Inspection on 08/05/07 for Palmers Lodge

This inspection was carried out on 8th May 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 24 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 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 8th May 2007 08:15 Palmers Lodge DS0000031152.V333015.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.V333015.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.V333015.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 Post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Palmers Lodge DS0000031152.V333015.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (excluding nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following catergory:Service users with a learning disability (Category LD) (no more than 6 persons) Service users with a learning disability who are over the age of 16 (Category LD) (no more than 1 person) The maximum number of service users who can be accommodated is 6 2. Date of last inspection 12th December 2006 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.V333015.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 8 May 2007 and was unannounced. The inspection took five and a half hours to complete. The inspector was able to spend time with all of the service users. The inspector was also able to speak to the Director of Operations who was visiting the service. The acting 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 inspection is the annual key inspection and 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 a good standard of care and support to a group of service users 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. The people who live in the home are supported to have their individual needs met by a key working and care planning system. Three of the residents are offered access to structured activities. The people who live in the home are supported to maintain positive contact with their relatives. Palmers Lodge DS0000031152.V333015.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Twenty-four requirements and five recommendations have been made at this inspection. Four requirements were made under the section choice of home and this was to provide a 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 and to ensure all the contracts between the home and the people living in the home are appropriately signed. Three requirements 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, to ensure they all have a review meeting with their care manager and to ensure any restrictions and the reasons for them are recorded. 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. Three requirements and three recommendations were made under the heading of lifestyle to enable all the people living in the home to attend a structured day service, to support everyone to access community based leisure activities and to keep a full record of the food consumed in the home. 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. Two requirements were made under the heading of personal and healthcare to ensure that people living in the home are supported to have their weight checked on a regular basis and that the medication in the blister packs is Palmers Lodge DS0000031152.V333015.R01.S.doc Version 5.2 Page 7 administered correctly, that a medication fridge is provided 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 a record of their savings and access to appropriate levels of cash. In the section on staffing five requirements were made to ensure at least 50 of the staff have completed or are studying for the NVQ in care, to ensure the staffing levels are adequate and the manager is supernumerary, to have a record of the training staff have completed and book training to meet any unmet needs, to ensure staff have regular supervision and to also ensure all staff have a completed and signed contract of employment. Four requirements were made in the section called conduct and management of the home to ensure a permanent manager is appointed, to complete a quality assurance exercise and to ensure all staff have completed health and safety training. It was also required that the fire safety risk assessment is reviewed, regular drills take place and that the fire extinguishers which are in locked boxes can be accessed quickly in an emergency situation. 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.V333015.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.V333015.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. Quality in this outcome area is adequate 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 the visit the home. A statement of purpose needs to be available explaining what the home aims to achieve to provide accurate information to the people in the home, their relatives and other care professionals. EVIDENCE: I asked for the statement of purpose but this could not be located in the home. This document needs to include the services that the service wants to provide including respite care. In each residents case notes I was able to see that they had been given a service user guide in an appropriate pictorial format. 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. Palmers Lodge DS0000031152.V333015.R01.S.doc Version 5.2 Page 10 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 acting manager and he explained that a recent person who was thinking about moving into the home was able to visit with his relatives as part of the process of deciding whether he wanted to 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. None of the contracts had been appropriately signed by a representative acting on behalf of the resident. Palmers Lodge DS0000031152.V333015.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. Quality in this outcome area is adequate 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. They would however benefit from clarity over restrictions that are in place and the reasons for this action. There is also the need to record how each person is supported to manage their personal finances. EVIDENCE: I inspected care plans for the four people currently living in the home. I also spoke to the acting 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 Palmers Lodge DS0000031152.V333015.R01.S.doc Version 5.2 Page 12 six months. Three 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 but a meeting needs to be arranged for the final person. The minutes of these reviews were available but the action from these meetings had not all been addressed for example one person had action agreed at their meeting which included buying new clothes, going on holiday and being supported to have a power of attorney and this was not reflected in the residents care plan. Each resident had a named key worker but the care plans had been updated by the acting manager and not the key worker. I read the risk assessments for the same four 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. Where restrictions are needed the reasons were not always recorded in the case notes. For example one person living in the home needs to have the kitchen door locked as he will grab and eat excessive amounts of food. This was not covered in his case notes. Each person living in the home had individual behavioural guidelines and these were clearly written and gave appropriate guidance. The four 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. The acting manager told me that none of the residents has an advocate at the present time. I observed the four 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.V333015.