Care Home: Gothic Lodge

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What the care home does well Residents are able to make decisions about their lives, with assistance as necessary. Residents are consulted about aspects of the running of the home, for example, menus and activities. Residents have access to leisure and personal development opportunities and they are part of their local community. Action is taken to minimise identified risks and residents take risks as part of maintaining or developing their independence. Residents have the opportunity to engage in age appropriate activities and maintain friendships and relationships. Residents are satisfied with the meals and they help to choose the menus. Residents can be assured that their complaints will be listened to and acted upon and effort is made to promote their understanding of the complaints procedures. The registered provider takes appropriate action to safeguard residents from abuse during any investigations and they take appropriate action where allegations are substantiated. The home is clean and tidy. What has improved since the last inspection? There has been significant improvement in this service and the majority of the requirements made in previous inspection reports have been addressed. The manager has taken steps to improve the standard of health care provided to the residents. This has been done by better planning, taking more professional advice and keeping better records. There is better evidence in the home that staff are checked properly during recruitment and they are inducted properly when they start work in the home. Procedures to protect the valuables held in safekeeping have improved and this makes it safer for vulnerable adults. Risk assessments have been reviewed to make sure that they are accurate and up to date. This makes it safer for residents, especially those who use mobility aids. Controlled drugs storage is available should any controlled drugs be prescribed. Staff are better trained to recognise issues that require investigation by safeguarding authorities and the registered provider takes the correct action to safeguard residents during investigation. Staff are keeping better records of accidents and incidents and they are notifying the correct authorities. What the care home could do better: The way that medicines are handled in the home must be made safer. There are two outstanding requirements about medication that have not been fully addressed and the service is warned that this must be improved or the Care Quality Commission will consider further enforcement action. There must be a better system for monitoring and improving the quality of service being provided. Key inspection report Care homes for adults (18-65 years) Name: Address: Gothic Lodge 21 Idmiston Road West Norwood London SE27 9HG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sonia McKay     Date: 1 9 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Gothic Lodge 21 Idmiston Road West Norwood London SE27 9HG 02087618044 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): gothiclodge@yahoo.co.uk www.larche.org.uk L`Arche Lambeth Name of registered manager (if applicable) Miroslawa Wasiuk-Wojcik Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home Gothic Lodge is a large detached gothic style house with three floors. It is located in a residential road in West Norwood close to the organisations workshops, high street shopping and transport networks. The home is registered to provide care and accommodation for six adults with a learning disability. Accommodation is also provided for staff. The house is spacious and is surrounded by a reasonably sized garden. The organisations gardening workshop is adjacent to the home. The home is one of a group of homes managed by LArche Lambeth, an Ecumenical Christian Community that welcomes people of all faiths and people of no stated faith. Strong emphasis is placed on the community of staff and service users. Prospective service users receive an information pack about the service and a copy of Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 0 6 6 0 2 1 2 2 0 0 9 Brief description of the care home the most recent Commission inspection report is available on request at the home. Current fees range between £433.60 and £517.39 per week and depend on the support needs of individuals placed. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out by two inspectors over one day. The methods used to assess the quality of the service being provided were as follows. Talking with residents, staff and the home manager. Observation of interactions between staff and residents and how they were spending their time. Looking at records relating to care and staffing. Looking at the information that the provider sent to us in their annual quality assurance audit. Looking at the outcomes of recent safeguarding investigations and getting feedback Care Homes for Adults (18-65 years) Page 6 of 33 from the local authority. A partial tour of the premises. Looking at ways that medicines are handled in the home. The Care Quality Commission would like to thank all those who kindly contributed their time, views and experiences to this inspection process. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? There has been significant improvement in this service and the majority of the requirements made in previous inspection reports have been addressed. The manager has taken steps to improve the standard of health care provided to the residents. This has been done by better planning, taking more professional advice and keeping better records. There is better evidence in the home that staff are checked properly during recruitment and they are inducted properly when they start work in the home. Procedures to protect the valuables held in safekeeping have improved and this makes it safer for vulnerable adults. Risk assessments have been reviewed to make sure that they are accurate and up to date. This makes it safer for residents, especially those who use mobility aids. Controlled drugs storage is available should any controlled drugs be prescribed. Staff are better trained to recognise issues that require investigation by safeguarding authorities and the registered provider takes the correct action to safeguard residents during investigation. Staff are keeping better records of accidents and incidents