Inspection on 18/09/07 for Palmers Lodge

This inspection was carried out on 18th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found 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 19 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 15/04/08

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

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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 Key Unannounced Inspection 18th September 2007 09:00 Palmers Lodge DS0000031152.V345644.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.V345644.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.V345644.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.V345644.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 8th May 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. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Palmers Lodge DS0000031152.V345644.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 18 September 2007 and was unannounced. The inspection took three and a half hours to complete. A Regulation Manager, Sue Mitchell, accompanied the inspector. The inspector was able to spend time with all of the service users. The manager and two care staff who were on duty assisted the inspector. The inspector did a full tour of the premises and also looked at all the relevant records including service user records, staff files and health and safety information. The is the second key inspection since April 2007. This was arranged in response to the significant number of requirements made at the previous inspection and the change in management of the home. The aim is to look at how well the service is meeting the key National Minimum Standards for Younger Adults. The inspector also assessed the progress made by the service in meeting the requirements from the previous inspection. The inspector would like to thank the service users and staff for their assistance with the inspection process. What the service does well: The home provides an adequate standard of care and support to a group of residents with a range of very complex needs. The people who live in the home are supported by the staff to access members of the multidisciplinary team to ensure their personal care, social and emotional health needs are met. The staff demonstrate a good knowledge of the residents and are able to recognise their individual needs. Two of the residents are offered regular access to structured activities and the third person is just being introduced to a day service. The people who live in the home are supported to maintain positive contact with their relatives. Palmers Lodge DS0000031152.V345644.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? The last key inspection at Palmers Lodge took place on the 8 May 2007. Progress with meeting previous requirements is as follows: • • • • • • • • • • • • The contracts between the home and the residents were now completed and signed. Annual review meetings have been arranged with the care managers. One resident has a risk assessment in place explaining restrictions that are in place. On resident has been offered some structured day activities. A record is kept of the food consumed by the people living in the home. A medication fridge has been provided. The manager is supernumerary on the staff rota. Staff have a signed contract of employment. A record of what training each member of staff has received is available. The results of the last quality assurance exercise with an action plan are available in the home. New containers for the fire extinguishers that are accessible to the staff are now in place. A manager has been appointed. It was disappointing that further work was needed to fully complete all the other requirements. What they could do better: A significant number of areas for improvement were identified as follows: Two requirements were made under the section choice of home and this was to provide an accurate and clearly written statement of purpose, and to ensure all the staff have received training on how to positively work with people who have complex challenging behaviours, autism and sensory impairments. One requirement and two recommendations were made under the heading individual needs and choices. This was to ensure each person living in the home has a record of how they are supported to manage their personal finances. It was also recommended that the key workers keep the care plans up to date and that the risk assessments are recorded on one format. Two requirements and three recommendations were made under the heading of lifestyle to support everyone to access community based leisure activities and to use fresh rather than frozen food where possible. It was also recommended that the vehicle with a driver is made available for leisure activities, that there is money available to pay for equipment for activities and that there are discussions with care managers about the residents having a holiday. Palmers Lodge DS0000031152.V345644.R01.S.doc Version 5.2 Page 7 Two requirements were made under the heading of personal and healthcare to ensure that the resident who cannot use the existing scales has equipment available to allow him to check his weight and that staff have all had medication training. A requirement was made in the section concerns, complaints and protection to ensure that the people living in the home whose money is held by the company head office have records of their accounts and all their expenditure available in the service. This must ensure that their monies are not going into a company account. The company must also prepare a policy on managing resident’s finances explaining how they will be safeguarded to prevent financial abuse. Following the inspection a letter of “serious concern” was sent to the company regarding the residents’ personal finances. In addition the placing authorities have been made aware of the concerns. The environment section included four requirements to complete all the outstanding building work and to prepare risk assessments to prepare the residents whilst all the work is taking place. In the section on staffing two requirements were made to ensure at least 50 of the staff have completed or are studying for the NVQ in care and to ensure staff have regular supervision. Five requirements were made in the section called conduct and management of the home to ensure a permanent manager is registered, and to ensure all staff have completed health and safety training. It was also required that regular drills take place and that a gas landlord safety check takes place. The provider also needs to undertake monthly regulation 26 monitoring visits. 