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Inspection on 02/10/08 for Lodge Hill (167)

Also see our care home review for Lodge Hill (167) for more information

This is the latest available inspection report for this service, carried out on 2nd October 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a welcoming and friendly atmosphere in the home, which is reflected in the experience and comments of other visitors to the home. The staff are good at helping the residents. There is good help provided by health care professionals such as psychology, GPs, dentist, and community nurse, and there are plans for involvement from chiropody and a speech and language specialists to improve the care provided. Citizen`s advocacy provides residents with help to speak up and make decisions. Relationships with family and friends are encouraged. Staff are enthusiastic about working at the home, and help residents to go out very regularly to shops, day centres and other activities. The staff are calm in their response to challenging situations and provide very specialist support in helping some residents in eating their meals. The staff support the residents to shop and cook meals that they like, and are very sensitive and helpful in the way the provide support. There are good written care plans and guidance for staff describing how to best support each resident, and staff show that they understand these. The home is warm and homely, the residents have been involved in decoration of their own rooms, which are well maintained. The home is clean and everything works well.

What has improved since the last inspection?

Each resident has a life plan in place, which shows their life experiences, relatives and important people, and things they would like to do. Residents care plans are now reviewed six monthly by the home, and medication is well managed. Staff training and supervision information has been improved and staff now are receiving a good level of training which helps them to best support residents. The home now has improved the ways in which they ask residents and their families about how the home is run, and where improvements could be made. (However more work is needed to continue to do this well, see "What they could do better") Night staff are now involved in fire drills so that they can better protect residents.

What the care home could do better:

The home must make sure that they ask social services for a full care assessment for each resident, and request that social services and other health care professionals be involved in annual care reviews. This will help make sure that residents get the support they need. Resident`s contracts must be completed fully and agreed in writing so that they will know their rights and the cost of their care and support. A number of important guidelines for how to support some residents in eating, using transport and health care support must be reviewed so that staff can be sure of how to help residents. Risk assessments reviews have improved but must be reviewed at least every six months to make sure that residents are always safely supported. All important areas where residents need support must be clearly written in their care plans so that staff will be able to easily know where to find information they need to support residents. Information about who is responsible for resident`s finances must be made clearer and written into residents care plans and explained to them. Important sections of residents are plans must be also written in a way that residents can more easily understand them, for example by using larger writing, pictures or symbols. A visitor who will check that the home is well managed must always visit the home monthly.The home must include resident`s views in the plans for improving the home and tell residents or their families about these plans.

CARE HOME ADULTS 18-65 Lodge Hill (167) 167 Lodge Hill Abbeywood London SE2 0AS Lead Inspector Sean Healy Unannounced Inspection 2 October 2008 10:00 nd Lodge Hill (167) DS0000036908.V373711.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 Lodge Hill (167) DS0000036908.V373711.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. Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lodge Hill (167) Address 167 Lodge Hill Abbeywood London SE2 0AS 020 8310 9534 020 8311 1139 feizalglo@yahoo.co.uk 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) Greenwich Council Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories 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. Learning disability - Code LD The maximum number of service users who can be accommodated is: 6 26th September 2006 Date of last inspection Brief Description of the Service: 167 Lodge Hill is a modern chalet style building situated in the grounds of the former Goldie Leigh Hospital, close to the facilities of Welling and Bexleyheath. There are six single bedrooms for residents with physical and severe learning disabilities. The accommodation is arranged on one floor with a large sitting room/ diner, a large kitchen and level access to a small garden at the rear of the house. The home has its own mini bus to facilitate outings and other appointments for service users. The home is run by Greenwich Living Options part of the London Borough of Greenwich Social Services provision. Twentyfour hour care is provided by care staff and this is supplemented by regular daily visiting by District Nurses to provide peg feeding to two service users requiring this intervention. Residents are provided with a good level of activities and all attend local day centres on a four or five day basis. Most residents attend a day service for up to four days a week. Information about the services provided is made available to current and potential residents in the homes Statement of Purpose and Service Users Guide. The recent CSCI report is currently referred to in the home’s Statement of Purpose, and a copy is kept in the manager’s office. This was last reviewed in October 2007. The manager agreed to make the CSCI report available to residents in a more public area of the home. At 2nd October 2008, the homes fees for support are paid for by the Greenwich Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 5 local authority. The individual costs for support for each resident is not yet recorded in information given to residents. (Refer to Requirement Standard 5) Each individual resident pays £36.76 per week for food costs. Residents have to pay for other personal expenses such as hairdressing, transport and personal shopping. The provider’s email address is: rebecca.wilde@greenwich.gov.uk Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality Rating for this service is 2 Star. This means that the people who use this service experience good quality outcomes. The inspection was unannounced and was conducted over one day on 2/10/08. It ended on 10/10/08 following receipt of further information requested. It was facilitated by the acting care manager, who was efficient in providing all of the information needed for the inspection. The inspection included discussion with one resident, and observations of staff helping three other residents. One support staff was also interviewed. The inspection also included a tour of the premises and examination of three residents’ files, three staff files, and recruitment records and maintenance records. What the service does well: What has improved since the last inspection? Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 7 Each resident has a life plan in place, which shows their life experiences, relatives and important people, and things they would like to do. Residents care plans are now reviewed six monthly by the home, and medication is well managed. Staff training and supervision information has been improved and staff now are receiving a good level of training which helps them to best support residents. The home now has improved the ways in which they ask residents and their families about how the home is run, and where improvements could be made. (However more work is needed to continue to do this well, see “What they could do better”) Night staff are now involved in fire drills so that they can better protect residents. What they could do better: The home must make sure that they ask social services for a full care assessment for each resident, and request that social services and other health care professionals be involved in annual care reviews. This will help make sure that residents get the support they need. Resident’s contracts must be completed fully and agreed in writing so that they will know their rights and the cost of their care and support. A number of important guidelines for how to support some residents in eating, using transport and health care support must be reviewed so that staff can be sure of how to help residents. Risk assessments reviews have improved but must be reviewed at least every six months to make sure that residents are always safely supported. All important areas where residents need support must be clearly written in their care plans so that staff will be able to easily know where to find information they need to support residents. Information about who is responsible for resident’s finances must be made clearer and written into residents care plans and explained to them. Important sections of residents are plans must be also written in a way that residents can more easily understand them, for example by using larger writing, pictures or symbols. A visitor who will check that the home is well managed must always visit the home monthly. Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 8 The home must include resident’s views in the plans for improving the home and tell residents or their families about these plans. 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. Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 9 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 Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 10 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 and 5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. All of the information is available to help residents make a choice about whether to live at the home. Adequate information about care and support needs are have not been provided by social services. Residents do not have completed written contracts explaining their rights and the cost of the service provided. EVIDENCE: The home has produced a Statement of Purpose and a Service Users Guide, (called a Tenants Guide), which provide all the necessary information to help people decide whether they want to live there. These documents set out the aims, objectives and philosophy of the home. They are clearly written, and were reviewed in December 2007. The information includes the purpose of the home, the facilities, description of the accommodation, number of rooms, manager and staff qualifications, and the summary of the complaints procedure. The home facilitates introductory visits by prospective residents, and organises overnight visits to help residents decide whether they like the accommodation. These documents are clearly written and the section about how to make complaints is written using pictures so that it can be more easily understood. Given that all of the residents have learning disabilities it is recommended that these documents be reproduced in a shorter accessible format using pictures or symbols. (Refer to Recommendation YA1) Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 11 There are no complete social services care assessments in place for five of the six residents. The home had completed it’s own assessments and transferred these into care plans for each resident. All of these residents have been placed by Greenwich local authority, and all have very high support needs regarding learning disability with a number having high physical disabilities support required. There is currently relatively little involvement from social services in participating in residents reviews, and the homes management were not clear about who in social services is responsible for carrying out these reviews for each resident. The manager explained that they have been trying to establish this information but that social services have not yet provided this information. The homes management must make a request in writing, from Greenwich social services, clarification as to who in social services is responsible for carrying out annual care reviews, and request their participation in the next annual care review. The homes management must also request that a complete formal assessment of care needs be provided by them to the homes management for each of the residents. (Refer to two Requirements YA2) The landlords Hyde Housing on moving in to the home provided all of the residents with tenancy agreements. However not all residents have signed their tenancy agreements and these agreements did not refer to costs such as cost of support, food, transport. There are more complete contracts being finalised