Inspection on 17/12/08 for Noble Lodge

This inspection was carried out on 17th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Noble Lodge 14/06/07

Noble Lodge 11/12/06

Noble Lodge 05/09/05

Noble Lodge 03/05/05

Noble Lodge 09/09/04

Noble Lodge 10/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Noble Lodge 143 Bounds Green Road London N11 2ED     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jacqueline Izzard     Date: 1 7 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Noble Lodge 143 Bounds Green Road London N11 2ED 02082457560 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Shaukatally Hossenally care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: One specified service user who is over 65 years of age may remain accommodated in the home. The home must advise the registering authority at such times as the specified service user vacates the home. Date of last inspection Brief description of the care home Noble Lodge is a private care home providing personal care for up to 6 adults who have mental health needs. The home, which opened in 1990, is in Bounds Green, close to the underground station and local shops and services. There are six single bedrooms on the ground, first and second floor. There is a small dining room and lounge as well as a small paved garden to the rear. The home is not accessible for wheelchair users. The aim of the home is to provide a quality service for people who have mental health needs and to promote their independence. Noble Lodge aims to achieve this by providing support to help residents maximise their potential, physically, intellectually, emotionally and socially, within a homely atmosphere. At the time of this inspection there were three women living at the home. The fees charged range from #500-#700 a week. Noble Lodge intends to make inspection reports available to residents, their families and professionals but has not yet done so. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was unannounced and lasted one day. We spent time talking with the manager, provider, and one staff member and we were able to meet the three residents. A person who had just moved out was also present during part of the inspection. We spent time talking individually with the residents and also observed their interactions with staff. We were also able to speak with the relative of one resident. We checked on the requirements made at the last inspection and looked around the building. We also checked the residents care and health records to see if their needs were being met at the home. We looked at staff records to see if they were trained and Care Homes for Adults (18-65 years) Page 6 of 27 supervised to do their job and we checked food, medication and some health and safety records. We spent time observing the daily life in the home including a mealtime and activities. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their needs have been assessed before being offered a place at this home. Evidence: We checked the files for three residents of the home to see if their needs and wishes had been assessed before they moved to Noble Lodge. We saw that each resident had been assessed prior to their placement at this home and the assessments were in their files and used as a basis for their care plans. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are satisfied with the care they receive at this home and are supported to take risks to develop their independence. Evidence: We checked the care plans for two residents and discussed their care with them. The manager has attended a training event in person centred planning and intends to make care plans more person centred in 2009. The current plans cover a residents needs in areas such as medication, domestic skills, personal hygiene, budgeting and relationships. The plans were seen to be reviewed on a three monthly basis. Risk assessments were in place and were also reviewed regularly and updated. The reviewing of these documents has improved since the last inspection. Both residents said they were happy with their care at the home. One said she would Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: like more structured activity. The manager and her relative agreed that more structure would be of benefit to this resident and the manager said she was awaiting social services to arrange a day service place for this person. Both residents also said that they were listened to by staff and were able to make decisions for themselves on a day to day basis. One said , I can go and lie down when i want, they let me. If I want to eat they will get me something to eat. The other resident agreed that she was free to get up and go to bed and eat when she wanted and was able to choose how to spend her time. One of the three residents can travel independently. The other two are encouraged to take a short walk alone which both said they liked to do. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents say they enjoy living in this home and are happy with their current lifestyle there. They are given support to maintain relationships with their families and are encouraged to be as independent as they are able. Evidence: We met all three residents and were able to spend a few hours with two of them, talking and observing their daily life in the home. One resident said she attended a daycentre once a week and spent most of the week at home which was her choice. She told us she was happy at this home, enjoyed her meals and that the home was better than the care home where she previously lived. This resident said she was able to use the kitchen to make drinks whenever she wanted and staff cooked all her food which she preferred to doing her own cooking. Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: She said that staff encouraged her to be independent and said They do nag me sometimes but theyre alright. Another resident attended a daycentre three times a week, church once a week and spent time with family. She said she was happy at the home. The third resident had very limited activities at the time of the inspection. This was discussed with the manager and the residents relative. The manager said she would be organising a structured programme of activities for this resident. This residents cultural needs were addressed by a carer from the same cultural background visiting twice a week to spend time with her. All three residents indicated that their religious needs were met and one showed us a prayer book and photos of a religious ceremony staff had supported her to attend. One resident went for short walks alone and enjoyed this independence. She said she was looking forward to a planned shopping trip the next day. During the day of the inspection residents helped decorate the house for Christmas and spent time drawing and talking with staff. One resident told us that she had enjoyed a trip to Windsor castle in the summer and another said she had enjoyed a meal out to a Chinese restaurant. Food records showed a diet which contained regular convenience foods. One resident said she didnt mind this. Another had her diet supplemented with foods supplied by her family. Both said they enjoyed fizzy drinks, crisps and sandwiches which they had during the inspection. The two residents whom we spent time with said they enjoyed literacy and drawing activities and were looking forward to celebrating Christmas which they enjoyed at the home. They also said that the manager supported them to maintain contact with their families. The manager had taken one resident to Sussex to visit family. One residents mother was visiting on the day of the inspection and this person visited her family regularly. Both residents said they had a good relationship with the manager and one said, she is like a mother to me. Both also said that another female staff member supported them well on a day to day basis. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People recieve the support they need with their personal care and are encouraged to look after their appearance. Their health needs are supported but they may are not protected by the homes medication practice which needs to be improved. Evidence: Two of the three residents need and receive support with personal care. One said that staff help her with having a shower or bath and washing her hair. We observed that staff encouraged the residents to look after their appearance and prompt them to brush their hair and ask whether they would like to paint their nails and wear make up. We looked at health records for two residents. Both had their appointments with GP, psychiatrist, etc recorded. One resident was visited by a district nurse during the inspection and on a regular basis. The other is visited by a Community Mental Health Nurse though these visits were not recorded and we advised the manager to record each visit and any outcome. Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: One person said her mental health was poor at the time of the inspection and was clearly distressed. She told us that she considered her medication was not helping. The manager said that she would be requesting an appointment with the psychiatrist to see if the residents mental health needs could be better met. One resident is diabetic and self medicates. We saw that this medication was stored safely. We then looked at medication storage and records in the home. Medication was not being stored in a proper medication cabinet and had been moved to wooden cupboard in the dining room which was not secure. A requirement is made to store medication safely. We saw that all staff had been trained in administering medication. We checked a sample of medication charts to see if medication was recorded accurately. On two occasions it was noted that the initials of a staff member appeared different from this persons usual initials when signing that s/he had given medication. The manager said that another staff member had signed on this persons behalf. This is not good practice as the person who signed may not have witnessed that the correct medication was given. There were errors on the instructions on one residents medication chart. One dosage was written for liquids when we saw that this medication was currently given to her in tablet form. One chart said one medicine was to be given at 5.30pm when the container stated lunchtime. Another medicine had no dosage recorded on the chart as the instruction was for tablets when in this instance it was a liquid. The manager was advised of the importance of up to date accurate medication charts to minimise the risk of medicines being administered wrongly. Another residents dose of a medicine had changed but there were no written instructions to staff to change the dose available for inspection. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel their views are listened to and acted on in this home. They know how to complain if they are not happy and their wellbeing is safeguarded. Evidence: No complaints have been made to the home in the last year. The manager said there have also been no safeguarding issues. The complaints procedure has been updated and is included in the service user guide which is given to all new residents. We asked one resident if she had ever complained. She said that she did not need to complain as she would ask staff for anything she wanted and they give me everything. They are good. She said she would tell the manager if she was not happy. The other resident also said she felt able to tell the manager if she had any concerns. The manager said that staff have all attended training in the protection of vulnerable adults. We did not check the certificates on this occasion to verify this. Safeguarding policies are in the home to advise the manager if a safeguarding alert needed to be made in respect of any resident. Care Homes for Adults (18-65 years) Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are satisfied with the facilities and live in a homely environment, however further attention to the physical environment would improve the appearance of the home. Evidence: We looked in all rooms in the home and the front and back garden areas. A requirement made last year to tidy up the front and back of the premises has only been partly met. The provider decided to improve and resurface the front, however this job is not completed and concrete has been dug up and left. The front and back of the home are untidy and in an unfinished state. The laundry facilities are in an outhouse in the garden and have been cleaned since the last inspection. As a result of requirements made at the last inspection there has been some improvement to the physical condition of the house. Rooms have been redecorated which makes them look cleaner and more homely. Most furniture is in an adequate state of repair. Two broken chairs were stored in the dining room and so a requirement