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.V345644.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.V345644.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 poor 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 new people moving to the service will be offered an opportunity to visit the home. The people in the home, their relatives and other care professionals need access to accurate information about the service through an updated statement of purpose. People living in the home are supported by staff who still need some training in order to effectively meet their needs including how to support people who have a sensory impairment. EVIDENCE: I inspected the statement of purpose this document needs to be updated so that all the information is accurate. The format needs to be reviewed to ensure it is user-friendly and presented in a clear and professional format. In each residents case notes I was able to see that they had been given a service user guide in an appropriate pictorial format. Palmers Lodge DS0000031152.V345644.R01.S.doc Version 5.2 Page 10 I 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. I discussed the current needs of the people who live in the home with the acting manager and inspected the staff training records. This indicated that the residents have a number of very specific needs including two people who are deaf blind and people who have very complex behaviours linked to their autism. The staff training records show that some of the staff have received training on working with people who have challenging behaviours and autism but none of the staff have received training on supporting people who have a sensory impairment. I discussed the admission process with the staff and they explained that prospective residents can visit the home before they move in. There have been no new people moving to the home in the past few years. I also looked at the contracts between the people who live in the home and the owners. These contracts are in place and explain what services the residents can expect to receive. They have all been appropriately signed by a representative acting on behalf of the resident. Palmers Lodge DS0000031152.V345644.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 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 can be confident that they will be supported to have an individual care plan and risk assessments. The support to service users would be enhanced by a fully operational key-working system. EVIDENCE: I inspected care plans for the three people currently living in the home. I also spoke to the manager 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 in the last six months. One of the people living in the home had all been supported to have a review meeting with their care manager and relatives in the last year and review meetings had been arranged for the other two people. Each resident Palmers Lodge DS0000031152.V345644.R01.S.doc Version 5.2 Page 12 had a named key worker but the care plans had been updated by the previous acting manager and not the key worker. Staff spoken to said they were not fully implementing the key-worker system in terms of attending healthcare appointments, joining review meetings and assisting users with personal shopping. I 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 were however on two different forms and there was some duplication, which meant they were hard to follow. One person has had his risk assessment reviewed to include measures to restrict his food consumption and keep him safe by keeping the kitchen door locked. Each person living in the home had individual behavioural guidelines and these were clearly written and gave appropriate guidance. The three residents care plans did not clearly state what arrangements were in place to support them to manage their personal finances including who acts as their appointee, who holds the building society books, who deals with queries from the DSS etc. I 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 move around the home, when they were ready to eat and in some cases what they wanted to eat or drink. Palmers Lodge DS0000031152.V345644.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 poor 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. It is however evident that there are still not enough leisure activities available to enable the residents to enjoy interesting and active lifestyles. EVIDENCE: I was 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 two other people were being helped to feed themselves. Palmers Lodge DS0000031152.V345644.R01.S.doc Version 5.2 Page 14 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 two of the people currently living in the home go to specialist day centres five days a week. The other resident has just been offered three days a week at a specialist day service and he has started to attend half a day a week as part of an introductory process. The home has its own vehicle but the manager explained that none of the current care staff are drivers. The staff said that agency staff who can drive, occasionally work in the home. The records of leisure activities showed that the people living in the home were being offered very few occasions to enjoy community based leisure activities. Two of the residents had no recorded leisure