and these must be completed and agreed/signed by residents or their representatives. (Refer to Requirement YA5) Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 12 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 and 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The resident’s needs may not be adequately reflected in individual care plans due to lack of involvement in care reviews from other care professionals. The residents are fully supported to make important decisions about their lives. Risk assessments do adequately protect residents and staff but need more frequent review. EVIDENCE: The home provides specialised support for people with Learning disabilities some of who also have high physical disabilities. The management and staff are experienced in providing this care, and the staff training regarding moving and handling and specialist feeding systems for some residents is good. Person centred planning is now a part of the homes planning system and the home has ensured that staff are trained in how to use a specialised feeding system to also give medication so that a number of residents are able to go out and go on holidays more easily. Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 13 The home has a good system for care planning which is linked to individual residents needs assessments. Care plans are being initially set up with each resident quickly after moving into the home, identifying objectives and review dates. I examined three residents’ care planning files and each was well written. Care plans clearly described the support specifically needed by each resident, and show how best to support the resident with the use of risk assessments and written guidance for staff. They also show where residents are independent and should be allowed to do things for themselves. This enables the staff to provide support only where it is necessary and to help residents to be more independent. All of the residents have learning disability support needs, some of which are very complex and require a very good understanding of how the person communicates through non-verbal means, high levels of personal care support and specialised support in eating for two residents. Each resident has a well written “Life Support Plan”, which is in fact a person centred plan describing who each resident is and includes their skills, abilities and personal things they would like to achieve. These documents are not yet fully complete. There was a requirement made at the last inspection for the home to review care plans for residents at least every six months. This is now being done. Generally care plans are now being reviewed every six months with the last reviews having taken place in August and September 2008. However these reviews did not involve health care professionals who are involved with resident’s care, and important elements of the care plans have not been recorded as reviewed in some time involving other relevant health care professionals. For example guidelines for supporting some residents in: “Chewing food”, “Using Transport”, “Managing Epilepsy”, while there has been regular input from healthcare professionals who visit the home, the written guidelines, which are regarded as still relevant, were last recorded as reviewed in 2003 and 2005. The home must ensure that care reviews include involvement from relevant other care professionals at least annually, and that important written guidance is also reviewed as part of the six monthly care plan review process. (Refer to Requirement YA6) A number of residents use bedside rails to prevent falling out of bed at night. It is recommended that the current agreement for the use of bedside rails be formally reviewed in the next care review meeting involving the relevant health and social care professionals, and included in each subsequent care review. (Refer to Recommendation YA6) The homes manager confirmed that currently all of the resident’s finances and benefits are managed the Greenwich local authority. However it is not clear who in the local authority is responsible for this function. This means that the residents do not know who to contact regarding any queries they may have, Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 14 and that there is not a formal written record of agreement for this on file for each resident. The homes management must request of Greenwich social services, in writing, that this be clarified for each individual resident for who they have responsibility, and a record of this be kept on each residents file, and residents and their representatives be informed. Subsequently the home must seek formal agreement from each resident and their representatives. (Refer to Requirement YA7) A number of residents need support in understanding in signing their contracts with the home and in participating in the home surveys. It is recommended that the home request advocacy support in providing this service. (Refer to Recommendation YA7) There are a range of relevant risk assessments on each residents file, which help to protect them. Some of these include risk regarding: wandering off, tripping, eating, pressure sores, use of bedside rails, challenging behaviour management of epilepsy and using transport. There was a requirement made at the last inspection for the risk assessments to be reviewed regularly. This has now been met as there is now an annual review taking place. With last reviews of these having taken place towards the end of 2007. However risk assessments must be reviewed as and when necessary and at least every six months as part of the care review process. (Refer to Requirement YA9) Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents have opportunities for personal development, and are able to take part in age/peer and culturally appropriate activities. They are part of their local community, and are supported to have relationships. Resident’s rights are respected, and good meals are provided. EVIDENCE: Care files of three residents showed that opportunities are being made available for the personal development of residents. Daily records showed that staff do work well and creatively to involve residents in the daily running of the home, in order to foster their abilities as much as possible. Activities plans and records for residents show the following activities being provided : Attending a day centre four days a week for many residents where they have long established relationships with other attendees and with staff, eating out, going to the theatre three to four times a year, going to the “beautiful octopus” social club, shopping, bowling and sometimes boat trips on the Thames. Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 16 The residents know other residents of a neighbouring home which is run by the same provider and although walking in the local community is difficult due to living on a very busy road, which doesn’t have a footpath, there is transport easily available which is constantly used. There are now more drivers employed, and the dependency on using day centres for activities is decreasing, with a view to more person centred activities for residents. Staff actively support and encourage family contact for the residents who have family. Advocacy support from Mencap is available and the home has now agreed advocacy support for some residents. The home has decided with the residents to reduce the number of days at the day centre for residents and to avail of Direct Payments to fund other more meaningful activities for residents, which may provide better opportunities to make friends and develop other relationships. This seems a good approach and fits nicely into the philosophy of person centred planning, and may provide residents with better opportunities for doing activities they prefer. Food is bought from local shops and there was a good supply of fresh fruit and vegetables in the kitchen. The menu was varied and nutritious and the food eaten by each resident was recorded in their daily diary. The manager described how over time staff had got to know what residents liked and staff comments showed that residents seem to enjoy their food. Some residents have specialist support needed when eating and this has been considered in their care plan and staff have adequate training and guidance in how to provide this support. Lodge Hill (167) DS0000036908.V373711.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 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Respectful and sensitive support is provided for residents regarding personal care, health and emotional needs. Residents are supported to retain administration of their medication and medication is well managed. EVIDENCE: All residents have a comprehensive personal care plan, which has been completed following a personal care assessment when they first moved in to the home. Personal care needs are included as part of the homes assessment and review process, and is used to make a judgment as to whether the home can provide the personal care support needed. Three residents files showed that these plans include information for staff about how to maintain independence for residents, while allowing them to do things for themselves when possible. The residents need personal care support of varying levels; six need support in bathing and dressing, five of these having a physical disability. Personal care plans are very detailed and are supported by risk assessments and guidance for staff in how to provide personal care while maintaining residents independence. And number of residents have very high moving in handling support needs and all staff are trained and experience in doing this. Providing the support includes using the specialised equipments such as hoists Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 18 and tracking devices in bedrooms and bathrooms. All of the staff spoken to were clearly able to describe the guidance in how to provide support for two of these residents. The home manages resident’s health care needs well with the involvement of a broad range of healthcare professionals including GPs. There is a high level of involvement from a variety of health care professionals who visit the home, and there is good written guidance in place such as moving and handling and eating. While this affords good monitoring of how staff provide the support, these professionals are not routinely involved in care reviews and should be. The review of guidance for staff in the provision of personal care is not currently reviewed every six months with the rest of the care plan. The home needs to ensure that this happens and that any necessary changes are made following these reviews. (Refer to two Requirement made under Standard 6 of this report) The manager said that the home plans to develop closer working relationships with healthcare professionals to overcome any physical barriers for residents who have mobility support needs, and to access use of a hydrotherapy pool for some residents. Improving communications for residents is also a stated objective of the home. There was a requirement made at the last inspection for the date when liquid medication is opened be recorded and that the fridge containing medication have its temperature routinely checked and recorded. This is now happening and this requirement is met. The majority of residents use prescribed medication for a range of issues such as epilepsy, digestion of food, and behavioural management. There is good recording and storage of prescribed medication and all of the staff have been trained in medication administration. The homes management have shown that they support staff in providing this support and can also intervene when appropriate management of medication is not happening. However the home does not ensure that GPs are involved in regular review of medication, and GPs currently are not involved in reviewing medication annually. The home must ensure that GPs are prompted to review each resident’s medication at least annually as a matter of routine and not only as a result of concerns or medication changes. (Refer to Requirement YA20) Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 19 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 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents feel their views are listened to and acted on appropriately, and that they are protected from abuse, neglect and self-harm. EVIDENCE: The home has a complaints policy in place, which was last reviewed in December 2007. This policy is clearly written, and shows responsibilities of the provider and the home staff in relation to dealing with complaints. This complaints policy is available in the home on the notice board, and is also clearly summarised in the homes Statement of Purpose. A section of this policy is provided in a user-friendly format, using pictures and symbols in order to residents might better understand what it says. There have been no complaints received since last inspection. There was one written compliment recorded