Inspection on 11/05/06 for Tomswood Lodge

This inspection was carried out on 11th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tomswood Lodge 26/11/07

Tomswood Lodge 01/11/06

Tomswood Lodge 30/06/05

Tomswood Lodge 01/12/04

Tomswood Lodge 24/06/04

Tomswood Lodge 10/07/03

Tomswood Lodge 29/04/03

Tomswood Lodge 21/05/02

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

CARE HOME ADULTS 18-65 Tomswood Lodge 154 Tomswood Hill Hainault Ilford Essex IG6 2QP Lead Inspector Key Unannounced Inspection 11th May-20th June 2006 10:30a Tomswood Lodge DS0000025932.V294520.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 Tomswood Lodge DS0000025932.V294520.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. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tomswood Lodge Address 154 Tomswood Hill Hainault Ilford Essex IG6 2QP 020 8500 7554 020 8262 5295 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) Mr Jackdeo Meetaroo Mrs Sushita Meetaroo Mr Jackdeo Meetaroo Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to eight adults with low to moderate learning disabilities, excluding adults exhibiting severe challenging behaviours. May include residents with associated mental health problems and a maximum of two residents who are wheelchair bound. 30th June 2005 Date of last inspection Brief Description of the Service: Tomswood Lodge is a care home for eight people aged between 18 and 65 who have low to moderate learning disabilities, they may also have associated mental health problems. The home is privately owned and one of the proprietors is also the registered manager. The house is detached and in keeping with others in the road. It is situated in a residential part of Hainault, on a bus route and within a 20 minute walk of the underground station. Shops and other local community resources are within walking distance. There are three bedrooms on the ground floor, along with two toilets and two showers. Also on the ground floor is a dining/lounge area, domestic style kitchen, conservatory, staff room and office. The upper floor has five bedrooms, two toilets, a shower and a bathroom. There is parking space to the front of the house, a large garden to the rear and a utility room, which is accessed via the garden. Activities are organised both within the home and in the local community, residents are encouraged to attend day centres and local clubs. The Statement of Purpose and the Service User Guide are issued to every prospective service user and these documents can be found on the residents’ notice board, which is situated in the lounge. A copy of the most recent inspection report is also available. The fees for the home are £725-£1521 a week. The proprietor/manager made this information available on 6th May 2006. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days. The inspector spoke to all five of the residents about their experience of living at the home. Relatives were contacted by telephone or a questionnaire was sent, asking for their views. Discussion took place with the proprietors/manager, and several members of the care staff. Staff were spoken to about care practices and their employment at the home. A tour of the home took place and a number of staff and residents’ records were examined. The inspector also attended a staff meeting. The views of other professionals who visit the home were also sought during the inspection. Two additional monitoring visits have taken place, one December 2005 and one in March 2006, improvements were noted on both of these visits. A statutory requirement notice and a notice of proposal to impose conditions have been issued. The registered persons are appealing against the wording of the statutory requirement notice and the proposal to impose conditions, which proposes to reduce the occupancy levels of the service to five people. There is currently an Adult Protection multi-agency investigation being carried out, which is led by the police. The outcome will determine whether staff have kept service users safe. On receipt of the draft inspection report the provider submitted an action plan that detailed the action already taken by the provider to implement the requirements of the report. He also submitted a three page document challenging some of the findings of the report, as a result of which some amendments have been made. The action taken by the provider will be tested at the next inspection. What the service does well: The home, which is clean and tidy provides a family style environment. Residents and relatives all spoke highly of the manager and the staff. The residents spoke about their lives, which includes contact with family and friends, going out for meals, visiting local leisure activities and arranging their next holiday. The residents are involved in the day-to-day running of the home wherever possible. All of the bedrooms are single and residents are encouraged to have personal possessions, such as televisions and music centres. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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 Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 7 contacting your local CSCI office. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 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 Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Prospective residents and their relatives have the information they need to be able to make an informed choice about moving into the home. The assessment of needs and other information and reports received from health and social care professionals means that the staff have detailed information to enable them to determine whether or not they can meet the prospective resident’s needs. Prospective residents know that the home can meet their needs. EVIDENCE: Tomswood Lodge has a Service User Guide which is also used as the Statement of Purpose, parts of the guide are in pictorial form. This document give prospective residents and their relatives information regarding the home and what services the home can offer. There have been no new admissions to the home since the last inspection, however two of the female residents have recently moved out. The file of the most recent resident was examined and it was found to contain an assessment that had been undertaken by the manager prior to the resident’s admission to Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 10 the home. The registered persons had also received an assessment and care plan from the referring local authority and information from health professionals. The registered person’s care planning system would identify the needs of prospective residents, and set out how these were to be met. Both the resident and his relative had been involved with the decision in him moving into the home. The resident told the inspector ‘I was happy to move into the home, as they made me feel very welcome’. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 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 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 is poor. This judgement has been made using available evidence including a visit to the service. Residents’ identified needs are not always reflected in up to date care plans or risk assessments, which could put themselves and others at risk. The residents, with assistance, are able to participate in all aspects of life in the home and to make decisions about their lives. EVIDENCE: There is a care planning system in place that is clear and concise. Each resident has an individual care plan and the care plans of all five residents were examined. The care plans cover in sufficient detail all aspects of health and personal care needs, as well as social and recreational needs. Residents’ preferences and choices are also taken into account. Care plans were examined alongside the daily records and compared with the support being given. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 12 The daily log reflects the care being given on a day-to-day basis and how residents are involved in the life of the home assisting with tasks such as setting and clearing the tables, tidying their bedrooms, and loading the dishwasher. A resident said that ‘he could work the new dishwasher and had showed a member of staff what button to push’. Other records seen, showed resident’s choice of meals and whether or not they participated in activities within the home and in the community Staff were observed interacting with the residents, and some aspects of the residents’ care were discussed with the staff, particularly in relation to their personal care, dietary and social needs. All of the residents were at home during the inspection and gave their views as far as possible. Comments from the residents were ‘I am happy here’, ‘the staff always help me’, and ‘M takes me out’. Risk assessments are in place for activities such as shopping, delivering newspapers, assisting with household tasks, showering, and other risk assessments evidenced residents were being supported to experience ordinary living within a safe environment. There was evidence that some of the residents’ care plans and risk assessments are being evaluated and reviewed on a regular basis and the outcome of reviews are recorded and maintained on file. However, one of the residents has had a risk assessment on his aggressive behaviour but there is no evidence that this has been carried forward to his care plan. Information on another resident states that ‘he is a risk to females’. Again this information has not been carried forward to his care plan, detailing guidance for staff. Also there has recently been serious allegations by two residents, that should have seen care plans being updated and new risk assessments being undertaken. The care plans should have been updated identifying the need and how these needs would be met with actions and guidance for staff, to reduce risk to the residents, staff and others. This is Requirement 1. The risk assessments should clearly identify the risks and the actions to be taken to minimise these risks. This is Requirement 2. Residents’ meetings take place every two months and issues are discussed and recorded. The most recent discussion has been around where the residents want to go on holiday this year. It is important that risk assessments take into account risks on holiday, particularly where there may also be risks to others in the community. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14,15,16 and 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents are able to take part in leisure activities within the local community that are appropriate to their age and culture. Although most of the residents have appropriate personal and family relationships, the manager/proprietor must take positive steps to ensure that all of the residents personal/sexual relationships are appropriate to their needs, ability and capacity to make decisions. Residents’ rights are not always respected and they are not always supported to take responsibility for their actions. Residents are offered and encouraged to eat a healthy diet. EVIDENCE: Residents’ care plans identify lifestyle choices, such as going to church, clubs, local leisure activities and visiting families and the daily logs now record Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 14 whether these activities have taken place. All of the residents have opportunities for personal development and a varied activity programme, which takes into account their preferences and interests. Only one of the residents attends a day centre but all of the residents participate in leisure activities within the home and the local community. Some of the residents deliver a local newspaper with the assistance of a member of staff and then enjoy visiting a local café for a cup of tea and cake. One of the residents told the inspector that ‘I enjoy going to the café and talking to the owners and the waitress about the countries they use to live in’; he then went into great detail explaining to the inspector where the countries were. Some of the residents enjoy playing bingo at the local bingo hall, and one of the residents went to watch Leyton Orient play football with his keyworker. All of the residents enjoy going out for meals, some prefer a pub lunch on a Sunday and others prefer a Chinese meal. They had all been for a pub lunch the previous Sunday and all said how much they had enjoyed it. All of the residents have