Care Home: Forest Lodge

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What the care home does well This is a family style home with a warm, relaxing and friendly atmosphere. People who used the service were observed to be treated with dignity and respect. Forest Lodge residents who spoke with the inspector said that they liked living at Forest Lodge. Staff encourage and support those living in the home to go out and be a part of the local community. Good level of activities was on offer. There is a stable staff group and staff are aware of the service users needs, likes and dislikes. Food is freshly cooked and attractively presented. The premises were generally well maintained. What has improved since the last inspection? Since the last inspection, a number of staff have either obtained their National Vocational Qualifications (NVQs) in Care Level 2 or 3, or were in the process of obtaining one. The home`s policy in relation to staff recruitment has now been revised to reflect the current legislation (Care Homes Regulations 2002). The home has developed a written annual development plan for quality assurance, which is based on a cycle of planning, action and review, as previously required. The registered managers have ensured that each care plan includes a photo of the service user, in order to comply with the legislation. All food was now being labelled once opened, in order to avoid food poisoning. Since the last inspection, the registered managers have ensured that all care plans are reviewed on a monthly basis or more often when required in order to comply with the National Minimum Standards. Improvements have been noted in recording any input from any healthcare professionals, including recording any appointments attended by service users, however it would be a good practice to develop a separate sheet, on which any medical appointments could be recorded. The home`s Whistleblowing Procedure has been amended and it now includes details of the Commission for Social Care Inspection, as previously required. The home has now also got a Confidentiality Policy in place and it has been implemented. Stained carpet in one of the service users bedrooms has now been replaced. What the care home could do better: There was one requirement, which remains unmet from the last inspection: - The registered managers must ensure that the home`s statement is reviewed to reflect the exemption granted to the home to accommodate one service user with a clinical diagnosis of dementia. In addition the following five statutory requirements were made following this inspection visit:- The registered managers must ensure that an accurate record is kept of any medication brought to the care home, in order to ensure that safe medication systems are in place. - The registered managers must ensure that when hand written instructions are made on the medication administration sheet, these are countersigned by another member of staff, in order to avoid entering incorrect information. - The registered managers must ensure that ventilation in the en-suite bathroom on the first floor is repaired. - The registered managers must ensure that the lock is replaced on one of the service users` door, in order to maintain their privacy and dignity. - The registered managers must ensure that staff are only employed, once they are satisfied on reasonable grounds as to the authenticity of the references in respect of each person employed in the home, in order to comply with the legislation. There were also four good practice recommendations made: - It is recommended that all medical appointments be recorded on a separate document, in order to allow easier accessibility to all relevant information. - It is recommended that the home review its arrangements for storage of continence pads, so that the dignity of service user`s is respected. - It is recommended that staff supervision notes are more detailed and are signed by both the supervisor and person supervised. - It is recommended that Mr Taleb obtain a relevant qualification in management. CARE HOMES FOR OLDER PEOPLE Forest Lodge 1 Hartley Road Leytonstone London E11 3BL Lead Inspector Robert Sobotka Unannounced Inspection 30th April 2008 11:00 X10015.doc Version 1.40 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 Forest Lodge DS0000007232.V362995.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 Older People. 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. Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Lodge Address 1 Hartley Road Leytonstone London E11 3BL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8530 2009 020 8530 1242 Mr Imteyaz Hussein Taleb Mrs Cliona Taleb Mr Imteyaz Hussein Taleb Mrs Cliona Taleb Care Home 9 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (9) of places Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on the 21st August 2006, one (1) named service user with Dementia can be accommodated. The CSCI must be informed if this service user no longer resides at the home 1st May 2007 Date of last inspection Brief Description of the Service: Forest Lodge was first registered as a care home in 1995 but was bought by the present owners in April 2001 as a going concern. Many of the current residents and staff therefore transferred with the new registration. The proprietor/managers, Mr and Mrs Taleb, are both qualified nurses but nursing care is not offered by staff in the home. Mr and Mrs Taleb aim to offer a family style environment. The home has comfortable accommodation for nine elderly people, currently aged from their late 60s to their 90’s. The home has got an exemption to accommodate one service user with dementia. The house is decorated in a homely and attractive manner. There is a large lounge/dining area downstairs and two bedrooms on the ground floor including one double with an en-suite shower. Two of the single rooms have en-suite toilet facilities, one with a shower. There is no lift and so the residents using the first floor bedrooms need to be able to negotiate stairs. The paved rear garden is accessed via steps, although a ramp is planned. The current scale of charges is between £428.40- £535.50 per week. Forest Lodge DS0000007232.V362995.