activities in the last fortnight other than going to the day centre. The staff confirmed that there were very few leisure activities taking place although they did think that occasional walks in the local area with one resident were not recorded. One member of staff said there were also very limited activities they could offer in the home, as there was no specialist equipment available to meet the needs of the residents. In terms of holidays the manager explained that a holiday is being considered for later in the year. There was no record however of this being discussed with care professionals and relatives to consider if this would be in the best interests of the individual residents as recommended at the last inspection. I 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. I was 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. I saw the menu used in the home and this offered a nutritional and varied menu. I also saw that there was fruit and vegetables available in the home, although the manager said that most of the meat or fish used was frozen. All the people living in the home have an individual record of the food they eat. Palmers Lodge DS0000031152.V345644.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 poor 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. Whilst their healthcare needs are promoted, one resident needs access to appropriate weighing scales that meet his needs. In addition some staff need medication training to ensure they use the medication systems correctly. EVIDENCE: I 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. I 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 Palmers Lodge DS0000031152.V345644.R01.S.doc Version 5.2 Page 16 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. Two of the three residents are having their weight checked regularly but one cannot be weighed, as he needs scales he can sit on. The requirement for all the residents to be weighed regularly has been restated from the previous inspection as this is a significant indicator of peoples health and wellbeing. I looked at the medication, administration records and staff training records. The home has changed pharmacists since the last inspection and no longer uses a blister pack system. A medication fridge is now available. Most of the medication is in a liquid form. The manager said that none of the residents are self- administering their medication. None of the residents have PRN medication. The home records the medication received in the home and returned to the pharmacy so an audit trail is available. The training records were inspected and one member of staff needs to receive the training and two need the training updated. A training date has not yet been arranged. Palmers Lodge DS0000031152.V345644.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 poor 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 but they need to be protected by all staff having received up to date training on the protection of vulnerable adults and on how to work appropriately with people who have challenging behaviours. Residents also need access to information about finances held on their behalf by the company to ensure their monies are safe guarded. EVIDENCE: There have been no written complaints since the last inspection. The Commission has however been contacted by a care manager who was concerned about the management of the home and has decided to move a resident to another service. There have been no adult protection issues since the last inspection. I looked at the staff training records and these show that two staff need to receive training on the protection of vulnerable adults. The training has not yet been booked. Palmers Lodge DS0000031152.V345644.R01.S.doc Version 5.2 Page 18 I 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 and two still needed to receive this training. This training has not yet been booked. I 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. There was no evidence of the residents having their own accounts rather than their personal monies being paid into the company accounts. It was not possible to see what benefits they were receiving and their individual balances and records of expenditure. The record of cash expenditure was not maintained between May and September for one resident and from March to September for the other resident. There was no evidence that these records had been audited during this period. One resident had a record in February 2007 of his personal finances being used to buy furniture and curtains, which should be provided by the company. There was little evidence from looking at the cash records of the residents being supported to buy personal items such as toiletries or clothes, of being able to go out for meals or other leisure activities. Following the inspection a letter of “serious concern” was sent to the company regarding the residents’ personal finances. In addition the placing authorities have been made aware of the concerns. Palmers Lodge DS0000031152.V345644.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 poor 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 slightly improved since the last inspection there is still much to be done to make the building safe, homely and suitable for the individual needs of the people living in the home. EVIDENCE: I 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 and there were no unpleasant odours. Since the last inspection the following work has been undertaken: Palmers Lodge DS0000031152.V345644.R01.S.doc Version 5.2 Page 20 • The lighting in the sensory area has been replaced. Outstanding work from the three previous inspections includes: • • Radiators need to be covered The flooring in communal areas has not been replaced, although this has now been ordered Outstanding work from the previous two inspections includes: • • Lighting in the dining area needs to replaced Curtains need to be hung correctly I felt that there was more work to be done in terms of