and they are notifying the correct authorities. Care Homes for Adults (18-65 years) Page 8 of 33 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs and aspirations of new residents are fully assessed before they are offered a placement in the home. There are opportunities to visit and spend time with fellow residents and staff before they make a decision as to whether the service is suitable for their needs. Evidence: The service is fully occupied and there have been no new residents admitted since the last inspection. The process for assessing the needs of prospective residents is deemed to be good at previous inspections. The admissions procedures allow for trial visits and opportunity to experience life in the home before making a decision to move in for a trial period. Referrals for placement are via an application form and submission of care needs assessments produced by local authority social work teams. Care Homes for Adults (18-65 years) Page 11 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. 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 manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is some good written information about the support needs of each resident but there is no consistent care planning and review process in operation. This means that some areas of support are not adequately recorded or reviewed frequently enough. The manager has tried to address this by reviewing essential information and there is adequate information about key areas and risks. More could be done to ensure that each resident benefits from a planning process that covers all areas of their life and we recommend that a standard format for planning care be adopted so that new staff can provide consistent support to achieve each residents personal goals and aspirations. Evidence: I looked at records for three of the residents during this inspection. Staff maintain numerous files of written information about the care and support of each resident. These files are stored in the staff office. Each resident has a key worker from within the team. Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: The Registered Provider does not provide staff with a consistent care planning system and gathering all of the information required to assess the quality of care planning is harder as a result. The new home manager has focused her attention on ensuring that key areas of current care need and risk are recorded and recently reviewed. It is noted that this also makes it harder for staff to maintain and review the records in a systematic way. The homes coordinator, who visited the home during this inspection, assisted by gathering the relevant information from various files. The first set of records seen were about the care of a resident with a learning disability. There is no defined care plan but there is a personal information sheet that provides staff with information about other professionals involved, next of kin, Friends and family and likes and dislikes. There is also advice for staff in how to support the resident to prepare for her daily activities, as she sometimes finds it difficult to start activities and go out of the house and about words the resident uses and what she is trying to communicate when she uses them. The placing authority recently conducted a review of her care at the home. There are no current personal goals or aspirations recorded and recent review minutes are not yet available. I contacted the social worker who undertook the review and he is satisfied with the care provided and noted that records were of concern but were improving with the input of the new manager. Records for a second resident are currently being collated by the key worker to produce a care plan. The manager said that she has begun to meet with staff to discuss and review planning information and goals. There was recent behaviour support involvement from the local community team and a behaviour support plan is in place and was reviewed and revised in February 2010. This resident also has a personal information sheet and recent handwritten notes have been added to this record to ensure that the information is accurate and up to date.The resident has a mobility need and uses a wheelchair and other aids. Risk assessments about the use of this equipment was reviewed in February 2010. Information about her cultural needs are currently being developed. Records for a third resident show that he has developed dementia and has increasing care and support needs. His social worker completed a Care Quality Commission survey before this inspection and subsequent to a recent placement review. The feedback about the quality of care and support provided is positive and notes that staff have continued to offer the resident choice by using communication aids, such as pictures. Also that they have shown commitment to maintaining a good quality of life during this difficult period by managing the changes with minimal disruption to his day to day routines. Records include a personal information sheet, which contains brief but sufficient information about the nature of care and support required. The manager Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: reviewed the risks relating to use of cot sides and a wheelchair strap whilst out in the community in February 2010. The resident is advised to eat a soft diet and there is information about this. There are no currently recorded goals. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are part of their local community and they are able to take part in activities of their choosing. There are opportunities for personal development and leisure. Staff support the residents to develop and maintain their friendships and family relationships, providing practical support as necessary. Residents are encouraged to take part in daily routines such as menu planning and shopping. Evidence: LArche Lambeth is a faith based community that offers support and accommodation to each resident to enable them to develop their faith and spiritual lives, although residents may choose not to attend religious activities of any particular denomination if they wish. The LArche community has good links with the local community. Residents of Gothic Lodge attend LArche community workshops and groups and some attend local authority day provision also. One resident has increasing dementia care Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: needs and has additional staffing so that someone can stay with him at home in the daytime if he does not want to attend a relaxation group. The annual quality assurance audit says that the LArche Community in Lambeth is also continuing to develop a wider range of day activities in addition to the workshops. There are gardening, weaving and candle making workshops and residents can take part and be paid therapeutic earnings. I started this inspection early in the morning and was able to meet residents before they went out for their days activities. The close proximity of the other LArche residential homes in the Lambeth community means that residents have regular contact with each other at workshops and clubs. There are also regular community meetings and opportunities for celebrations all together. The community go on regular group pilgrimages and meet other LArche community members. All residents have an opportunity to go on holiday either in small groups or on a one to one basis at least once each year. The home manager updated the homes annual quality assurance audit document the day after this inspection visit and sent it to us and this confirms that residents have had a variety of trips away from the home. It also says that the community are produce an accessible monthly timetable of LArche community events. There are a range of things to do in the house. There is a television, DVD player, music equipment and musical instruments and there is a large garden where people can relax. Residents help to choose the menus and a record is kept of the meals served. Food is stored properly in the larder room and food stocks were observed to be good and contained fresh fruit and vegetables. Residents are supported and encouraged to take part in shopping for foods and preparing and cooking the meals to the best of their ability. One resident is advised to have a soft diet and this diet is being prepared by staff. Residents eat most evening meals together with staff in the large dining room and have breakfast at a time that suits their days plans. I contacted the local authority contracts monitoring team for feedback about this service before the inspection. The feedback is positive in the area of supporting residents to maintain lifestyles of their choosing and they the local authority consider that there is some excellent support provided in regards to community inclusion. Records seen show that there is information for staff about how residents like to spend their time and their hobbies. There is also good information to help the residents to maintain friendships and family relationships, for example, family birthdays and special occasions. Care Homes for Adults (18-65 years) Page 16 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are appropriately supported to maintain their personal care and appearances and they are well dressed and groomed. Staff have got better at keeping records of health care appointments and advice given and this means that residents are receiving better care with their health issues. Although medications are being given there is still concern that medicines are not being handled safely enough and the service is warned that this is an area in need of urgent improvement, without which, the Care Quality Commission will consider taking enforcement action in regards to two of the previous requirements which have not been met at this inspection. Evidence: Current residents need varying levels of support to maintain their personal care and appearance, from verbal prompting to assistance with bathing and continence care needs. Residents were observed to well dressed and well groomed and all were dressed appropriate for the weather. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: Local authorities who place at the home have conducted placement reviews and the three authorities who commented are satisfied with the care provided. There is written information about each persons personal care needs and routines, and these are sufficiently detailed to inform new staff. The manager has recently reviewed all of the written information available to staff about the personal care and health needs of each resident. At the last inspection we were concerned that there was little evidence that residents had been supported to make and attend health care appointments and there was inadequate health care planning. We issued a requirement about this. The new home manager has prioritised health care and has spent time going through records to track recent health care issues. Each resident has a health action plan in place and records are easier to locate in regards to outcomes of recent health care appointments, the health professionals involved and how to contact them. The Annual Quality Assurance Audit says that the manager also plans to work more closely with the local group practise to further develop each persons health action plan in the coming year. I looked at health care records for three of the residents and this examination showed that standards of record keeping have improved since the last inspection. Records for all three showed that staff have made appointments to various health professionals and kept a record of what advice was given. Some residents need assistance to monitor their health and well being, for example, monitoring bowel movements to watch for signs of constipation and these monitoring systems are in place. All of the residents are registered with a local GP and evidence seen suggests that staff seek medical advice when required. A local dental surgery has closed and the manager is currently looking for another surgery who are skilled at meeting the dental needs of people with a learning disability. At the last inspection we were concerned that staff did not keep appropriate records if they noticed any marks or injuries. The manager has reminded staff about recording any marks or injuries that they see and a body chart record is place. Accidents and incident forms have been completed appropriately. At the last inspection, we left 3 requirements and 2 good practise recommendations on medicines handling as the home had no storage for controlled drugs, which has Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: been a legal requirement since 2008, some medicines were not being used as prescribed, some medicines did