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 inspection took place over one day and was unannounced. It included speaking with some of the people who use the service and staff working there. In addition, he spoke to a relative of one person who lived in the home. The inspector also spent some time with one of the registered managers during which he reviewed various records. A tour of premises was also conducted. Prior to this inspection the home was asked to complete the Annual Quality Assurance Assessment. Some of the information provided in the assessment has been incorporated into this inspection report. The aim of this unannounced visit was to check the home’s progress towards full compliance with the National Minimum Standards and the Care Homes Regulations. The inspector would like to thank everyone who contributed to the inspection. What the service does well: This is a family style home with a warm, relaxing and friendly atmosphere. People who used the service were observed to be treated with dignity and respect. Forest Lodge residents who spoke with the inspector said that they liked living at Forest Lodge. Staff encourage and support those living in the home to go out and be a part of the local community. Good level of activities was on offer. There is a stable staff group and staff are aware of the service users needs, likes and dislikes. Food is freshly cooked and attractively presented. The premises were generally well maintained. Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There was one requirement, which remains unmet from the last inspection: - The registered managers must ensure that the home’s statement is reviewed to reflect the exemption granted to the home to accommodate one service user with a clinical diagnosis of dementia. In addition the following five statutory requirements were made following this inspection visit: Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 7 - The registered managers must ensure that an accurate record is kept of any medication brought to the care home, in order to ensure that safe medication systems are in place. - The registered managers must ensure that when hand written instructions are made on the medication administration sheet, these are countersigned by another member of staff, in order to avoid entering incorrect information. - The registered managers must ensure that ventilation in the en-suite bathroom on the first floor is repaired. - The registered managers must ensure that the lock is replaced on one of the service users’ door, in order to maintain their privacy and dignity. - The registered managers must ensure that staff are only employed, once they are satisfied on reasonable grounds as to the authenticity of the references in respect of each person employed in the home, in order to comply with the legislation. There were also four good practice recommendations made: - It is recommended that all medical appointments be recorded on a separate document, in order to allow easier accessibility to all relevant information. - It is recommended that the home review its arrangements for storage of continence pads, so that the dignity of service user’s is respected. - It is recommended that staff supervision notes are more detailed and are signed by both the supervisor and person supervised. - It is recommended that Mr Taleb obtain a relevant qualification in management. 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. Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s statement of purpose required a minor amendment, so that it accurately reflects a range of people’s needs that the home is aiming to meet. Service user’s needs were being met by the home. EVIDENCE: The home’s statement of purpose required minor amendment to reflect the exemption granted to the home to accommodate one service user with a clinical diagnosis of dementia. This is a repeated requirement and must be met without any further delay. Each service user has a costed contract/statement of terms and conditions in place. There have been no new admissions to the home since the last inspection. The home was fully occupied and there were no vacancies. The standard in relation Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 10 to the home assessment process was therefore not fully assessed on this occasion, however it was fully met at the previous visit. At the time of this inspection, the home was accommodating one person with a clinical diagnosis of dementia. An exemption has been obtained from the Commission, so that this person could be cared for by the home. Based on direct and indirect observation, discussion with the people who use the service, staff working in the home and one relative, as well as review of various documents, such as care plans, risk assessments, minutes from reviews undertaken by placing authorities and daily logs, the inspector was satisfied that the assessed needs of those accommodated in the home were being met. Standard 6 is not applicable, as intermediate care is not offered in the home. Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been noted to the home’s care planning systems. The home was appropriately meeting the assessed needs of those accommodated at Forest Lodge. Medication systems required improvement. Staff treated people who use the service with dignity and respect, however the home should review its arrangements for storage of continence pads, so that the dignity of service user’s is respected. EVIDENCE: During this visit, the inspector checked care plans of four people who used the service. All care plans were chosen at random. Each document was kept up-todate and was reviewed on a monthly basis, as previously required. There was evidence that the service involved service users and their relatives in the care planning process and their views were taken into account. Each service user’s care plan now includes his/her photograph, as required by law. Although both registered managers are qualified nurses, the home is not registered to provide nursing and it is therefore not provided. Based on Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 12 discussion with the registered managers