Inspection on 30/04/10 for Unique Lodge

This is the latest available inspection report for this service, carried out on 30th April 2010.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Unique Lodge 16/07/07

Unique Lodge 11/05/06

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Clovelly House Residential Home Ltd

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Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Unique Lodge 8 Llanthony Road Morden Surrey SM4 6DX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Emma Dove     Date: 3 0 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Unique Lodge 8 Llanthony Road Morden Surrey SM4 6DX 02086483871 02086483728 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Grace Aghoghovbia Name of registered manager (if applicable) Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Unique Lodge is registered with the Care Quality Commission to provide care and support for up to four people who have mental health problems. The home is located in a residential road in Morden and is in keeping with neighbouring homes. It is situated close to bus routes and local amenities in Morden and Sutton. Accommodation is provided over three floors and includes a lounge, kitchen/dining Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 4 0 8 0 7 2 0 0 9 Brief description of the care home area, bathroom and separate shower area. There is a paved area to the rear of the property. The home is staffed twenty-four hours a day. Information about the service is available in the Statement of Purpose and Service User Guide. Unique Lodge charges fees which range from £650 to £900 per week depending on individuals needs. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out over six and a half hours on the 30th April 2010. One inspector visited, spoke with people who use the service, staff and the manager and looked at records. Surveys were sent to people who use the service and staff. Four completed surveys were received and comments from these are included throughout this report. We received an annual quality assurance assessment from the manager. This gave us some good information about the service but could have included some more evidence of how they meeting peoples needs and details of the quality assurance systems. We looked at other information received from the service since the last inspection in July 2009. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home understands the importance of having sufficient information when choosing a care home. It has developed information that needs updating to reflect the services currently provided. We saw assessments completed before people moved in. Evidence: The service has developed a Statement of Purpose and Service Users Guide. These documents contain details about the services provided, the therapuetic support groups and the house programme. Details of the services provided indicate that there are five bedrooms for people who use the service. The home is currently registered to provide care and support to four people. The Statement of Purpose and Service Users Guide must be updated to reflect that the service is available to four people. There have been no new admissions since the last inspection when a recommendation was made for assessments to be more detailed. We looked at two case files and saw assessments completed before the person moved in. Care Homes for Adults (18-65 years) Page 9 of 25 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 who use the service are involved in planning and reviewing the care and support they receive and in making decisions about their future. Staff have developed care plans but they could still include more detail. Risk assessments are in place and should be more detailed. Evidence: We looked at two case files, they both contained initial assessments, care plans, a life picture of the individual, written goals, monthly reports and risk assessments. Case files contained evidence that people who use the service have been involved in developing and reviewing their care plan. One care plan included some detailed information about the individual but should be more specific about their religion. We saw the life picture in both case files to be quite brief and not include a photograph of the person. More work could be done to elaborate on people and places that are important to individuals. The service operates a key work system. People who use the service are aware who Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: their key worker is and said they meet with them and discuss their needs. We saw good notes of key work sessions, although these were not always held on a regular basis. Key workers write a monthly report, these are used to prepare for reviews. People who use the service told us they attend their reviews. We saw records confirming reviews are held regularly. Reports for reviews are very detailed and give a full picture of the individual and progress since the last meeting. Risk assessments are completed with people who use the service. These documents could contain more detail of actions staff should take to deal with any inappropiate behaviour and keep other people safe. Care Homes for Adults (18-65 years) Page 11 of 25 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. The service has a commitment to enabling people to develop their skills and could do more to evidence this. People have the opportunity to maintain important personal and family relationships. People are encouraged to be involved in the domestic routines and running of the home. We saw a varied menu which takes into account peoples preferences and any dietary requirements. Evidence: People who use the service told us they are encouraged to live independently and said they go out to places of their choice and said they can have visitors. We saw people go out in local area and to see friends, to play dominoes and scrabble with staff and spend time talking with staff during our visit. Staff told us one person goes out once a week to a local gym and one person likes to go on bus journeys. Staff feel they could improve the level of outings, saying they could do more day trips, Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: go out more in the community, take people away for a short holiday and find local activities to help people keep fit. People told us they enjoyed lunch and said the food is usually good. One person said staff support them with cooking although said this has not happened recently. We saw people sit around the kitchen table to eat their meals. At the last inspection there were concerns around the amount of money available each week for food. Staff and the manager confirmed that they now have more money to buy food every week. We saw sufficient food in the fridge, freezer and cupboards during our visit. Care Homes for Adults (18-65 years) Page 13 of 25 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 who use the service have access to appropriate health services and their health care needs are well met. There have been good improvements to medication management over the last nine months. Evidence: Case files contain details of individuals health needs. People who use the service told us staff are available to take them to appointments. Staff said people who use the service need minimal support with personal care and said they are available if and when required. People said staff provide support when required. We saw Medication Administration Record Sheets (MARS) up to date and signed by staff. MARS include a photograph of the individual. There is an appropriate policy and practices for medication when people are away from the home. Records show staff sign that they have read and understood the medication policy and completed training in medication administration. Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: One case file identified that the person did not want to discuss their wishes regarding terminal care and illness. It is good that staff are asking for this information and record when people do not wish to discuss this area of need. However they must ensure there is some information for staff in the event of an emergency to ensure the individuals wishes are known and can be met. Care Homes for Adults (18-65 years) Page 15 of 25 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. The service has a clear complaints procedure which is accessible to people who live there. Appropriate policies are in place for safeguarding and staff have completed training. Evidence: People who use the service told us they are aware how to make a complaint. One person told us about a complaint they had made and said they felt staff had listened and responded appropriately. The manager told us they have not received any complaints since the last inspection and confirmed she is aware of the information to be recorded and actions to take should they receive a complaint. The manager told us staff have completed training in safeguarding. We saw records confirming staff attendance at training sessions and staff told us they have completed training. Care Homes for Adults (18-65 years) Page 16 of 25 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. The home provides a physical environment that is appropriate for the people who currently live there, it is generally well maintained and kept at an adequate state of repair and redecoration. The home is generally clean. Evidence: Unique Lodge is a small home in a residential road in Morden. There are two single bedrooms, a lounge and kitchen with dining table on the ground floor, an office, staff room, one single bedroom and a shower and toilet on the first floor. The remaining single bedroom, bathroom and staff sleep in room are on the third floor. People who use the service have access to paved garden with a large shed used as a smoking room. At the last inspection the kitchen was being kept locked except around mealtimes. People who use the service did not raise this as an issue during our visit. We saw that the kitchen was open during our visit. People who use the service said they have all they need in their rooms. One person said the only thing missing is an ensuite. We saw all areas of the home to be generally clean. People who use the service told us the home looks very clean. Care Homes for Adults (18-65 years) Page 17 of 25 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 levels are sufficent to meet the needs of the people who use the service. Staff recruitment is in line with regulations to keep people safe. Staff have access to training and have regular supervision from the manager. Evidence: People who use the service told us staff look after them very well. We saw some good interactions between staff and people who use the service. Staff demonstrated good knowledge of peoples needs. The manager told us they have reviewed staff levels since the last inspection. One member of staff is on duty in the morning and the afternoon and there is now a member of staff on duty during the day. The manager is at the home five days a week. Staff feel they work well together to provide quality care. We looked at three staff files and they contained an application form, photograph and proof of the individuals identity, two written references and a Criminal Records Bureau check. Staff files contain details of training staff have attended. We saw staff have attended training in safeguarding, Mental Capacity Act, medication administration, mental Care Homes for Adults (18-65 years) Page 18 of 25 Evidence: health and alcohol and equalities and diversity. Staff said they have good training opportunities. The manager told us staff have monthly supervision. We saw details of supervision sessions in one staff file showing they had taken place every other month during the last year. Staff told us they have enough support to carry out their role. Care Homes for Adults (18-65 years) Page 19 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the experience needed to run the home but has failed to apply to register with the Care Quality Commission for three years. The annual quality assurance assessment was completed although it did not include relevant information in some sections. Some health and safety checks are not up to date. Evidence: The manager has been at the home for three years and has just started the process to register with the CQC. The annual quality assurance assessment was completed, although two sections did not contain relevant information with no evidence to support comments made. The manager told us that the owner visits once a month and is available for supervision and support when required. We saw staff team meetings are happening once a month with issues raised and reminders to staff about the importance of signing for medication and keeping records up to date. Care Homes for Adults (18-65 years) Page 20 of 25 Evidence: There is a monthly meeting for people who use the service, during this meeting people are given the opportunity to comment about the food and care they receive and reminders about keeping their rooms clean and the importance of attending appointments. There is still more work required to seek the views of people who use the service and their representatives about the quality of care and support received, to ensure their views can be used to develop the service. The insurance certificate displayed expired in 2008, the manager said they have received the renewal but did not have the new certificate. The insurance renewal indicated that the insurance was for a nursing or domiciliary care agency, the insurance must be for a care home. The weekly test of the fire alarm system was not completed in April 2010. This must be completed every week to ensure people who use the service and staff are safe. The portable electrical appliances were tested in April 2009, this test must be completed every year to ensure the health and safety of people who live there and staff is maintained. The gas safety was tested in February 2009 and this test must be completed annually to keep people safe. Care Homes for Adults (18-65 years) Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 The manager must register with the Care Quality Commission. This is to make sure that people who live there benefit from a well run home. 04/09/2009 Care Homes for Adults (18-65 years) Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 42 23 The fire alarm must be 25/06/2010 tested weekly, the gas safety must be checked annually and portable electrical appliances must be tested every year. This will ensure the health and safety of people who use the service and staff is maintained. 2 43 12 The insurance must be checked and a valid certificate of insurance be available for inspection. This will ensure the home is compliant with current regulations. 25/06/2010 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 1 The Statement of Purpose and Service Users Guide should Page 23 of 25 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations be reviewed and updated to ensure they contain correct details about the service for prospective and new people to use the service. 2 3 4 6 9 14 More detail could be included in care plans and life pictures to give staff details to help meet individuals needs. Risk assessments should include more detail of actions staff should take to ensure individuals are safe. People who use the service could have more opportunities to participate in community activities and go on holiday if they choose. This would ensure their social and leisure needs are fully met. Staff should try to get information from people who use the service or their representatives aboout their wishes regarding terminal care and end of life care, to ensure staff are aware of actions they must take. Further work is required to show how the quality assurance system is using the views of people who use the service and their representatives to improve and develop the service. 5 21 6 39 Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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