not have full instructions for use and the disposal logs were incomplete. At this inspection, we looked at records of medicines received, used and disposed of, to see whether record keeping had improved, and we carried out an audit of prescribed medicines in stock to see if the home was able to account for the use of medicines. We also inspected medicines storage areas. The outcome for residents is that all medicines are available, and there is evidence people are receiving the right medicines on time in most cases but recording keeping must be improved, so that the home can provide evidence medicines are being used as prescribed, and can all be accounted for, so two requirements are unmet. There are 5 residents at the home, and there were issues with each persons medicines or records, for example, one person has a supply of tablets for constipation in their locker, but this item did not appear on their record. Their care plan, updated in January 2010, says they take 2 tablets of another medicine, however the prescribed dose is one tablet. The Manager confirmed that there is an error in the care plan, and only one tablet is being given, as prescribed. One person has blister packed medicines for allergies, this had been signed for as given on the day of the inspection, but the dose was still in the blister. The Manager spoke with the member of staff responsible for giving medicines to this person, and confirmed that they had given the dose that morning, but had taken it from the wrong blister. This is dangerous, as another member of staff might assume the dose had not been given and could give a second dose. One person has a medicine in their locker dispensed in 2008 which would have expired, and needs to be reordered. One person is given a liquid medicine via a syringe, however this is kept in the bottle and is not removed and cleaned after each dose according to the written instructions supplied with it. We spoke with the member of staff who had given the medicine that morning, they were not aware of the need to do this, which suggests that staff have not read the instructions supplied. Leaving the syringe in the bottle could lead to contamination of the medicine. One person has 2 medicines on their record which are used once a month for pain, these are not prescribed, but are bought over the counter, however no stock checks Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: are kept, so it is not possible to check whether these can all be accounted for. These may have also been used for staff. Medicines prescribed or bought for residents must only be used for that resident. Stock check sheets are now being kept for all medicines, to ensure the home can account for the use of all medicines, and the Manager was able to explain how these worked and how they had been effective in picking up discrepancies. The organisations own internal Regulation 26 audits for February 2010 say these are complicated, and need to be simplified. These show that there have been some stock discrepancies for example, there is a significant overage of a liquid medicine for a thyroid condition where it is not clear if the mistake has been with the quantity supplied by the pharmacy or the quantity given to the resident. Either too much was supplied, or not enough has been given.Each bottle contains ml, which is one weeks supply. Each bottle should be reconciled at the end of each week, so it will be clear if the correct dose has been given. There is a note in this persons care plan to say there may be an issue with the levels of thyroid hormone, so the home must be able to show from accurate records that it is giving the correct dose to this person. A controlled drugs cupboard has now been installed. Other prescribed medicines are stored securely in a metal cabinet, with individual lockers for each person. Although this cabinet is not secured to the wall, it is not easily removed, and is kept in a locked room, so this is secure enough. Each locker is labelled with the persons name, and a photograph for identification, however the photograph for one resident is still missing, a comment made at the last inspection, and the name label was incorrect on one locker. This was rectified during the inspection. A sample signature sheet is now in place so the member of staff giving each dose of a medicine can be identified. Records of medicines returned are kept, but these are still incomplete. The record should also include the name of the resident as well as the name of the medicine, and as only one staff member initials the returns log, it would be good practise to obtain the signature of the pharmacist as confirmation that medicines have been returned. Other improvements are needed on records for example, creams still do not always have full instructions for use, the area to be applied to and how often they should be Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: applied, and staff have made some amendments to records but have not signed to say who has made the change and when. All prescribed medicines must have full instructions for use, and any changes should be signed and dated. There was also an excess of some medicines in stock for example, staff have been ordering creams every month, but each container has been lasting 2 to 3 months. We looked at the medicines policy, this is out of date and too brief, and is in the process of being updated. We looked at the training staff have had on medicines handling. We suggested that the Manager looks at the Care Quality Commissions document on training for care workers to safely administer medicines, and also the Skills For Care website to check whether the training is adequate, as the level of errors indicates that not all staff may be competent in this area. Care Homes for Adults (18-65 years) Page 21 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, 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. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Provider has taken steps to better protect the vulnerable adults who use this service. Evidence suggests that staff are getting better at recognising and referring safeguarding issues for further investigation by the appropriate authorities. A complaints procedure is in place and is accessible and appropriate to the needs of the people using this service. Evidence: There is a complaints policy and procedure in place and efforts have been made to making the process easier for people with a learning disability to understand and use, for example, there is a poster on the noticeboard in the communal kitchen that shows residents, using photographs and symbols, how to make a complaint and who they can talk to or contact to do so. There are also regular house meetings and wider community meetings where residents can raise concerns if they wish. The Annual Quality Assurance Audit, sometimes called an AQAA, says that there have been no complaints since the last inspection. I looked at the complaints record book during the inspection and there are none recorded, although a compliment about the service is recorded. At the last inspection we were concerned that residents were not adequately safeguarded from abuse. Staff look after and account for residents personal finances and the records were lacking and staff did not appear to be sufficiently knowledgeable Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: about procedures to safeguard vulnerable adults, for example, an injury had been noted but other than recording it in a daily diary for one resident no other action was taken. The new home manager has strengthened the procedures and staff now complete a body chart and incident form in such circumstances. Financial accounting procedures have been reviewed and now money that is held in the safekeeping of staff is being properly checked and recorded. During this inspection a spot check of records and valuables held for one resident shows that there has been improvement and residents personal valuables are better protected as a result. Each resident also now has a recorded inventory of their personal possessions. A record is kept of people who visit the home and staff were observed to be vigilant in reminding visitors to sign in the visitors book when they arrive. There have been two safeguarding investigations in the last twelve months. The registered provider raised one safeguarding referral themselves when a member of staff reported an incident of misconduct by another member of staff. The staff member was subsequently dismissed and referred to the list of people who should not work with vulnerable adults. The policy on the consumption of alcohol by staff was also reviewed and staff are no longer allowed to drink alcohol in the home, even when they are off duty. This is important because staff often live at the homes as well as work there. At the last inspection we were also concerned that staff were not fully checked before they began work in the home. Evidence seen during this inspection shows that staff are not allowed to work in the home until they have the initial check against the list of people who should not be allowed to work with vulnerable adults. The local authority, who have been monitoring the service since the last inspection when a poor rating was given and the Commission raised an alert, are also providing staff with additional training about safeguarding vulnerable people. Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. The home makes sure they have the right specialist equipment that encourages and promotes their independence. 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. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, comfortable and homely and there are adaptations for people with mobility needs, although accessibility for people who use wheelchairs not extend to the kitchen facilities. There is a structural problem with the building which is causing internal cracks and this is being worked on by the local authority at this time. Evidence: The home is a large Gothic style building with many original features. The home is set in a garden and is located next to the LArche Community gardening workshop so Gothic Lodge residents have use and access to a large garden area. The home is located in a residential area close to shops and transport links and is in keeping with other properties in the area. The home is registered to provide a service to people with a physical disability, and an adapted bathroom is available on the ground floor along with bedrooms for people with a physical disability and all communal areas. Further re-assessment of the changing needs of the current residents has led to further specialist recommendations about how the ground floor bathroom can be better adapted and work is being planned to make the changes recommended. The kitchen facilities are not accessible to people who use wheelchairs, so the home is Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: not currently suitable for people who use wheelchairs who would wish to cook independently. The home was observed to be clean and free from any offencive odours and the decor is homely and comfortable. The AQAA says that the hallway carpets have been replaced since the last inspection and that a maintenance and renewal programme is reviewed each tear. There are plans to replace curtains that are becoming faded. At the last inspection we noted that clinical waste was not being stored properly as yellow bags of waste had been left in the garden next to the clinical waste storage bin. At this inspection we note that an additional metal bin with a heavy lid is being used to store yellow bags of excess clinical waste that cannot fit into the clinical waste bin until it has been collected. Whilst action has been taken to meet the previous requirement and safer arrangements made, the clinical waste arrangements should be further reviewed to ensure adequate storage is available and as the metal bin is designed to burn garden refuse in it has holes in the side, which may attract pests and vermin. Pest proof storage should be used. The manager notified the Care Quality Commission that there is a problem with the building. There are still large cracks on the kitchen and dining room walls and ceiling and the problem has increased to effect the chimney stack. The local authority have erected scaffolding to make repairs and staff and residents are not using one of the garden exits at this time unless it is an emergency. The manager said that she has been assured that the building is safe by the attending local authority surveyors. Care Homes for Adults (18-65 years) Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider is working to improve the safety of the recruitment procedures which were observed to have