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. Quality in this outcome area is poor 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.V333015.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 acting manager explained that three of the people currently living in the home go to specialist day centres five days a week. The other resident has no structured day activity and this has been discussed at his review meeting with his care manager but is not yet resolved. The home has its own vehicle but the acting manager explained that he is the only driver. It was also noted that on the day of the inspection the vehicle was being used elsewhere in the company. 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 month other than going to the day centre. The staff confirmed that there were very few leisure activities taking place and expressed concern about the one person who has no structured day activity. One member of staff said there was also very limited activities they could offer in the home as there was no budget available to buy equipment needed for the residents intensive interaction programme. In terms of holidays the staff explained that a holiday is being planned for all of the residents 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. I observed that for the three 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 two of the people living in the home have regular contact with their relatives and either go to see them or the relatives visit the home. 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 fresh food available in the home. A record is kept of the food eaten by two of the people who live in the home who are prone to loosing weight. This record had not been completed for five days and did not provide information including how well the person ate and whether they enjoyed the food. The other two people living in the home also have weight issues and would benefit from also having an individual record of the food they eat. Palmers Lodge DS0000031152.V333015.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. Quality in this outcome area is poor 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. They do however need their health to be monitored more closely by regular weight checks. There is a medication system in place but this needs to be used correctly by the staff in the home. 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 four residents were appropriately dressed. I looked at the healthcare records for the four people living in the home. They had all been supported to access a range of healthcare professionals including Palmers Lodge DS0000031152.V333015.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. I saw in the case notes that one person had no record of having their weight checked and the other three had not had regular weight checks. The acting manager said it was difficult for the residents to stand on the scales and sit on scales may help. I looked at the medication, administration records and staff training records. The acting manager explained that the home has recently changed pharmacists and uses a blister pack medication administration system and some of the medication is in a liquid form. I saw that the staff had pushed out the medication from the blister pack in the wrong order. The medication is stored in a locked cupboard in the office. The temperature of the storage cupboard is being monitored. Within the cupboard a cool box is used to store the liquid medication and this needs to be replaced by a fridge. 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 for four staff and two had received medication training in 2004 and this training needs to be updated. The other two staff had not received any training. I gave an urgent requirement for the medication issues to be addressed as the inaccurate administration of medication could place the people in the home at risk of harm. Palmers Lodge DS0000031152.V333015.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. Quality in this outcome area is poor 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. Service users also need access to information about finances held on their behalf by the company to ensure their monies are safe guarded. EVIDENCE: I looked at the record of complaints and whilst there have been no complaints since the last inspection an appropriate format is available to record complaints. A complaints procedure is available. There have been no adult protection issues since the last inspection. I looked at the staff training records for four staff and only one of them had undertaken training on the protection of vulnerable adults. The manager was able to show that this training was booked to take place in May. I also looked at the training records for the four staff to see if they had been trained on how to appropriately support people who have complex challenging Palmers Lodge DS0000031152.V333015.R01.S.doc Version 5.2 Page 18 behaviours and two had received the training but the other two still needed to receive this training. I checked the personal finances for two residents including their cash record, cash and receipts. Both these people have their DSS benefits administered by social services and the director explained that these benefits are paid to head office. The director was however not able to confirm what benefits they received and whether the resident had a savings account and the extent of their savings. This information should be made available to the home on a regular basis so that they can plan expenditure on larger items such as clothes or holidays. The inspector also saw that one resident had less than £1 in her money tin and the other resident had less than £10. The acting manager said he can always access cash but there needs to be money available in the home for activities, toiletries etc. Palmers Lodge DS0000031152.V333015.