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Care Home: Carmen Lodge

  • 13 Bushwood Leytonstone London E11 3AY
  • Tel: 02085329789
  • Fax:
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Carmen Lodge is a privately operated care home registered to provide care and support to 11 adults with mental health problems. The home is a large converted 2 storey residential property. The ground floor comprises: 4 residents` bedrooms; kitchen; staff office; a large lounge/ dining room and an adjoining television lounge, which leads out to a large attractive garden; there are 7 further bedrooms on the first floor. There are sufficient toilet and bathroom facilities on both floors. There is an outhouse in the garden that is used as a smoking room and another large outbuilding that accommodates the home`s laundry facilities, a second office, staff shower and a storeroom. The area is well served by public transport and the home is within walking distance of shops and other community resources. A stated aim of the home is to provide its residents with a secure, relaxed and homely environment in which their care, well-being and comfort are of prime importance. At the time of the inspection, the weekly fee was from £650 per week depending on the person`s assessed need. The provider organisation makes information available about the service, including inspection reports, to people living in the home and to other stakeholders.

  • Latitude: 51.569000244141
    Longitude: 0.017000000923872
  • Manager: Manager post vacant
  • Price p/w: ~
  • UK
  • Total Capacity: 11
  • Type: Care home only
  • Provider: Mrs Jennifer M E Khan
  • Ownership: Private
  • Care Home ID: 4010
Residents Needs:
mental health, excluding learning disability or dementia

Latest Inspection

This is the latest available inspection report for this service, carried out on 31st July 2008. CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

For extracts, read the latest CQC inspection for Carmen Lodge.

What the care home does well The home is working hard to meet the needs of its residents, many of whom have lived at the home for a number of years following discharge from long stay hospitals. Some residents have complex needs that challenge the service. An experienced registered manager and a relatively stable staff group support residents. The home is domestic in scale and provides a comfortable environment for residents to live in. What has improved since the last inspection? At the last inspection 5 requirements were made. These requirements were in the following areas: recording of outcomes of meetings about residents that take place with health and social care professionals, evidencing that residents have been involved when the home reviews their progress, complying with new regulations regarding safe storage of medication, recording regarding staff recruitment, records relating to staff training and building on the home`s quality assurance mechanisms. At this inspection we found that these issues had been addressed. In the AQAA the registered person told us, that in the past 12 months, the windows and doors have been replaced with UPVC double glazing and that the kitchen had been refurbished. In addition the home has signed up to the Managed Care Training Programme, run by Keele University and Lloyds Pharmacy, to enable care workers to safely administer medication. The home has also made a commitment to work towards the Investors in People award by September 2009. What the care home could do better: At this inspection 3 areas for improvement are identified. These are to find ways to encourage residents to attend and contribute to residents meetings, to make sure that the redecoration of the home is completed and to make sure an air vent is covered in the kitchen. CARE HOME ADULTS 18-65 Carmen Lodge 13 Bushwood Leytonstone London E11 3AY Lead Inspector Caroline Mitchell Unannounced Inspection 31st July 2008 10:00 Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carmen Lodge Address 13 Bushwood Leytonstone London E11 3AY 020 8532 9789 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) jennifermkhan@hotmail.com Mrs Jennifer M E Khan Mr Paul Wright Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (11) of places Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2008 Brief Description of the Service: Carmen Lodge is a privately operated care home registered to provide care and support to 11 adults with mental health problems. The home is a large converted 2 storey residential property. The ground floor comprises: 4 residents’ bedrooms; kitchen; staff office; a large lounge/ dining room and an adjoining television lounge, which leads out to a large attractive garden; there are 7 further bedrooms on the first floor. There are sufficient toilet and bathroom facilities on both floors. There is an outhouse in the garden that is used as a smoking room and another large outbuilding that accommodates the home’s laundry facilities, a second office, staff shower and a storeroom. The area is well served by public transport and the home is within walking distance of shops and other community resources. A stated aim of the home is to provide its residents with a secure, relaxed and homely environment in which their care, well-being and comfort are of prime importance. At the time of the inspection, the weekly fee was from £650 per week depending on the person’s assessed need. The provider organisation makes information available about the service, including inspection reports, to people living in the home and to other stakeholders. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 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 the people who use this service experience good quality outcomes. This key unannounced inspection took around 5 hours to complete. The registered person and the registered manager were both involved and the manager of a neighbouring home owned by the registered person, who deputises in the absence of the registered manager, was also present. There were 11 people living in the home at the time of the inspection. During the inspection we spoke with several of the people living in the home, 3 of them at length, spoke to 2 care staff, and had some in depth discussion with the registered person and the registered manager. We looked at a number of the written records kept in the home, including parts of the records for 3 residents and the personnel records for 1 staff member, and we looked around the home. Further information was obtained from the Annual Quality Assurance Assessment (AQAA), which was given to us at the time of the inspection. The AQAA is a self-assessment, done by the service, which focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. What the service does well: What has improved since the last inspection? At the last inspection 5 requirements were made. These requirements were in the following areas: recording of outcomes of meetings about residents that take place with health and social care professionals, evidencing that residents have been involved when the home reviews their progress, complying with new regulations regarding safe storage of medication, recording regarding staff recruitment, records relating to staff training and building on the home’s quality assurance mechanisms. At this inspection we found that these issues had been addressed. In the AQAA the registered person told us, that in the past 12 months, the windows and doors have been replaced with UPVC double glazing and that the kitchen had been refurbished. In addition the home has signed up to the Managed Care Training Programme, run by Keele University and Lloyds Pharmacy, to enable care workers to safely administer medication. The home has also made a commitment to work towards the Investors in People award by September 2009. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 6 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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 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 Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. EVIDENCE: The home understands the importance of having sufficient information when choosing a care home. It has developed clear information to help them understand what specialist services the home can provide. The home provides a statement of purpose that is specific to the home and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a service user’s guide. The guide details what the prospective residents can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff, Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 9 how to make a complaint, recent CSCI inspection findings and contains comments and experiences of residents living at the home. All residents are given a copy of the guide. When requested the service can provide a copy of the statement of purpose and guide in a format which will meet the capacity of the resident. Practice and information giving is informed by the service’s written procedures. Admissions are not made to the home until a full needs assessment has been undertaken. We looked at the file of 1 new resident, who had very recently moved from another service, and who was coming up to their 6 week review. It contained a range of up to date assessment information undertaken by the home including an up to date risk assessment and minutes of a pre-admission planning meeting. The assessment information included a strengths and needs list to assist the home understand the person’s needs. The file also contained information about the person’s needs from health and social care professionals. The files of 2 other people that had lived at the home for a longer period were also inspected. These showed a range of assessment information about the person with evidence that it is reviewed on a regular basis to allow staff to be aware of any changing needs the person might have. From discussion with the resident who had recently moved in it was evident that the assessments had been conducted professionally and sensitively and involved the person. Admissions to the home take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. There was evidence that management team discuss the admission with the staff team and share information with them before agreement is give for the admission and prospective residents are given the opportunity to spend time in the home before they move in to help them to feel comfortable in their surroundings, and enable them to ask any questions about life in the home. Residents had been provided with a statement of terms and conditions/contract. This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the person. Theses were easy to understand and gave a clear understanding of what residents can expect. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the registered manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. EVIDENCE: The service involves people in the planning of care, which affects their lifestyle and quality of life. There is some challenge for the home around this for some residents as they are not keen to be involved in formal meetings and don’t like to sign forms. The registered manager stated that all residents were involved in discussion regarding reviewing their care plan, although some people refused to sign the plan to evidence this. This is the same as for reviewing risk Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 11 assessments. However, in discussion with residents and managers, in observing staff practice and in looking at the various records it was clear that staff understand the importance of residents being supported to take control of their own lives and there were other forms of evidence that people are encouraged to make their own decisions and choices. The service knows and recorded people’s preferred communication style, and used methods that enable the person to lead a full life that promotes independence and choice. We looked at the file of 1 new resident, who had very recently moved from another service. The files of 2 other people that had lived at the home for a longer period were also inspected. These included care plans, which were, for the most part, agreed with the person. These plans were written in plain language, easy to understand and looked at all areas of the person’s life. They included reference to equality and diversity and addressed any needs identified in a person centred way. Staff support and encourage residents to be involved in the ongoing development of their plan, using a variety of ways to help people make a worthwhile contribution. The plans included a range of information about risk assessments, their goals and aspirations, and skills and abilities. They also included information about people’s health. They had been kept up to date and focused on how people will develop their skills, and considered their future aspirations. Reviews focused on asking what has worked for the person, progress, achievements, concerns, and identified action points. Each care plan included a comprehensive risk assessment, which had been reviewed regularly. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. The registered manager said that a number of people living in the home have restrictions placed upon them under the Mental Health Act 1983. In 1 person’s file, where there were limitations placed upon them, these were reviewed as part of a multi-disciplinary process and were accurately recorded. Although involving some people can be a challenge for the home, residents are consulted regularly to gather information about their satisfaction with the home so that they are involved in both the development and review of the service. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 12 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): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. EVIDENCE: Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 13 Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. They have been fully involved in the planning of their lifestyle and quality of life. Where appropriate, education and occupational opportunities are encouraged, supported and promoted. Residents can access and enjoy the opportunities available in their local community, such as using public transport, the local pub, and local leisure facilities. In the AQAA that the registered person gave us at the time of the inspection she told us that people are involved in a range of activities in the community such as voluntary work at Whipps Cross Hospital (through the Capital Volunteering scheme), sheltered employment at Barnardo’s Charity shop, attending the Waltham Forest Black Peoples Mental Health Association (WFBPMHA) day service, attending the Ferguson centre (a specialist mental health day service) and undertaking the Pre-Volunteer Programme run by the London Development Agency. People living at the home can travel independently and have freedom passes to facilitate this. They attend various social and leisure activities in the community, for example, visits to the cinema, bowling and travelling to the local shopping centre. Staff also provide information and advice regarding available local activities offered by specialist organisations. We spoke to 3 people and each 1 had a very different interests and lifestyle, were getting out into the community. In the afternoon 1 person was getting ready to go out to a local pub. The registered person said that residents were discussing going to the seaside for this year and thinking bout going broad for a holiday next year. The registered manager said that it was sometimes difficult to motivate some residents to take part in structured activities, although evidence was seen in key worker notes that staff do try. Residents spoken to indicated in various ways that they preferred to do what they wanted to and did not want to attend structured activities. The registered person and registered manager talked about several residents, who have very complex mental health issues and histories saying that they were much more settled, and their mental health and self-esteem had improved since living in the home. There was evidence to support this in the residents’ files and from discussion with some residents. At the time of the inspection about half of the residents were White European in ethnic origin and the other half were Black Caribbean. People’s cultural needs and preferences were recorded in their file including their religious and dietary needs and preferences. Residents are supported to attend their preferred place of worship and 1 person told us that the attended church on a regular basis. People who use the service have the opportunity to develop and maintain important personal and family relationships, and are able to access information and specialist guidance about issues such as intimate relationships. The staff practices promote individual rights and choice, but also consider the protection of people in supporting them to make informed choices. Some residents were Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 14 assessed as being sexually vulnerable and this was recorded in their files. The registered manager said that residents were advised and supported regarding promoting their sexual health and some evidence of this was seen 1 person’s file. The registered person said that residents are supported to maintain and develop relationships with family members with a number of residents having regular contact, including some who visit and stay with relatives. 1 resident told us that they visit family members weekly. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. Staff were seen to interact positively and appropriately with residents throughout the inspection. People were also encouraged to undertake daily living tasks to assist develop their independence skills and this was documented in their files. This included people being able to cook meals with appropriate level of staff supervision. From viewing weekly menus and discussion with residents it was clear that the home provides meals of their choice and these were varied and balanced. The menu was varied with a number of choices. The meals are balanced and nutritious and cater for people’s varying cultural and dietary needs. Staff cook the main meal of the day in the middle of the day. Residents are supported to make their own breakfast and supper and also make drinks and snacks during the day. When we arrived, 1 person was eating breakfast. We look at the record kept for another person, listing what they had actually eaten. People living in the home said that they enjoyed the meals provided. 1 resident told us that they also like going to a local cafe. The home had sufficient food that was stored appropriately on the day. The kitchen was clean and tidy with satisfactory and current health and safety records. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. The home supports people with their medication in a safe way. EVIDENCE: People receive personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each person centred plan. They give a comprehensive overview of their health needs and act as an indicator of change in health requirements. The registered manager stated that all of the people living at the home are independent regarding their personal care, although some need varying degrees of verbal prompting on occasion. People’s support needs regarding their personal care were recorded on the files we looked at and staff spoken to were able to describe how they provided that support in keeping with residents’ preferences. The residents we spoke to were clear that they did not need physical assistance from staff regarding their personal care, but 1 person did say that they sometimes Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 16 discussed issues like as health and hygiene when they talked to their key worker. Residents have access to healthcare and remedial services. People are supported with a range of physical, mental and emotional health needs and everyone is registered with a GP. At the previous inspection the registered persons were required to make sure that, where staff attend meetings with health and social care professionals about residents, a record of the outcome of such meetings must be recorded on the person’s file. This requirement was made to facilitate sharing of up to date information between staff about residents’ needs and includes staff attendance at both review meetings and at medical appointments. At this inspection the registered person showed us the records for 3 people, which included a new form that the home is using to make sure that details and outcomes of all meetings with health and social care professionals are recorded and that the outcomes are noted. This included evidence of appointments with GP’s, mental health specialists, general hospital outpatient departments, dentist and a chiropodist. Records of the dates of appointments were seen, along with the outcome of these appointments. In the AQAA that the registered person gave us at the time of the inspection she told us that some people receive support at home, from a community psychiatric nurse (CPN), who comes to administer regular injections. Staff have access to training in health care matters. The aims and objectives of the home reinforce the importance of treating people with respect and dignity. At the last inspection the registered persons was required to fit a controlled drugs cupboard in the home to comply with the recent change in statutory regulations. At this inspection we found that a controlled drugs cupboard had been obtained. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records were fully completed, contained required entries, and were signed by appropriate staff. Overall, the home has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs. Staff have completed an appropriate medication course. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people have concerns with their care they know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. EVIDENCE: The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. The residents we spoke to said that they are happy with the service provided and feel safe and well supported by the home. They were clear about who they would talk to if they wanted to complain, although nobody had any concerns to tell us about at the time. The service has a complaints procedure that is clearly written and easy to understand. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. However, no complaints had been received in the home, from residents or their representatives, since the last inspection. Some concerns had been raised with the Commission recently, by a neighbour. These concerns were passed on by the Commission to the home, for the registered person to look into. The concerns were about anti-social behaviour from people with mental health problems, who might be resident in a number of registered homes in the area. The registered person and registered manager were clear that none of the concerns were relevant to anybody living in the home and had written to the Commission to confirm this. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 18 The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. The management team make sure that staff working at the service know when incidents need external input and who to refer the incident to. There is a clear system for staff to report concerns about colleagues and managers. In the AQAA that the registered person gave us at the time of the inspection she told us that staff training has been provided on safeguarding and that the management team have recently reviewed the policies and procedures about whistle blowing and safeguarding people. The management team intend to continue to improve in this area by incorporating more regular discussion on safeguarding people and whistle blowing in supervision, residents’ and staff meetings, and provide further training for staff. They continue to identify residents with specialist behavioural needs to a Clinical Psychologist for assessment and support around behavioural management. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. EVIDENCE: The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home is a large converted 2 storey residential property. The ground floor comprises: 4 residents’ bedrooms; kitchen; staff office; a large lounge/ dining room and an adjoining television lounge, which leads out to a large attractive garden. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. There are 7 further bedrooms on the 1st floor. There are sufficient toilet and bathroom facilities on both floors. There is an outhouse in the garden that is used as a smoking room and another large outbuilding that Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 20 accommodates the home’s laundry facilities, a second office, staff shower and a storeroom. The registered person told us that the home had the use of a handyperson to undertake routine maintenance tasks. At the time of the inspection the décor was a little tired and the registered person said that they had made arrangements for the communal areas to be redecorated. A recommendation is made about this. Generally, the home was a pleasant, safe place to live and the fixtures and fittings meet the needs of the people who live there. However, during the tour of the home we noted that an air vent was uncovered in the kitchen. The registered person explained that this was done by an engineer, who had recently dealt with a problem with the central heating boiler. The vent needs to be recovered appropriately, and a requirement is made about this. The cooker was standing away from the wall slightly as work was being done by the gas engineer, to replace a pipe. People have single bedrooms and 2 residents showed us their rooms. 1 person had personalised theirs with pictures, posters and ornaments. 1 person had only recently moved in and said that they were just settling in, but were very pleased with the size and decoration in their new room. The bathrooms and toilets are in sufficient numbers, although they were a little stark and in need of decoration. However, as stated, arrangements had already been made for their redecoration. The people we spoke to said that there is plenty of hot water. The home was generally clean and tidy during the inspection and the registered manager stated that people living in the home were encouraged and supported by staff in keeping their rooms clean. The staff member who showed us the laundry room said that residents are encouraged to do their own laundry, with support from staff. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. EVIDENCE: People have confidence in the staff who care for them. Rotas show that the there are a minimum of 2 staff on duty around the clock. A copy of the rota was seen and accurately recorded the staff on duty during the time of the inspection. The staff work both day shifts and night shifts as part of their rota, and the registered manager said this makes sure that there is consistency of approach in the team. There are consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The residents we spoke to said that staff working with them are skilled in their role, and very supportive. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 22 At the last inspection the registered persons were required to make sure that a copy is kept of all the documentation relating to staff recruitment required in the updated Care Homes Regulations 2001, including a copy of 2 references, to evidence residents are being properly protected through the home’s recruitment procedures. At this inspection we looked at the personnel records for 1 staff member, who had been most recently recruited, and the necessary information was in place, including a written application, a photograph, Criminal Records Bureau (CRB) check details and 2 references. The registered manager told us that he intends to review all staff files with a view to further improvement, and to update the staff application form. At the last inspection the registered persons were required to develop a stafftraining matrix or similar system to allow them to effectively monitor training staff have undertaken and to assist them to arrange new training and refresher training when required. At this inspection we found that this had been addressed. The record showed that staff receive relevant training that is focussed on delivering improved outcomes for residents, showed the training provided and highlighted staff members’ training needs. The staff we spoke to said that they are supported through training to meet the needs of people in a person centred way. The registered person told us that all staff have now completed training at NVQ level 2, that 2 staff have completed NVQ level 3, and that 2 more staff were undertaking training at level 3. She added that the home is registered with Skills for Care, and is committed to being assessed for the Investors in People award in September 2009. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the home because the registered manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home keeps records appropriately and makes sure staff understand the way things should be done. EVIDENCE: The registered manager is very experienced, is a registered nurse for people with mental health needs (RMN) and has a range of other nursing and management qualifications, these skills and experience to enable him to undertake his role effectively. The registered person is involved in the running Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 24 of the home and has recently completed the Registered Managers Award (RMA). We spoke at length with the registered manager and registered person. The registered manager had a clear understanding of the key principles and focus of the service and he works to continuously improve services. There is also a focus on person centred thinking, with residents shaping service delivery. There is an ethos of being open and transparent in all areas of running of the home. The registered manager leads and supports a good, stable staff team who have been recruited and trained to a good standard. The manager is aware of current developments both nationally and by CSCI and plans the service accordingly. The home monitors the quality of care it provides in a number of ways: satisfaction surveys had recently been given to residents and staff and the results of these have been collated into summaries that showed areas of strength and identified areas that could be improved. The home is using a key worker system to assist in better understanding people’s wishes and preferences and the registered person undertakes regular visits to the home and provides monthly reports of these to the registered manager. At the last inspection the registered persons were required to seek the views of external stakeholders regarding the quality of care the home offers including from involved relatives and health and social care professionals. At this inspection we found that a questionnaire had been produced and the registered person told us that they were being distributed to the health and social care professionals involved with the home. There was evidence that staff meetings take place regularly. Notes and action points are taken of meetings. Meeting formally with residents does pose a challenge to the service, as some residents are not keen to attend formal meetings. We discussed ways that the registered manager might make these meetings more attractive to residents and recommendation is made in respect of this. The AQAA contains clear, relevant information that is supported by a good range of evidence. In the AQAA the registered person told us that the home has been successful in rehabilitating people back into the community and retained a high occupancy by receiving referrals from the placement authority, which shows the confidence of the placing authority in the management of the home. The registered manager and registered person promote equal opportunities, had good people skills and understand the importance of person centred care and effective outcomes for people who use the service. The registered manager’s practice, skills, and knowledge, is based on continuous development, gained through training and enthusiasm for the role. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 25 The service has sound policies and procedures, which the manager effectively reviews and updates, in line with current thinking and practice. The registered manager makes sure that staff follow the policies and procedures of the home. The staff team are positive in translating policy into practice. There are effective systems to monitor staff adherence to policies and procedures during their practice. Management processes make sure that staff receive feedback on their work. The home works to a clear health and safety policy. Staff are fully aware of the policy and are trained to put theory into practice. Regular random checks take place to make sure they are working to it. The home has a consistent record of meeting relevant health and safety requirements and legislation, and closely monitoring its own practice. Records are of a good standard and are routinely completed. The registered manager make sure risk assessments are fully completed and taken into account in planning the care and routines of the home. During the tour of the home we noted that the fire alarm panel was showing a fault, and noted that the engineer attended to deal with this on the day. Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 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 X 2 3 3 X 4 3 5 3 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 X 26 3 27 3 28 X 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 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 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 YA24 Regulation 23 (2) (b) Requirement The registered persons must make sure that the uncovered air vent in the kitchen is recovered. Timescale for action 29/09/08 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 YA24 Good Practice Recommendations It is recommended that the registered person makes sure that the scheduled redecoration of the shared areas of the home, including the bathrooms, is completed, so that the home is a more pleasant place for people to live. It is recommended that the registered manager seek ways to make residents’ meetings more attractive to residents, so that they are more likely to attend and contribute. 2. YA39 Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carmen Lodge DS0000007243.V366752.R01.S.doc Version 5.2 Page 29 - 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. 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