improved at this inspection. The new manager has developed a team training plan and staff are supervised and their performance appraised regularly. Evidence: The LArche community of residential care homes uses staff who are essentially volunteers who are contracted and paid a nominal fee for living expenses and accommodation is usually provided. Staff are usually recruited from overseas. They are called assistants and are expected to take part in the wider LArche Community life and activities. In the Annual Quality Assurance Audit the manager identifies that this attracts staff with a high level of commitment and that prospective assistants are sometimes offered opportunities to visit other LArche communities before they travel to England to take up a position in the Lambeth community. However, this method of recruitment presents challenges to safe recruitment and staff turnover has been high in recent years. This has reduced the quality and consistency of the service being provided. The new manager has stabilised the staff team and is supervising them closely with the aim of improving their understanding of each residents daily routines and needs. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: She assesses that there has been significant improvement in this area since the last inspection. Team meetings are held regularly and minutes recorded. Staff receive induction training and annual appraisal. The manager has also analysed the team training needs and drawn up individual training and development plans for each member of staff. For example, all of the staff were given additional training about the care of people with dementia as one of the residents has developed this condition. She hopes that this support and leadership stability will encourage staff to stay for more than the usual one year commitment to community life. High staff turnover also effects the impact of team training and development and none of the current team, other than the manager, have a vocational qualification in care. A learning disabilities qualification is offered instead as this is a shorter course. Four of the staff have completed this training and one member of staff is currently undertaking the award. At the last inspection we were concerned that staff recruitment was unsafe and did not ensure thorough vetting before staff began working and living in the home. Records for two staff who were most recently recruited were looked at during this inspection. Records include references, application forms with work history, evidence that any gaps in work history are explored during interview and evidence of identity verification. Both have enhanced criminal records checks in place. The manager explained that one new member of staff lived in staff only quarters elsewhere until a full criminal records disclosure was obtained and only then had she been allowed to live at Gothic Lodge. This indicates that the safety of the recruitment procedures has improved. The local authority is also advising the Human resources team about safer recruitment. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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 care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has addressed the majority of requirements made in the last report and has stabilised the service. Record keeping and care planning have improved although more must be done to monitor and improve the service. There are outstanding requirements in regards to the safe administration of medications and the service is warned that rapid improvement is necessary. Evidence: The new home manager has applied to the Care Quality Commission to be registered. The manager is experienced and qualified and has been registered to manage similar services in the LArche community. The new manager has worked hard to raise the standard of day to day care and record keeping in the service since the last inspection. The registered provider conducts regular monthly checks of the service and reports of the findings of these visits are sent to the home manager so that copies are available in the home. The reports are also sent to the Commission along with regular updates to the improvement plan requested after the last inspection. Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: The registered provider is working with the local authority monitoring team to raise standards across the LArche community. The registered provider has acknowledged that there is inadequate senior manager positions within the community and this is being addressed. There is a lack of quality assurance. The majority of requirements made in the last report have been met. There are outstanding issues in regards to the safe management of medicines in the service and the Registered Provider is warned that rapid improvement is necessary or the Care Quality Commission will consider taking further enforcement action. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 20 13 The registered person must 05/01/2010 ensure that residents receive their medication as prescribed. To ensure the health and safety of the residents. 2 20 13 Medication administration 31/01/2010 records must contain accurate directions for use and what dose of medication is to be given. To ensure the health and safety of the residents. Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 39 24 The registered Provider 04/09/2010 must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. To ensure that improvements are made and that outcomes are monitored. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 There should be a standard format for care plans so that staff , who change frequently, know what areas of care and support to review and plan for. It is good practise to obtain the signature of the pharmacist as confirmation that medicines have been returned. Staff training in the safe handling of medicines should also involve competence assessment. Clinical waste contracts should be reviewed to ensure that they are adequate to meet the current needs of the Page 31 of 33 2 3 4 20 20 30 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations residents and any excess clinical waste that cannot currently fit into the yellow clinical waste storage unit should be stored in a vermin proof container. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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