from a hospital nurse complimenting the manager in which staff provided support to a resident who had been admitted. There is the local authority adult protection policy available at the home, which was last reviewed in 2006. All of these staff interviewed were able to clearly say how they would deal with complaints and how they would report of the protection allegations should the need arise. The management reports concerns to social services and to CSCI efficiently and take appropriate action to protect residents. This was shown by the manner in which two incidents were reported to social services and to CSCI and in how the home involved social services and the police to protect Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 20 resident’s rights and interests. There was one adult protection issue reported concerning a resident who had sustained a fractured leg the cause of which was unexplained. Social services were notified and involved in overseeing the investigation of what had happened. A second adult protection issue concerned a resident hitting two other residents. This was also reported and managed efficiently. Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 21 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): 24,27 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is homely, comfortable and safe and is kept very clean and well maintained. Toilet and bathrooms are designed to meet resident’s needs and specialist equipment is provided. EVIDENCE: There was a requirement made at the last inspection for the home to make various repairs to a bathroom and kitchen. This has now been done and this requirement is met. Since the last inspection the home has been redecorated and the garden has been improved to facilitate wheelchair users. The home is comfortable and homely and all areas are safe. All residents have their own bedrooms. They are well furnished and resident’s bedrooms are personalised. There are six single bedrooms for residents with physical and severe learning disabilities. The accommodation is arranged on one floor with a large sitting room/ diner, a large kitchen and level access to a small garden at the rear of the house. Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 22 While the home is situated away from easy access to shops and high Street facilities, the staff and management are effective in ensuring that residents get out to use these facilities very regularly. The building is owned by Hyde Housing Association who is responsible for it’s upkeep and renewal. The home is now almost due to have a five-year refurbishment programme carried out, but the home was not yet made aware of the extent of the work planned. Currently there is a need for some redecoration in the sleep-in room and lounge, and both the shower room and bathroom need updating. (Refer to Recommendations YA24/27) Currently the toilet available to residents is reported to be regularly very busy at peak times causing some residents to have to wait. Staff and the manager agree that there is a need for another toilet to be provided. The home should discuss this further with the housing association as part of the intended refurbishment plans. (Refer to Recommendation YA27) There are weekly health and safety checks carried out by the management in the home, and there is very good management of continence, so that there are no unwanted odours. A sluice washing machine is used for washing soiled materials, and staff have a daily checklist for ensuring that cleaning has been done. The home is maintained to a good level of hygiene and cleanliness. Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 23 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): 32,33,34,35 and 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are supported by competent and qualified staff, and are protected by the homes recruitment policy and practices. Staff are well supervised and supported by the homes management, but annual performance appraisals need to be carried out. EVIDENCE: The staff team consists of a manager, a deputy manager and 13 others support workers, nine of whom are female and four are men. Care staff are experienced and well trained in working with people with people with learning disabilities. Almost all of the care staff are qualified to NVQ level 2/3. There are at least two staff on each shift during the daytime with two night waking staff providing support at night. There are normally three staff available in the afternoon and evening. There is also a separate management on call support system to provide backup support if needed, and emergency support is also available from a nearby home also managed by the registered provider. At the time of the inspection there were three staff vacancies, one of which was the deputy managers post. Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 24 It is recommended that this post be recruited to ensure robust management support. (Refer to Recommendation YA33) Discussion with the home’s management and staff suggest that residents and staff would be better supported if at least two of the three staff vacancies were recruited to. (Refer to Recommendation YA33) The staff and the manager were very knowledgeable about the individual needs of residents, and work sensitively in communicating with residents some of whom have limited verbal communications skills. All staff undergo comprehensive induction and there are excellent records maintained of this induction, which are signed by the supervisees. The home’s induction and training programme is comprehensive and meets the requirements of Skills for Care and the learning disabilities quality framework. The staff I spoke to said they had been fully inducted and that they receive very good opportunities for training. The information in staff files supported this. It was my observation from the care plans, and from how staff relate to residents, that they are able to work well to meet their care needs. Examination of three staff files showed that excellent recruitment processes are in place and are being consistently applied. Very good records are being kept about staff recruitment including health and police checks, references, and checks on gaps in employment history. These are well organised, enabling the management of the home to make sure that everything is in place properly before staff begin employment. There was a requirement made at the last inspection for the home to ensure that each member of staff have a training and development assessment