CARE HOME ADULTS 18-65
White Moon Lodge 156 Philip Lane London N15 4JN Lead Inspector
Brian Bowie Unannounced Inspection 08:15 13 February 2006
th White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 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 White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 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. White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service White Moon Lodge Address 156 Philip Lane London N15 4JN 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 8376 4246 020 8376 4246 Mr Sona Beezadhur Mr Sona Beezadhur Care Home 3 Category(ies) of Learning disability (3) registration, with number of places White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th June 2005 Brief Description of the Service: White Moon Lodge is run by Mr Sona Beezadhur who is both the owner and registered manager. It is a small care home for up to three people with learning disabilities. The home is close to local facilities and shops. The house is a terraced property situated in a residential area. Upstairs there are three bedrooms for residents and a small office for staff. Downstairs there is a kitchen diner, lounge, bathroom with toilet, shower room and another office that is also used for staff sleeping in. There is a small back garden which residents make use of in warmer weather. The home provides support to people who have complex needs, including autistic spectrum disorders, and behaviours that can be challenging. There is a minimum of one staff member available throughout the daytime and sleeping in on the premises at night. The home’s aim is to provide as ordinary a life as possible for residents and to encourage them to be as independent as possible. White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and lasted 4.5 hours. Mr Beezadhur, the owner and manager of White Moon Lodge, was interviewed and helped with the inspection. The home was looked round and all three residents were seen and spoken to briefly. It was not possible to have any detailed discussion with the residents about their care because of their communication difficulties. The interaction between the 3 residents and the manager before they went to their day centre was observed. The parent of one of the residents was contacted and their view and judgement of the standard of care provided by the home obtained. A variety of records, including care plans and health & safety documents, were looked at. The overall impression from the inspection was of a home that is providing a very good standard of care to people with complex needs within a homely and supportive environment. What the service does well:
Residents feel at home and relaxed at White Moon Lodge because staff pay close attention to meeting their individual needs and wishes. They benefit from being supported by staff who they have got to know them well since moving into the home four years ago and who they get on well with. The stability of the staff team has been especially valuable since two of the residents have an autistic spectrum disorder which means it takes longer for them to make relationships and they also feel more secure in a situation where they do not have to deal with a lot of different staff members. The social worker for the three residents had written to Mr Beezadhur: ‘I am very happy with your standard of care and procedures.’ The home has an experienced manager who keeps in close touch with both residents and relatives. As a result residents have frequent visits from relatives and in one case a resident regularly stays with their family. The manager has also built up close links with the consultant psychiatrist and the residents’ social worker which is helping the home to respond to and meet the changing needs of the residents. A high priority is given to training so that staff are as competent as possible in their support of residents. White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
3 areas where the home could be doing better were discussed and agreed with the manager. These included the following: • • • The medication profile and administration record to correspond with each other Care staff to have regular 1-to-1 meetings with the manager so that their practice can be further improved Front and rear exit arrangements to be approved by the LFEPA 3 recommendations to improve practice are made in relation to: • • • Indicating clearly on risk assessments if risks are increasing/decreasing and what is making the difference Staff meetings to be held at least quarterly Independent parties, such as advocates, to be used to enable residents in a variety of ways to express their comments and suggestions about the home. Mr Beezadhur emphasised that he is keen to work closely with CSCI to raise standards further at the home in order to be able to provide the best possible quality of life for residents. 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.