providing an environment that meets the sensory needs of the people living in the home and that the sensory area needs proper mats so that people can sit or lie down. Additional furniture in the garden such as a rocking seat should be provided that is strong enough to meet the needs of people with challenging behaviours. The provider organisation would benefit from seeking expert advice on how to develop the environment to meet the specific needs of the people living in the home. This inspection also identified other work that needs to be completed as follows: • A laundry area needs to be provided with a working tumble drier, as there was no working drier. The location of this area along with a new ground floor bathroom needs to be decided following professional advice from the Environmental Health Officer. A system of master keys needs to be introduced to reduce the staff difficulties in locking rooms when needed The pond must be removed and a large terrace area must be created as the current pond is a safety risk for the residents The top floor bedroom needs proper ventilation and impervious surfaces to reduce the unpleasant odours and facilitate effective cleaning • • • The manager explained that an extensive programme of redecoration and refurbishment is about to commence. Risk assessments to protect the residents must be in place whilst this work is taking place. Palmers Lodge DS0000031152.V345644.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 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 are supported by adequate numbers of staff working to meet their needs and maintain their safety. Staff need to have access to an ongoing programme of training including NVQ training. EVIDENCE: I checked the rota for the home and this showed that there is a team of nine 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 one part-time carer has joined the team. Two staff members are shortly going on maternity leave. The staff explained that there have not been any staff team meetings since the previous manager left, although a meeting date has been arranged. Palmers Lodge DS0000031152.V345644.R01.S.doc Version 5.2 Page 22 The manager explained that five out of the eight existing staff have not started their NVQ and this training has not been arranged. I looked at the recruitment records for four staff. It was found that all the staff had two references, ID and a CRB disclosure. The staff all had completed and signed contracts of employment. I inspected the training records. I looked at the induction records for the four staff and they all had a completed induction record available. Since the last inspection the manager has prepared a summary of all the staff training details. He is starting to arrange a training programme to meet those training needs, but training dates still need to be booked. I looked at the supervision records. The manager explained that he has just started to carry out supervisions and has so far supervised three staff. The format used for supervision is appropriate and includes a record of any action agreed. Palmers Lodge DS0000031152.V345644.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 poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. The care of the people in the home has been potentially compromised by the changes of managers in the home, which has resulted in inconsistent practice and uncertainty. Outstanding work such as the gas safety check potentially compromise the health and safety of the residents. EVIDENCE: Since the last inspection the company stopped using the acting manager. Then a newly appointed manager left after only two weeks and the assistant manager took the post of acting manager. The Commission was not informed of any of these changes. Two weeks ago a new manager started working in the Palmers Lodge DS0000031152.V345644.R01.S.doc Version 5.2 Page 24 home who has the correct skills and experience. In addition the Operations Director who line managed the home also left the company since the last inspection. The completed questionnaires and action plan for a quality assurance exercise completed in October 2006 was inspected. This exercise will soon need to be undertaken again. The Regulation 26 visits to the home have not been taking place on a monthly basis and some reports contained very little information and did not reflect thorough internal company checks being carried out on the operation of the service. In terms of fire safety I looked at the fire safety risk assessment. This was still not comprehensive but the manager explained that a specialist fire safety advisor is coming to the home to carry out this work. The fire alarm and fire extinguishers had been serviced. The extinguishers are kept in locked boxes and these have been replaced to allow easy staff access. The fire alarm records show the alarm is checked weekly but the fire drills took place November 2006 and September 2007 so are not yet happening regularly. Fire safety training has been booked. The gas system has still not been checked for over a year and the service check had not yet been booked. Other health and safety training needs to take place including infection control, first aid and food hygiene and this still needs to be booked. Palmers Lodge DS0000031152.V345644.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 2 2 3 3 1 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 1 ENVIRONMENT Standard No Score 24 1 25 3 26 x 27 x 28 1 29 x 30 3 STAFFING Standard No Score 31 x 32 1 33 3 34 3 35 3 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 1 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 1 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 x 1 x 2 x x 1 x Palmers Lodge DS0000031152.V345644.