Inspection on 13/05/08 for Nickleby Lodge (Welcome House)

This is the latest available inspection report for this service, carried out on 13th May 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Nickleby Lodge (Welcome House) 22/06/06

Nickleby Lodge (Welcome House) 22/02/06

Nickleby Lodge (Welcome House) 29/11/05

Nickleby Lodge (Welcome House) 16/06/04

Nickleby Lodge (Welcome House) 23/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Nickleby Lodge (Welcome House) 32 The Close Rochester Kent ME1 1SD Lead Inspector Joseph Harris Key Unannounced Inspection 13th May 2008 10:00 Nickleby Lodge (Welcome House) DS0000028989.V363344.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 Nickleby Lodge (Welcome House) DS0000028989.V363344.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. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nickleby Lodge (Welcome House) Address 32 The Close Rochester Kent ME1 1SD 01634 843372 01634 827481 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) Dr Toqeer Aslam Manager post vacant Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th June 2007 Brief Description of the Service: Nickleby Lodge (the Home) is registered to provide accommodation and personal care services for up to 10 adults (service users), who have difficulties with managing aspects of their mental health. The premises are a three-storey property which has been modernised and adapted for its present use. There is provision for six of the service users to have their own bedroom. The remaining four people are accommodated in two shared occupancy bedrooms. All of the bedrooms have a private wash hand basin. The property is located in a quiet residential street and it is within normal walking distance of various shops. The Home is owned and operated by Welcome House. This is a private company which operates a number of similar residential care services in the general area. The Responsible Individual is Dr Aslam. The Registered Provider supplies information to prospective service users through a variety of routes. These include the provision of a Service Users’ Guide. This is a brochure which outlines the principal features of the facilities and services available in the Home. Also, the Registered Provider ensures that a copy of the most recent Inspection Report from the Commission is available for reference in the Home if requested. The Registered Provider has informed the Commission that the current fee it charges for residence in Nickleby Lodge is £580.00 per week. Nickleby Lodge (Welcome House) DS0000028989.V363344.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 process culminated in a site visit to the home on 13th May 2008. The site visit commenced at approximately 10am and concluded at 3.30pm, lasting for around 5.5 hours. During the course of the visit a tour of the premises was undertaken and discussions were held with the registered manager, staff members and service users. A range of documentation was examined relating to the residents, staff, medication, health and safety and the day-to-day running of the home. What the service does well: What has improved since the last inspection? Following the appointment of a new manager for the service significant strides forward have been made in the provision of support for service users and record keeping. Care plans and risk assessments have improved providing clearer guidance for staff and are linked to assessment information. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 6 Training issues have also been addressed in the main with the organisation now using external providers for the majority of mandatory training backed up by induction videos, processes and competency assessments. Staff have also received training in medication issues and adult protection topics. Restrictions on the liberty of some residents have now been tightened and where these restrictions are in the best interests of the individual they are discussed within the multi-disciplinary team and with the service user themselves. Recruitment processes have also been strengthened. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. The needs and aspirations of prospective service users are assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 2 individual service user’s files were examined during the site visit, one of which related to a relatively recently admitted service user. The home gathers pertinent information from the health and social care professionals including Care Programme Approach (CPA) care plans and risk assessments. Prospective service users are invited to visit the home and also have the opportunity for longer stays including overnight visits. An in-house assessment of needs linked to the CPA documentation is completed. The pre-admission assessments are used to inform the care plan. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 9 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 good. The needs and risks for service users are assessed. Residents have the right to make decisions affecting their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 2 individual service user plans were examined. It was evident that the new manager of the home has worked to improve the quality and depth of resident’s support plans. A sufficiently detailed plan of care had been developed in both cases that is linked to the needs assessments. The manager was advised to consider developing the support plans around activities of daily living, putting into place short and long-term goals enabling residents to work towards greater independence using measurable targets and steps. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 10 The organisation has developed risk management protocols, which the home adheres to. This includes a preliminary and detailed risk assessment where a high or medium risk is identified. The manager was advised to ensure that guidance to minimise risks are clear and unambiguous and that the detailed risk management plans address individual areas of risk. Refer to recommendation 1. Residents are supported to make decisions affecting their day-to-day lives. Where restrictions are in place these are discussed with relevant professionals and the service user to ensure that they are in the best interests of the individual. Where a financial appointee is required this is managed independently from the home. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 11 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 and 17. Quality in this outcome area is good. Service users have a lifestyle that meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of residents are able to access community resources and local facilities independently. There has been an increase in staffing hours throughout the week to ensure greater flexibility enabling residents who require support to be accompanied by a member of care staff. It was reported by the manager that there are reasonable community mental health resources including a day centre and drop-in centres. One resident continues to do voluntary work and some other residents attend college courses. Service users spoken to said that they are happy with the level of activities available in and out of the home. One person said, “I like to keep Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 12 busy. I go shopping and into the town most days. I also help out around the house.” Visitors are welcomed into the home and there is sufficient space in the house for people to meet in private should they wish to do so. Residents are involved in the planning of menus and assist with aspects of food preparation. Menus are discussed regularly at resident meetings and choices are offered at mealtime. Service users stated that quality of food is good and confirmed that if they don’t like what is on the menu staff are happy to prepare an alternative. Menu records are maintained and suitable food stocks were available. The kitchen is domestic in size with all equipment in good working order. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 13 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 and 20. Quality in this outcome area is good. Service users receive personal support in the way they prefer and their healthcare needs are met. Suitable medication systems are in place to ensure safe administration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of service users are self-caring with regard to personal support and hygiene and may require encouragement to maintain this aspect of their needs. Service user plans adequately address personal care issues where higher levels of assistance are required. Residents confirmed that they are able to care for their own personal care needs and that staff are respectful when providing any input or assistance. The home maintains good healthcare records encouraging professionals to write up their visits to the home where possible. The manager was advised to ensure the information documented in healthcare records clearly states the actions and changes for the staff team to be aware of. However, in the Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 14 individual files examined this had been satisfactorily completed. The inspector was able to talk to a visiting Community Psychiatric Nurse (CPN) who had only positive comments about the home. She stated that her client had recently gone through a difficult time, but that the staff in the home had supported the residents well and liaised with the community mental health team. Evidence was available to demonstrate that residents maintain their physical and complimentary health needs through visits to the GP, optician and dentist, etc. There are policies and procedures relating to medication issues and the home maintains administration records to a good standard including MAR sheets and records of medication returned or destroyed. All staff have receive suitable medication training and also undergo an in-house competency assessment. The home does not have the facility to store controlled drugs. No controlled drugs are in use and the storage facilities are adequate for the needs of the home. Some service users, following assessment, have been supported to work towards self-administration of medication. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 15 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. Service user’s views are listened to and they are protected from forms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints process in place, a copy of which is on display and provide to each service user when they move into the home. Residents stated that they would feel comfortable raising any issues with staff in the home or senior managers who visit the service. However none of the service users spoken to relayed any concerns about the home. There have been no complaints since the last inspection, but a complaints book is maintained. The manager aims to deal with any issues on an informal basis in the first instance with recourse to formal processes if need be. All staff have attended training covering adult protection issues and the mental capacity act. Awareness and the recording and reporting of abuse are also covered through the induction process. Discussions were held with the manager and staff regarding the adult protection process all of whom demonstrated a good working knowledge of the issues and what to do if they suspected abuse occurring. Policies and procedures are in place and copies of key documentation including ‘No secrets’ and Kent and Medway adult protection protocols available in the office. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 16 There have been no safeguarding vulnerable adult alerts since the last inspection. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 17 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 and 30. Quality in this outcome area is good. The premises are homely and comfortable suitable for the individual and collective needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nickleby Lodge provides comfortable and homely accommodation for up to 10 service users with mental health problems. The home is bright, airy, spacious and free from offensive odours. There is a good range of communal space including a large lounge and dining room. There is a conservatory to the rear of the building that is currently used as a smoking room. The outside space is paved, but provides space for residents to sit outside should they wish to do so. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 18 The kitchen and laundry facilities are domestic in size and are suitable for the needs of the home. It was reported that the home meets the requirements of the fire and environmental health departments. There are 6 single bedrooms and two shared rooms. One resident who shares a room was spoken to and said that they are happy with the current arrangements. Suitable toilet and bathing facilities are available throughout the home. The manager stated that there are no maintenance issues that need addressing and that the organisation responds quickly to any maintenance requests. The home is in a good state of repair and decoration. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 19 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 and 35. Quality in this outcome area is good. Service users are supported by a competent and appropriately trained staff team in sufficient numbers. The organisation operates a thorough recruitment procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Training records were examined including the home’s training matrix and certificates of attendance held on file for 2 staff members. These records demonstrate that staff receive all required mandatory training, work through an induction programme and attend other courses specific to the needs of the home. The organisation is now providing training in the mandatory topics through recognised external training providers. It is advised that the fire safety training is also provided periodically through a recognised training provider. Refer to recommendation 2. The manager also uses in-house competency assessments in key topics such as medication, fire safety and adult abuse awareness. Over half of the staff team have achieved an NVQ level 2 or an equivalent qualification. In discussion Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 20 it was evident that staff have good principles of care and support and are aware of the needs of the service users. The organisation has increased staffing levels slightly since the last inspection providing an extra 4 staffing hours per day. This ensures that there is now greater flexibility in staffing and enables service users to be supported at home and in the community if required. 2 staff files were examined both of which contained all required information including two written references, evidence of CRB and POVA register checks. It was noted that application form for employment only requests that the last 10 years of employment details are provided. This should be amended to a full employment history. Refer to recommendation 3. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 21 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. The home is well-run in the best interests of the service users. Health, safety and welfare issues are positively managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the resignation of the previous Registered Manager in January 2008 the current manager was appointed on an acting basis. She has worked in the care sector for a number of years having previously been a senior support worker. The manager role, it was acknowledged, was a significant step. However, with the benefit of support from senior managers in the organisation and other home managers she has made a promising start to this new role. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 22 She has already shown an ability to tackle priorities and has addressed the requirements and recommendations made from the previous inspection. Staff stated that she has developed a good rapport with staff and service users alike and has a relaxed and inclusive management style. She has now enrolled on her Registered Manager’s Award/NVQ4. It is advised that she is put forward for registration with the Commission for Social Care Inspection. Refer to recommendation 4. The organisation has developed good quality assurance processes. An operations director has been in post for a number of years and has consistently improved the quality monitoring systems that include monthly visits to home providing actions and timescales for issues to be addressed. The visits also canvass the opinions of service users and staff. Service user questionnaires are sent out on an annual basis and the results collated in a report that also help to inform the annual business plan. The manager is also responsible for a number of in-house audits covering health and safety issues amongst other things. The health, safety and welfare of service is promoted and protected. A range of documentation was examined including fire safety, environmental risk and accident records, all of which were well maintained and up to date. All required safety and service certificates were in place and in date such as electrical wiring and gas safety certificates. Policies and procedures are developed and reviewed covering safe working practices. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 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 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA9 YA34 YA35 YA37 Good Practice Recommendations To ensure that detailed risk assessments provide clear guidance and address single areas of perceived risk. To ensure a full employment history is gained prior to employing new staff. To provide fire safety training through a recognised training provider. The manager should be put forward for registration with the Commission for Social Care Inspection. Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Nickleby Lodge (Welcome House) DS0000028989.V363344.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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