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. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Whilst the physical environment in the home has improved over the past six months 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. Palmers Lodge DS0000031152.V333015.R01.S.doc Version 5.2 Page 20 Since the last inspection the following work has been undertaken: • • • • • Two garden chairs have been provided although they may not be suitable for the people living in the home as it is possible for them to be lifted and potentially thrown The tumble drier has been moved from the kitchen to the downstairs bathroom The house has been mainly redecorated including two of the residents bedrooms The ground floor bedroom has been re-plastered Broken furniture has been removed, repaired or replaced Outstanding work from the two previous inspections includes: • • Radiators need to be covered The flooring in communal areas has not been replaced There was a discussion about a previous requirement to remove a pond. The acting manager and staff said the people who live in the home are constantly supervised in the garden and therefore will not come to harm in the pond. A water feature has been installed in the pond. Outstanding work from the previous inspection includes: • • Lighting in the dining area and sensory 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. Palmers Lodge DS0000031152.V333015.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. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The people living in the home cannot be sure that there will be 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 10 staff working in the service. The acting manager explained that the manager and two care staff have left in the last few months. 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 included in this rota and is not shown as being supernumerary. When the inspector arrived at the inspection the manager was completing administration work in the office at a busy time when the people living in the home were getting up. This meant there were only two staff supporting four residents and two of these residents have care plans that Palmers Lodge DS0000031152.V333015.R01.S.doc Version 5.2 Page 22 say they need 1:1 staffing. It is therefore required that the manager is not included in the shift rota and that there are a minimum of three care staff available when all the people living in the home are present. I have made an urgent requirement about these staffing levels as the people in the home could potentially be placed at risk of a serious accident if there are not enough staff available to look after them. The staff explained that there have not been any staff meetings since the previous manager left and the record of meetings showed the last one took place in February 2007. The acting manager did however explain that a team meeting has been arranged. The acting manager explained that only one member of staff has completed an NVQ in care although two other staff have professional qualifications. The director explained that NVQ training is being arranged but there is no date yet for when it will commence. I looked at the recruitment records for four staff. It was found that all the staff had two references, ID and a CRB disclosure. Out of the four staff, three had a contract of employment but one had not been signed and did not include current details of their rate of pay. I inspected the training records. I looked at the induction records for the four staff and they all had a completed induction record available. I could see that there was no summary of all the staff training details so that it was not possible to identify how many staff had outstanding training needs. There was also no training programme arranged to meet those training needs. I looked at the supervision records for the four staff. Three of them had received individual supervision in the previous four weeks but there had been a gap of three to four months since their previous supervision. The format used for supervision is appropriate and includes a record of any action agreed. Palmers Lodge DS0000031152.V333015.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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The people in the home are not supported by a permanent manager with the appropriate skills and experience although the recruitment process is underway. Additional fire safety measures are needed to ensure health and safety is maintained in the home. EVIDENCE: I spoke to the acting manager and he explained that most of his experience comes from working with older people with dementia. I was concerned from discussions with the acting manager about certain aspects of the service such as the physical environment that he did not have enough knowledge and experience of people with autism and sensory impairments to be an effective Palmers Lodge DS0000031152.V333015.R01.S.doc Version 5.2 Page 24 manager of the service. The Director of Operations explained that they have interviewed and offered a managers post to a person with an employment history of working with people who have a learning disability. The acting manager and director of operations were unable to locate the quality assurance questionnaires and so it was not possible to establish if an action plan had been prepared. This exercise will need to be completed again. In terms of fire safety I looked at the fire safety risk assessment. This was not comprehensive and did not include the precautions needed to different areas of the home and staff training. The fire alarm and fire extinguishers had been serviced. The extinguishers are kept in locked boxes as one service user could throw them, but the manager and director struggled to open the boxes with the keys available. The fire alarm records show the alarm is checked weekly but the last fire drill was six months ago in November 2006. An emergency plan is in place. The fire safety training records were checked for four staff and only two had received the training. I have made the fire safety work identified at this inspection an urgent requirement as the people in the home could be placed at risk if fire safety measures are not in place. The certificates were checked to see if maintenance checks had taken place for the electrical installations and portable electrical appliances and these were both satisfactory. The gas had not been checked for over a year but the service check had been booked. Other health and safety training certificates were checked for four staff and only two had completed first aid training, three had completed food hygiene and two had completed moving and handling. Palmers Lodge DS0000031152.V333015.