is made to remove these as they detract from homely environment. The kitchen fire door was held open with string and the manager was advised that this door must be kept closed to ensure a fire could be contained. Some of the lounge chairs were Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: stained and needed cleaning. Bedrooms were in a variable condition. Two bedrooms were clean and suitably furnished and decorated. One had a dirty floor, which staff did immediately clean for the occupant when we pointed this out. One room was in a poor condition of furnishing, decor and cleanliness. however the resident of this room was in the process of removing her belongings and had moved out. The manager said this room would be thoroughly cleaned and refurbished before future use. Two other vacant rooms will need some cleaning and preparation before use but these room have not been used for some time. We asked residents if they were satisfied with their rooms, if they were adequately heated and whether the bed was comfortable and all three said that they were satisfied. The kitchen and dining room were clean. Two residents said they kept their own rooms clean but were assisted by staff. Care Homes for Adults (18-65 years) Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by staff who are trained and supervised in their duties. They benefit from a stable staff team who know their needs well. Evidence: At the time of this inspection there was a small staff team; the manager, the provider, one full time member of staff and one part time staff. Another full time staff member was on long term leave at the time of the inspection. One resident was experiencing poor mental health and needing extra staff support. We noted that as there were two staff on duty they were managing but that this would be difficult at times where only one staff was on duty. The manager said that staff were flexible and worked extra hours when this resident needs more intensive support. She told us that she was discussing extra staffing support for this resident with the placing authority. We inspected two staff files and saw that they were receiving appropriate training and supervision on a regular basis. Both full time staff had completed NVQ level 2 and one was hoping to start level 3 in January 2009. They receive supervision on a two monthly basis as required and the manager said she discusses their duties with them regularly as she works alongside staff. The staff team is stable and no new staff have been employed since the last inspection so no recruitment records were inspected on Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: this occasion. All long term staff have had their recruitment records checked at previous inspections and were found to be satisfactory. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit form a home where their best interests are considered and where they have confidence in the manager to meet their needs. Evidence: The manager has managed this home for many years so has become experienced. She is completing the registered managers award training and also attends other training to keep up to date with improvements in care practice. We discussed the management of the home with two of the residents. Both said that they considered the manager to be like a family member and had formed close relationships. They said they were happy with the way the home was run and that their views were listened to. One gave examples of how the manager asked her daily to choose her own meals and activities. The other said that the manager often asks her to plan activities, meals, changes to the home etc. She said, I was asked how I wanted my room and she always asks me what I want to eat. We discussed quality assurance and looked at the most recent surveys completed by Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: residents and their representatives. These showed general satisfaction with the home. Two concerns were raised and the manager was able to explain what had been done to address these. We discussed improvements made to the building in the last year and future improvements needed. The manager showed a commitment to continue to improve the home. We looked at a sample of health and safety records in the home and also considered information sent to to us by the manager relating to health and safety. Staff are trained in health and safety topics such as food hygiene, medication and first aid and these certificates were seen. The most recent inspection of the kitchen by the local environmental health department was good and gave the home four of a possible five stars. We noted that the kitchen was cleaned to a good standard on the day of the inspection and that records were kept of fridge and freezer temperatures to ensure foods were stored safely. The fire alarm system and electrical appliances in the home had been inspected in 2008. Therefore the health and safety records inspected showed attention to protecting residents health and safety. Care Homes for Adults (18-65 years) Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The registered persons must 21/01/2009 ensure that residents are protected by safe medication practices. Medicines must be stored safely in a proper medication cabinet, administered in accordance with written dosage instructions and accurate records kept. This is to protect reisdnets from risk of medication errors. 2 24 23 Fire doors must close properly and not be blocked open. This is to improve fire safety arrangements for residents. 16/01/2009 3 24 23 The front and back of the home must be made fit for residents to use. This is to improve the safety and appearance of these areas so that residents can enjoy access to them. 27/03/2009 Care Homes for Adults (18-65 years) Page 25 of 27 4 24 23 The chairs must be cleaned or replaced. This is so residents and their visitors have clean chairs to sit on at all times. 30/01/2009 5 30 23 Broken furniture must be removed from the home. this is so residents can enjoy a homely safe environment. 30/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 20 The home should consider changing to a monitored dosage medication system where the paharmacy prepare the prescribed medication and the medication adminstration charts for the home to use. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - 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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