profile, and an overarching staff team training plan. This is now met, as there was information available about the training each member of staff had done and a training plan showing training coming up with each member of staff included. However it is recommended that staff training histories and their training plan be kept together as one document individually for each member of staff rather in order to more easily facilitate continuous monitoring in future, and that their training be linked to a clearly written training profile showing the training needed to effectively work at the home. (Refer to Recommendation YA35) There is a good standard of training offered to staff, and the registered provider coordinates training. More specialised training such as medication, health and safety, fire safety, first aid, and moving in handling are contracted in from trained professionals. Training needs of staff are identified at annual appraisal and through supervision. Staff induction training includes: learning disability support, medication, moving and handling, fire prevention, protection of vulnerable adults, first aid, food hygiene, health and safety, death dying and Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 25 bereavement, and the organisations policies and procedures. Given the support needs of a number of residents it is recommended that the home include skills teaching training and more in depth challenging needs training in the training schedule for staff. (Refer to Recommendation YA35) The homes manager provides formal supervision for staff, and examination of three care staff files showed that staff are receiving consistent formal supervision regarding their work, residents care and support needs, training and development, and employment issues. However annual appraisals are not currently being consistently done. This was evident from the files examined and the manager said she intends to address this. (Refer to Requirement YA36) Lodge Hill (167) DS0000036908.V373711.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 and 42 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home is well managed by a qualified manager who receives good support from the registered provider. Resident’s views are not yet fully included in the homes system for quality assurance and planning. The home and registered provider promotes the health and safety of residents and staff. EVIDENCE: There was a requirement made at the last inspection for the manager at that time to register with CSCI. This was done and this requirement was met. The home has undergone a lot of change in staffing and management since the last inspection but this has been well managed. The staff team is now stable and the management is active in ensuring that staff are well supervised, and that there are also important other developments taking place at the home. The current manager is in post since June 2008, with the previous manager having Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 27 been promoted now providing supervisory support to the manager. The recently appointed manager is very experienced and has the necessary NVQ4 qualification. Staff members interviewed stated that she is approachable and supportive and would not hesitate to discuss any concerns about the home or the welfare of service users with her. Communication within the home was of a good standard with team meetings held regularly and the manager, overall, complies with the requirements of Standard 37. The manager has undertaken training in order to update her own skills and knowledge. The manager does need to apply to CSCI to become the Registered Manager, as soon as practicable. (Refer to Requirement YA37) The home now carries out annual surveys of residents, staff, and professionals views on how the home is managed. There were two surveys carried out since the last inspection, but the results of these surveys are not being published for residents and their families. The manager commented that there was a poor response to these surveys. So it is difficult for them to fully understand the meaning of the surveys or to know what the outcome and action will be. The home must publish the results of the resident’s surveys results in a format that is understandable to residents, and ensure that they are given feedback in a way that they best understand. These must also be included in a development plan for the home. (Refer to Requirement YA39) There was a requirement made at the last inspection to ensure that night staff be involved in at least two fire drills per year and this is now being done. The home takes the management of health and safety very seriously and is able to show that there is a high standard of checks and balances in place for making the home safe. There is a health and safety policy in place including a fire safety risk assessment, which was reviewed in May 2007. The fire alarm is tested weekly and records are consistently kept. Fire evacuation drills are done quarterly on there is a clear understanding of how to support residents including where to take them to within the building during the course of a fire drill. Staff interviewed were able to clearly describe the arrangements for supporting people during a fire evacuation drill. The kitchen is well maintained and kept very clean. The portable appliance tests were normally carried out annually but this years checks were 3 months overdue. The home’s gas, and electrical, and hoist maintenance certificates are up-to-date, but a copy of the current 5 year electrical certificate was not available at the home. This must be kept at the home for inspection and portable appliance tests must be brought up to date. (Refer to Requirement YA42) Manual Handling, fire, infection control and food hygiene training is provided for all staff. The hoists used and specially adapted beds and bath are serviced every 6 months. However clear information about the servicing of wheelchairs Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 28 was not available. The home must check who is responsible for the servicing of wheelchairs and ensure that this is included in health and safety checks within the home and records kept of this. (Refer to Requirement YA42) Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 29 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 2 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 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 2 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 3 2 X 3 X 2 