Inspection on 09/02/09 for Abbey Lodge Care Home

This inspection was carried out on 9th February 2009.

CSCI found this care home to be providing an Adequate 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

Similar services:

Chesham House

Argyll House

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Extracts from inspection reports are licensed from CQC, this page was updated on 19/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Abbey Lodge Care Home 3 Finch Lane Bushey Herts WD23 3AH     The quality rating for this care home is:   one star adequate service 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: Jeffrey Orange     Date: 0 9 0 2 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. 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. 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. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Abbey Lodge Care Home 3 Finch Lane Bushey Herts WD23 3AH 02084218174 02075381559 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Venus Healthcare Group Ltd Name of registered manager (if applicable) Miss Jacqueline Anne Spencer Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 7 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Abbey Lodge is a residential care home for younger adults with either a learning disability or a mental health disorder and provides both accommodation and care. The home is a newly refurbished and adapted building in a residential area of Bushey, close to the shopping and leisure facilities of Watford and within easy reach of good public transport services. Parking is available to the front of the home or on the road subject to local parking restrictions. Care Homes for Adults (18-65 years) Page 4 of 28 care home 7 Over 65 0 0 7 7 Brief description of the care home The home has been designed to provide domestic scale accommodation, with sensitive provision of any necessary adaptations. All bedrooms are ensuite and provide pleasant and spacious accommodation in each case. There are appropriate communal facilities, including a lounge and dining area, together with a large kitchen and laundry facility. The home has a large rear garden that includes a decked area accessible for people living in the home to sit out on. Current fee levels range from £700 to £1200(February 2009) depending on individual assessment of need. Each person living in the home has a contract that sets out what is included in the fee and what may be subject to additional charge. The home has a detailed service user guide and statement of purpose that include contact details for the Commission for Social Care Inspection (CSCI). Care Homes for Adults (18-65 years) Page 5 of 28 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 was the first key inspection of this service which was registered with the Commission for Social Care Inspection (CSCI) in June 2008. The inspection was carried out by one inspector over the course of one morning. When this report refers to we it recognises that it is written on behalf of the CSCI. Because of delays associated with ensuring the required permissions in respect of fire and other regulations to do with the premises were in place, the home did not become operational until January 2009 and at the time of this inspection, there was only one respite client living at the home. During the period between registration and becoming operational, the manager kept Care Homes for Adults (18-65 years) Page 6 of 28 the CSCI informed of progress. The home also submitted an annual quality assurance assessment or AQAA, which is a self-assessment document that would usually set out in detail how well care outcomes are being achieved for people living in the home together with some useful statistical information for example about staff training. The AQAA would also usually provide an opportunity for assessing progress over a period of up to a year and set out the homes assessment as to how their performance could be improved in the future. Due largely to the lack of information available, the AQAA was of limited use as it was only very partially completed. Whilst we were at the home we spoke to and observed the person living there for a period of respite and also spoke to the only member of care staff on duty. We had further useful discussions with the manager and were able to look at some key documents, including care plans, medication administration records and staffing details. Again, due to the short period of active operation of the home the documentation available was limited, there was for example only one medication record covering a period of two weeks. It is difficult under these circumstances to make other than a provisional and restricted judgement, until an inspection can take account of a more realistic and sustained period of activity and operation. 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 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. Care Homes for Adults (18-65 years) Page 8 of 28 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 9 of 28 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. People who are considering Abbey Lodge as a home for themselves or someone they are responsible for can be confident that before admission there will be a thorough assessment of their individual needs and an individual process of introduction to the home that should ensure that only those people whose needs can be met fully are admitted. Evidence: When we looked at the information that the home provide to people considering a move to Abbey Lodge, we found that it contains sufficient information about what they can expect to be provided, what facilities the home has and what the terms and conditions of their stay will be. This means that they should be able to make a reasonably well-informed decision about moving into the home. When we saw the pre-admission assessment for the current person living in the home, we found that it contained information received from the placing local authority and that the home had also done their own assessment of need and risk assessments to take account of specific factors affecting the care needs of the person concerned. This Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: should mean that only those people whose care needs have been fully assessed and can be appropriately met will be admitted. When we talked to the manager about the pre-admission assessment process, she made it clear that pre-admission visits to the home, to allow people to see where they might be living would always be encouraged and facilitated. When we spoke to a person currently living in the home they indicated that they were very happy. It is good here