White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The home is good at assessing and meeting the needs and wishes of residents. EVIDENCE: All the current group of residents moved into the home when it opened. The files indicate that residents’ needs had been carefully assessed before they moved in. The residents indicated by their behaviour and their contact with the manager that they felt relaxed and at home at White Moon Lodge. White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 Residents are supported by staff so that wherever possible they make decisions for themselves. The home is good at ensuring each resident has risk assessments in place in order to keep them as safe as possible. EVIDENCE: The residents at the home all have high needs and it requires staff to be skilful at finding opportunities for the residents to make decisions and have choices in their life. Residents in conjunction with their relatives had been consulted about colour schemes when their bedrooms were recently redecorated and their preferences acted on. Guidance to staff was clear about giving residents choices wherever possible. One care plan had the manager’s direction to staff as follows: ‘If at any point or any day this resident does not wish to participate in any of the activities staff should respect their wishes.’ The manager has completed detailed risk assessments for each resident to ensure that any risks identified could be managed by the home. As a result residents benefit from being supported to be as independent as possible whilst minimising risks to their welfare. In order to improve practice even further in this area it is recommended that risk assessments indicate clearly if the risk is
White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 10 increasing or decreasing over time so that there is as much understanding as possible about what helps to minimise risks for that individual, especially in relation to challenging behaviours. White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,16 Residents are getting a better quality of life because they take part in a range of stimulating activities, including getting out and about in their local community. Residents benefit by having staff who allow them wherever possible to make choices for themselves and to have as much control over their life as possible. EVIDENCE: Residents take part in a variety of daytime activities, including attending day centres and college classes. Outings and short break holidays are also provided by the home. Residents are also encouraged by staff to help with domestic tasks in the home such as cleaning. Feedback from the manager showed that residents get out and about in their local community, including going shopping, to the cinema, local cafes and leisure centre. Additional funding has been agreed by the placing authority for one of the residents to allow an additional member of staff to be employed
White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 12 during the weekends. As a result the resident is going out more on a one-toone basis with staff into the local community. The interview with the manager and the care plans indicated that the home is giving careful thought to how they can empower the residents and increase the choices they can make over how they live their lives. The manager will be attending person-centred planning training in order to promote this area further within the home. Mealtime arrangements had been changed so that residents did not have to put up with one of the other residents snatching their food away. White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,20 Staff are good at supporting residents in a way which the residents are happy with and which makes sure their physical and emotional health needs are met. Residents benefit from effective arrangements regarding medication in the home. However medication profiles for each resident need to be kept updated and to match the administration sheet. EVIDENCE: Residents indicated by their manner and behaviour that they felt relaxed in the home and felt supported and cared for when staff were around. The close family-like atmosphere in the home helps individuals with challenging behaviours and high anxiety levels to feel more relaxed which in turn enables them to have improved relationships both with other residents and with staff. The relative spoken to said: ‘The staff give my relative a lot of support, especially at weekends. The staff are very nice. I’ve no complaints.’ The medication cabinet and medication records were looked at and were satisfactory. However medication profiles seen did not always correspond to what was on the administration sheet. It is important that these do match up so that it is less likely for a mistake to be made in the administration of medication. The manager must ensure that the medication profile and administration record correspond with each other.
White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 14 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 The home deals well with complaints so that residents and relatives feel confident their complaints and concerns will be listened to and acted on. EVIDENCE: The home had a satisfactory complaints procedure. The manager stated that no complaints had been made in the previous twelve months and this was supported by looking at the complaints book. Feedback from a relative indicated that they felt able to raise concerns with the manager. White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 15 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): 24,30 Residents at White Moon Lodge enjoy an attractive, comfortable and clean living environment which adds considerably to their quality of life. EVIDENCE: White Moon Lodge is homely and comfortable with plenty of space in the downstairs area which enables residents to be on their own, when they want to be, downstairs as well as in their own bedroom. This is particularly helpful for those residents with an autistic spectrum disorder. Since the last inspection most areas of the home had been redecorated and new carpeting fitted. As a result the home was looking particularly attractive and well maintained, with bedrooms reflecting the individual tastes and preferences of each resident. On the day of the inspection the home was being cleaned to maintain its tidy and hygienic appearance. One of the residents was