Care Home: Hartwood Lodge

What the care home does well The registered manager and her staff continue to work hard to review and further develop the service offered to residents, some of whom have complex needs. Residents spoken to independently told us the home is "one of the best places I have been to" and another said, "I feel happy and quiet safe". The home has a range of up to date policies and procedures to assist staff to meet resident`s needs and works cooperatively with health and social care professionals. Staff spoken to were able to demonstrate a good knowledge of the resident`s overall needs and preferences and how people were supported to meet these. What has improved since the last inspection? At the last key inspection nine requirements were made and we were pleased to see that these had all been complied with. The required improvements made were in the following areas: more detailed records of health care appointments, and the outcome of these, to assist staff more effectively monitor residents ongoing health care needs; providing a lockable space in residents bedrooms to assist them keep their property safe; repairs to an identified shower to maximise infection control and make the use of the shower more pleasant; to comply with current legislation regarding where smoking is permitted to promote the health of all the people that spend time in the home; to keep staffing levels under review to ensure that enough staff are on duty to meet residents changing needs; to improve documentation kept in the home regarding staff recruitment to be able to demonstrate robust protection for residents; to further develop the home`s quality assurance system to promote continual improvement in the quality of care residents receive and two health and safety issues to maximise protection for residents and others that spend time in the home. A good practice recommendation was also made regarding reviewing the space available in the home and how it is used to better meet the needs of residents. This recommendation had been acted upon. What the care home could do better: Two requirements are made at this inspection. The first is to further develop information about people`s individual needs and aspirations regarding equalities and diversity to assist staff to meet people`s aspirations and needs in a more individualised way. The second requirement is to maximise protection for residents by making sure there is a more robust audit trail regarding any recent changes in their prescribed medication. Two good practice recommendations are also made. One is to refer to the Commission`s recently published equality and diversity prompts to further assist the home in meeting people`s individual aspirations and needs. The second is for key workers to regularly reinforce with residents the importance of attending dental appointments and good mouth care as an effective way of maintaining good health generally. CARE HOME ADULTS 18-65 Hartwood Lodge 14 Bushwood Leytonstone London E11 3AY Lead Inspector Peter Illes Unannounced Inspection 23rd July 2008 09:30 Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hartwood Lodge Address 14 Bushwood Leytonstone London E11 3AY 020 8518 8988 020 8532 9842 manager.hartwoodlodge@careuk.com 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) Care UK Mental Health Partnership Limited (Arc Healthcare Limited) Karlene Yvonne Palmer Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 17 10th January 2008 Date of last inspection Brief Description of the Service: Hartwood Lodge is a private care home owned by Care UK and is registered to provide care and support to seventeen adults with mental health needs. The home is a large converted three storey residential property. The ground floor comprises: the home’s dining room; main lounge; small quiet room; five residents’ bedrooms; bath/ shower and toilet facilities; kitchen; kitchenette for residents; laundry; medication room; main office and entrance hall. The first floor contains eight bedrooms and bath/ shower and toilet facilities and the second floor contains four bedrooms and bath/ toilet facilities. All the bedrooms are for single occupancy and contain a wash hand basin. The home also has a pleasant rear garden with two storage sheds and a paved front garden used for car parking. The area is well served by public transport and the home is within walking distance of shops and other community resources. A stated aim of the home is to promote and encourage each individual to achieve his/her level of independent functioning, leading to independence in daily life. At the time of the inspection, the weekly fee was from £650 per week depending on the person’s assessed need. The provider makes information available about the service, including inspection reports, to people living in the home and to other stakeholders on request. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection took approximately seven half hours with the registered manager being available to assist throughout. There were eleven people accommodated at the time of the inspection, three of whom had been admitted since the last key inspection, and six vacancies. The inspection was undertaken by the lead inspector although terms such as “we”, “our” and “us” are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. The inspection activity included: meeting and speaking with the majority of people living in the home including seven independently; discussion with three care staff, two of them independently; detailed discussion with the registered manager; and independent discussion by telephone with two Community Psychiatric Nurses (CPN’s), who have had contact with the home since the last key inspection. Further information was obtained from: an Annual Quality Assurance Assessment (AQAA) submitted by the home to the Commission prior to the inspection, returned questionnaires including from residents and health and social care professionals that we had sent out prior to this inspection, a tour of the premises and documentation kept at the home. What the service does well: The registered manager and her staff continue to work hard to review and further develop the service offered to residents, some of whom have complex needs. Residents spoken to independently told us the home is “one of the best places I have been to” and another said, “I feel happy and quiet safe”. The home has a range of up to date policies and procedures to assist staff to meet resident’s needs and works cooperatively with health and social care professionals. Staff spoken to were able to demonstrate a good knowledge of the residents overall needs and preferences and how people were supported to meet these. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Two requirements are made at this inspection. The first is to further develop information about people’s individual needs and aspirations regarding equalities and diversity to assist staff to meet people’s aspirations and needs in a more individualised way. The second requirement is to maximise protection for residents by making sure there is a more robust audit trail regarding any recent changes in their prescribed medication. Two good practice recommendations are also made. One is to refer to the Commission’s recently published equality and diversity prompts to further assist the home in meeting people’s individual aspirations and needs. The second is for key workers to regularly reinforce with residents the importance of attending dental appointments and good mouth care as an effective way of maintaining good health generally. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 7 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. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Up to date information is available to prospective residents and other interested people to make an informed choice about living in the home. People’s needs and preferences are properly assessed when they are referred to make sure that the home can meet these although further attention is needed in detailing people’s needs and preferences regarding equalities and diversity. People’s needs and preferences are reviewed on a regular basis once they are living in the home to assist staff to be aware of any changes in these. EVIDENCE: The home has a satisfactory and up to date statement of purpose and service user guide that were seen. In the annual quality assurance assessment (AQAA) that was sent to us since the last inspection in states that the home has introduced a more comprehensive information pack for prospective and existing residents that includes the home’s service user guide. It goes on to state that all residents have been offered an information pack to keep in their rooms if they would like that. The registered manager and residents spoken to during this inspection confirmed this. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 10 Three new residents have been admitted to the home since the last key inspection and the files for two of them were inspected. The assessment information available to the home was generally comprehensive, detailed and assisted the registered manager in making a decision as to whether the home could meet the person’s needs or not. The two files showed that a preadmission assessment had been undertaken by the home by visiting the person where they were living before being admitted. There was evidence that the two people had been able to visit the home, including having overnight stays if appropriate, as part of the admission process. One of these people spoken to independently told us that the home was “One of the best places I have been to”. We also spoke independently by phone to a Community Psychiatric Nurse (CPN) who had placed one of the two people at the home. She stated that she was pleased with the way the admission process had worked for her client. The CPN stated that the registered manager had attended Care Planning Approach (CPA) meetings, which are multi-disciplinary meetings of health and social care professionals involved with the person, before the person moved from where they were living previously. The CPN also confirmed that the person had been invited to visit the home and have overnight stays before moving into the home. The CPN went on to say that she was really very happy with the home. The files inspected also contained a range of assessment information from health and social care professionals that were available to the home before the admission. This included specialist reports from healthcare professionals including psychology, occupational therapy and nursing reports as well as Care Planning Approach (CPA) documentation that gave a multi-disciplinary perspective of the person’s current needs. The home’s own assessment format was clear and included sections regarding the person’s needs and preferences including in relation to their gender, religion, and sexuality. However, the information seen regarding some of these areas was not always comprehensive, and did not show how the individual may wish to be supported with these needs and preferences. The Commission has recently developed a range of prompts to assist providers in raising the profile of equalities and diversity for people that use registered services. This guidance is available on the Commission’s website for providers, “CSCI Professional”. A requirement is made regarding making information about equalities and diversity in people’s assessment and care planning documentation more comprehensive. A good practice recommendation is also made that to assist with this the home refers to the Commission’s equality and diversity prompts that can be found on the Commission’s website. The files of two other residents, who had lived in the home for a number of years, were also inspected and showed that their needs and preferences continued to be reviewed on a regular basis. This included by health and social care professionals and by the home’s managers and key workers, to allow staff to properly address residents changing needs. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are consulted when their needs are assessed and both people’s needs and preferences are recorded in their care plans to assist staff in meeting these. However, further attention is needed in identifying how people can be further assisted in meeting their needs and preferences regarding equalities and diversity. Staff are working hard to support people in maximising their independence and to make as many decisions as possible for themselves. People are also supported to take appropriate risks in their daily lives to assist them in safely achieving their aspirations. EVIDENCE: The care plans for four residents were inspected. These all contained a list of the resident’s individual needs that reflected current assessment information and included clear guidance for staff in how to help the person meet these. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 12 Staff spoken to were able to discuss individual residents needs in detail and how staff tried to address these with the person. The care plans for two residents that had been admitted since the last section contained sections on that person’s needs regarding settling in to their new home. Another person’s care plan was seen to include a new section that had been added to their care plan when a new health need was identified and gave guidance to staff regarding this. The plans also identified a range of issues relating to how people were to be supported in the wider community. These included areas of strengths that needed to be further developed as well as identified areas of potential vulnerability that the person needed assistance with. There was evidence that the people living in the home are being encouraged to be involved in their care planning process including by the person signing the care plan or else a note being entered on the plan to indicate that the person had refused to sign. People living in the home spoken to independently indicated that they had been involved, or given the opportunity to be involved, in drawing up their care plans. As indicated in the Choice of Home section of this report the Commission is keen to assist providers further in helping them to identify people’s individual needs and preferences regarding equality and diversity and how to address these more systematically. The care plans inspected did record some needs and preferences for individual residents with examples including: how an individual was supported to attend their preferred place of worship; how another resident was being supported to attend a specialist day service that assists the person in meeting their cultural needs and preferences and detailed guidance on assisting another resident with their direct personal care. However, our judgement is that both residents and staff would benefit further by more comprehensive and detailed information and guidance on meeting residents’ needs in these areas. As stated in the Choice of Home section of this report a requirement is made at this inspection regarding making information about equalities and diversity in people’s assessment and care planning documentation more comprehensive. A good practice recommendation is also made that to assist with this the home refers to the Commission’s equality and diversity guidance that can be found on the Commission’s website. The staff are trying very hard to engage with residents about decisions relating to their daily lives, including through regular key worker sessions. The home holds residents meetings each month to encourage residents to express their views on the running of the home and minutes of these meetings showed that residents were invited to express their opinions and preferences regarding such areas as their choice of meals and suggestions for activities/ outings. Key policies such as the concerns and complaints policy are also reinforced at most meetings. Many residents appeared reluctant to participate in decision making about the home although evidence from records sampled and from discussion with staff showed that the home continues to engage residents regarding this. All four files inspected contained up to date risk assessments that recorded identified risks that had been identified for the individual. The risk assessments Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 13 identified each individual risk and contained a risk management plan to address the risk. Risk assessments were being reviewed regularly with evidence that the resident had been involved in the process. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home continue to receive support and encouragement to take part in a range of activities including within the wider community. They also enjoy contact with relatives and friends to the extent that they wish. People are supported to enjoy healthy and nutritious meals that they enjoy. EVIDENCE: The residents living at the home have Freedom Passes to assist them travel on public transport. The majority of people are able to access the local community independently with some being able to travel further a field on their own. Where a resident does need staff support to access the community this is identified in their care plan and risk assessment. One person currently attends the Waltham Forest Black People’s Mental Health Association day service and Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 15 the home has also referred one of the new residents to that service as well. Evidence was seen from records inspected