was one comment made. Care Homes for Adults (18-65 years) Page 11 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Based upon what we have seen so far people who live in Abbey Lodge can be confident that they will be encouraged and supported to control their lives to the greatest possible extent. This will be done within an individual framework of risk assessment that ensures that they can do so safely, recognising also the need for them to be able to take reasonable risks. Evidence: When we looked at the care plan for one person living in the home, we found that it included a reasonable level of detail although the manager told us that they had found it difficult to obtain as much additional information about the person from their placing authority as they would have liked. As the person living in the home had only recently moved in and was, at the time of the inspection the only person resident there, it was not possible to assess the standard of record keeping over a sustained period of greater activity within the home. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: The daily notes that we saw were however full and descriptive and gave a good record of what had taken place each day. As no-one has lived in the home long enough to warrant a routine review, we were not able to assess how robustly the review process will be in practice. We saw that the person living in the home was being asked by a member of the care staff team about the menu for the week and that his wishes were being acknowledged and acted upon wherever possible. We saw the person living in the home make use of the vacuum cleaner to clean some communal areas and we were told that they had also taken an active role in using the washing machine to clean their own clothes. We were also told that the person living in the home was an able cook and that they were being encouraged to shop for, prepare and cook their own meals. This suggests that the person living in the home is being enabled and encouraged to take part in the usual routines of daily living in the home and to maintain their daily living skills. The person living in the home told us they would be accompanied to Watford shopping, later in the day and there were appropriate risk assessments in place on the care plan file to ensure that independence is maintained within a risk-assessment framework to ensure safety. When we read the homes AQAA and spoke to the homes manager they indicated that the philosophy of the service is very much to build and maintain independent living skills wherever possible. It is not possible at this stage in the homes development to assess how consistently that very positive goal will be achieved when the service is operating at full capacity. Care Homes for Adults (18-65 years) Page 13 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Abbey Lodge can be assured that they will be assisted to maintain and develop relationships, skills and independence and to access community facilities in line with their own choices and preferences. Evidence: The AQAA tells us that Service users will be encouraged at every opportunity to develop skills and access community resources to enable them to live as independently as possible. Currently there is only one person receiving care for a period of respite and so we were not able to assess this outcome area on any sustained basis for a number of people. The home have attempted to provide appropriate activities in the community during the period of respite care for the person currently living in the home and have Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: managed to access some tai chi classes for them at a local facility. The person living in the home told us that they usually do drama at college, unfortunately it has not been possible, in the short term to access equivalent activities to those provided at their permanent home address as they are available locally only to permanent local residents. When we talked to the manager we were told that the service has a strong commitment to enabling people living there to develop their independent living skills and to actively seek to build skills and capability. The absence of any sustained evidence to support that statement, due to unexpected delays in commissioning the home following registration by the CSCI, means that it is difficult to assess if it has been achieved or not. However, what evidence has been seen, in respect of the current person receiving respite care in the home gives grounds for confidence that it can be. The person currently living in the home for a period of respite, goes shopping, determines their menu with guidance and is encouraged to do their own cooking, and some reasonable routine domestic tasks so as to maintain their independent living skills in what is a new environment and locality for them. Care Homes for Adults (18-65 years) Page 15 of 28 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 live in Abbey Lodge can be confident that they will be supported to access the health care services they require to maintain their health and well-being and that if they require assistance with their medication that this will be provided safely. Evidence: When we looked at the care plan for the only person currently living in the home we found that it contained details of any specific health and personal care issues and how they were to be addressed and their needs met. When we looked at the way that the home records and administers medication for the person living there we found that it was essentially sound and the single record that we could check was accurate. This suggests that provided the same standard of care and accuracy is maintained when the number of people receiving care is more demanding, people living in the home will be adequately protected by the homes medication practises. When we observed the interactions between the person living in the home, the care Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: worker on duty and the homes manager we found that they had a relaxed and comfortable relationship and that the person living in the home was treated with respect, taking account of their wishes and preferences. Care Homes for Adults (18-65 years) Page 17 of 28 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 living in Abbey Lodge can be confident that they are able to make a complaint if they wish to and that it will be dealt with appropriately. They can be assured that the home will seek to safeguard them from abuse, neglect and self-harm and will take effective action to follow up any allegations of abuse. Evidence: When we looked at the documentation relating to complaints, in