birthday parties at the home, to which family and friends are invited and during the summer months barbeques are a regular feature. One of the resident’s behaviour to women is not always appropriate and it is clearly logged that he can be a risk to females. Professionals that have visited the home feel that the manager needs to take this matter more seriously and deal with this behaviour in a more pro-active and positive way, rather than giving the impression that this sort of behaviour is acceptable and also ensuring that the resident is aware that this behaviour is unacceptable and the consequences of his behaviour. This is Requirement 3. Two of the residents visit their family weekly, one of the resident’s friends visits him at the home and most of the residents receive regular visits from family. Currently all of the residents are male, as the two female residents have left the home. As stated earlier in the report, two of the residents had made serious sexual allegations; one of these allegations was against another resident, the other was against a member of staff. The manager did not act upon one of the allegations, including failing to report an allegation against a member of staff when the allegation was made. This left the alleged victim in a vulnerable position. These allegations are being investigated by the Police. The rights of female residents are considered to have been compromised (see Standards 22&23 regarding protection issues) and this particular resident’s rights were not respected as no action was taken and the registered persons failed to follow their own Adult Protection or Complaints procedure. This is Requirement 4. The menu is set weekly taking into consideration the resident’s likes and dislike, as well as dietary requirements. On the day of the inspection the menu corresponded with the meal being served. There are two choices but one of the residents asked for something different, which was cooked for him. Another resident is diabetic and Asian, each day, he is offered a culturally appropriate meal, which sometimes he has and sometimes he asks for the same meal as Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 15 the other residents. This resident’s brother stated that ’he was very pleased as the home has managed to keep his sugar levels under control’. One of the residents was seen eating his breakfast at 11.00 as he had just got up, staff stated that ‘if residents wanted to have a lie in and have a late breakfast, that was fine’. Food store cupboards, the refrigerator and freezer were inspected and all foods were appropriately stored. The food in the refrigerator corresponded with the meals planned for the day, there was also fruit, cakes, biscuits and crisps, if residents wanted a snack. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 16 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 and20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents receive personal support in the way they prefer and their physical and emotional needs are met. Due to the level of disability, residents are unable to administer their own medication. There are policies and procedures in place to ensure that this done safely. EVIDENCE: Care plans and daily records were examined and discussed with the manager. The care plans clearly identify health and personal care needs and how these should be met. The daily log is written to show how each of these needs have been met during the day. Most of the residents require encouragement and prompting rather than physical assistance. A member of staff was observed asking a resident if he would like to go to the toilet before lunch, this was carried out in a very discreet way, which did not appear to cause him any embarrassment or distress. One of the residents stated that ‘he didn’t like a bath and he preferred to have a shower’. A relative stated ‘that her son always looks neat and tidy’. All of the residents were appropriately dressed at the time of the inspection. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 17 Records inspected showed that residents are being referred to health professionals such as physiotherapist, psychiatrist, audiology, chiropodist, dentist and opticians. Every resident has had a general check up with their G.P. within the last three months. One of the residents had attended the local hospital the previous day for a minor operation on his face. He said that ‘I felt very nervous, but my keyworker went with me and that made me feel better’. There are policies and procedures for the handling and recording of medication within the home. Staff have received medication training as part of their induction programme. Medication Administration Records (MAR) charts and the medicine cupboard were checked and found to be correct. Two of the residents’ medication was audited and the amount given and the amount remaining reconciled with the MAR charts. A previous recommendation was that the amount of tablets brought forward from the previous 28-day cycle is entered on the current MAR chart to allow for audit trails. This is now being carried out, and therefore the recommendation is met. Another recommendation was that each bottle/packet of medicine is dated when first opened to allow for audit trails. This is now being carried out, and therefore this recommendation is met. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 18 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 using available evidence including a visit to the service. Residents cannot always be sure that their views are listened and acted upon, and that they are protected from abuse. EVIDENCE: The home has a clear complaints procedure, which is available in written and pictorial format, and both versions include details of who to contact at the Commission. A copy of the policy is available on the notice board in the lounge. All of the residents were individually asked what they would do if they were unhappy with anything at the home, responses included ‘I would tell Jack (manager), M (senior care staff) or my family’, ‘I would tell J (care staff)’, or ‘I would tell Jack or my mum’. The home has a comprehensive Adult Abuse and Protection policy and procedures and the procedure to inform the Commission of untoward incidents under Regulation 37 have been signed as read by all the staff. Three staff members that were spoken to were very clear on what constituted abuse and their responsibilities to report any potential abuse. Staff files indicated that all members of staff have now attended Abuse Awareness/Adult Protection training. This was a previous requirement that has now been met. Two female residents who have recently left the home, both made serious sexual allegations to the manager who did not follow the very good procedures that are held in the home, specifically in relation to the most serious of the two allegations. The effect of which was to place female service users at risk. One of the allegations was reported to the placing authority and the Commission. The other allegation, which was against a member of staff, was not reported to Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 19 the placing authority or the Commission. This allegation was eventually told to a member of the family, who reported it to the Commission and the Police. There is currently an Adult Protection multi -agency investigation that is being lead by the Police. The outcome will determine whether staff have kept residents safe. The Commission remains concerned that the proprietor/manager may still not fully understand the importance of always following the correct procedure in relation to potential or actual adult protection issues, as opposed to relying on their own judgement. The manager and all staff must continue to develop their understanding and knowledge of adult protection, to ensure that service users are protected from abuse and can be confident that their views are listened to and acted upon. This is Requirement 5. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 20 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): 24,25,26,27,28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents live in a homely and comfortable environment but some of the furniture is showing signs of wear. Bedrooms, communal areas, toilets and bathrooms meet the residents’ needs. EVIDENCE: The house is in keeping with other properties in the road. A tour of the home was undertaken including the residents’ bedrooms. The home is decorated and furnished in a homely fashion and all parts of the home were clean and tidy. All of the bedrooms were personalised with football memorabilia, CDs, Videos and DVDs, posters and family photographs. Some of the bedroom furniture needs replacing, the back of one wardrobe has come away from the sides, in another bedroom, a chest of drawers is broken, these need to be repaired or replaced. This is Requirement 6. The ground floor consists of three bedrooms, a conservatory that leads from the lounge/dining room; a family sized kitchen, a shower room and separate toilet. On the first floor there are further bathing and toilet facilities as well as the remaining bedrooms. A utility room at the back of the garage is accessed via the large well-kept garden. The garden at Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 21 the front of the home requires some attention as it is full of weeds. This is Requirement 7. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 22 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 good. This judgement has been made using available evidence including a visit to the service. Residents are supported by competent staff that are qualified. Staffing levels are satisfactory and there are sufficient staff on duty and have the appropriate skills and training to meet the individual needs of the residents. The procedures for the recruitment of staff are robust and provide safeguards for residents living in the home. Staff receive regular supervision and annual appraisals take place. EVIDENCE: Duty rotas were inspected and they correlated with the staff on duty, there were sufficient staff on duty to meet the needs of the residents. There are normally two staff on duty on each shift and one waking night staff, as well as the manager who normally works Monday-Friday. The manager covers staff absences with the permanent staff, which ensures continuity of care. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 23 The registered persons have a clear recruitment policy and procedures. All of the staff files were inspected and showed that appropriate recruitment procedures are now being followed; all of the staff have an up to date Criminal Records Bureau (CRB) check, the most recent member of staff had a completed application form and two written references and her POVA first were taken up prior to her commencement, her CRB check was also applied for prior to her commencing work and this was returned four weeks later. This member of staff, who has worked in the home for six months, confirmed that she had an interview and that she has undertaken an induction programme. She has also attended other training – Food & Hygiene, Health & Safety, COSSH, Adult Protection/Abuse Awareness and has commenced her NVQ2. There are four staff who hold the NVQ2, another four are currently undertaking their NVQ2 and two staff are undertaking their NVQ3. Other courses that staff have attended are – understanding learning disability, administration of medication, risk assessment and care management. Six members of staff hold their first aid certificate and one of the senior carers has recently completed a key skills course in Maths and English and the Learning Disability Framework in Care. Staff files indicated that they are receiving supervision every two months and annual appraisals have taken place, this was confirmed by staff. A recommendation of the previous inspection was that senior staff who supervise should attend a supervisors’ course, this has been arranged with an external agency. This Recommendation is now met. There was evidence that annual appraisals have also taken place and staff meetings take place every two months. The inspector attended a staff meeting, eight members of staff were present; issues discussed were, supervision, care plan review, risk assessments and recording of visits to health specialists. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 24 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): 37,38, 39, 41,42 and 43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The management approach to running the home has improved in some areas, since the last inspection, but some Regulations are still not fully complied with. This means that residents’ health, safety and welfare are not always protected. The Commission remains concerned about the current management arrangements for this home, as it could place residents at risk. Residents cannot be confident that their views underpin all self-monitoring, review and development of the home. The home’s record keeping, policies and procedures do not safeguard the residents’ rights and best interests at all times. EVIDENCE: Prior to the last two additional monitoring visits a repeat Requirement had been set, spanning a two year period, that the registered manager must demonstrate a clear sense of leadership. The Commission have also had Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 25 repeated discussions with the proprietor/manager as to what is required. This was not taken forward from the first additional monitoring visits as the manager had taken some steps to address this issue and most of the requirements from the previous inspection (30/06/05) had been met. The Service User Guide, the Statement of Purpose and the medication procedures had all been updated. The daily written logs were comprehensive and were an accurate account of events that happened. Most staff had attended Adult Protection/Abuse Awareness and staff had knowledge and understanding of what constituted abuse and whom they had to report the incident/allegation to. Since the first additional monitoring visit there has been two serious sexual allegations made by two female residents. As stated previously in this report one of the allegations was reported to the placing authority and the Commission, this allegation has been dealt with under Adult Protection procedures. The second allegation was reported by the resident to the manager and two members of staff. There is no evidence in the home’s record keeping of this allegation and neither the manager nor the members of staff took any action. The manager is aware of Regulation 37 that the Commission should be notified of ‘any event in the care home which adversely affects the well-being or safety of any service user’. Other professionals who have visited the home have expressed concerns regarding the manager’s ability to manage. The allegations have been discussed inappropriately within the home and there are concerns that the allegation was not taken seriously by the manager and senior staff. The proprietor has been served with two Statutory Requirement Notices, the first (23rd March 2006) being the failure to notify the Commission of an event in the home. The second (24th April 2006) to reduce the number service users that the home is registered to accommodate to a maximum of five, (the proprietor is appealing against the second notice).The home is jointly owned, with one owner being the registered manager, and the other working as a member of the care staff. Both are therefore very ‘hands on’. This type of arrangement can often disadvantage a home, in that there is no one taking a more objective view. This has been discussed with the manager at previous visits and at a meeting with the Commission. Requirement 8 has been set so that the proprietors can consider how the home can be best managed so that all standards and regulations are met. There is no evidence that the home undertakes an annual audit, which would reflect the aims and outcomes for residents or an annual questionnaire to obtain the views of relatives, health professionals and stakeholders. This is Requirement 9. The inspector has obtained relatives’ views, one relative stated that ‘she is very happy with the care and there has been a big improvement in her son’s behaviour’. Another relative stated that ‘my brother is looked after really well’. Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 2 26 3 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 1 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 1 16 1 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 1 1 1 1 1 1 1 Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 27 No Are there any outstanding requirements from the last inspection? 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 YA3 Regulation 14 Requirement Care plans must clearly indicate the assessed needs of the resident and how these needs are to be met. This must include staffing requirements for any interventions required. The registered persons must ensure that all risk assessments should clearly identify the risks and they are kept under regular review to ensure the safety of the residents and others The registered persons must ensure that there are specific and appropriate responses to residents’ challenging behaviour, specifically inappropriate sexualised behaviour. The registered Timescale for action 15/07/06 2 YA9 13(4) (a) 15/07/06 3 YA15 12(5)(a) 31/07/06 4 YA16 12 (4)(a) 30/06/06 Page 28 Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 22 5 YA23 13 (4)(c) 6 YA24 16(2)(c) 7 YA24 23(2)(b) 8 YA43YA42YA41YA38YA37 10 (1) (3) 12 & 24 9 YA39 24 persons must ensure that all residents’ rights are respected and their complaints listened to and acted upon. The registered persons must ensure that unnecessary risks to the safety of nnnnnnnnnnnnnnn residents are identified and eliminated as far as possible. The registered persons must ensure that residents’ bedroom furniture is fit for the purpose. The registered persons must ensure that the front garden is properly maintained. The registered person must ensure that arrangements are in place for the home to be managed effectively and in accordance with legal requirements, national minimum standards and best practice. The registered person shall establish a system for reviewing the quality of the care provided at the home, that takes into account the views of the residents and significent others. 30/06/06 31/10/06 31/08/06 31/10/06 31/12/06 Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Tomswood Lodge DS0000025932.V294520.R01.S.doc Version 5.1 Page 31 - 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!