Inspection on 23/05/06 for Palmers Lodge

This inspection was carried out on 23rd May 2006.

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 27 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 18/09/07

Palmers Lodge 08/05/07

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 23rd May 2006 08:30 Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 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.V290018.R01.S.doc Version 5.1 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.V290018.R01.S.doc Version 5.1 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 F/P 020 8889 6231 Aspire Lifestyle Limited Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 13th December 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. 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 £1300 - £1800 a week. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 23 May and was unannounced. The inspection lasted for the whole day and was the main 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 meet and observe all the service users. The inspector was also able to spend time talking to the manager, three care staff who were working in the home. The inspector did a tour of the premises and also looked at a range of records including service users records, staff files and health and safety documentation. What the service does well: What has improved since the last inspection? At the last inspection seven requirements were made. Five of these requirements have been met and work on the remaining two requirements is underway but not yet complete. The work that has been completed relates mainly to the building and includes the decoration of the top floor bedroom, work in the bathroom to make a step by the entrance safe and to decorate the room and work in the shower room to replace the shower curtain and install grab rails. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 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.V290018.R01.S.doc Version 5.1 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): 1,2 and 5 Quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to this service. Prospective service users cannot yet access a service user guide in a format appropriate for their needs. Contracts need to be made available between the service users and the home to ensure there is a clear record of what services the home will offer. EVIDENCE: The manager explained that the service user guide in a user-friendly format is still not complete but will be available shortly. Four service user case notes were inspected. They contained a copy of the contract between the home and the placing authority but no contract is available between the home and the service user clearly stating what services the home will provide. All the service users had assessments prepared by care professionals at the time of their admission to the home. They have now been living in home for several years and their needs have changed. Their assessments prepared by the home are included in a care planning document but again these need to be updated to reflect the service users current needs. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 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): 6,7,8 and 9 Quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to this service. Service users do not have care plans that clearly reflect their current goals. They also need to have clear behavioural guidelines. Service users are however supported to make decisions in their daily lives in the home. EVIDENCE: Four service user case notes were inspected. They each contained extremely long care plan documents covering all aspects of the service users life. These documents were in the process of being updated. On close inspection it was apparent that these documents did not accurately reflect the specific needs of the service users. For example one care plan talks about offering the service user an opportunity to express her views on what should happen in the event of her death. The service users needs mean that these kinds of decisions would need to be made with the support of a representative. The documents also contained multiple goals that were not necessarily achievable. A useful care plan document would allow each service user to have a few individual goals that reflect their needs and which can be implemented and reviewed. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 10 The four service users all have complex challenging behaviours. The case notes did not include clear behavioural guidelines on how service users should be supported. One of the case notes had behavioural guidelines from the previous care provider and one had guidelines prepared by the day centre and the third set of guidelines were prepared by the home but were out of date as the service users needs had changed. The service users and staff need clear guidelines to ensure that the service users are supported in a consistent manner at all times. The service users have individual key workers and when a member of staff was interviewed about the role of a key worker she had a good understanding of what the role involves. The key workers prepare an individual report each month recording how their support to the service user is progressing. Each service user has individual risk assessments and these were in the process of being reviewed. The risk assessments covered all the areas of risk but did not clearly state action that was being taken to reduce the risks. Due to the needs of the service users there are a number of restrictions in place in the home such as the kitchen and bathroom doors being locked. These need to be clearly recorded as part of the risk assessment and these practices should be discussed with and agreed by the multi-disciplinary team. The inspector was very impressed to see how the staff work with the service users to support them to make decisions about their daily lives in the home. The inspector observed the staff supporting each of the service users to make their breakfasts. By carefully watching gestures and facial expressions as well as listening to sounds the staff are able to respond to the wishes of the service users and enable them to make choices about food and drink and how they wish to eat. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 11 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): 11,12,13,14,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to this service. Service users are supported to develop their independence in the home but some would benefit from accessing a wider range of community based leisure activities particularly at weekends. Service users are offered a healthy diet that meets their individual needs. EVIDENCE: The service users were observed getting up and preparing their breakfasts. They were being supported by staff to develop their independent living skills by making a drink or preparing their cereal. The level of support depended on the individual needs of the service users with some just needing prompts and other needing hand over hand assistance. The home supports the service users to fulfil their cultural and religious needs. One service user goes to church with staff support. Another service user has her hair groomed in a culturally appropriate manner at the hairdressers. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 12 Three of the service users attend structured day services five days a week. One service user has had psychology and speech and language therapy input to address his complex behaviours and has a day activity programme developed by the home with the input of the other care professionals. The daily records were looked at for the service users for the previous four weekends. With the exception of one service user going to church on one occasion and one service user going to the hairdressers, none of the service users have participated in any community-based activities. The manager explained that the service users did not have a holiday last year but this is being explored for this year. This will need to be arranged on an individual basis and will need to be discussed with the multi-disciplinary team to decide what is in the best interests of the service users. The manager explained that two of the service users have very regular family contact and two have occasional contact. Families are welcome to visit the home and one service user also goes to the family home for visits. The inspector observed the routine and also interviewed a member of staff. The routine during the week is more structured as three of the service users attend day services. At the weekend the routine is a little more flexible and service users can have a lie in. The needs of the service users mean that a fairly structured routine is of benefit in supporting them particularly with their autism. The daily records show that service users choose when they wish to go to bed. The menu and record of food consumed was inspected. This shows that the service users are offered a healthy diet. Two of the service users are having a healthy diet and one service user who was extremely overweight has been supported to loose weight. Two of the service users need their food to be soft and finely chopped and this is provided for them. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 13 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): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to this service. Service users are receiving a high standard of personal care and are safe guarded by the appropriate handling of medication in the home although tablets entering the home need to be recorded. Service users would however benefit from all having dental and optical checks and all having their weight monitored on an ongoing basis. EVIDENCE: The service users were observed during a time when they were being supported to receive personal care. This took place in their bedrooms and bathroom and their privacy was maintained at all times. All the service users were observed to be well groomed and were wearing appropriate clothing. One service user is very reluctant to get dressed and the inspector observed the staff working with him to encourage him to get dressed. The female service user was supported by a female member of staff with her personal care. The healthcare records were inspected for the four service users. All the service users had seen the GP and on the day of the inspection one service user was going to the GP for a healthcare check. They also see the psychiatrist when he visits the home although these visits need to all be recorded. All the service users appeared to not have had an optical check in the last two years Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 14 and three had no record of a dental check in the last year. These checks may be very difficult due the service users complex behaviours however checks must be arranged or risk assessments must be in place to explain why the checks are not possible. Three of the service users had no record of their weight in the last six months. One is prone to being overweight and two have a history of being underweight and their weight must be monitored on a monthly basis. The medication was inspected. The majority of the medication is in a liquid form. The medication cupboard is in the office. The temperature is monitored on a daily basis. The tablets coming into the home are not recorded on the medication administration record and there was no up to date record of medication being returned to the pharmacy. The medication administration sheets were properly signed by the staff. One service user has PRN medication and there are appropriate guidelines in place for this. The training records were inspected for three staff who had been in post for over a year and they had all received medication training. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 15 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): 22 and 23 Quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to this service. Service users would be better protected if all the staff had received adult protection training. Improvements can also be made in complaints recording, the whistle blowing procedure and the recording of the expenditure of service users monies to safeguard the service users. EVIDENCE: The record of complaints was inspected. There has been one complaint since the previous inspection. This complaint was from neighbours about the noise being made by one of the service users. The complaint record did not explain what action was taken in response to the complaint and when this action was complete. The adult protection training is being provided through in house training. The staff training records were inspected. Four staff on the team need to receive this training. The manager has been trained as a trainer for CPI to teach the staff how to work appropriately with service users who have challenging behaviours. This training is arranged for the following week. The whistle blowing procedure was inspected. This procedure is satisfactory but does not include contact telephone numbers for staff to use if they want to raise concerns. It is recommended that this policy with the appropriate Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 16 telephone numbers is displayed in an easy to use format on the staff notice board. The manager explained that two of the service users are supported to manage their personal monies by their relatives and two are having their monies organised by their care manager. The service user monies were inspected for two service users. The monies are held in individual cash boxes stored in the medication cupboard. The cash boxes have the keys in the lock. The inspector was concerned that the cash boxes are not very secure. Each service user has an individual record of expenditure and receipts are kept. The cash balances in the cash tins were correct. The receipts were hard to identify as they are not attached to a petty cash folio and the numbering system is confused and old receipts had not been removed from the cash tins. It is recommended that old receipts are removed from the tins each month and safely stored and that the new receipts each month are numbered clearly on the receipt and the cash record book and attached a petty cash folio which has a record of the item bought. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 17 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 and 30 Quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to this service. Service users need to be offered the opportunity to live in an environment that is not dilapidated and looks homely rather than institutional even though it is recognised that the service users create significant damage to the home. EVIDENCE: The inspector did a full tour of the premises. The house is in a very poor state of repair. This is because the environment and furnishings are damaged by the service users and because the home has not been properly maintained. The house however was clean. The following work is needed as a matter of urgency: • • • All the communal areas must be properly decorated and this includes filling in any damage to the walls All the paintwork including skirting boards, windowsills and banisters must be properly repaired and decorated Adequate lounge and dining furniture must be provided that is designed to meet the specific needs of the service users DS0000031152.V290018.R01.S.doc Version 5.1 Page 18 Palmers Lodge • • • • • • • • • • The radiators need to be covered as they were very hot and could scald the service users The pond must be removed in the garden as it presents a risk to the safety of the service users The damp on the wall of the dining room must be addressed The flooring in the communal areas needs to be replaced with flooring that does not look institutional. The lounge and sensory area could be carpeted and the dining area and hallway should have flooring that looks domestic whilst still being non-slip and washable Garden furniture designed to meet the needs of the service users must be provided such as a rocking garden seat The tumble drier must be relocated out of the kitchen as it is currently blocking a chest freezer and is not appropriately placed for infection control purposes The bolt must be removed from the front door to ensure it is not used The kitchen must be decorated where a cupboard has been removed The office must be decorated and the broken desk replaced The home must be made more homely by the provision of pictures Once this work is complete the home must be maintained on an ongoing basis to ensure it does not fall again into this state of dilapidation. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 19 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): 32,33,34,35 and 36 Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to this service. Service users are supported by a stable team of staff who have the appropriate recruitment checks. The staff have received an adequate induction but ongoing training and regular supervision is needed to ensure they have the correct skills to support the service users to an appropriate standard. EVIDENCE: The staff team consists of the manager, a senior carer and a team of five permanent care staff and four bank staff. The manager explained that the home has not needed to use agency staff. In the mornings and evenings there are three care staff supporting the four service users. During the day there is one member of staff working with the service user who does not go to the day service. At night there is one waking and one sleeping member of staff. The manager spends part of the week delivering direct care and has time to carry out management tasks. The rota was inspected and there were adequate staff available. The manager explained that one member of staff has left in the previous six months and three bank staff have been recruited. The manager explained that out of the ten staff working in the home five staff have either completed or are undertaking their NVQ training in care. Not all the staff who have completed the training have provided a certificate to the home. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 20 The record of staff meetings were inspected and these have been taking place on a regular basis. The recruitment checks were inspected for three staff appointed in the last three months and for three staff who have been in post for over a year. The staff all had the appropriate recruitment checks including a CRB disclosure, two written references and ID with visas where appropriate. Only one of the staff had a record of their contract in their file and this had not been signed by the employee. The manager explained that the staff had been given their contracts and had taken them away to read and sign. All the staff had been given an induction and a record of this was available in the staff files. The training records were inspected for three staff who had been in post for over a year and only one had received training on autism and this had taken place four years ago and none of the staff had been trained on how to work with people who have a sensory impairment, specifically those who are visually and hearing impaired. The manager explained that two of the staff have started training using the Learning Disability Award Framework. The supervision records were inspected for three staff and two had received supervision but this was not happening on a regular basis. The manager explained that he sees his line manager at least once a month but is not formally supervised. It is necessary for the manager to also receive individual recorded supervision. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 21 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): 37,39 and 42 Quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to this service. The service users live in a service, which is supported by a manager with a previous career in learning disability services. This manager needs to apply to be registered. The majority of health and safety measures are in place but there is still some action needed to safeguard the service users. EVIDENCE: The manager explained that he has been in post for five months but has not yet applied to be registered. This application needs to be made as a matter of urgency. The manager explained that he is studying for the Registered Managers Award. The inspector recognised that the manager is very enthusiastic and willing to learn as part of the job. The manager explained that the company head office carries out a quality assurance exercise seeking the views of stakeholders. The results of this survey relating to Palmers Lodge were not available in the home. It is necessary to ensure a quality assurance exercise happens on an annual basis Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 22 seeking the views of relatives, care professionals and other stakeholders on the operation of the home through questionnaires. The returned questionnaires must be available in the home with an action plan addressing any areas for improvement identified through the survey. The regulation 26 reports were inspected and the last one was completed in September 2005. These visits and reports need to be completed on a monthly basis to ensure the performance of the home is monitored on behalf of the company. The insurance certificate for the home was inspected and was satisfactory. Health and safety records were inspected. Fire safety measures are in place with weekly fire alarm checks and regular fire drills recorded. The fire alarm and extinguishers had been serviced. The home has a fire safety risk assessment in place. A certificate was inspected for the maintenance of the gas system and was satisfactory. The portable electrical appliances and water need to be tested as the certificates are out of date. The electrical installations had been tested but the report said they were unsatisfactory. The manager said that repair work had taken place and the electrical systems need to be checked again to ensure they are now a satisfactory standard of safety. The staff training records were inspected and it could be seen that not all the staff had been trained on all the necessary health and safety issues including fire safety, food hygiene and infection control. This outstanding training must be arranged. The record of accidents and incidents was inspected and these are being recorded and reported appropriately. Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 23 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 1 2 2 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 1 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 2 x LIFESTYLES Standard No Score 11 3 12 3 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 x 2 x 1 x x 1 x Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 24 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 5(1)(b) Requirement The registered person must ensure that the work on the service users guide to make it available in a format that service users can access is completed. This requirement is amended and restated from the previous inspection. Previous timescale of 28/02/06 was not met. The registered person must ensure that each service user has a current assessment that reflects their present needs. The registered person must ensure that each service user has a contract between themselves and the home clearly stating what services the home will provide. The registered person must ensure that each service user has a number of clear care plan goals that reflect their needs and aspirations. Progress with meeting these goals must then be reviewed on an ongoing basis. The registered person must DS0000031152.V290018.R01.S.doc Timescale for action 30/06/06 2. YA2 14(1) 30/06/06 3. YA5 5(1)(b) 15/07/06 4. YA6 15(1)(2) 15/07/06 5. YA6 12(1) 15/07/06 Page 25 Palmers Lodge Version 5.1 6. YA9 12(1) 13(4) 7. YA13 16(2)(m) 8. YA19 13(1)(b) 9. YA19 12(1)(a) 10. YA20 13(2) 11. YA22 22(1)-(8) 12. YA23 18(1)(c) ensure that each service user has clear behavioural guidelines in place that the whole staff team understand and can implement. The registered person must ensure that each service users risk assessments clearly state any restrictions that are placed on them and this document must be shared with the multidisciplinary team. 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. The registered person must ensure the service users access dental and optical checks. If these are not possible then this must be stated in their risk assessment. The registered person must ensure that all the service users are supported to have their weight checked on at least a monthly basis. The registered manager must ensure that medication in a tablet form entering the home is recorded on the medication administration record and a record is also kept of medication returned to the pharmacist. The registered manager must ensure a record is kept of action taken in response to a complaint and the timescale. The registered person must ensure that staff receive training that has been planned in positively supporting service users who have complex challenging behaviour. This requirement is amended and restated from the previous DS0000031152.V290018.R01.S.doc 15/07/06 15/06/06 30/06/06 31/05/06 31/05/06 30/06/06 15/06/06 Palmers Lodge Version 5.1 Page 26 13. YA23 14. YA23 15. YA23 16. YA26 17. YA26 18. YA34 19. YA35 20. YA35 21. YA35 inspection. Previous timescale of 01/03/06 was not met. 13(6) The registered person must ensure that all the staff have received training on adult protection. 13(6) The registered person must ensure the whistle blowing procedure is displayed in a user-friendly format and includes all the contact telephone numbers for staff to use if needed. 13(6) The registered manager must make arrangements for the service users personal monies to be stored in a manner that safeguards them from theft. 23(2)(a)(b) The registered person must ensure all the building work identified in the environment section of the report is completed. 23(2)(a) The registered person must ensure that arrangements are in place to ensure ongoing maintenance of an adequate standard is completed as required. 17(2) The registered person must schedule ensure all the staff have a copy 4 of their signed contract available in their staff file. 18(1)(c) The registered person must ensure that all the staff have received training on how to support people with a sensory impairment and autism from an appropriately qualified person. 18(2) The registered person must ensure that all the staff working in the home receive regular individual supervision. 18(2) The registered person must ensure the manager receives regular individual supervision and a record of this is made DS0000031152.V290018.R01.S.doc 30/06/06 30/06/06 31/05/06 30/09/06 30/09/06 30/06/06 31/08/06 30/06/06 30/06/06 Palmers Lodge Version 5.1 Page 27 available to the manager. 22. 23. YA37 YA39 9(1)(2) 26(1)-(4) The registered person must ensure the manager applies for registration. The registered person must ensure the monthly provider monitoring visits take place each month and copies of the regulation 26 report is sent to CSCI. The registered person must ensure the home completes an annual quality assurance exercise and that the outcomes of questionnaires sent to relatives and other stakeholders are drawn up into an action plan for the home. The registered person must ensure the portable electrical annual safety check is complete. The registered person must ensure that the work identified in the electrical installation check is complete and that the home has a certificate stating that the installations are now safe. The registered person must ensure that all the staff have the necessary health and safety training including fire safety, infection control and food hygiene. 31/05/06 31/05/06 24. YA39 24(1)-(3) 30/09/06 25. 26. YA42 YA42 13(4) 13(4) 15/06/06 15/06/06 27. YA42 13(3)(4) 23(4)(d) 31/08/06 Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 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. 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. The registered person should arrange for the receipts for items purchased on behalf of the service users to be well organised. This should include removing and safely storing old receipts currently in the cash box and attaching receipts to folios that describe the item bought and are clearly numbered. The registered person should ask staff to bring in copies of their NVQ training certificate to go in their training file to provide evidence that this training is complete. 2. YA23 3. YA32 Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 29 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 © 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 Palmers Lodge DS0000031152.V290018.R01.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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