Care Home: Barons Lodge Psychiatric Nursing & Rehabilitation

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What the care home does well Barons Lodge provides a homely environment which is being redecorated and refurbished to a good standard for the people who live there. Comments from people who use the service included ‘it’s good here’, ‘the food is very good’, ‘I go to bed when I choose’, ‘I do what I want’, ‘there is plenty to do’, ‘I go out and buy the things I need’, ‘I have all I need in my room’ and ‘we have regular meetings’. Relatives of people who use the service said, in surveys that the communication from the service is excellent, that the standard of care is good and that the place ‘feels like home’. The placing social worker and CPN told us they are happy with the services provided, that they feel the needs of the people they have placed are met. They told us that they visit regularly both by appointment and unannounced and find the place the same when they visit. They told us they have not needed to make a complaint but feel confident that any issues would be appropriately addressed. They feel communication from the home is good and that they are kept informed of changes or concerns. We saw people who use the service to look well and to look well cared for. We saw some staff provide appropriate support during our visit, with some good and positive communication between staff and people who use the service. The manager and staff demonstrated good knowledge of the needs of the people who use the service.Barons Lodge Psychiatric Nursing & RehabilitationDS0000019074.V378470.R01.S.docVersion 5.3 What has improved since the last inspection? The manager has focussed on developing new care plans, staff training and improving the environment over the last year. A more detailed care plan format has been introduced, with more work needed to ensure all sections of the new care plan are completed. Staff have completed in-house training covering adult abuse, challenging behaviour, person centred planning, fire safety, mental capacity, communication, first aid awareness, risk assessment and medication. Some staff have completed training through the local authority covering safeguarding, equalities and diversity, health and safety and food hygiene. The laundry room has been renovated, the rehabilitation unit is being redecorated with a new health and beauty salon area developed in the old art room. What the care home could do better: Continue with the redecoration and refurbishment programme to get the home to a good standard for the people who live there. Further work is required to complete care plans and ensure they include all the information needed for staff to provide the appropriate care and support. The Statement of Purpose and Service Users Guide should be updated to include the correct details of the Commission. The registered person must complete a report following a visit to the service to check on the quality of service provided each month. The reports should be available for inspection and be used to develop the service. The manager should look at ways of getting more responses from surveys from people who use the service and their relatives and representatives. This will assist with the quality assurance and ensure all people have the opportunity to comment on the services provided. The manager told us that following consultation with the people who use the service, they plan to develop a sensory garden and sensory room. They are also looking at getting transport for the service, to assist with accessing the community and increase opportunities for outings. The service is looking at involving people who use the service in relevant training sessions and in staff recruitment.Barons Lodge Psychiatric Nursing & RehabilitationDS0000019074.V378470.R01.S.docVersion 5.3 Key inspection report CARE HOME ADULTS 18-65 Barons Lodge Psychiatric Nursing & Rehabilitation 24 Baron Grove Mitcham Surrey CR4 4EH Lead Inspector Emma Dove Key Unannounced Inspection 9th November 2009 09:00 Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Barons Lodge Psychiatric Nursing & Rehabilitation 24 Baron Grove Mitcham Surrey CR4 4EH 020 8646 8280 020 8687 0355 baronsadmin@gmail.com Address 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) Genec Limited Catherine Bose Olaniyan Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (21) of places Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 21 19th November 2008 Date of last inspection Brief Description of the Service: Barons Lodge is a registered care home with nursing for up to twenty one adults with mental health needs. Fifteen people are currently living there. The home is situated in a residential area of Mitcham close to shops, public transport and leisure facilities. Accommodation is provided on the ground and first floors of the home. People also have access to communal lounge areas, a dining room, a large garden and the rehabilitation unit. Fees for this service are from £840 per week. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means people who use this service experience good quality outcomes. This unannounced inspection took place over four hours on the 9th and six hours on the 12th November 2009. One regulation inspector visited, looked at records, spoke with people who use the service, a care manager, a community psychiatric nurse (CPN), staff and the registered manager. The manager completed an Annual Quality Assurance Assessment (AQAA), which included good information about improvements the service has made and plans for development for the coming year. We also looked at other information received from the service since the last inspection in November 2008. What the service does well: Barons Lodge provides a homely environment which is being redecorated and refurbished to a good standard for the people who live there. Comments from people who use the service included ‘it’s good here’, ‘the food is very good’, ‘I go to bed when I choose’, ‘I do what I want’, ‘there is plenty to do’, ‘I go out and buy the things I need’, ‘I have all I need in my room’ and ‘we have regular meetings’. Relatives of people who use the service said, in surveys that the communication from the service is excellent, that the standard of care is good and that the place ‘feels like home’. The placing social worker and CPN told us they are happy with the services provided, that they feel the needs of the people they have placed are met. They told us that they visit regularly both by appointment and unannounced and find the place the same when they visit. They told us they have not needed to make a complaint but feel confident that any issues would be appropriately addressed. They feel communication from the home is good and that they are kept informed of changes or concerns. We saw people who use the service to look well and to look well cared for. We saw some staff provide appropriate support during our visit, with some good and positive communication between staff and people who use the service. The manager and staff demonstrated good knowledge of the needs of the people who use the service. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 6 What has improved since the last inspection? What they could do better: Continue with the redecoration and refurbishment programme to get the home to a good standard for the people who live there. Further work is required to complete care plans and ensure they include all the information needed for staff to provide the appropriate care and support. The Statement of Purpose and Service Users Guide should be updated to include the correct details of the Commission. The registered person must complete a report following a visit to the service to check on the quality of service provided each month. The reports should be available for inspection and be used to develop the service. The manager should look at ways of getting more responses from surveys from people who use the service and their relatives and representatives. This will assist with the quality assurance and ensure all people have the opportunity to comment on the services provided. The manager told us that following consultation with the people who use the service, they plan to develop a sensory garden and sensory room. They are also looking at getting transport for the service, to assist with accessing the community and increase opportunities for outings. The service is looking at involving people who use the service in relevant training sessions and in staff recruitment. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 7 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 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. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 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 Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 People using the 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 service understands the importance of having sufficient information when choosing a care home and has developed a Statement of Purpose and Service Users Guide. These documents detail the service provided, the aims of the service and some of the key policies. We saw assessments completed before people move in, to ensure that the service is able to meet the individual’s needs. EVIDENCE: The service has developed information for new and prospective people to the service. This information tells people the philosophy of care, management arrangements, describes the facilities available, fire safety, staff training, the referral and admission process and how to make a complaint. We saw that this information about the Commission needs updating with the correct address. The manager told us the referral process includes receiving an assessment of need from the placing authority, completing their own assessment and inviting the person to visit. This process gives prospective people the opportunity to Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 10 see the home, meet other people who use the service and staff and help them make the decision about whether the home is right for them. This introduction process also gives staff the information they need to decide if the service can meet the individual’s needs. People told us they had visited before they moved in. Placing social workers confirmed that they were invited to visit with prospective people and are fully involved in the assessment process to ensure the service can meet the person’s needs. We saw assessments completed before people moved in. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the 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 service involves people in the care plan and review process, supporting them to make decisions which affect their future. Care plans are more person centred. Risk assessments are in place. EVIDENCE: The manager told us they operate a person centred, holistic care approach. We saw new care plans have been developed which cover all areas of the individuals life, including their needs assessment, a brief medical history, brief social history, their religion and any religious needs, communication, hearing, eyesight, breathing, eating, personal care, expressing sexuality and their mental state. We looked at two care plans and saw different levels of information provided with some areas not complete for one person. Staff told us they were still in the process of completing some sections of the care plan Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 12 with the individual. We saw people’s cultural and religious needs with regard to food and attending church to be completed in detail. We feel further work could be done with individuals to identify goals to work towards with achievements recorded. Daily records contain information about what the individual has done including any activities, outings or visitors. We saw some daily records to note ‘satisfactory day’ and ‘no challenging’. Staff must take care when writing daily reports to ensure they are accurate and not opinion. If they want to include how the individual felt their day was, they must record this clearly. People who use the service confirmed that they meet with staff regularly to discuss their needs and how they are being me. People feel their needs are being met. Staff told us they have information to meet the needs of the people who are currently using the service. We saw risk assessments in the care plan although there is a separate sheet for risk assessments which was not completed. The manager said this will be addressed. Staff understand the balance between managing risk and allowing people to live the lives they want. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using the 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 service is committed to enabling people to develop and maintain their social, emotional and independent living skills. People who use the service have the opportunity to maintain family and personal relationships. There is a varied menu that takes into account peoples medical and religious needs as well as individuals preferences. EVIDENCE: The manager told us people are able to keep their individual lifestyle when they move in and can continue to attend day centres, groups and clubs. We saw people go out shopping, meet with visitors, read the paper, watch television, do their washing and talk with staff during our visit. People told us they do things they want to. One person said they ‘enjoy shopping’. One Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 14 person told us they join in with activities and said that they were looking forward to seeing a film later in the afternoon. There is a weekly timetable of activities with one session in the morning and the afternoon. These sessions are held in the separate building called the rehabilitation unit. This area has a large room with a pool table and computers for people to use; a salon for hair washing and health and beauty sessions; a library with a selection of books and a kitchen area for people to prepare light snacks and do their washing as a part of their rehabilitation programme or to improve their life skills. There could be some more appropriate books in the library, people who use the service could be involved in choosing the books or magazines they are interested in. There are two daily papers delivered and one person told us they often get another newspaper from staff who travel in by public transport. We saw a varied menu which takes into account peoples preferences and religious and medical requirements. People told us they ‘enjoyed lunch’ and ‘like the food’, they said the ‘food is good’ and ‘the food is very good’. There is a choice of main course at lunch and evening meal. People told us the food meets their cultural needs. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support with health and personal care based upon their rights, dignity and respect. People’s health care needs are well met. Medication is generally well managed. EVIDENCE: We saw details of individuals health needs in care plans. People told us staff are available to attend appointments with them when required. Staff do regular blood sugar monitoring for some people who use the service. Clear records of what the reading should be and actions staff should take if the reading is outside this level must be recorded. This will ensure people’s health needs are fully met and staff know when they should contact the GP. The manager told us people who use the service are asked their preference for receiving support from male or female staff. When the individual has been specific about receiving same gender care, this is facilitated by the staff rota. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 16 We saw partially completed personal hygiene record sheets. The manager told us these are relatively new records and staff had been completing them regularly. If these records are to be used, they must be completed every day and staff should report issues to the manager. The medication administration practices and recording has improved since the last inspection. Records are kept of medication received at the home. The count of medication for two people showed it had been administered with the balance correct. Medication Administration Record Sheets are up to date and signed by staff. We saw that one person is refusing to take their medication, it was not possible to track that this had been raised with the GP, although the placing authority had been informed. There was a care plan but no risk assessment for this issue. The ‘as required’ medication for one person was recorded to be taken once a day when necessary. The records identified it had been given twice in one day with no records of discussions with the GP, although staff did speak with the manager. Any ‘as required’ medication must have clear guidelines, agreed by the GP or psychiatrist for staff, to ensure people who use the service receive the appropriate amount of medication. These guidelines should be included in the care plan as well as the medication records so that all staff have access to the information even if they do not administer medication. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the 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 is a clear complaints procedure which is accessible to the people who use the service and their representatives. People are aware of who to speak with and how to make a complaint. Staff have completed training in safeguarding. EVIDENCE: The service has developed a clear complaints procedure which is displayed around the home and is accessible to the people who use the service and their representatives. People told us they would speak to the manager, their placing social worker or their family if they had any worries or concerns. The manager told us they had not received any complaints in the last year. No complaints or concerns have been raised through the Commission. The manager told us all staff have completed training in safeguarding at the home and some staff have completed this training with the local authority. Staff training records confirmed that staff have completed training in safeguarding. The manager demonstrated a clear understanding of the process and who to report concerns and issues to. There has been one safeguarding issue during the last year which was reported appropriately to the local authority. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 18 The service holds some money for people who use the service. This is securely stored with good records that are up to date and signed when money is spent and received. Placing social workers check receipts and finances at reviews and are able to check them during any visit. We checked one balance, this was correct and tallied with money received and monies spent. People who use the service said they ‘feel safe’ and ‘generally feel safe’ here. One person said their money is ‘safe’. The service has appropriate and adequate insurance cover. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30 People using the 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 home provides a physical environment that is appropriate to the needs of the people who live there. The environment is generally well maintained with the redecoration schedule continuing. Bedrooms are single, seven have ensuite facilities. All areas were seen to be clean. EVIDENCE: People have access to a large lounge, dining room and a second lounge on the ground floor. There is a separate building at the end of the garden called the rehabilitation centre which has a large room with a pool table and computers, a salon for health and beauty sessions, a library with more computers, a kitchen, laundry room and toilets. We saw the dining area has been moved out of the lounge, providing more space. New furniture has been purchased for the lounge. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 20 The original house has fifteen single bedrooms, one with ensuite facilities, and has been extended, adding six single bedrooms, all ensuite. The manager told us people bring their own belongings and can bring small items of furniture. Bedrooms have been personalised to the individuals taste with pictures, photographs and belongings. People told us ‘I’ve got all I need in my room’, ‘I like my room’ and ‘there’s enough room’. The manager told us they had been told to stop people smoking in a communal lounge, following changes in the law. This should be checked again, because this means people who use the service now smoke outside, which is not good for people during the cold winter months. There are sufficient toilets and bathrooms with a new fully accessible shower room on the ground floor. The laundry room has been renovated and has two washing machines and a tumble drier. Staff told us some people who use the service do their own laundry and they support other people with their washing, drying and ironing. The manager told us they plan to redecorate the interior of the home, to bring it to a good standard for the people who live there. They are going to develop a sensory room and improve the garden to give people who use the service more opportunities within the home. We saw all areas of the home to be clean and fresh with the exception of some extractor fans in toilets and bathrooms. These should be added to the cleaning schedule, to ensure they are kept clean. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff levels are sufficient to meet people’s needs. Staff recruitment is in line with regulations. Staff have access to regular training and supervision. EVIDENCE: We saw one nurse and two or three care assistants to be on duty during the day with one nurse and one care assistant at night. These staffing levels were seen to be sufficient to meet the needs of the people who currently use the service. The manager told us they have good staff team who work well together and have remained stable over the last year. The manager told us they have been trying to recruit more nurses, to enable the manager to be supernumerary. Although they have not appointed any nurses to date, they will continue to advertise and interview until they appoint some new nurses, which will enable the manager to focus on management and developing the service. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 22 People who use the service said there are enough staff to meet their needs. Staff confirmed that there are enough staff to carry out their role and meet the needs of the people who use the service. The manager told us they have worked at getting all staff to complete the required training. The company have bought a training programme which is delivered in house on a monthly basis. We saw records confirming all staff have completed training in adult abuse, and fire safety and most staff have completed training in working with people who present challenging behaviour, person centred planning, mental capacity legislation, communication, first aid awareness, risk assessments and medication administration. Staff have attended training through the local authority on safeguarding, equalities and diversity, health and safety and food hygiene. We looked at files for two new members of staff, both contained an application form, two written references a clear protection of vulnerable adults first check and a clear enhanced Criminal Records Bureau (CRB) check for one member of staff. The service has applied for a CRB check for the other member of staff. The manager told us this member of staff will not start work until they have received the CRB check. One of the references for one member of staff was addressed ‘to whom it may concern’. It is important that references are returned to the service, for the post applied for. It may be useful to follow up references with a telephone call to the person, to confirm details, with records kept of the date and details. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the 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 manager has the experience needed to run the home. Quality assurance systems are in place, although improvements need to be made to ensure people have the opportunity to comment about the care and support they receive and see changes they have instigated. Health and safety is well managed with records up to date. EVIDENCE: The manager has been at the home for eighteen months and has worked to improve the services provided and work towards meeting the requirements made at the last inspection. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 24 There are quality assurance systems in place, although the manager told us they plan to start using new surveys and are looking at ways to increase the number of responses they receive. The registered person visits the home every week, although he does not write a report on the quality of the services provided and any areas to be improved. The manager told us they have regular meetings with people who use the service and use these meetings to get comments about the quality of services provided. People who use the service confirmed they attend regular meetings and have opportunities to comment about the service they receive. We saw records of health and safety checks to be up to date and completed in the required timescales. Gas safety and electrical supply were checked in May 2009. The manager told us that all staff have completed training in fire safety and we saw records confirming this. Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000019074.V378470.R01.S.doc 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Version 5.3 Page 26 Barons Lodge Psychiatric Nursing & Rehabilitation Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement To protect the health of people who use the service staff must ensure:That clear guidelines are in place for ‘as required’ medication. Clear procedures are in place for when people refuse to take their medication, including when to contact the GP, with records kept. People who use the service must be provided with the dosage of medication as prescribed. 2. YA35 18 (c) (i) To ensure that staff have the skills and knowledge to meet the needs of people using the service. All staff must be provided with training, appropriate to their role in the service, on supporting people with mental health needs. (timescale of 01/03/09 not met) 18/02/10 Timescale for action 18/02/10 Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The Statement of Purpose and Service Users Guide should be updated to include the correct contact details for the Commission. Care plans should include more details, all sections should be completed in full and people should identify goals they wish to achieve. Consideration should be given to having a more appropriate selection of books and magazines available to the people who use the service. The personal hygiene record sheets should be consistently completed to ensure they include the required information. Serious consideration should be given to providing an indoor or at least undercover smoking area for the people who use the service. The extractor fans in toilets and bathrooms should be added to the cleaning schedule. The use of the registered manager as the only qualified nurse on duty should be reviewed to allow for time to carry out management duties and develop the service. The quality assurance and monitoring system should be further developed to ensure all people using the service have the opportunity to comment on the care and support they receive. An annual review of the care provided and development plan should be produced. The registered person must complete a visit to the home every month to check on the quality of care provided and write a report, with clear details of actions taken following this visit. 2. YA6 3. YA14 4. 5. YA18 YA24 6. 7. YA30 YA33 8. YA39 Barons Lodge Psychiatric Nursing & Rehabilitation DS0000019074.V378470.R01.S.doc Version 5.3 Page 28 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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