Inspection on 26/08/09 for Tansi Lodge

This inspection was carried out on 26th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tansi Lodge 10/10/07

Tansi Lodge 13/06/06

Tansi Lodge 02/09/05

Tansi Lodge 20/05/05

Tansi Lodge 01/02/05

Tansi Lodge 09/08/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tansi Lodge 125 Audley Road Hendon London NW4 3EN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Teferi Degeneh     Date: 2 6 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Tansi Lodge 125 Audley Road Hendon London NW4 3EN 02089220856 02089220856 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Kaine Ikwueke care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Tansi Lodge is a care home registered to provide care for four people who have mental health needs. The home is owned by Dr. Kaine Ikwueke. Currently there is no registered manager. Tansi Lodge is in a pleasant residential area of Hendon close to shopping and transport facilities. There are single bedrooms for the service users on the ground and first floors. A lounge and a dining/kitchen area are on the ground floor. There is a garden to the rear of the home. The staff office is on the first floor and a sleep-in bedroom for staff use on the second floor. Information about the home and a copy of the inspection report can be obtained by Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 4 Brief description of the care home contacting the owner or the manager. The current weekly fees for the home range from £750-£1000. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a surprise inspection which means the home had not been told we were visiting. When we arrived there was one member of staff at the home and another member came a few minutes later. None of these care staff had a key to the office where the residents files and the homes policies and procedures were kept. We were informed that there was only one resident at the home with the other two being away either visiting their family or going out for their planned activities. The owner of the home and another member of staff came to the home later on to help with the inspection and to open the door of the office where the files were kept. The inspection we did included a tour of the building, the examination of service users care records, the examination of health and safety records, the viewing of staff rotas and discussions with people who use the service. We also spoke to care staff and the owner of the home. As part of the inspection we have checked the homes annual Care Homes for Adults (18-65 years) Page 6 of 26 quality assurance assessment (AQAA). The AQAA is a self assessment which we asked the home to complete and send it to us. This is to give the home an opportunity to tell us how they are providing the service to meet the residents needs and the plans they have to make improvements. We also reviewed the last inspection report and all the other information we have about the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedure is good. The people who use the service can be confident that their admission is based on the availability of services and facilities to meet their needs. Evidence: We checked the files of three people who use the service. We also spoke to the owner of the home. It was clear from the files that new residents have been assessed by the home and detailed information received from their social workers. The owner of the home said all new residents are assessed before admission to make sure that the home meets their needs. The AQAA says that the home carries out assessments of needs of new service users before making decisions to accept them. The AQAA also confirms: We [the home] match their [new residents] assessed needs to our resources to ensure we can meet their needs. We draw up person centred care plans. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are not confident of the home being able to develop satisfactory care plan and risk assessment to meet their needs and to ensure their safety and wellbeing. Evidence: We mentioned above that the office keys were not available for us to have access to and review care plans when we arrived at the home. This was because the care plans were locked in the office and the staff present did not have access to it. The owner of the home came in later on and we were able to check three residents files. We noted in the files that care plans have been completed for the three residents. The care plans were designed in a format showing areas of need, key workers views, residents views and dates of next reviews. The care plans were detailed but there was no evidence to show the residents or their representatives have been involved in the review of the plans. We asked the owner to make sure that the residents care plans are reviewed regularly and the residents and their representatives are involved. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: One of the files we checked did not contain a risk assessment while the other two have evidence of risk assessments which have not been reviewed. It is important that the home completes and reviews risk assessments which identify the risks and the way they are managed. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good opportunities for the residents to engage in the community and to food that meets their needs at the home. Evidence: From conversations with a resident it is clear that the people who live at the home are engaged. Two of the residents go out to shops and different places independently. At the time of our visit there was one resident at the home. We understand from conversation with the staff and a resident that staff are available to assist residents to access community based facilities such as shops and a local library. The AQAA confirms that each resident has keys to the front door and their bedrooms. There is also a pay phone which the residents can use to contact families and friends. At the last inspection we asked the owner of the home to ensure that people who use the service are supported to go to the shops to buy food items as part of their Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: aspirations to gain skills for independent living. The staff and the manager said the residents are encouraged to buy items and cook their meals. A resident we spoke to said they like the food at the home. There was a menu displayed in the kitchen. It was clear from conversations with the staff that the residents do not follow their menu preferring to cook and eat whatever they liked at a given time. The owner of the home confirmed said that all the residents are registered on the electoral roll and they are free to vote if they wished to. He said that the residents either manage their own finances or have their relatives manage for them. He said the staff enter the residents rooms by knocking on the doors and by asking permission from the residents. We noticed from observations that the staff knocked on a bedroom door and waited for permission before entering the room. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are put at risk due to the homes inadequate system of storage and administration of medication. Evidence: All the residents are registered with their own general practitioners (GPs). From the files it was evident that the home liaises with health professional to ensure that the residents make appointments and see their GPs, psychiatrists and community psychiatry nurses. We also noted from the records and discussions with the staff that the staff encourage the residents to do their own personal care. A resident we observed and talked to looked presentable and comfortable. The resident said the staff treat them with respect and dignity. We checked the medicines and the medication administration record sheets (MARS). All the residents are on prescribed medication administered to them by the staff. From the staff files and discussions with the staff we understand that most of the staff have attended training on how to administer medication. However, we noted that there are some staff who have not attended this training but administer medication. We asked the owner of the home to ensure that no member of staff is allowed to administer Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: medication without appropriate training. While checking the MARS we noticed some gaps where the staff did not sign to confirm administration of medication. We were not able to tell whether or not the medicines were given on four occasions as the staff left the space on the MARS blank. We asked the owner of the home to investigate these and let us know the action he takes to ensure that a similar error does not happen at the home. We were also concerned with the homes practice of keeping medication in a cupboard with staff bags and other items in the sitting room. We thought this was not a safe way of keeping medication. We asked the manager to make sure that all medicines are kept in a secure and safe place. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are confident that their complaints are taken seriously and dealt with by the home. Evidence: No complaints have been recorded since the last inspection. The home has a policy and procedure on complaints. A resident we spoke to said they know they can talk to the staff or the manager if they have a concern. The home has also a policy on safeguarding. There was also a copy of the local authoritys policy on the protection of adults from abuse. The staff we spoke to were able to explain what safeguarding means and how they can ensure that the residents are safeguarded from any form of abuse. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and the facilities of the home are good and the residents live in a comfortable environment. Evidence: The AQAA confirms there is a plan to improve the home by replacing the old fixtures and fittings such as the curtains. The home was clean and bright with no trace of unpleasant smells. A resident we talked to said they liked the home. As we mentioned earlier all the residents have keys to their bedrooms and the front door. The home is located within easy reach of shopping and transport facilities. Care Homes for Adults (18-65 years) Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service can be confident that they are supported by staff team who are vetted, experienced and committed. Evidence: A random selection of three staff files showed that they all have satisfactory criminal record bureau (CRB) checks and two written references. The owner of the home explained the staff recruitment procedure. He said that job vacancies are advertised and suitable candidates are selected through interviews. He said that staff start work at the home only after all the necessary requirements such as CRB certificates are obtained. We were not able to see contracts or job descriptions in the staff files. From the staff files and discussions with the staff it was evident that the staff have previous experience of working in residential care homes. The staff we talked to said they attended different care related training at their previous employment. Many of the current staff are new to the home having been here for a few months. The owner said he has a plan to provide new staff with training in areas they have not had training. We have mentioned above that the staff who administer medication need to attend relevant training. A care worker confirmed that they had training in areas such as basic food hygiene, fire safety, and moving and handling. The rota showed that there are a minimum of two care staff during the day and a sleep-in staff at night. Care Homes for Adults (18-65 years) Page 19 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents and their representatives are not confident of the way the home is managed. Evidence: The registered manager has resigned and a new acting manager has been employed. The acting manager was not present during this inspection. The owner said the acting manager has previous training and work experience with residents in care homes in this country and abroad. He said the acting manager is in the process of applying to the Care Quality Commission to be the registered manager of the home. We understand from conversations with the owner of the home that the acting manager remains a part time manager until she gets registered with CQC. The owner also confirmed his intention to employ an assistant manager. The owner confirmed that fire alarms and emergency lights are checked weekly. We noted from the records that fire safety officers visited the home on 2nd May 2008 and confirmed that the premises were safe and comply with fire safety requirements. The portable electrical appliances were checked while this inspection was taking places. A Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: certificate issued to the home confirmed that there were no safety concerns regarding the use of the appliances. The owner explained the homes system of quality assurance. He said that the home holds regular meetings with the residents families and care coordinators. He also said the staff talk to the residents to ask them how they feel about the home. At the last inspection we asked the owner to establish and maintain a system of reviewing at appropriate intervals a system of quality assurance. This had been done over a year ago. However, there was no evidence that the practice has been maintained since the previous manager had left. Care Homes for Adults (18-65 years) Page 21 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 22 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 17 Care plans and risk assessments must be kept in secure and accessible places for the care staff to use them. The staff become up-to-date and are able to use care plans to meet the residents needs. 30/09/2009 2 6 14 Care plans and risk 30/10/2009 assessments must be reviewed regularly with the involvement of the residents and, as appropriate, with their representatives. In this way the needs of the residents are identified and met by the home. 3 20 18 Staff who administer medication must be trained and competent to do so. 30/09/2009 Care Homes for Adults (18-65 years) Page 23 of 26 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This would allow the residents to have their medication administered to them safely. 4 20 13 Care staff must sign on 30/09/2009 medication administration record sheets to confirm medication has been taken by the residents. The registered person must investigate why medication administration record sheets were not signed on 13th, 14th and 16th August. The outcome of the investigation and action plan must be sent to CQC. This ensures safety of the residents. 5 20 13 Arrangements must be made for safekeeping of medication. This reduces the risk to the residents. 6 37 8 A manager who can be 30/11/2009 registered by the Care Quality Commission must be appointed to manage the home. This ensures that the services and facilities are managed well to meet the needs of the residents. 30/09/2009 Care Homes for Adults (18-65 years) Page 24 of 26 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 39 24 A system of quality assurance must be fully implemented. This would allow the residents and their representatives to give their views about the home and improve the quality of the services and facilities. 31/12/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 34 All staff should be provided with terms of employment and job descriptions. These allows the staff to know their responsibilities and fulfill their duties. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - 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!