X X 3 X Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 30 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 14.2 Requirement Timescale for action 28/02/09 2 YA2 14.1 a&b 3 YA5 5 The registered provider and manager must make a request, in writing, to Greenwich social services, for clarification as to who is responsible for carrying out residents annual care reviews, and request their participation in the next annual care review for all residents placed by them. This is to ensure that the home is providing appropriate care and support and that resident’s welfare is protected. The registered provider and 31/03/09 manager must make a request, in writing, to Greenwich social services, for complete formal assessments of care needs to be provided by them for each of the residents placed by them at the home. This is to ensure that the home is providing appropriate care and support and that resident’s welfare is protected. The registered provider and 30/04/09 manager must ensure that all residents are provided with up to date contracts/statements of terms and conditions DS0000036908.V373711.R01.S.doc Version 5.2 Lodge Hill (167) Page 31 4 YA6 15.c 5 YA7 12.3 12.3 6 YA9 15 (2) & 17 (3) 7 YA20 13.1 agreed/signed by them or their representatives, so that they are aware of their rights and obligations. The home must ensure that residents care reviews include involvement from relevant other health care professionals at least annually, and that important written guidance be reviewed as discussed in this report. This is to ensure that the best and most appropriate care is provided. The registered provider and manager must request in writing of Greenwich social services, clarification as to who in social services is responsible for residents finances managed by them. A record of this must be kept on each residents file, and residents and their representatives must be informed. Subsequently the home must seek formal agreement on this from each resident and their representatives. This is in order to protect resident’s financial interests and welfare. The registered provider and manager must ensure that risk assessments be reviewed as and when necessary and at least every six months as part of the care review process. This is to ensure that residents and staff are best protected from risk of harm. The registered provider and manager must ensure that GPs are prompted to review each residents medication on a regular basis, at least annually, as a matter of routine and not only as a result of concerns arising or medication changes. This is to ensure that prescribed DS0000036908.V373711.R01.S.doc 30/06/09 30/06/09 30/06/09 31/03/09 Lodge Hill (167) Version 5.2 Page 32 8 YA36 18.2 9 YA37 9 10 YA39 24 11 YA42 23.2 12 YA42 23.2 c medication is appropriate and current The registered provider and manager must ensure that annual performance appraisals are consistently done for each member of staff and that a record of this is kept on their personal files. This is in order to ensure that they have an opportunity for involvement in planning for their individual training and development The Registered Provider must ensure that the home’s manager submits a completed application to register with the Commission for Social Care and Inspection. This is in order to comply with the Care Standards Act 2000 for registered homes The registered provider and manager must publish the results of the resident’s surveys in a format that is most easily understood by residents, and ensure that they are given feedback in a way that they best understand. Appropriate matters arising from surveys must also be included in a development plan for the home. The registered provider and manager must ensure that the 5-year electrical certificate be available at the home for inspection. This is to demonstrate that the homes electrical wiring is safe. The registered provider and manager must check who is responsible for the servicing of wheelchairs and ensure that this is included in health and safety checks within the home, and records kept of this. This is to ensure that wheelchair users are kept safe DS0000036908.V373711.R01.S.doc 31/03/09 31/03/09 30/06/09 31/01/09 31/01/09 Lodge Hill (167) Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA1 YA6 Good Practice Recommendations The registered provider and manager should reproduce the home Statement of Purpose and Service Users Guide in a shorter accessible format using pictures or symbols. For each resident who uses them the registered provider and manager should formally review the current agreement for the use of bedside rails, involving the relevant health and social care professionals, and include such reviews in each subsequent care review meeting. The registered provider and manager should request advocacy support in supporting some residents to understand and sign their contracts, and in participating in the home surveys. The registered provider and manager should address the redecorations and refurbishments as outlined in this report. Currently there is a need for some redecoration in the sleep-in room and lounge, and both the shower room and bathroom need updating. The registered provider and manager should explore any options available for providing an additional toilet in the home. Currently the toilet available to residents is reported to be regularly very busy at peak times causing some residents to have to wait. The registered provider and manager should recruit to the vacant assistant managers post to ensure robust management support for the home. The registered provider and manager should recruit to two of the three care staff vacancies The registered provider and manager should ensure that staff training histories and their training plans be kept together as one document individually for each member of staff, in order to more easily facilitate continuous monitoring in future, and that their training be linked to a clearly written training profile for the home showing the training needed to effectively work at the home. The registered provider and manager should include skills teaching training and more in depth challenging needs training in the training schedule for staff. DS0000036908.V373711.R01.S.doc Version 5.2 Page 34 3 YA7 4 YA24 YA27 5 YA27 6 7 8 YA33 YA33 YA35 9 YA35 Lodge Hill (167) 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 Lodge Hill (167) DS0000036908.V373711.R01.S.doc Version 5.2 Page 35 - 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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