and from talking to staff and residents that staff are working hard to try to motivate people to take part in structured daytime activities although were having variable success in this. Following consultation with residents the home had set up a weekly activity programme that includes indoor games, keep fit, swimming, cinema, pool/ snooker and keep fit. One person is currently supported to attend church when they wish to attend . The registered manager stated that the staff rota was managed to facilitate residents’ activities but went on to say that on the day attendance by residents on many of these activities ranged from limited to non-existent. The home has purchased a pool/ snooker table since the last inspection and we were informed that this was quite popular although was not seen being used during the inspection. We were informed that the weekly keep fit session was also popular and two residents spoken to independently told us they really enjoyed this. Evidence was seen from residents’ meetings minutes and from case files that residents are regularly consulted on activities they might like to try. An example of this was that minutes of a recent residents’ meeting showed that options for a day’s outing had been discussed and following this an outing to Southend had been arranged for the day following this inspection. However, at this inspection only three residents had confirmed they wanted to go with the majority of the others, including several spoken to independently, saying they would rather not go on the trip. Despite the above the registered manager stated in the annual quality assurance assessment (AQAA) that their has been some progress in assisting residents take part in activities of their choice and that the home intended to build on this progress during the coming year. Residents are from different ethnic minority communities and records indicated that their cultural needs and preferences were recorded and acted upon by the home to the extent that those individuals wanted. However, it is our view that this can now be built upon further and a requirement is made in the Choice of Home and Individual Needs and Choices sections of this report to further develop the focus on promoting equality and diversity issues within the home. People living in the home who were spoken to independently indicate that staff respected them. One person told us that “Staff are good to me” and staff were seen interacting with residents in an appropriately friendly and relaxed manner throughout the inspection. Evidence was seen that the majority of people living at the home have contact with relatives and friends ranging from weekly to annual contact depending on the wishes of the individuals involved. Evidence was also seen that, where appropriate, residents were also supported in maintaining and developing personal relationships. This included supporting individuals in helping keep themselves safe and in minimising the risk of exploitation by others. The home’s statement of purpose indicates that the home operates an open visiting policy and people spoken to confirmed that visitors were made welcome. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 16 The home has a menu that contained a range of healthy meals with choices; evidence was seen that the menu continues to be developed in consultation with residents. The home works hard to try to help residents become more independent regarding cooking and has a resident’s kitchen to facilitate this. The registered manager stated that some residents had requested cooked breakfasts and were being supported to prepare these themselves. One of the new residents has their own supply of maize flour and other ingredients to cook meals that meet their own cultural preference. At the last inspection a requirement was made that the fridge in the residents kitchen was maintained at the correct temperature. The fridge had been replaced following that inspection and a range of satisfactory health and safety records were seen relating to food and food storage. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The personal support needs of people living in the home continue to be reviewed to ensure that staff can assist in meeting any changing needs in this area. People are also supported in meeting their physical, mental and emotional healthcare needs, including by accessing relevant health care professionals. The medication administration procedures within the home safeguard people living there although any changes in prescribed must be clearly documented when this change occurs. EVIDENCE: The majority of people living at the home can manage their personal care without staff assistance although some may need verbal prompts on occasion. A few people need more direct staff assistance and where this is the case guidance regarding the assistance they need, and the way they prefer it to be provided, is documented in their care plans. Evidence was seen in an identified person’s care plan that the home is continuing to review the person’s Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 18 health and personal care needs with the relevant placing authority and healthcare professionals. This is to ensure that the person’s ongoing needs in these areas can continue to be properly managed and to identify any more appropriate alternative placement that may meet the person’s specific needs more effectively. The home continues to work in cooperation with mental health services and this assists in keeping people well. We spoke independently by phone to a Community Psychiatric Nurse (CPN) from the local Mental Health Trust. He told us that he assisted in supporting some of the residents that had lived at the home for a number of years. He stated that the current registered manager and her staff asked his opinion on relevant issues regarding residents’ mental health needs and followed his advice. All the residents are registered with a GP and evidence seen of appointments being made and kept. At the last inspection a requirement was made that a clear record was kept of all healthcare appointments that residents attend or are offered, including a summary of the outcome of the appointments attended, to assist staff be more proactive in monitoring and addressing peoples’ ongoing health care needs. At this inspection we were pleased to see satisfactory records of appointments with health care professionals on the files inspected. The records showed both a summary of appointments the person had attended and also the outcome of the appointment and any follow up action that the home was required to take as a result of that appointment. The records of appointments seen included with mental health specialists, district nurses, general hospital outpatient departments, GP’s, dentist and optician. It was noted on some people’s records that they had been offered an appointment with a dentist but had declined to attend. One person spoken to independently stated that they just did not like attending dentists. A good practice recommendation is made that key workers should regularly reinforce with residents in key worker sessions the importance of attending dental appointments and of proper mouth care as an effective way of maintaining good health generally. The home had a satisfactory medication policy that was seen to have been reviewed in November 2007. The home also continues to display a range of information leaflets in the lounge regarding medication frequently prescribed to assist people with their mental health needs. Medication was satisfactorily stored in a medication cupboard although the registered manager stated that the home was considering purchasing a medication trolley. This was to make the storage and handling of medication easier and more effective for staff. To assist with this we referred the registered manager to recent guidance, published on the Commission’s web site, regarding changes to regulations about the safe storage of medication in care homes. This guidance also relates changed regulations relating to the storage of controlled drugs although we were informed that no one living at the home was currently being prescribed controlled drugs. Medication and medication administration record (MAR) charts were inspected for three people living in the home and these were generally current and satisfactory. However, the mental health Home Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 19 Treatment Team had recently increased a prescribed medication for one person although this was not clearly documented on the person’s MAR chart. Although staff were clear that the person continued to receive the correctly prescribed medication there was not a robust audit trail to evidence this as the change, and when it was made, was not clearly documented. A requirement is made regarding this. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are able to express their views and concerns and have these acted on appropriately. The home’s safeguarding adults policy and procedures assist in protecting people from abuse. EVIDENCE: The home has a satisfactory complaints policy and procedure that was seen as well as a pictorial summary of the procedure displayed in the lounge and in the dining room. Evidence was seen in the record of residents meetings that the complaints procedure, and people’s understanding of how this worked was regularly reinforced in the meetings. The record of complaints received by the home was inspected and showed two complaints/ concerns recorded since the last inspection. The record also indicated that these had been properly dealt with. People spoken to during the inspection indicated that they felt comfortable raising any concerns or complaints with staff and that these would be appropriately dealt with. The Commission has received no complaints about the home since the last inspection. However, a concern was received by the L.B. of Waltham Forest about the alleged anti-social behaviour of people with mental health needs in the area that the home is situated in. The Commission passed this on to a number of registered homes situated in the general area including Hartwood Lodge. We were pleased to see that the registered Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 21 manager and her staff took this seriously at the time although no evidence came to light that the concern was related to residents at Hartwood Lodge. The home was seen to have a copy of the latest safeguarding adults policy for L.B. of Waltham Forest, the local authority the home is situated in. The home also had an in-house safeguarding adults policy, which referred to the local authority policy, and which had been reviewed in 2007. Evidence was seen that staff had undertaken training in safeguarding adults and staff spoken to were able to explain the actions that need to take place should an allegation or disclosure of abuse be made to them. One resident stated, “I feel happy here and quiet safe”. There have been no allegations or disclosures of abuse made to the home or to the Commission since the last key inspection. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 & 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is comfortable, satisfactorily decorated and maintained and that meets their current needs. People who live, work and visit the home benefit from the building being kept clean and tidy. EVIDENCE: The home is a large converted three storey residential property. The ground floor comprises: the home’s dining room; main lounge; small quiet room; five residents’ bedrooms, four of them grouped in a separate unit; bath/ shower and toilet facilities; kitchen; kitchenette for residents; laundry; medication room; main office and entrance hall. The first floor contains eight bedrooms and bath/ shower and toilet facilities and the second floor contains four bedrooms and bath/ toilet facilities. All the bedrooms are for single occupancy Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 23 and contain a wash hand basin. The home also has a pleasant rear garden with two storage sheds and a paved front garden used for car parking. At the last key inspection three requirements were made in relation to the physical environment. These were: that each resident has a lockable space within their bedroom in order to assist keep their property safe; that grouting and sealant was replaced in an identified first floor shower room, to maximise protection to residents and to provide a more pleasant environment to shower in and that the home fully complies with current legislation regarding smoking within registered care homes. We were pleased to see that all three requirements had been complied with. Each person had a lockable chest of drawers in their room as well as the option of a key to their room and the identified shower had been refurbished. The home has now implemented a smoking ban throughout the home with those residents that smoke being asked to do so outside. The registered manager stated that staff had spent a lot of time assisting those residents that smoke to comply with this and that residents are now generally accepting of these arrangements. We undertook a tour of the building and noted that it was comfortable, reasonably decorated and generally met the needs of the existing residents. The annual quality assurance assessment (AQAA) stated that new furniture and furnishings had been purchased in the past year and identified flooring replaced. It also states that an ongoing programme of redecoration is to be implemented over the coming year, including residents’ bedrooms. Some residents’ bedrooms were seen during this inspection although most residents told us they did not want their rooms looked at. Those bedrooms seen were adequately decorated, satisfactorily furnished and personalised. Residents that did not want us to see their rooms told us they were happy with them and indicated that they had the furniture and other fittings that they needed. The home has a maintenance person and the registered manager stated that items that were identified as needing maintenance were dealt with in a timely way. At the last inspection a good practice recommendation was made that the use of the existing (communal and other) spaces in the home were reviewed to better meet the needs of the residents. This was because it was judged that there was limited communal space to undertake different therapeutic activities, especially as and when the number of residents increased. The registered manager stated that this had been acted upon although she went on to say that no major structural changes to the building were being considered by the provider organisation at this time. The home was clean and tidy during the inspection. The home had suitable laundry facilities and an infection control policy that had been reviewed and reissued by the provider organisation in September 2007. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A staff team with a range of qualifications and competencies and that is deployed in sufficient numbers, support people living in the home. The home’s recruitment policy assists in protecting people living in the home. People are supported by staff who have access to a range of appropriate training. Staff also receive formal supervision to assist in meeting the needs of people living in the home and in their own personal development. EVIDENCE: At the last inspection a requirement was made that the staffing ratio at the home was kept under review and the home must be able to demonstrate that enough staff are deployed at the home at all times to meet the assessed needs of all residents as and when the number of residents increases. This requirement was made as nine people were living at the home at the time leaving eight vacancies and to reinforce that when vacancies were filled the home could demonstrate people’s needs could be met. We judged that this Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 25 requirement was being met. At this inspection staff were deployed as follows: three care staff on the morning and afternoon shifts, one of whom is either a senior or designated shift leader and two waking night staff. The registered manager is in addition to the rota as is the deputy manager post although the deputy post was vacant at the time; we were told that the post was in the process of being recruited to. The home also employs a maintenance person and cleaner, both full time equivalent. Eleven people were living at the home at this inspection and the current staffing ratio was judged as being sufficient to meet those people’s current needs. The registered manager stated that the rota could be flexible to meet specific needs of residents such as for arranged appointments or for outings from the home. We were told in the home’s AQAA that only bank staff, as opposed to agency staff, are used to cover vacancies including sickness and annual leave. All of the care staff employed at the home have either achieved the national vocational qualification (NVQ) level 2 in care or are working towards this. The registered manager stated that three staff had also achieved NVQ level 3 in care. Records sampled and staff spoken to independently showed evidence of this. Although the home’s recruitment procedures were judged to be generally robust at the last inspection a requirement was made at that time that a record was kept in the home to evidence that the provider organisation has included a protection of vulnerable adults (POVA) clearance with the criminal records bureau (CRB) check