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 2 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 1 25 3 26 x 27 x 28 2 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 x LIFESTYLES Standard No Score 11 2 12 1 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 x 2 x 1 x x 1 x Palmers Lodge DS0000031152.V333015.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 that there is a completed statement of purpose available and a copy is sent to the CSCI. 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 two inspections. Timescales of 31/08/06 and 31/03/07 not met. CSCI will consider what action will be taken in the event of this requirement not being met. The registered person must ensure all the staff have received training on how to support people who have autism or who have complex challenging behaviours. The registered person must ensure that each person living in the home has the contract between themselves and the home signed by a DS0000031152.V333015.R01.S.doc Timescale for action 31/07/07 2. YA3 18(1)(c) 30/06/07 3. YA3 18(1)(c) 31/07/07 4. YA5 5(1)(b) 31/07/07 Palmers Lodge Version 5.2 Page 27 5. YA6 15(2) 6. YA7 13(6) 7. YA9 13(6) 8. YA11 16(2)(m) 9. YA13 16(2)(m) representative acting on behalf of the service user. This requirement is amended from the previous inspection. Timescale of 31/01/07 not met. The registered person must ensure that all the residents are supported to have an annual review meeting with their care manager and that where action is agreed at this meeting that this is incorporated and monitored as part of the care planning process. The registered person must ensure that all the people living in the home have a record of how they are supported to manage their personal finances and this includes who acts as their appointee. The registered person must ensure that where restrictions are placed on a person in the home such as locking the kitchen door that the reasons for the restriction are fully recorded in their risk assessment. The registered person must ensure that the one person living in the home who does not have any structured day activity is supported to attend an appropriate day resource. 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 DS0000031152.V333015.R01.S.doc 31/07/07 30/06/07 30/06/07 31/07/07 30/06/07 Palmers Lodge Version 5.2 Page 28 10. YA17 16(2)(i) 11. YA19 12(1) 12. YA20 13(2) 13. YA23 13(6) 14. YA24 23(2)(a)(b) from the previous two inspections. Timescales of 15/06/06 and 31/01/07 were not met. CSCI will consider what action will be taken in the event of this requirement not being met. The registered person must ensure that a full record is kept of the food consumed by the people living in the home including how much they ate and whether they enjoyed the food. The registered person must ensure that all the people living in the home are supported to have their weight checked on a regular basis with the appropriate weighing equipment. The registered person must ensure that the staff are trained on how to open the blister packs in the correct order. The staff must all receive medication training. A medication fridge must be provided. This is an URGENT requirement. 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 what DSS benefits they receive and what savings they have available. Residents must also have adequate amounts of cash available in the home to use as required. The registered person must ensure all the building work identified in the environment DS0000031152.V333015.R01.S.doc 15/06/07 31/07/07 04/06/07 30/06/07 31/07/07 Palmers Lodge Version 5.2 Page 29 15. YA28 16. YA32 17. YA33 18. YA34 section of the report as being outstanding from the previous two inspections is completed. This requirement is restated. Previous timescales of 30/09/06 and 31/03/07 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 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. 18(1)(c) The registered person must ensure that at least 50 of the staff have completed or are studying for an NVQ in care. 18(1)(a) The registered person must ensure that all management time is supernumerary and that there are a minimum of three care staff available when all the people living in the home are present. This is an URGENT requirement. 17(2)schedule4 The registered person must ensure all the staff have a copy of their signed contract available in their staff file. This requirement is restated from the previous two inspections. Timescales of 30/06/06 and 28/02/07 were not met. CSCI will consider what action will be taken in the event of this DS0000031152.V333015.R01.S.doc 31/08/07 31/08/07 04/06/07 31/07/07 Palmers Lodge Version 5.2 Page 30 19. YA35 18(1)(c) 20. YA36 18(2) 21. YA37 8(1) 22. YA39 24(1)-(3) 23. YA42 23(4) 24. YA42 13(4)(5) requirement not being met. The registered person must ensure a record is available of the training received by the whole staff team and then a programme is in place to show how any unmet training needs will be addressed. The registered person must ensure all the staff are supported to receive regular individual supervision. The registered person must ensure a permanent manager is recruited who has the appropriate skills and experience and that they complete the registration process. The registered person must ensure the home completes an annual quality assurance exercise and that the results are collated into an action plan. The registered person must ensure a comprehensive fire safety risk assessment is completed, that regular fire drills take place and that a mechanism is in place to ensure the fire extinguishers can be accessed quickly in the event of a fire. This is an URGENT requirement. 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. 31/07/07 30/06/07 31/07/07 31/08/07 04/06/07 31/07/07 Palmers Lodge DS0000031152.V333015.R01.S.doc Version 5.2 Page 31 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. 3. Refer to Standard YA6 YA9 YA12 Good Practice Recommendations 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 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 must ensure that there is money available to purchase the ongoing equipment needed to the intensive interaction work. 4. YA14 5. YA14 Palmers Lodge DS0000031152.V333015.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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. Extracts may not be used or reproduced without the express permission of CSCI Palmers Lodge DS0000031152.V333015.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!