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 YA1 Regulation 4(1) Requirement The registered person must ensure the statement of purpose is updated and written in a clear language. The registered person must ensure that all the staff have received training on how to support people with a sensory impairment. This requirement is amended and restated from the previous three inspections. Timescales of 31/08/06, 31/03/07 and 30/06/07 not met. CSCI will consider what action will be taken in the event of this requirement not being met. The registered person must ensure the service users are offered access to community based activities each weekend based on their individual needs and risk assessment. This requirement is restated from the previous three inspections. Timescales of 15/06/06, 31/01/07 and 30/06/07 were not met. CSCI will consider what action will be taken in the DS0000031152.V345644.R01.S.doc Timescale for action 31/10/07 2. YA3 18(1)(c) 15/11/07 3. YA13 16(2)(m) 31/10/07 Palmers Lodge Version 5.2 Page 27 4. YA17 16(2)(i) 5. YA19 12(1) 6. 7. YA20 YA23 13(2) 13(6) 8. YA23 18(1)(c) event of this requirement not being met. The registered person must ensure that fresh rather than frozen food is used where possible. The registered person must ensure that appropriate weighing equipment is made available to ensure all the residents can have their weight checked regularly. This requirement is amended and restated from the previous inspection. Timescale of 31/07/07 not met. The registered person must ensure all the staff receive medication training. The registered person must ensure that there are records available in the home for the residents whose personal finances are held at the company head office. This must include a record of their account details, what DSS benefits they receive and what savings they have available. Accurate records must be kept of their expenditure and personal monies must not be used to buy items that the provider should make available. The company must also prepare a policy on managing resident’s finances explaining how they will be safeguarded to prevent financial abuse. This requirement is amended and restated from the previous inspection. Timescale of 30/06/07 not met. This is an URGENT requirement at this inspection. The registered person must ensure all the staff have received training on how to DS0000031152.V345644.R01.S.doc 31/10/07 15/11/07 15/11/07 09/10/07 15/11/07 Palmers Lodge Version 5.2 Page 28 9. YA24 10. YA24 11. YA24 12. YA28 13. YA32 support people who have autism or who have complex challenging behaviours. This requirement is restated from the previous inspection. Timescale of 31/07/07 not met. 23(2)(a)(b) The registered person must ensure all the building work identified in the environment section of the report as being outstanding from the previous three and two inspections is completed. This requirement is restated. Previous timescales of 30/09/06, 31/03/07 and 31/07/07 not met. CSCI will consider what action will be taken in the event of this requirement not being met. 23(2)(a)(b) The registered person must ensure all the building work identified in the environment section of this report from this inspection is completed. This includes the work identified on the pond, laundry, key system and top floor bedroom. 13(4) The registered person must ensure risk assessments are in place to protect the residents during any building work that is taking place in the home. 23(2)(a)(b) The registered person must ensure the sensory area and garden are developed to meet the needs of the people living in the home through the provision of appropriate equipment. This should be arranged by seeking advice from appropriate professionals. This requirement is restated from the previous inspection. Timescale of 31/08/07 not met. 18(1)(c) The registered person must DS0000031152.V345644.R01.S.doc 30/11/07 31/12/07 30/09/07 31/12/07 30/11/07 Page 29 Palmers Lodge Version 5.2 14. YA36 18(2) 15. YA37 8(1) 16. YA39 35 17. 18. YA42 YA42 23(4) 13(4)(5) 19. YA42 13(4) ensure that at least 50 of the staff have completed or are studying for an NVQ in care. This requirement is restated from the previous inspection. Timescale of 31/08/07 not met. The registered person must ensure all the staff are supported to receive regular individual supervision. This requirement is restated from the previous inspection. Timescale of 30/06/07 not met. The registered person must ensure a permanent manager is recruited who has the appropriate skills and experience and that they complete the registration process. This requirement is restated from the previous inspection. Timescale of 31/07/07 not met. The registered person must ensure that monthly regulation 26 visits take place and that they monitor compliance with the Care Home Regulations 2001. The registered person must ensure that regular fire drills take place. The registered person must ensure all the staff have received the necessary health and safety training including food hygiene, first aid and moving and handling. This requirement is restated from the previous inspection. Timescale of 31/07/07 not met. The registered person must ensure the gas landlord safety check is completed. 31/10/07 30/11/07 31/10/07 31/10/07 15/11/07 15/10/07 Palmers Lodge DS0000031152.V345644.R01.S.doc Version 5.2 Page 30 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 YA14 Good Practice Recommendations 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 inspection. The registered person should ensure the staff who work as key workers are supported to review and amend the care plans. The registered person should ensure the risk assessments are available in one format to avoid confusion. The registered person should ensure the homes vehicle is available at the weekends and with sufficient drivers to enable the people living in the home have opportunities to go out. The registered person must ensure that there is money available to purchase the ongoing equipment needed to the intensive interaction work. 2. YA6 3. 4. YA9 YA12 5. YA14 Palmers Lodge DS0000031152.V345644.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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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