the home and also submitted during the recent registration process, we found that the policies and procedures in place appear adequate and appropriate and should enable people who want to make a complaint about any aspect of their care to do so. In their AQAA, the home state that; Procedures are in place to respond to complaints and protect the welfare of service users. As the home has only recently admitted anyone to live there, there have been no complaints recorded and it is not possible to make any informed judgement as to how well the policies and procedures will be put into practice. Current staff are understood to be predominantly recruited through an agency and have received basic training in safeguarding vulnerable adults. When we looked at staff files they included evidence that the appropriate checks have been made in order to protect people living in the home from the employment of unsuitable people to care Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: for them. Care Homes for Adults (18-65 years) Page 19 of 28 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. Abbey Lodge provides a safe, comfortable and homely environment for those people who live or work there. Evidence: When we looked around the home we saw that it had been recently refurbished and redecorated throughout and that it was in excellent decorative order. The home was clean and tidy and was essentially domestic in scale and layout, providing a homely rather than institutional feel. We saw that all bedrooms were en suite and that they were of varying sizes and layouts but always well-furnished and comfortable. When the person currently living in the home showed us their room, they were evidently pleased with it and its facilities. The grounds of the home are extensive, well-laid out and include a decking area for people to sit out on. Equipment and furnishings are domestic in scale and quality and we were told that additional items will be provided once more people are living in the home, and that Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: they would have a hand in choosing them. We saw that the television reception was poor at times, this has been identified already and steps are being taken to ensure that it will be of a consistently acceptable standard in future. When we discussed choice and individualisation with the manager they indicated that they were committed to involving people living in the home in decisions about the decoration and furnishing of their own rooms and any communal areas. This will ensure that their views are obtained and wherever possible taken into account so that the decor and furnishing of the home reflects the tastes and preferences of the people living there. Care Homes for Adults (18-65 years) Page 21 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Abbey Lodge can be assured that they will receive care from care workers, with the skills and experience needed to meet their needs. They can also be confident that the home ensures all people working in the home have been subject to a robust recruitment process, including any temporary agency staff used by the home. Evidence: When we talked to the care staff present they told us that they had a national vocational qualification in care at level two, we were also able to see training and induction records from the agency which currently provides all care staff to the home. We were shown pro-formas from the agency that currently provides all care staff to the home on a temporary basis. These included evidence that criminal record bureau checks had been carried out and were satisfactory. The home did not hold other details such as references from previous employers or health declarations. We saw staff rotas which indicated that current staffing ratios are one to one, this is because there is only one person currently living in the home. We were told by the manager that the home would recruit permanent staff once the number of people living in the home increased from the current level. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: We were told that a staff meeting had already been held and the manager accepted that currently staff supervision is entirely informal, with no formal one to one sessions having taken place. The care staff interaction with the one person currently living in the home was positive and respectful and when we talked to the member of staff concerned, they had a good understanding of the needs of the person currently living in the home. Care Homes for Adults (18-65 years) Page 23 of 28 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. People living in Abbey Lodge can be confident that the service will be well-managed and will ensure that their interests are safeguarded and promoted by the way it operates. Evidence: We have been kept very well updated on progress by the registered manager during the period whilst the home was waiting to become fully operational. The AQAA was not a particularly useful document as it could not be fully completed due to the lack of available information and any sustained experience for the home from having been operational for any appreciable time. The manager was not prepared to accept anyone to live in the home until it had received the necessary certificates and approvals to confirm it was safe and satisfactory to do so. This shows that the well-being of people living in the home was being put ahead of any commercial pressures and reflects well both on the manager Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: and the registered providers. The outcome rating reflects the lack of any sustained and comprehensive body of evidence to make a long-term judgement and does not reflect on the capacity of the manager who has been registered by the CSCI as a fit person to manage a registered care service. The manager demonstrated throughout the inspection a high degree of commitment to the well-being of existing and prospective service users as well as a very good understanding of current best practice and developments in individualised care provision and moves to develop more independent living services. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 26 of 28 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 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 20 The temperature of the medication storage cupboard should be monitored and recorded to ensure that the medication it contains is being stored at the correct temperature as otherwise this could affect its effectiveness. Care Homes for Adults (18-65 years) Page 27 of 28 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. 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