Most of the people living in the home were able to manage their own money. Staff were responsible for safeguarding one persons personal money. Records were maintained about money that was handed to staff for safekeeping and money that was used to purchase personal items for the service user. There were no receipts for purchases and it was not clear what one sum of money was spent on. There were no signatures for some of the entries and no witness signature. See requirement 8. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was clean and comfortable but staff and service users did not always have access to adequate hand washing facilities to help prevent the risk of cross infection. EVIDENCE: The home is situated in a three storey Victorian house close to shops and a local bus route. There are five single bedrooms located over three floors and a shared toilet and bath or shower room on each floor. On the lower ground floor there is a laundry room, lounge, dining room and kitchen. At the back of the property there is a good size garden with a patio and seating. This area was well maintained and tidy. The home was in good decorative order but some maintenance issues were identified. Part of the decking in the garden was loose and could present a tripping hazard, the taps on the hand washbasin in the kitchen were loose, there was no lock on the bathroom door on the top floor and the toilet seat and some of the cabinet doors in two of the bathrooms Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 21 were loose. Some of these issues were addressed before the inspector returned to the home. See requirement 9. The home was clean overall but some areas such the cupboard in the ground floor bathroom and the area behind the toilet on the lower ground floor were rather dusty. There were no hand washing facilities in the lower ground floor toilet on the first day of the inspection but a bar of soap was provided by the time the inspector returned to the home. There were no hand towels. None of the staff had completed infection control training and the sharps disposal box was not labelled or dated. See requirement 10. Little Heath Lodge DS0000064562.V339037.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 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing arrangements and access to training had improved but induction training for support staff did not meet the required standard. Recruitment practices had improved but further checks must be carried out to protect the people living in the home. EVIDENCE: 75 of care staff had a vocational qualification or equivalent qualification in care. This exceeds the standard set by the Department of Health. Since the last key inspection the staffing arrangements had improved. The roster indicated that all of the shifts now included a registered nurse and there was a support worker on duty Monday to Friday between 10am and 4pm. The inspector was told that the Occupational Therapists hours had recently increased but this was difficult to evidence, as the person’s hours were not recorded on the duty roster. The deputy manager agreed to amend the roster. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 23 The staff on duty had previous experience of working with people with a mental health disorder and demonstrated an adequate knowledge about rehabilitation and capacity issues. Three staff files were examined. There was no evidence that one nurse was registered to practice and some of the references were not checked to ensure that they were authentic. One file did not include a recent photograph of the employee. The files included several loose pieces of paper that could easily become detached and lost. Concerns had been identified in the past regarding the homes recruitment procedures but had improved at the last random inspection. The manager must ensure that work that was undertaken in the past to address this issue is sustained. The date that staff members had started work in the home was unclear. This information must be recorded. See requirement 11. The majority of staff working in the home were employed on a sessional basis and had other jobs in the NHS or private sector. Some staff had undertaken relevant training courses in connection with their other jobs. Copies of certificates were kept in staff personnel files. Since the last inspection some staff had attended medication, fire safety, lone working, health and safety and customer care training sessions. Induction training was provided for new staff. The induction training for support staff did not cover the common induction standards. See recommendation 5. Little Heath Lodge DS0000064562.V339037.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 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some improvements were noted during this inspection but it remains a concern that a significant number of standards were not fully met and work to improve the recruitment procedure was not sustained. The home had started to develop systems to monitor and improve the quality of care provided in the home. EVIDENCE: The manager was sick at the time of this inspection. The deputy manager was in charge of the home. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 25 The manager is registered with the commission. The manager has a degree in education, a Post Graduate Diploma in Counselling and is a Registered Mental Health Nurse. The manager was now working four days a week. Many of the standards that were assessed during this inspection were almost met. A significant amount of work is required to ensure compliance with the care homes regulations and to meet the national minimum standards. See requirement 12. Staff and service users said that the manager was approachable and helpful and listened to their views. The home had developed some systems to monitor and assess the quality of care provided in the home. Several audits had been undertaken to assess compliance with medication procedures, the standard of documentation maintained by staff and safety issues in the home. It was not clear if issues identified during audits were used to improve the service, as there were no action plans or reviews. See recommendation 6. There was evidence that ‘community meetings’ had taken place in February, March and April 2007 but the meetings appeared to have declined in recent months. Staff should establish how often the people living in the home would like to meet. The minutes from these meetings indicated that various issues were discussed such as food and activities and some people had put forward ideas such as providing a radio or stereo in the dining room. There was no evidence that staff had acted on