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Inspection on 03/03/09 for The Lodge Trust

Also see our care home review for The Lodge Trust for more information

This is the latest available inspection report for this service, carried out on 3rd March 2009.

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.

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

The Lodge Trust continues to be well managed and provides care that is tailored to individual people.People are supported to live a fulfilling life, where their needs are assessed and care plans drawn up, with the emphasis on supporting the person`s abilities, in a safe and nurturing environment. The paperwork completed prior to people moving in includes that produced by Social Services, and also relies the Trusts` own assessment details, which provide a greater depth of knowledge and detail for this Service User group. People are offered a range of social and leisure activities that are arranged within the home and greater community. There is a homely and relaxed atmosphere throughout the community, which is backed up with specialised equipment to aid personal care. Staff and volunteers are recruited safely with a number of security checks being in place before starting work at the home.Care staff demonstrated a very good awareness of the people they care for, being able to give a good account of people`s individual needs.Staff are well trained with a number of routine courses being encouraged by the senior management. The home is safe and well maintained.Medication is administered properly and stored securely. Visits to the Doctor and specialist health staff being arranged on a regular basis.The staff continue to provide a good personalised service to the people in the home, and continue to develop the ongoing care and environment for their benefit.

What has improved since the last inspection?

The standard of accommodation has been increased with the building of three self contained bungalows which will provide three current residents with the benefit of independent living.The newly opened cafe provides a useful chance of a work placement as well as a useful introduction to the community of a useful amenity.

What the care home could do better:

