Inspection on 15/01/07 for Natal Lodge

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Natal Lodge 31/01/06

Natal Lodge 22/09/05

Natal Lodge 17/02/05

Natal Lodge 27/09/04

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

CARE HOMES FOR OLDER PEOPLE Natal Lodge 19 Natal Road Thornton Heath Croydon Surrey CR7 8QH Lead Inspector Michael Williams Key Unannounced Inspection 15th January 2007 3.00pm X10015.doc Version 1.40 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 Natal Lodge DS0000025816.V311432.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 Older People. 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. Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Natal Lodge Address 19 Natal Road Thornton Heath Croydon Surrey CR7 8QH 020 8771 4595 020 8251 2785 vijayen@hotmail.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Goinsamy Anenden Mrs Jayamane Anenden Mrs Jayamane Anenden Care Home 3 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (0) of places Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow one specified service user under the age of 65 to be accommodated subject to: (1) a minimum annual review of the service user’s health needs (2) staff continuing to have the necessary skills and training to meet the service user’s needs (3) alternative arrangements being sought should the home no longer be able to meet the service user’s assessed needs. Date of last inspection Brief Description of the Service: Mr & Mrs Anenden own Natal Lodge and also work in the home. It is registered with the Commission for Social Care Inspection to provide care and accommodation for three elderly service users with mental health needs. A variation has also been granted for one service user to live there who is under the age of 65 years. The home is a residential terraced house situated in Thornton Heath, approximately 10 to 15 minutes walk from the main town centre. The home is well placed to access local transport links and amenities. All service users have the benefit of a single room and plenty of communal space that includes a lounge, dining area, conservatory room and pleasant garden. There is also a well-equipped kitchen and separate laundry facilities in the conservatory area. Fees as at January 2007 are from £500 to £650 and additional charges will be negotiated with funding authority of additional care is required. Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted during the course of several visits - to accommodate service users’ daily programme of activities and appointments. In addition to meeting the three residents; the owners were interviewed and the premises were inspected. In order to crosscheck or ‘case-track’ observations a range of statutory records and documents were also examined. This is a very small, family-type service and so the inspection was conducted in a proportional manner reflecting a lighter touch but ensuring the safety and well being of service users is maintained. Amongst the choices that service users can make known, or their family can assist them in making known, are the residents’ cultural and diversity needs and wishes and so the home seeks to ensure residents can follow their religious and cultural beliefs whether that is in the form of worship, leisure pursuits or special diets. What the service does well: What has improved since the last inspection? Recruitment practices have improved and an appropriate CRB (police check) and POVAFirst check has been obtained for all staff members. Menus had been revised to reflect individual residents’ preferred tastes for cultural foods and dishes. Plans are in place for further staff training although some courses have Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 6 been completed including those related to resident safety and further training specifically relating to mental health will follow. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 3 was assessed and the quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New service users are being admitted only on the basis of a full assessment undertaken by people trained to do so and this involves the service users; so residents know that their needs have been fully assessed and can be met in this home. EVIDENCE: A sample of case notes of those residents being ‘case-tracked’ was checked. The two owners were interviewed during the course of this and the previous inspections; the service users themselves also advised the inspector of their experiences at the time of admission and how care provided since admission. The pre-admission assessments include general information about each service user, details of their background medical and social history and comprehensive details of specific issues such as mobility nutrition, diabetes, continence, medication and diversity needs or choices. Service users assist in the compilation of these case notes. Areas of strength are well document admission assessments and information provided to service users, including a Service User Guide, and as no matters requiring improvement arise this section, about choice, is assessed as good. Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7 8 9 and 10 were assessed and the quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning, the provision of health care and the procedures for dealing with medication are all satisfactory so as to ensure the social, and health care of service users can be met. EVIDENCE: As with the standards about choice a sample of residents case files were read; residents interviewed; the owner/manager also explained how they aim to met the social and health care needs of all three residents. Administration, paperwork, in this home is very good and the case files were in good order. They include assessments, care plans, risk assessments, medication records, list of preferences and a variety of other records relating to the care needs of each of service users. There was also evidence that this documentation is being reviewed periodically and includes meetings/conferences with the health care professionals supporting each service user. The resident interviewed privately advised the inspector about how well he was and how much progress he has made since arriving at the home. Areas of strength are the close support residents get, particularly in relation to their mental health care needs, and as no matters requiring improvement arise this section, about health and personal care, is assessed as good. Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12 to 15 were assessed and the quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The daily routines in this home are reasonably flexible, within the constraints of a small family-type service. Service users are being supported and encouraged to maintain links with family, friends and to exercise choice and control over their lives in so far as they wish and are able to do so. Service users are receiving a wholesome, appealing and well balanced diet in a congenial setting in accordance with their recorded requirements and preferences. EVIDENCE: There have been no significant changes to the residents’ lifestyles and all three individuals continue to follow their preferred interests and hobbies. Their personal preferences are recorded in the care plans. One resident travels independently to a local day centre during the week and confirmed that he enjoys going. Another resident said that he sometimes goes to a luncheon club. The third individual generally prefers to stay in the home aside from visiting the nearby shop for his daily newspaper or going shopping with staff. Recreational activities available within the home include television, radio, gentle exercise sessions, newspapers/ magazines, and board games. Information about activities and local social events.is displayed on a notice board. The owner and his wife, who is the manager, encourage residents to exercise choice and control in their lives and, due to the small size of the home, residents benefit from this close support. This is achieved through Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 11 regular consultation with residents on a daily basis as well as via meetings held periodically throughout the year – the last such meeting being to plan for the Christmas celebrations. Two residents handle their own affairs and keep their own purse / wallet of personal monies. Records of transactions concerning the other resident were seen and maintained appropriately. Menus had been revised to reflect individual resident’s preferred tastes for cultural dishes. Areas of strength are the close support and supervision of residents whilst enabling as much independence as is safe for each resident and as no matters requiring improvement arise this section, about daily life, is assessed as good. Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18 were assessed and the quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear and simple procedure for dealing with complaints so service users’ are confident their concerns will be dealt with promptly and effectively. To ensure vulnerable service users are safeguarded from abuse the home has written policies and procedures about the protection of service users and their property; this includes procedures for passing on concerns to the relevant authorities including the Commission. EVIDENCE: The home’s complaints procedure contains all of the relevant and necessary information and is readily available to the people who live there, their relatives and other visitors. Information can be made available in large print and defines clear guidance on how to make a complaint. A record book is kept and no complaints have been made either to the home or to the Commission since the last inspection or indeed within the last four years. The manager explained that any minor concerns are dealt with informally without recourse to a formal complaints process within the home but a formalised process is available if the need arises. Staff have received training in handling complaints and in dealing with allegations of abuse and how to report such matters to the local Social Services and to the Commission. Also as matter of service user protection it is recommended that police checks be renewed three-yearly. Areas of strength are openness and wiling ness of the owner/manger to listen to residents and their concerns and as no matters requiring improvement arise this section, about complaints and protection, is assessed as good. Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19 and 26 were assessed and the quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The layout of the home and the manner in which it is being maintained means that this is a safe, comfortable and suitable environment for the service users. The premises are being kept clean, hygienic and free from offensive odours and systems are in place to control the spread of infection. EVIDENCE: Local shops and public transport are within easy reach of the home and so these community facilities are accessible for residents. The premises are decorated to a high standard and furniture and fittings were of good quality. One bedroom was viewed on this occasion with the assistance of a resident and was seen to be to a good standard of décor -although the bedrooms do not have all the elements required of modern care homes such as ensuite facilities. Nevertheless bedrooms are very homely and comfortable. Good standards of hygiene practice are observed and the home appeared clean and free from odour. Areas of strength are the homeliness and good standards of décor and as no matters requiring improvement arise this section, about the environment, it is assessed as good. Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27 to 30 were assessed and the quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number of staff employed and their skill mix are appropriate to the assessed needs of the current service users in this home – so this will ensure that their needs are being met. The required procedures are in place to ensure recruitment of staff protects service users. The home has a staff induction, training, support and supervision regime in place so service users can be assured that staff are competent in their jobs. The recruitment, training and support of staff will ensure service users are ‘safe in their hands’. EVIDENCE: Both the proprietors, Mr and Mrs. Anenden live and work in the home. Their two daughters also work there plus one senior trained staff. The small staff team provide twenty-four hour staffing in a family type setting. Requirements identified at the last inspection have been addressed including the provision of a day-to-day staff rota, a suitable induction pack and contract of employment for all staff. The registered manager has also compiled personal files for her two daughters that now include all the necessary documentation required by the care homes regulations. Since the last inspection the owner has recruited a part time cleaner. Staff training has progressed and the owners’ daughters have attended some further courses to keep their knowledge and skills up to date. Such information shows that staff are fit to work in the home and have been provided with appropriate guidance to do their jobs properly and meet the residents needs. The provider explained that the home accesses training through a local Care Homes Association - who send out a list of courses on a quarterly basis. Mr and Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 15 Mrs Anenden’s daughters still need to attend training that is specific to the needs of the residents including mental health awareness and this is planned for later in 2007. All staff, including family members, had completed a full orientation period relevant to this small care home and been given guidance on meeting the residents needs and the correct references and police checks are in place for each member of staff. As some of these checks are now at least three years old a recommendation is made to update police checks at three-yearly intervals. The service users made a point of commenting on how kind, supportive and helpful the staff team is. Areas of strength are owners willingness to ensure good recruitment practice is maintained despite this being a small family run business and that all staff will in future be properly vetted and as no matters requiring improvement this section, about staffing, is assessed as good. Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31 33 35 37 38 were assessed and the quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is registered with the Commission as a person competent to run this care home in accordance with its stated aims and objectives and so in the best interests of the service users. The home is well managed, including administration and finances, and so it is safe for service users. EVIDENCE: It is evident that there have been no substantive changes to the manner in which this home is being managed and so the observations of the previous inspections are restated. A range of quality assurance systems are used to measure the success of how the home is achieving its aims and serve the best interests of the people who live there. Examples include care plan reviews, meetings, monthly rotational audits of care plans, risk assessments and the environment. Due to the small size of this home, daily discussions with residents regularly take place as well as formal monthly meetings to seek their Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 17 views about the running of the home. A ‘residents satisfaction survey’ is offered on an annual basis and had been completed periodically. Feedback has indicated highly complimentary views about the home and the care provided. Questionnaires are also offered to residents’ family members and other professionals. Again, positive feedback was noted from these surveys. As previously required, the home has implemented an annual quality development plan. Two residents handle their own affairs and keep their own purse / wallet of personal monies. The provider is appointee for the third resident and as suggested at the last inspection, he has written to the placing authority to request that they take up appointeeship. Croydon wrote back and stated that they were in the process of reviewing their financial procedures concerning appointeeship so it is envisaged that this will be dealt with at a later date and may have been resolved by the time this report is published. Residents are issued their weekly personal allowance and sign to confirm that they have received this. Records confirmed that an accurate financial monitoring system is in place and that transactions as well as correspondence relating to financial affairs are well managed. It is acknowledged that this service is a small home and staff supervision is mostly informal and undertaken by the registered manager or provider on a day-to-day basis to discuss concerns, monitor job performance and offer guidance. The manager had undertaken a yearly appraisal with one staff and plans to complete the others. As required previously, formal records of supervision for all staff is now in place and a record of this was noted during the inspection. It was also noted under the staffing section that Police checks are recommended be renewed at approximately three-yearly intervals. Record keeping concerning health and safety is in good order. Staff were fully up to date in key areas of health and safety training i.e. moving and handling, food hygiene and first aid. Accurate records are kept for accident and incident reporting. Fire drills, fire equipment and hot water temperature checks were being carried out at appropriate intervals and cleaning products are stored safely. Informative risk assessments for the premises have been put in place since the last inspection that further safeguards the health, safety and welfare for all those living and working in Natal Lodge. Areas of strength are good and administration and professional manner in which the home is run and as no matters requiring improvement arise this section, about management and administration, is assessed as good. Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 19 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP18 Good Practice Recommendations Police Checks: It is recommended that police POVA checks renewed at three-yearly intervals. Standard 18, about service user protection, standard 29 about recruitment practices and standard 36 about ongoing staff supervision also apply. Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Natal Lodge DS0000025816.V311432.R01.S.doc Version 5.2 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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