participating in this process as far as they were able to. White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 16 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): 32,34,36 Residents benefit from a committed and experienced team of staff who have the skills to meet their needs. Residents are also protected by the home having rigorous recruitment procedures for new staff. However residents do not fully benefit from staff who are regularly guided on how to improve their practice. EVIDENCE: Staff at the home have got to know the needs and wishes of the residents over time and learnt how best to respond to and meet the complex needs of all three residents. As a result residents who previously had had their placements break down because of their challenging behaviours are getting a stable and supportive home to live in. Staff meetings are held but tend to be in response to situations arising, rather than on a planned and regular basis in order that the work of staff is as coordinated as possible. It is recommended that staff meetings are held at least three-monthly. Staff have attended a range of relevant courses and are undertaking appropriate NVQ training in Health & Social Care for adults. More specialised training appropriate for staff to work with the current group of residents is also being followed up in areas such as working with people with autism and
White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 17 person-centred planning. Each member of staff has a training plan so that residents benefit from a skilled staff team. White Moon Lodge has three full time staff with support as needed from the manager. An additional member of staff is being recruited so that the home can manage better any staff shortages. Staff files were looked at and contained the information needed to confirm that all new staff in the home have had the appropriate checks made. The staff files showed that staff are continuing to have one-to-one supervision meetings with the manager now and again, and not on the regular twomonthly basis needed to ensure staff are fully supported and guided on how to improve their practice. The manager must ensure that he supervises all care staff at least two-monthly so that they are supported and developed in their demanding role. This requirement is therefore made again in order to ensure staff have supervision at the appropriate frequency. The manager agreed to do this in future. White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Residents really benefit from living at White Moon Lodge because the home provides a very personalised service to each of the residents in order to meet their needs. The home is run in the best interests of the residents with their views and wishes shaping how the home is run. The home is good at making sure residents are kept safe and secure whilst living at White Moon Lodge. However the London Fire Emergency Planning Authority need to check the entrance and exit arrangements at the home. EVIDENCE: The manager and staff work closely together to achieve high standards for the home. Written feedback from the residents’ social worker was very positive about the way in which the home is run: ‘I am very happy with your standard of care and procedures.’ As a result what the residents get out of the home is a very caring and supportive place to live where they are being helped to get as much as possible out of life. White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 19 An annual survey is carried out to get feedback from residents, relatives and professionals on how they think the home is doing. These surveys contained positive feedback about the home. Staff help residents to complete questionnaires so that they can give their views about the home. It is recommended that where possible independent parties, such as advocates, are used to enable residents in a variety of ways to express their comments and suggestions about the home. A range of records was looked at, including health & safety and accident reports. These records were detailed, up-to-date and accurate and confirmed that the home is being run responsibly with essential checks being made and acted on. As previously required the water storage system has been serviced and there is now a maintenance contract in place. Fire safety procedures are being carried out regularly and responsibly by the home. In order to safeguard residents front and rear exits to the home are kept locked. However these are also fire exits and the arrangements in place for locking these exits need to be approved by the London Fire Emergency Planning Authority. White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 4 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 X 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
White Moon Lodge Score 3 X 2 x Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 2 x DS0000010821.V259125.R01.S.doc Version 5.0 Page 21 Yes 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 YA20 Regulation 13 (2) Timescale for action The registered person must 31/03/06 ensure that the medication profile and administration record correspond with each other. The registered person must 31/03/06 ensure that all care staff are supervised by the manager at least 6 times each year. Requirement restated. Timescale of 31/7/05 not met. The registered person must 31/03/06 ensure that arrangements for locking the front and rear exits to the home have been approved by the London Fire Emergency Planning Authority. Requirement 2 YA36 18 3 YA42 23 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 White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 22 1 YA9 The registered person should ensure that risk assessments indicate clearly if the risk is increasing or decreasing over time so that there is as much understanding as possible about what helps to minimise risks for that individual, especially in relation to challenging behaviours. The registered person should ensure that staff meetings take place at least 3-monthly. The registered person should ensure that independent parties, such as advocates, are used to enable residents in a variety of ways to express their comments and suggestions about the home. 2 3 YA32 YA39 White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI White Moon Lodge DS0000010821.V259125.R01.S.doc Version 5.0 Page 24 - 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!