Risk assessments could be better detailed and reviewed more regularly to ensure staff are fully aware of the risks involved in caring for people in the home.Risk AssesmentsSome policies and procedures have still to be produced; again this would assist the staff with required knowledge to ensure resident safety. To aid the accounting of medicines held by the home, a system could be developed where the number of tablets or capsules could be transferred to the incoming months records.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Lodge Trust Main Street Market Overton Rutland LE15 7PL two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Keith Williamson Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Information about the care home Name of care home: Address: The Lodge Trust Main Street Market Overton Rutland LE15 7PL 01572767234 01572767503 liz@lodgetrust.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Lodge Trust care home 25 Number of places (if applicable): Under 65 Over 65 25 1 learning disability Additional conditions: No further Service Users in the category of LD may be admitted when there is already a total of 25 Service Users accommodated in this Category. No further Service Users in the category of LD(E) may be admitted when there is already a total of 1 Service Users accommodated in this Category. Date of last inspection A bit about the care home The Lodge Trust is registered to accommodate up to twenty-five adults with learning disabilities. The Lodge Trust was established in 1984, and is an Evangelical Christian Community. Residents who choose to live at there make a decision to live by Christian principles. The Lodge Trusts ethos is to promote and support all residents who are able to work to be involved in communal work at the Lodge Trust or work in the local area. There are a number of areas the residents can participate in work experience; products are sold in the shop on site and in the newly built cafe. The community is based just outside Market Overton, a small village in Rutland, in 21 acres of rural countryside and six miles from the county town of Oakham. Accommodation is provided in three houses, each with its own kitchen, dining room and sitting areas. The houses are close to the workshops and garden areas. Bedrooms are located on the ground and first floors of each house and close to bath/shower and toilet facilities. Rooms in one of the houses all have ensuite facilities. A new building is currently under construction that will provide ground floor accommodation for three people on an independent living basis. The following fees were confirmed by the responsible individual as being current at the time of the inspection on March 2009: Fees start at £550.00 per week with additional charges made for those people assessed as requiring additional staff time. The fees include personal care, accommodation and meals. There are no additional charges for day services. Chiropody and hairdressing services can be arranged and are charged separately. Other costs would include clothing and toiletries. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The focus of inspections is on outcomes for Service Users and their views of the services provided. The main method of inspection used was case tracking which involves selecting a sample number of clients and tracking their care they received through talking with them, where possible and looking at their records and accommodation, in this case three Service Users were chosen. Time This visit took place over one day, commencing at 10.00am and took six and one half hours to complete. An opportunity was taken to talk with the Manager staff, look around the home, view records, policies and care plans. Information was also obtained from the Annual Quality Assurance Assessment, which gives information on the people living in the home and the staff group. Four staff were spoken with, and most residents were seen, and their interactions with the staff group observed. Information Good Service The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. What the care home does well The Lodge Trust continues to be well managed and provides care that is tailored to individual people. People are supported to live a fulfilling life, where their needs are assessed and care plans drawn up, with the emphasis on supporting the persons abilities, in a safe and nurturing environment. The paperwork completed prior to people moving in includes that produced by Social Services, and also relies the Trusts own assessment details, which provide a greater depth of knowledge and detail for this Service User group. People are offered a range of social and leisure activities that are arranged within the home and greater community. There is a homely and relaxed atmosphere throughout the community, which is backed up with specialised equipment to aid personal care. Staff and volunteers are recruited safely with a number of security checks being in place before starting work at the home. Care staff demonstrated a very good awareness of the people they care for, being able to give a good account of peoples individual needs. Staff are well trained with a number of routine courses being encouraged by the senior management. The home is safe and well maintained. Medication is administered properly and stored securely. Visits to the Doctor and specialist health staff being arranged on a regular basis. The staff continue to provide a good personalised service to the people in the home, and continue to develop the ongoing care and environment for their benefit. What has got better from the last inspection The standard of accommodation has been increased with the building of three self contained bungalows which will provide three current residents with the benefit of independent living. The newly opened cafe provides a useful chance of a work placement as well as a useful introduction to the community of a useful amenity. What the care home could do better Risk assessments could be better detailed and reviewed more regularly to ensure staff are fully aware of the risks involved in caring for people in the home. Risk Assesments Some policies and procedures have still to be produced; again this would assist the staff with required knowledge to ensure resident safety. To aid the accounting of medicines held by the home, a system could be developed where the number of tablets or capsules could be transferred to the incoming months records. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Keith Williamson CPCI Capital Park Fulbourn Cambridge CB21 5XE If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A detailed and individual assessment process ensures that residents needs are effectively met. Evidence: Assessment information is well detailed and contains information relating to the residents needs and abilities. This is important as this information forms the basis for any plan of care. Information for some older residents is being updated, and produced in a more person centred way. This is important as this then reflects peoples current abilities and personal detail in the assessment process. Assessment information includes documents from the persons placing authority. People are encouraged to come for a visit prior to any stay starting. These are arranged well in advance of any place being offered, and can be for as long as a week. This enables the person to make an informed choice, living with the group they would be placed with long term. Contracts are also in place, and these are important to signify the terms and conditions of persons stay. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a well informed staff group, backed up by detailed care and Person Centred Plans (PCPs). Evidence: Four peoples care was case tracked, this group was made up of people from various parts of the home. All the peoples care and Person Centred Plans (PCPs) were detailed with the plans promoting Independence and individual care. Information included in the plans promoted peoples safety, as all plans had risk assessments included. These covered some areas within the persons life, and could be expanded to provide staff with more detailed information. Decision making was covered with a questionnaire as to the likes and dislikes of the person. These and other documents were produced in a format, which the individual could understand, this enables people to understand and participate in changing information if or when required. This is good as it shows the staff communicate in many ways with the current resident group. Care and Person Centred plans are regularly updated and stored securely in the main office, near where Service Users live. This is important as it allows staff to access the correct information when required. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a good lifestyle, and are enabled to make positive choices to influence their chosen goals. Evidence: Care plans for people show that there is a development of their lifestyle including their leisure and social life. All files seen confirm that people have their education interlinked with their lifestyle, the Person Centred Plan (PCP) being used consistently as part of the development process. The community employs their own tutors and operate within the open college network. This provides people with meaningful educational qualifications as well as enabling peoples Independence. The staff have introduced wide choices of menus and assist in meal choices through the weekly group meetings, held in each area of the community. This enables small groups of people individual choices to be introduced into the meal choice system. People are encouraged to have a life outside the community, with evidence of regular trips out, for meals, trips to the pub and bowling. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well looked after in terms of personal support, health care and medication administration. Evidence: Personal support is individually detailed in both care and Person Centred Plans (PCPs). Some of the people spoken with, confirmed they have copies of their plan and are involved in the review process. This is where changes to the plan are agreed with the resident. Evidence was in place, for the regular monitoring of peoples health needs. Individual records of Service User visits to General Practitioners and other health care workers were noted on files. This is good as people can be assured the staff attempt to keep people as healthy as possible. Medication is well managed, though the risk assessments could be updated to include specific staff instruction on when to give as required medications. This would make this area of medicines more secure, and so safer for residents. All medicines are dispensed in bulk bottles, though currently there is no way to carry out an instant audit of these medicines. A bottle of indigestion medicine was being used for a person in the home. This was a prescribed medication that could also be bought over the counter. The manager indicated that this was not a recognised practice, and would not be repeated. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the policies, procedures and staff training and knowledge regarding information on complaints and safeguarding. Evidence: The complaint procedure is available in a number of formats that would enable people to complain if they wish. Residents spoken with were aware of whom to contact and speak with should they have any concerns. The complaint log was viewed, this detailed information about the complaints received by staff in the home. All those recorded were acted on appropriately, and were investigated within set timescales. Residents and staff showed an awareness of adult protection policies and protocols. An advocate assists individual residents and also attends the residents meetings. This is important as people can deal with issues personal to them on a confidential basis. Meetings are held periodically, with an agenda and minutes kept of the outcomes. Personal finances are all kept in a central office. Records were up to date with accurate money balances in place. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a comfortable and safe standard of accommodation. Evidence: People live in a homely, comfortable and clean environment. The staff continue to provide personalised and individual accommodation for people on a long stay basis with an emphasis on individual care. A programme for upgrading and replacing of worn out furniture and equipment is in place. Since the last inspection a number of improvements have taken place, with three self contained houses being available later this year. This shall provide a further degree of independence for three of the current residents at the home. Other areas that are planned to be upgraded are the cottage. Three residents bedrooms were viewed, and found to be personalised with electrical equipment. This is important as it adds to the homely feel of the home. People are aware of cross infection and cross contamination issues. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff files are stored securely in the main office; the appropriate recruitment and preemployment checks are in place so ensuring peoples safety in the home. The number of staff employed to work in the home is sufficient in meeting peoples assessed care needs. The recruitment process is rigorous enough to ensure peoples safety. Evidence: Staff are offered a structured programme of training opportunities commencing at the point of induction. Staff confirmed the wide range of subjects addressed during their induction. Many staff have completed the Learning Disabilities Award Framework (LDAF) training, which contributes towards a National Vocational Qualification. Staff spoken with on the day confirmed the extent of training offered to them, and stated that this was a two way process and the management staff would look at courses for staff, that they thought beneficial to the people living in the home. The rota was viewed. This showed a recording of those staff on duty throughout a 24hour period. People agreed that the staffing numbers were adequate to meet the needs of the current resident group. Staff are regularly supervised and also have regular appraisals. These meetings between staff and management form the basis for individual staff training and development. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people who live and work at the home. Evidence: The manager is registered, with the Commission for Social Care Inspection, is qualified and has a number of years experience in the caring field. A quality assurance system is in place with questionnaires circulated by the staff. The questions are compiled by the resident group, at the weekly meetings. The outcomes are made available to prospective residents. The Statement of Purpose and Service User Guide are available to people in a number formats, making them widely available people with an interest in the home. Further visits are undertaken by the board of trustees. These visits also form part of the Quality Assurance within the home, and further ensure that people are well cared for. The quality assurance system is further enhanced by the inclusion of an advocate who assists in the Service User meetings, so providing an independent voice to help influence procedures and development of the home. Fire records were examined for areas throughout the home; these indicated that suitable checks of fire safety equipments are being made on a regular basis. Risk assessments were viewed, some including pictorial information, again these are in place. Two staff members spoken with gave good verbal responses on how peoples care needs must be met, knowledge of Control of Substances Hazardous to Health (COSHH) and how to keep people safe in the home and free from infection. Policies and procedures that are in place are reviewed periodically. However a number of policies are not yet in place. This was highlighted at the last visit and urgent work is required to ensure these are put in place, and so ensure peoples safety. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Risk assessments could be more detailed, and reviewed on a regular basis. This would provide staff with detailed information to enable a safer caring environment. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 20 To aid the accounting of medicines held by the home, a system could be developed where the number of tablets or capsules could be transferred to the incoming months records. Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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