and staff working in the home the inspector was satisfied that local healthcare facilities are appropriately utilised and staff working in the home ensure that service users receive appropriate care from outside healthcare professionals. Although improvement was noted in relation to recording appointments attended by the people who use the service, at the time of this inspection any medical appointments were being recorded in the individual daily logs. This made it difficult for any information to be easily accessible. It is recommended that all medical appointments be recorded on a separate document, in order to allow easier accessibility to all relevant information. None of the service users were assessed as being able to administer their own medication at the time of this inspection visit and this information was included in individual care plans. Staff administer medication using the Boots blister pack, measured dosage system. Staff receive medication training on a yearly basis, which is facilitated by the local pharmacist. Medication is stored in a medicines trolley, which is securely locked and chained when not in use. There was a list of staff authorised to administer medication. The inspector crosschecked medication stocks, which were found to be correct. It was noted that staff did not always accurately record all medication received into the home. This requires improvement. One of the medication administration sheets contained hand written instructions for administering a medication, which were written by staff. In order to avoid entering incorrect information, the registered managers must ensure that when hand written instructions are made on the medication administration sheet, these are countersigned by another member of staff. Staff employed in the home were observed to work with the people who use the service in a courteous and professional manner. This was also confirmed by the people who use the service, who told the inspector that staff were very kind and treated them well. Their right to privacy was upheld. Staff were observed knocking on individual’s doors before entering their rooms. During the tour of the premises, the inspector noted that some continence pads were kept in individual rooms and were not discreetly stored away, hence identifying any individuals with continence issues. It is recommended that the home review its arrangements for storage of continence pads, so that the dignity of service user’s is respected. Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those who use the service are encouraged and supported to be part of the local community and to develop and maintain friendships and family links. Service users enjoyed food offered by the home. EVIDENCE: Care plans viewed showed that service users are encouraged, supported and encouraged to become a part of the local community, as well as taking part in appropriate leisure activities. Following discussions with several service users and staff working in the home, the inspector was satisfied that the proprietors and staff encourage and support service users to take part in age and culturally appropriate outings and activities. The registered manager stated that outings offered to the service users included: trips to the seaside, barbeques (weather permitting), there is an entertainer who visits the project on a weekly basis (Wednesdays), shopping trips (Walthamstow Market) and bingo. Service users who spoke with the inspector felt that there was a wide range of activities offered to them, which they said they enjoyed. As previously mentioned, care plans have recently been updated and they now contain a section about leisure activities, Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 14 as well each service users religious and cultural needs. The registered manager stated that two extra staff are employed in during summer period to support service users in taking part in activities. At the time of this unannounced visit, there was an entertainer visiting the home and she was facilitating an entertainment group and gentle exercises classes. Relatives are allowed to join in any activities, should they so wish. At the time of this inspection, the home accommodated 8 service users who were of either white British or white Irish origin and one person who was from originally the Caribbean. The inspector spoke to this person and she confirmed that she felt that the home was appropriately meeting her cultural needs. During this inspection visit, a discussion took place around supporting people identify themselves as gay/lesbian. The home has got some previous experience of supporting people who are gay/lesbian and the inspector was satisfied that positive outcomes were achieved for this person. Visitors are welcome to the home. Visitors book was maintained. Staff working in the home encouraged and supported service users to maintain contact with family and friends. Some of the service users confirmed that the home encouraged them to maintain relationships with their relatives and old friendships. During this visit, the inspector spoke with one of the relatives, who confirmed that she is always welcome to visit her sister. She also told the inspector that staff always kept her informed any important issues in relation to her sister’s wellbeing. She felt that the home was appropriately meeting the needs of her relative. Those who live in the home are encouraged to be as independent as possible and make choices about times to get up or go to bed, colour schemes in their rooms etc. They are able to bring small items of furniture for their rooms and have their personal possessions around them. Residents are encouraged to make decisions about their own financial affairs for as long as possible, although most are assisted by relatives. Residents were encouraged to maintain their independence in personal care, but assisted in sensitive way, when necessary. The inspector observed one person requesting different food for their lunch; their request was readily accommodated. The inspector was invited to have lunch with the service users. Lunch served on the day of this visit was attractively presented and nutritionally balanced. There were two different meal options given. Mealtimes were unhurried and service users were given sufficient time to eat and there was a relaxing atmosphere in the dining room. Those who spoke with the inspector said that they liked the food served in the home. Record of food served to service users was maintained. There were sufficient quantities of food in the home. Since the last inspection, the registered managers have ensured that all perishable food was now labelled once opened, as previously required. Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate complaints system was in place. Service users’ legal rights are protected. The inspector was satisfied that relationships in the home between the staff and the service users were sufficient to protect the safety and wellbeing of those accommodated at Forest Lodge. EVIDENCE: There have been no complaints made to the home since the last inspection. Appropriate complaints policy was in place. Those who spoke to the inspector were confident that their complaints would be heard and promptly resolved. Service users are registered and enabled to vote in elections by post and the registered manager confirmed that those who live in the home were on the electoral register. One of the people who used the service told the inspector that she would be voting in the forthcoming mayoral elections. Appropriate adult protection policies and procedures were in place. Staff working in the home were aware of adult protection issues. The adult protection procedure for the London Borough of Waltham Forest was also available for guidance to staff. The home’s Whistleblowing Procedure has been amended and it now includes details of the Commission for Social Care Inspection, as previously required. Records of accidents/incidents were checked and these were appropriately maintained. Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was clean, comfortable, homely and generally well maintained. The premises meet the standards for a pre-existing home is relation to the washing and bathing facilities and the number and size of bedrooms. The lack of a lift and steps to the garden limits the type of residents who can be accommodated in the home. The proprietors are working, in a planned way, towards meeting areas such as this, where the home does not fully meet the standards. Some minor improvements are required, such as ventilation in one of the en-suite bathrooms, storage of continence pads and changing locks on one of the service user’s bathrooms. EVIDENCE: The home is situated in a residential area, blending in with the surroundings. The new office building has been completed and was in use at the time of this inspection visit. Further planned improvements to the premises included provision of a level access to the garden and installation of a lift enabling Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 17 service users who use wheelchair and/or have mobility needs to be able to access the upstairs part of the building. These changes should allow the home to extend the range of residents’ needs that can be accommodated and meet all the current standards. The double bedroom and five of the single bedrooms are above the minimum sizes of 16 and 10 square meters. Two single bedrooms are below 10 square meters, but meet the standard, as the home was registered before the current National Minimum Standards were introduced. The home has toilets on the ground and first floor, accessible to bedrooms and communal rooms. Some bedrooms have en-suite facilities. The bathroom is fitted with a chair to enable residents to be assisted in and out of the bath. One of the toilets (in a service user’s room) has recently been fitted with a macerator. The garden area has a large table and chairs and a barbeque. Some of the service users were seen using the garden area on the day of this inspection. As part of the inspection, all but one bedrooms were viewed, with permission from the people who used the service. Rooms appeared to be personalised and reflected individual tastes and interests of service users. Service user said that they were happy with their bedrooms and fixtures and fittings. The inspector noted that ventilation in one of the en-suite bathrooms was out of order and required repair. In addition a lock on one of the service user’s door required replacing. As previously mentioned, it is recommended that the home review its arrangements for storage of continence pads, so that the dignity of service user’s is respected. Some mobility equipment, which was no longer in use have been removed from the main lounge since the last inspection. The premises were found to be clean and hygienic and free from offensive odours. Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels were sufficient to meet the needs of the current service users group. Staff recruitment procedures required improvement. EVIDENCE: Duty rosters were checked as part of this inspection visit. The inspector was satisfied that there were sufficient numbers of staff on duty to meet the needs of the current service user group. The duty rosters showed that there were two care staff on duty between 8 am and 9 pm each day and one staff awake at night and one person sleeping in. The home does not use agency staff. Any staff shortages are covered by an existing staff team. The inspector spoke with a member of staff on duty. She said that although sometimes it could be busy in the home, it never had a negative impact on the quality of care offered to those accommodated in the home. Since the last inspection, a number of staff have either obtained their National Vocational Qualifications (NVQs) in Care Level 2 or 3, or were in the process of obtaining one. The home’s policy in relation to staff recruitment has now been revised to reflect the current legislation (Care Homes Regulations 2002). Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 19 During this visit, the inspector checked staff personnel files of three staff working in the home. Improvements are required in relation to staff references, as one person’s file contained only one reference. Another person’s file contained two false references and the registered manager confirmed that they had not been verified prior to allowing this person to commence employment in the care home. The registered managers must ensure that staff are only employed, once they are satisfied on reasonable grounds as to the authenticity of the references in respect of each person employed in the home, in order to comply with the legislation. Staff receive appropriate training. Evidence in a form of training certificates to demonstrate that staff have received mandatory training and any other training required for the job was available in each person’s file. At the previous inspection, it was noted that record of induction offered to new care staff was not being kept. As no new staff have been employed since the last inspection, the requirement in relation to this standard has therefore been removed. It will be retested once any new care staff have commenced employment in the home. Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The ethos of the home is open and positive. Health and safety checks were found to be satisfactory. EVIDENCE: The proprietors are involved in the day-to-day running of the home and are both registered as registered managers/owners of Forest Lodge. They share roles and tasks usually undertaken by the manager and proprietor e.g Mr Taleb: invoicing, finances, GP/hospital visits, pharmacy, maintenance, staff rota; Mrs Taleb: staff supervision/appraisal, policies and procedures, recording and documentation. Both of the proprietors/managers demonstrated that they are sufficiently competent and experienced to run the home and to meet it’s stated purpose, Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 21 aims and objectives. Both Mr and Mrs Taleb are registered nurses. The inspector was informed that Mrs Taleb was in the process of obtaining the Registered Managers Award, as previously required. It is recommended that this qualification is also obtained by Mr Taleb. As previously mentioned, people accommodated in the home benefit from the ethos, leadership and management approach of the home. The home has developed a written annual development plan for quality assurance, which is based on a cycle of planning, action and review, as previously required. As both proprietors and also the registered managers of the home, monthlyunannounced visits to the homes were therefore not required. The registered manager stated that at the time of this inspection they did not manage any finances on behalf of service users, however they were supporting one person with managing her allowance. Records of money kept by the home on behalf of this person were checked and were found to be well maintained. Minutes from staff supervision sessions were available for inspections and there was evidence that staff receive supervision in line with the National Minimum Standards (at least 6 times a year). The inspector noted that supervision notes were very brief that they did not include signatures of both parties. It is recommended that staff supervision notes are more detailed and are signed by both the supervisor and person supervised. The home’s Whistleblowing Procedure has been amended and it now includes details of the Commission for Social Care Inspection, as previously required. The home has now also got a Confidentiality Policy in place and it has been implemented. Health and safety checks were found to be satisfactory. There was evidence that fire drills and now being carried out on a regular basis and the home’s electrical wiring certificate has now been obtained. Electrical wiring certificate was issued on 24/06/06 and is valid for 3 years. All portable appliances have been tested. Appropriate fire safety checks were carried out on regular basis. Fridge/freezer temperatures were being recorded. Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 2 3 2 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 23 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 OP1 Regulation 6(a) Requirement The registered managers must ensure that the home’s statement is reviewed to reflect the exemption granted to the home to accommodate one service user with a clinical diagnosis of dementia. (Previous timescale of 01/07/07 was not met.) The registered managers must ensure that an accurate record is kept of any medication brought to the care home, in order to ensure that safe medication systems are in place. The registered managers must ensure that when hand written instructions are made on the medication administration sheet, these are countersigned by another member of staff, in order to avoid entering incorrect information. The registered managers must ensure that ventilation in the ensuite bathroom on the first floor is repaired. The registered managers must ensure that the lock is replaced DS0000007232.V362995.R01.S.doc Timescale for action 01/07/08 2. OP9 13(2) 01/06/08 3. OP9 13(2) 01/06/08 4. OP25 23(2)(p) 15/06/08 5. OP24 12(4)(a) 15/06/08 Forest Lodge Version 5.2 Page 24 6. OP29 19(1)(c) on one of the service users’ door, in order to maintain their privacy and dignity. The registered managers must ensure that staff are only employed, once they are satisfied on reasonable grounds as to the authenticity of the references in respect of each person employed in the home, in order to comply with the legislation. 15/06/08 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. 2. 3. 4. Refer to Standard OP8 OP10 OP36 OP31 Good Practice Recommendations It is recommended that all medical appointments be recorded on a separate document, in order to allow easier accessibility to all relevant information. It is recommended that the home review its arrangements for storage of continence pads, so that the dignity of service user’s is respected. It is recommended that staff supervision notes are more detailed and are signed by both the supervisor and person supervised. It is recommended that Mr Taleb obtain a relevant qualification in management. Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 25 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 Forest Lodge DS0000007232.V362995.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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