this suggestion. The minutes indicated that one person’s behaviour was discussed during a meeting. The deputy manager said the person had consented to this discussion but there was no evidence to support this in the records. See recommendation 7. The home had completed a fire risk assessment. Fire exits were clear and extinguishers were positioned at relevant points around the home. A new fire alarm system and panel had recently been installed. The alarm and emergency lighting system were tested and serviced regularly and some fire drills had taken place. The deputy manager was advised to ensure that fire drills were unannounced so that he could assess how service users and staff responded. The front door was locked from the inside and the minutes from a staff meeting indicated that fire doors must be locked at all times. These issues could create problems if there were a fire in the home. The manager should write to the fire authority to obtain their advice about these arrangements. A copy of the response from the fire authority must be forwarded to the commission. See requirement 13. The records of accidents and incidents were examined. Some accidents were recorded in a book, some were recorded on a form and some were recorded on the form and in the book. The manager should establish a simple procedure for staff to follow. Many of the issues related to disputes between service Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 26 users. The reporting of significant events and incidents to the commission had improved. Health and safety records were sampled. The sample included service reports for gas appliances, the main electrical installation and portable electrical appliances. All of these certificates were up to date. Some of the staff had attended COSHH (control of substances hazardous to health) training during their induction but there were no assessments in place for staff to refer to if a service user ingested or was exposed to some of the chemicals that were used in the home. See requirement 14. The manager had assessed the risk of falls from windows and burns and scalds from hot water. As a result of these assessments the home had introduced regular checks to monitor the temperature of the hot water and to check that window restrictors were fitted correctly. Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 27 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 2 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 4 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 3 2 X X 2 X Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14 Requirement The Registered Person must ensure that before a new person is admitted to the home, a full assessment and where appropriate, a copy of the persons CPA plan is obtained. The Registered Person must not provide accommodation to a service user unless; after considering the care management assessment they are satisfied that they can meet the persons needs and have confirmed this in writing to the person. The Registered Person must ensure that care plans state how the home intends to fulfil its responsibilities under the CPA agreement and meet people’s needs. The Registered Person must obtain a photograph of the service user. The Registered Person must ensure that risk assessments provide clear guidance for staff about the action that they should take to maintain the persons safety. DS0000064562.V339037.R01.S.doc Timescale for action 16/08/07 2. YA3 14 16/08/07 3. YA6 15 13/09/07 4. 5. YA6 YA9 17 13 13/09/07 16/08/07 Little Heath Lodge Version 5.2 Page 29 6. YA20 13 7. YA22 22 8. YA23 17 9. YA24 23 10. YA30 13 11. YA34 19 12. YA37 10 13. YA42 23 The Registered Person must ensure that medication changes, part- way through a MAR chart cycle, are recorded. The chart must state the date the change was made and who authorised the change. The record should be signed and dated by the person that amended the MAR chart. The Registered Person must amend the complaints procedure to include information about the timescale for investigating concerns, the different stages the complainant can follow if they are not satisfied with the managers response and contact details for the commission. The Registered Person must ensure that adequate and up to date records are maintained about service users money. The Registered Person must ensure that the loose tap in the kitchen and the loose decking in the garden are repaired. A lock must be fitted to the door in the top floor bathroom. The Registered Person must ensure that adequate steps are taken to prevent the risk of cross infection within the home. The Registered Person must not employ a person to work at the care home unless they have obtained in respect of that person, the information and documents specified in Schedule 2. The Registered Person must take adequate steps to ensure that the home is managed with sufficient attention to detail. The manager must ensure compliance with the care homes regulations. The Registered Person must DS0000064562.V339037.R01.S.doc 16/08/07 13/09/07 16/08/07 13/09/07 13/09/07 16/08/07 11/10/07 16/08/07 Page 30 Little Heath Lodge Version 5.2 14. YA42 13 obtain advice from the fire authority about locking fire doors. The Registered Person must ensure that COSHH assessments are completed and made available to staff 13/09/07 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. Refer to Standard YA11 YA16 Good Practice Recommendations The Registered Person should ensure that service users are encouraged to participate in the day- to- day running of the home. The Registered Person should ensure that people are given a key to their bedroom and the front door. Decisions to limit people’s movements and privacy should be based on their assessed needs and must be recorded. The Registered Person should ensure that service users are encouraged to attend regular health checks and are weighed regularly if there are concerns about their appetite or weight loss. The Registered Person should: • Review the homes restraint and whistle blowing procedure • Ensure staff are aware of the homes whistle blowing procedure The Registered Person should provide structured induction training for support staff. The training should cover all of the common induction standards. The Registered Person should ensure that action plans are developed to address survey or audit findings. The Registered Person should ensure that staff do not discuss confidential issues about individual service users during community meetings. 3. YA19 4. YA23 5. 6. 7. YA35 YA39 YA10 Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Little Heath Lodge DS0000064562.V339037.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!