undertaken before a member of staff starts work in the home. This was to demonstrate proper protection to residents was being implemented in this area. The requirement was being complied with and satisfactory documentary evidence of this was seen for existing staff at this inspection. No new staff have been recruited to the home since the last inspection although we were told that recruitment to identified vacant posts was underway. The home has a clear rolling staff-training programme that was seen. Evidence from the staff training matrix and from staff spoken to independently showed that regular staff training continues and included the following training that had been undertaken since the last key inspection: infection control, fire safety, food hygiene and health and safety. The training matrix allows managers to plan for when staff need refresher training in core subjects. A supervision plan with dates for monthly supervision for all staff was seen at this inspection. The registered manager confirmed that this was up to date and staff spoken to confirmed that they received individual supervision and that they found this useful. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from the home being effective managed and their views are sought regarding the quality of life they experience. Health and safety procedures assist in protecting people living at the home, staff and visitors. EVIDENCE: The registered manager has been in post now for approximately eighteen months and, with her staff team, continues to work hard to improve the quality of life for residents in the home. The registered manager is a registered nurse, is currently completing her Registered Managers Award and has a range of experience in management and of meeting peoples mental health needs. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 27 Discussion with both individual staff and residents indicated that she is competent, approachable and interested in them. At the last inspection a requirement was restated that external stakeholders are included in the ongoing review of the quality of the service and that this is reflected in the home’s development plans. Evidence was seen that this requirement was being complied with. The home had sent out satisfaction surveys to residents, staff and health and social care professionals in March 2008. Feedback from these were sampled and seen to be generally positive. The registered manager stated that feedback would be included in the home’s aims and objectives for the coming year. We also sent out questionnaires to residents and health and social care professionals prior to this inspection. Feedback was generally positive, one social care professional stated, “The home works well with social workers”. As well as satisfaction surveys the home also monitors the quality of care at the home through residents meetings, staff meetings, key worker sessions and in-house provider evaluations by the provider organisation. The provider organisation also undertakes regular monitoring visits to the home and has revised the format of the reports of these visits since the last inspection. This is to make the reports clearer and more useful to the home. A range of the above documentation was sampled and judged to be satisfactory. At the last inspection a requirement was made that identified outstanding work to the home’s electrical installation was completed by a person competent to do so, that a satisfactory electrical installation certificate was obtained by the home and that a copy of the certificate was sent to the Commission to evidence the electrical installation in the home is satisfactory. The requirement was made to promote the health and safety for all in the home. This requirement had been complied with and a copy of a current certificate was sent to us soon after the last inspection. At this inspection a range of other satisfactory health and safety documentation was seen. This included: a gas safety certificate, portable appliance test certificate and evidence that the home’s water storage system had been checked to minimise the risk of legionella. The home’s fire log was inspected and showed a current fire risk assessment, that the fire fighting equipment had been serviced, weekly safety checks on fire equipment were being carried and that fire drills were being undertaken every three months. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 YA2 YA6 Regulation 14 & 15 Requirement The registered persons must ensure that people’s needs and aspirations in regards to their gender, sexuality, culture and religion, are clearly documented in the home’s assessment and care planning documentation, including sensitive guidance for staff on how to address these. This requirement is made to further assist the home in meeting people’s individual aspirations and needs. The registered persons must ensure there is a clear audit trail in place at all times to document any changes to residents’ prescribed medication in order to minimise the possibility of staff making mistakes when administering medication. Timescale for action 30/09/08 2. YA20 13(2) 15/08/08 Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA2 YA6 2. YA19 Good Practice Recommendations The home should refer to the Commission’s recently published equality and diversity prompts to further assist the home in meeting people’s individual aspirations and needs. Key workers should regularly reinforce with residents in key worker sessions the importance of attending dental appointments and of proper mouth care as an effective way of maintaining good health generally. Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 31 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 Hartwood Lodge DS0000007249.V368472.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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