CARE HOME ADULTS 18-65
Palmers Lodge 36 Sidney Avenue London N13 4UY Lead Inspector
Tony Brennan Unannounced Inspection 12:00 13 December 2005
th Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 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 Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 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. Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Palmers Lodge Address 36 Sidney Avenue London N13 4UY 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) 020 8889 6231 020 8445 5585 Aspire Lifestyle Limited Mr Yves Theanne Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th June 2005 Brief Description of the Service: Palmers Lodge is registered to provide care for six adults with learning disability. Currently, there are four service users living at the home. The home is owned by Aspire Lifestyle Limited, a company that runs a number of similar care homes. The home is a semi-detached house located in a residential area. The home is on three floors. The bedrooms are on the ground and first floors. Communal areas in the home include a lounge, dining room, kitchen, bathrooms, toilets and a sensory area. The home aims to support people with learning disabilities, challenging behaviour and autistic disorders to live independently. Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken as part of the annual inspection process. The inspector also sought to confirm that the seven areas for improvement found at the last inspection were addressed. The inspection took place over an afternoon. The registered manager has resigned and the acting manager assisted the inspector. The inspector spoke with three staff. The inspector observed care practice as people living at the home are not able to communicate verbally. The inspector toured the building and examined a range of records relating to the care and management of the home. What the service does well: What has improved since the last inspection? What they could do better:
Eight areas for improvement were identified at this inspection. The statement of purpose and service user guide need to be available in formats accessible to the people living in the home. The downstairs bathroom needs to be redecorated so that it is more suitable for those who live at the home. The step in the bathroom needs to be repaired so that those who live at the home can access it safely. The upstairs bedroom needs to be redecorated and refurbished so that it provides a homely environment for the person living there. The shower curtain and shower mixer head need to be replaced so that people who live at the home can use the shower room. Grab rails need to be installed in the shower room so that those living at the home can access it. Training is needed on challenging behaviour and the Learning Disabilities Award Framework to ensure that staff have all the skills to meet the needs of people who live at the home. Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 6 Two requirement made at the last inspection has not yet been met and has been restated in this report, with a new timescale for compliance. In the ‘Timescale for Action’ column, the date in ordinary type relates to the timescale given at the last inspection. The date in bold type relates to the new timescale. Further information about unmet requirements can be found in the relevant standard. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. 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. Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 7 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 Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Service users do not have information on the service in formats they can access. EVIDENCE: The service user guide and statement of purpose were still not available in formats that service users could understand. The acting manager explained that they would be developing a number of formats for these documents. Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 Service users are supported to make decisions. EVIDENCE: Staff was observed assisting service users; this was done so that they were encouraged to make decisions. The inspector observed staff showing service users option for food and looking at a pizza menu as part of plan an outing. Assessments and care plans outlined when and how service users could take decisions. Staff spoken to understood the specific ways that service users could be supported to take decisions. Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 15 16 Service users are supported to engage in personal relationships and community contacts. Service users rights are supported so that they have control over how they live. EVIDENCE: Records showed that service users attend day centres throughout the week. Service users also attend the local Gateway club and two of the service users assist with the shopping at weekends. Staff explained that two of the service users have regular family contacts. Staff explained that they support this by providing one to one support with visits. Service users preferences were recorded as part of their care plans. The inspector observed interaction between staff and a service user and found that service users were supported to make choices. Service users like going to the local shops and staff supported them to do this. Staff understood the way that they could support service users to be independent. Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users are supported so that their personal care needs are met in ways that are sensitive and reflect personal preferences. EVIDENCE: Service users personal care needs and the support they required were identified in their care plans and risk assessments. Staff understood how to support service users in ways they preferred to be assisted. Staff explained how they encouraged service users to be self-caring. Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): N/A These standards were not inspected on this occasion. EVIDENCE: Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 Service users do not live in an environment that is homely and safe. EVIDENCE: The inspector walked around the building and found that there were a number of areas to be improved so that the home provides a safe and homely environment for service users. The downstairs bathroom is in need of redecoration and the vanity unit needs replacing, as it is broken. The step to the downstairs bathroom needs to be made safe as the flooring was broken and this constituted a trip hazard. The upstairs bedroom needed redecoration and refurbishing. The shower curtain needs fixing and a new showerhead is needed as these are both broken. Grab rails had been highlighted in a recent occupational therapist’s assessment for one service user who needs to use the shower. These had been purchased but not installed. This needs to be addressed so that this service user is able to access the shower room. Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 35 Staff do not have all the skills and knowledge necessary to meet the needs of service users. EVIDENCE: Since the last inspection, training had been provided on food hygiene and training was being planned on challenging behaviour. There is still a need for training in the Learning Disabilities Award Framework and NVQ. Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 Service users and staff health and safety is promoted. EVIDENCE: Since the last inspection the fire procedure has been updated and a fire risk assessment put in place to ensure the safety of service users and staff. The fire door on the ground floor has been moved in line with the fire officer’s recommendation. A hard wiring test had been carried out. This was found to be in order. Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 X X 2 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Palmers Lodge Score 3 X X X Standard No 37 38 39 40 41 42 43 Score X X X X X 3 X DS0000031152.V261288.R01.S.doc Version 5.0 Page 17 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5(1)(b) Requirement The registered persons must ensure that the statement of purpose and the service users guide are available in formats that service users can access. (Previous timescale of 01/11/05 was not met). The registered persons must ensure that the downstairs bathroom is redecorated. The registered persons must ensure that the bathroom step is made safe. The registered persons must ensure that the upstairs bedroom is redecorated and refurbished. The registered persons must ensure that the shower curtain and shower mixer head are replaced. The registered persons must ensure that grab rails are fitted in the shower room as recommended in a recent occupational therapist’s report. The registered persons must ensure that staff receive training in challenging behaviour and the Learning Disabilities Award
DS0000031152.V261288.R01.S.doc Timescale for action 28/02/06 2 3 4 YA24 YA24 YA24 23(2)(d) 23 16(2)C 23(2)(d) 23(2)C 30/03/06 30/03/06 30/03/06 5 YA24 30/03/06 6 YA24 23(2)(n) 30/03/06 7 YA35 18(1) 01/03/06 Palmers Lodge Version 5.0 Page 18 Framework. (Previous timescale of 30/11/05 was not met). 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 YA32 Good Practice Recommendations The registered persons must ensure that 50 of staff achieve NVQ in care. Palmers Lodge DS0000031152.V261288.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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