Inspection on 15/04/08 for Palmers Lodge

This inspection was carried out on 15th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Palmers Lodge 07/04/09

Palmers Lodge 18/09/07

Palmers Lodge 08/05/07

Palmers Lodge 23/05/06

Palmers Lodge 13/12/05

Palmers Lodge 28/06/05

Palmers Lodge 18/11/04

Palmers Lodge 21/09/04

Palmers Lodge 29/05/04

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 Palmers Lodge 36 Sidney Avenue London N13 4UY Lead Inspector Jane Ray Unannounced Inspection 15th April 2008 9:00 Palmers Lodge DS0000031152.V362173.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 Palmers Lodge DS0000031152.V362173.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. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 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 8889 6231 manager.palmtree@aermid.com Aspire Lifestyle Limited vacant post Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only: Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is 6 Date of last inspection 18th September 2007 Brief Description of the Service: Palmers Lodge is registered to provide care for six adults with learning disability. Currently, there are three service users living at the home. A company called Aspire Lifestyle Limited owns the home. This company runs a number of similar care homes. The home is a semi-detached house located in a residential area. The home is built on three floors. The bedrooms are located on all the 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 more independently. The current range of fees in the home is from £1061 - £1940 a week. A copy of this report can be obtained direct from the provider or via the CSCI website (web address can be found at page two of this report). Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection took place on the 15 April 2008 and was unannounced. The inspection lasted for four hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given to the current residents. The inspector was also able to spend time talking to the manager as well as the three care staff who were working. During the inspection we also spoke briefly to two day centre staff who came to the home to collect one of the residents. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a completed self-assessment questionnaire (AQAA) prior to the inspection. What the service does well: What has improved since the last inspection? The service has made a large number of improvements since the last key inspection in September 2007 that are resulting in better outcomes for the residents in the home. Firstly all the residents are now attending specialist structured day activities and participating in a number of leisure activities during their spare time. The meals made in the home are now prepared using fresh and healthy produce. New weighing equipment has been purchased, which means that all the residents can have their weight monitored. Each Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 6 resident is supported by two key-workers to ensure the care they receive is consistent and that all their individual needs are met. The provision of a multisensory room has provided stimulation for all the residents. Residents personal finances are better safeguarded by the provision of an appropriate procedure and individual records that are in place. A wide range of staff training has been provided to help improve their skills to work effectively. This training has included supporting people with a sensory impairment, medication training, supporting people with complex challenging behaviours, health and safety training and NVQ training. In addition staff are receiving regular individual supervision. The building has been refurbished, including work in the garden. This has included the provision of a separate laundry room. The health and safety in the home has also improved through the organisation of regular fire drills and the provision of a gas landlord maintenance check. What they could do better: There are a number of areas for improvement identified at this inspection. The residents should be offered more community based leisure activities particularly at the weekend. Plans for a holiday for the residents should also be progressed. The work to set up separate accounts for resident’s personal monies must be completed to ensure their finances are safeguarded. The care plans should be reviewed using guidance on person centred planning provided by the local social services. The medication entering the home must be recorded to ensure there is an audit trail and medication can be monitored. The work on the environment must be completed and new furniture must be delivered to ensure the home is complete and comfortable for the residents. The cause of the odour throughout the house must be found and the smell eradicated. Staff working in the home must have a copy of their photo ID in their file as part of the recruitment process. A permanent manager must complete the registration process. The homes quality assurance system must seek the views of care professionals and other stakeholders to help the service monitor and improve its performance. The monitoring visits undertaken by senior managers should be written up so that the manager can follow through any necessary action. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 7 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. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3,4 and 5 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that their individual needs will be assessed and that the staff have the skills and ability to meet these needs. New people moving to the service will be offered an opportunity to visit the home. EVIDENCE: We inspected the statement of purpose and this document had been updated to provide specific information about the home and the resident group they care for. This document is clear and would be useful for care professionals and relatives who could need information about the service. In each residents case notes we were able to see that they had been given a service user guide in an appropriate pictorial format. A service user guide is also available for relatives and care professionals, but while this document includes all the necessary information it would benefit from being in a more attractive and user-friendly format. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 10 We looked at the case notes for the four people who live in the home. They all had assessments that formed part of their individual care plans that covered their current individual needs and provided a good basis for the care plan goals. We discussed the current needs of the people who live in the home with the manager and care staff. They have very specific individual needs linked to their sensory impairments, complex behaviours and autism. The staff training records were inspected and showed that the majority of staff had received training in all these areas. An appropriate trainer including the National Autistic Society had provided this training. Further training is planned in October 2008. In addition it was observed that the staff were supporting the residents with great skill and sensitivity. We discussed the admission process with the manager and he explained that prospective residents could visit the home before they move in. There have been no new people moving to the home since the last inspection. The manager also explained how they are supporting one of the residents to move to more independent living. At the previous inspection we looked at the contracts between the people who live in the home and the owners. These contracts were all in place and explained what services the residents can expect to receive. They were all been appropriately signed by a representative acting on behalf of the resident. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,8 and 9 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home can be confident that they will be supported to have an individual care plan and risk assessments. This will facilitate the residents to make choices in their daily lives. EVIDENCE: We inspected care plans for the three people currently living in the home. We also spoke to the manager and care staff about the care plans. All of the people whose records were inspected had comprehensive care plans in place. These were clearly laid out and covered all aspects of each persons needs and were written using appropriate language. The care plans had all been reviewed on a monthly basis by the key-worker. All the residents had been supported to have an annual care plan review meeting with their care manager. Each Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 12 resident had a named key worker and co-key worker. The staff were asked about their role as a key-worker and this showed that the support they provided was very comprehensive including helping with personal shopping, attending healthcare appointments, ensuring all the residents personal care needs were met, organising leisure activities and updating care plans. The staff also showed a good understanding of each resident’s individual care plan goals. The manager explained that he has just been offered a place on the person centred care planning training offered by Enfield Social Services. He has also identified a format for the revised care plans that we were shown. This format is much more user friendly and includes photos and pictures. He is planning to implement this system in the home. We read the risk assessments for the same three people who live in the home. It was possible to see that an effort had been made to identify areas of personal risk and look at how this can be managed without placing unnecessary restrictions on people. The risk assessments had been prepared using one main format that was clear and easy to follow. Each person living in the home had individual behavioural guidelines and these were clearly written and gave appropriate guidance. The three residents care plans clearly stated what arrangements were in place to support them to manage their personal finances including who acts as their appointee and how they can access their monies. We observed the three people living in the home and their interaction with the staff. It was positive to note that they were being facilitated to make choices including when they wished to get up or move around the home, when they were ready to eat and in some cases what they wanted to eat or drink. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11,12,13,14,15,16 and 17 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to develop their daily living skills and are also enabled to follow their own routine. The home has made progress in supporting the residents to enjoy a stimulating lifestyle. EVIDENCE: We were able to observe during the inspection that, the people living in the home were being supported by staff to develop their independent living skills in line with their individual needs. For example one person was being supported by staff to prepare his own breakfast and one other person was being helped to feed himself. The development of independent living skills was also reflected in the residents care plans. Here it could be seen that there was Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 14 a strong focus on developing greater independence by developing skills to assist with personal hygiene or making progress with continence. I spoke to the staff and looked at the daily records to get an understanding about the activities that are taking place. The manager explained that all of the people currently living in the home go to specialist day centres three or five days a week. The home has its own vehicle but the care staff explained that unfortunately only the manager is a driver. The staff did however say that they support the residents to make use of public transport. The records of leisure activities showed that the people living in the home were accessing community based leisure activities more regularly than the last inspection. An area of significant progress was that the residents are regularly eating out at local restaurants. One person is also going to a local evening social club on an occasional basis. The people living in the home are also going for walks and spending time using the multi-sensory room. There does however appear to be scope for leisure activities to take place on a more regular basis as there are days at the weekend where residents do not leave the house. In terms of holidays the manager explained that a holiday is being planned for later in the year. The care staff said that this had been discussed at the last staff team meeting. We observed that for the two people who are living in the home who are AfroCaribbean that care had been given to ensure that their hair and skin care was culturally appropriate. The acting manager explained that one of the people living in the home has regular contact with his relatives and they come to visit him. This relative had completed a feedback form as part of the homes own quality assurance exercise and had been positive about the service provided. We were able to observe during the inspection that the people living in the home were able to follow a routine of their choice and that people get up at different times according to their individual wishes and needs. It was very positive to observe that the staff were very sensitive to each resident’s nonverbal communication and tried to meet their needs. We saw the menu used in the home and this offered a nutritional and varied menu. We also saw that there was fruit and vegetables available in the home. The staff said that most of the food they use is fresh and that they can use petty cash to buy additional produce if needed. All the people living in the home have an individual record of the food they eat. It was positive to note that one resident who had previously needed food supplements was now managing to eat proper meals and maintain her weight. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported in a manner that protects their privacy and dignity. Each person is supported to access professional healthcare input based on their individual needs. EVIDENCE: We observed during the inspection that the staff were supporting the people living in the home to receive personal care in a manner that preserved their privacy and dignity. It was observed that the three residents were appropriately dressed. The care staff said that all the residents had been supported to buy more clothes. The staff from the day centre said that one resident does occasionally attend with damaged clothing. The manager was aware of this issue and the need to keep replacing clothing. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 16 We looked at the healthcare records for the three people living in the home. They had all been supported to access a range of healthcare professionals including the GP, dentist, optician, psychiatrist and other appointments according to their individual needs. One of the residents was unable to attend dental appointments and the case notes showed that this had been discussed with other care professionals. Since the last inspection the home has purchased some sit down weighing scales and now all the residents can be weighed. All the residents are having their weight checked on a weekly or monthly basis according to their individual needs. We looked at the medication, administration records and staff training records. The home does not use a blister pack system as most of the medication is in a liquid form. The medication is stored in a cooled medication cupboard and a medication fridge is also available. The medication administration records show clearly when medication is administered but the staff had not signed to confirm when medication had been received in the home. This meant that there was no clear audit trail for the medication. The training records were inspected and ten of the thirteen staff had completed the medication training. The care staff spoken to said that trained staff only administers medication. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 17 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): Standards 22 and 23 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home have access to an appropriate complaints procedure. Procedures and training on safeguarding vulnerable adults are in place to protect the residents. New systems are being implemented to ensure residents personal monies are being managed appropriately. EVIDENCE: The AQAA stated that there have been no written complaints since the last inspection. The organisation has two complaints procedures, one designed for the service users and the other for relatives and care professionals. Both these documents are clear and can be found in the service user guide. There have been no adult protection issues since the last inspection. I looked at the staff training records and these show that all the staff apart from one person who is on maternity leave had received safeguarding vulnerable adult training. We spoke to the care staff about the complaints procedure and safeguarding adults procedure and they all displayed a good knowledge of the procedures and the importance to speaking to the manager about issues that arise. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 18 We also looked at the training records to see if the staff had been trained on how to appropriately support people who have complex challenging behaviours. These show that all the staff apart from one person who is on maternity leave had completed the training. One member of staff said that he felt much more informed after receiving the training and it had definitely improved his care practice. We checked the personal finances for two residents including their cash record, cash and receipts. Both these people have their finances managed through the company head office. The company finance officer confirmed that individual bank accounts were being set up for each resident and these will be in place by the beginning of June 2008. In the home there is now an individual finance record for each person and his or her cash is held in a lockable tin. All expenditure is recorded and receipts are available. The manager also had a record of each persons balance held at head office. The record of expenditure was inspected and money had been spent appropriately. The manager confirmed that for one resident with a lower balance an application had been submitted to increase her mobility allowance to the higher rate. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 19 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): Standards 24,25,28 and 30 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst the physical environment in the home has greatly improved since the last inspection but there is still more to do in order to ensure the environment is appropriately furnished. EVIDENCE: We did a tour of the premises. The house is built over three floors and each person living in the home has their own bedroom. The shared lounge, dining area and sensory area are all located on the ground floor. The garden can be accessed through the dining area. The house was observed to be clean but there was an unpleasant odour that might have come from a blocked drain. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 20 Since the last inspection the radiators have been covered, flooring replaced, curtains replaced, the pond in the garden has been removed, a laundry area has been built and the bedroom on the top floor has been refurbished. Most of the house has been redecorated. The lounge furniture and cupboards in the bedrooms still need to be replaced and some building work needs to be completed such as the walls in the laundry area. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 21 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): Standards 32,33,34,35 and 36 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are consistently enough staff available to meet the needs of the people living in the home. The staff receive relevant training and are supported by regular supervision sessions. This enables them to work to a high standard and deliver good care. EVIDENCE: We checked the rota for the home and this showed that there is a team of thirteen staff working in the service. The staffing structure consists of the manager, assistant manager and a team of carers. During the day there are three staff on duty and at night there is one waking member of staff and another sleeping in. The manager is shown as being supernumerary on the rota. Since the last inspection three carers have joined the team. One staff member is currently on maternity leave. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 22 The manager and care staff explained that staff team meetings take place on a monthly basis. The record of these meetings was inspected and it could be seen that they discuss a range of operational issues. The AQAA prepared by the home stated that three staff had completed an NVQ and five staff were studying towards an NVQ. One member of staff said that the NVQ training was going well and that the assessor visits the candidates at the home. There are more than 50 of the staff team who have completed or are studying towards an NVQ in care. We looked at the recruitment records for three staff who had started working at the home since the previous inspection. It was found that all the staff had two references and a CRB disclosure. The staff had completed and signed contracts of employment. Two staff did not have a copy of their ID in their record and one did not have evidence of current permission to work in the UK. We inspected the training records. We looked at the induction records for the three new staff and they all had a completed induction record available. The manager had an updated summary of all the staff training details. He had prepared an ongoing programme of training and was booking trainers. The staff said they had received training and that this was a good standard and very useful for their work. We looked at the supervision records. All the staff had received regular individual supervision. The format used for supervision is appropriate and includes a record of any action agreed. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 23 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): Standards 37,39 and 42 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. A permanent manager who can provide effective leadership and support still needs to be registered. Health and safety measures are in place to safeguard the people living in the home. EVIDENCE: Since the last key inspection the manager has made significant progress in improving the service. He has applied for registration but confusion has arisen about the company name and this needs to be clarified as part of the registration process. The senior management in the company has also changed and a new team appointed including an Operations Director who line manages Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 24 the manager at Palmers Lodge. The manager has an NVQ level 4 in care and management. The manager explained that he had sent quality assurance questionnaires to relatives as part of the homes annual quality assurance exercise. A response was seen from one of the relatives. Questionnaires also need to be sent to other care professionals in order to seek views as part of a quality improvement exercise. The Regulation 26 visits to the home had taken place regularly up to December 2007. The manager explained that since then the Operations Director has visited the service regularly but not completed the reports. In terms of fire safety we looked at the fire safety risk assessment and this was now complete. The service has an emergency plan. The fire alarm and fire extinguishers had been serviced. The fire alarm records show the alarm is checked weekly but the fire drills have been taking place monthly. Fire safety training has been completed for most of the staff and further training is taking place in May 2008. The AQAA showed that all the health and safety maintenance checks had taken place including the gas landlord safety check. The staff training records show that the staff have completed most of the health and safety training including food hygiene, moving and handling, first aid and infection control. Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 x 27 x 28 3 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 2 x x 3 x Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 YA20 Regulation 13(2) Requirement The registered person must arrange for the safe handling and recording of medication by ensuring that all medication received in the home is recorded so an audit trail can be established. The registered person must not pay any money belonging to a resident into a company account and therefore must complete the process of arranging separate accounts for each resident. This must be used for the receipt of all their benefits and regular statements must be available. This requirement is amended and restated from the previous inspection. Timescale of 9/10/07 was unmet. The registered person must keep the care home in a good state of repair internally and externally by completing the outstanding building work and ensuring the new furnishings are in place. The registered person must keep the home free from offensive odours by investigating and eradicating the cause of the DS0000031152.V362173.R01.S.doc Timescale for action 15/05/08 2. YA23 20(1) 31/05/08 3. YA24 23(2) 31/07/08 4. YA30 16(2)(k) 15/05/08 Palmers Lodge Version 5.2 Page 27 unpleasant odours. 5. YA34 19(1) The registered person must ensure the staff are fit to work in the home by obtaining a copy of their photo ID and ensuring where needed that they have permission to work in the country. The registered person must ensure the manager completes the registration process. This requirement is amended and restated from the previous two inspections. Timescales of 31/07/07 and 30/11/07 not met. The registered person must maintain a system for reviewing the quality of care provided in the home by seeking the views of care professionals and other stakeholders as part of this process. 15/05/08 6. YA37 8(1) 31/07/08 7. YA39 24(1) 31/07/08 Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 28 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 YA1 YA6 Good Practice Recommendations The registered person should review the service user guide so it is a user-friendly format for relatives and care professionals. The registered person should continue to review the resident’s care plans using knowledge obtained from the person centred planning training provided by Enfield Social Services. The registered person should continue to support the residents to participate in community-based activities on a regular basis at the weekend. The registered person should plan holidays for the service users in consultation with multi-disciplinary team so that it can be agreed if a holiday is in the best interests of the individual. This recommendation is restated from the previous two inspections. The registered person should ensure the regulation 26 monitoring visits are recorded and used as working documents. 3. 4. YA13 YA14 5. YA39 Palmers Lodge DS0000031152.V362173.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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