CARE HOME ADULTS 18-65
Abbeymead Lodge Abbeymead Avenue Abbeymead Gloucester GL4 5GR Lead Inspector
Richard Leech Unannounced 19 April 2005 10:00
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Abbeymead Lodge Address Abbeymead Avenue Abbeymead Gloucester GL4 5GR 01452 617566 01452 763890 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Aspirations Care Ltd Mr Colin Beard Care Home 8 Category(ies) of LD - Learning Disability - Both (8) registration, with number of places Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: N/A Date of last inspection 17TH December 2004 Brief Description of the Service: Abbeymead Lodge first opened in September 2004. The home is registered to provide care for up to eight people with a learning disability. At the time of the inspection there were seven residents. The Statement of Purpose indicates that service users may have complex needs.The property is a detached building in a residential area of Gloucester. The home was a care setting in the past (run by a different organisation). It has been completely refurbished to meet with the National Minimum Standards. Bedrooms are situated on both the ground and first floors. All have en-suite bathrooms. The home also has three lounges, a dining room, a conservatory, a staff sleeping-in room, office, kitchen and laundry. There is a large garden. Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection began at 10.00 and lasted for about six hours. Most of the service users were spoken with and comment cards were left for people to complete and send if they wished to (three were received by the Commission). Care plans and other records were examined and some staff were spoken with as part of the inspection. The registered manager was present and the directors of Aspirations Care also made themselves available. The building was not formally inspected in full, although various rooms were looked at during the inspection. One resident showed the inspector their room. What the service does well:
When a service user may be moving to the home the team goes to meet them and makes a detailed assessment of their needs to make sure that Abbeymead Lodge would be the right place for them. This includes thinking about how they would get on with the people already living there. In their comment cards the service users indicated that staff treated them well and that they felt well cared for (though one person also ticked ‘sometimes’ to ‘do staff treat you well?’). They also all ticked that they would know who to speak to if they were unhappy with their care. Care plans are good and are being written in different ways to suit each service user. For example, some care plans have photographs. Staff are skilled at offering the service users choices and helping them to work towards achieving their goals. The service users are made aware of their rights but also of the responsibilities that come with these. Service users’ personal and healthcare needs are met and they are helped to make choices about how they want to be supported. The three service users completing comment cards indicated that their privacy was respected. All of the service users who were asked about their activities said that they enjoyed how they spent their time. Activity programmes are varied and service users are in control of this. People are supported to go out and about in the local community and to get to know the area. In their comment cards the three service users indicated that the home provided suitable activities. The building is attractively decorated and spacious. Service users said that they liked their rooms. The lounges are being used very imaginatively and the service users have been involved in deciding on the use of each room. The home is clean, bright and airy.
Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 6 The food is healthy and service users have a choice about what they eat. One person talked about how nice the food was and said that they had a choice about what they ate. In their comment cards all three service users indicated that they liked the food. Two service users were asked if it was a good place to live and said ‘yes’. They also said that the staff gave them the help that they needed and said they felt safe in the home. One person said that Abbeymead Lodge was ‘perfect’ and that they would speak to the manager if they had any worries. In their comment card one person said, “my home is very nice and…is the best care home that I have lived at. The staff are very kind and caring to you.” Staff spoken with said that their inductions were good. What has improved since the last inspection? What they could do better:
The home should make sure that radiators can be controlled individually. One service user said that radiators were ‘weird’ and had ‘no controls on’ and also said that were quite dirty and dusty. One person’s bathroom needs some redecorating as one part has some peeling paint. The Fire Officer has visited the home. The team has acted on all of their points apart from not yet having put non-slip surfaces on a fire escape to make it safer to use. One staffing record did not contain some of the information that should be on file.
Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 There is a thorough admissions process including a detailed assessment of prospective service users’ needs and aspirations. This helps to ensure that only people whose needs can be met are admitted to the home. EVIDENCE: The manager described the admissions process. This includes an assessment by the director(s) and manager. An example was seen for a recently admitted resident. The care proposal to the placing authority was very detailed, relevant and well constructed. There was evidence on file of involvement by the service user and others involved in their care. Staff and service users spoken with felt that the people living in the home generally got on well and were a good mix. Staff indicated that the admissions process was working well and that compatibility with other residents was being appropriately considered. The manager and directors said that they were reviewing the medium to longer-term admissions strategy in terms of the balance of residents’ skills, abilities and needs. Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 & 7 Care plans are well written and service users are involved in devising them. They reflect each person’s needs and aspirations and are developed in a creative ways. The team supports service users to make informed, meaningful decisions about their lives. EVIDENCE: Care plans seen were detailed and clear. They provided appropriate guidance for staff and covered relevant areas. They included evidence of involvement from service users and reflected their choices and goals. Some creative person-centred work is taking place with individual formats to suit each service user. This work continues to develop. One person had written their own life history. Newer staff described being given time to read and discuss care plans as part of induction. Documents viewed were signed and dated. Service users gave examples of choices they made such as about activities. Staff described the ways in which choices were offered to service users. It was evident throughout the inspection that service users felt empowered to make decisions about their lives and received appropriate support to follow these through.
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The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16 & 17. Staff support each service user to take part in meaningful activities of their choosing, including leisure and vocational opportunities and skills development. A wide range of facilities in the local community are accessed according to people’s needs and interests. Contact with family is encouraged and service users have opportunities to meet friends and to develop their social lives. Service users are encouraged to recognise their responsibilities and are also supported to exercise their right to make decisions about their lives. A flexible, balanced and healthy menu is provided and special dietary needs are met. EVIDENCE: All service users spoken with expressed satisfaction with their activity programmes. Each person has an individual activity plan which includes different options to increase flexibility.
Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 12 Staff confirmed that plans are not rigid in any case, and that service users will sometimes choose to do something different. Activities include attending college, private tutoring (for areas such as literacy and budgeting), voluntary work, gardening, art and cookery. Service users access facilities and amenities in the community including the cinema, theatre, pubs, car boot sales, clubs, cafes, shops and the library. The team aims to provide more vocational opportunities where appropriate. Staff described the approach they took where motivation is an issue. Discussion with staff and service users provided evidence that the team encourages and supports people to maintain close contact with their family. Service users and staff also confirmed that there are opportunities to meet friends and develop a social life. There was evidence throughout the inspection that service users feel empowered to take control over their lives, such as by choosing their own college courses to match their goals and aspirations. Staff are promoting the development of independent living skills such as cooking, shopping, cleaning, gardening and laundry to the point where some people are becoming very confident in these areas. The Statement of Purpose refers to service users’ rights. Some service users store alcoholic beverages in the office for safekeeping. The manager said that there have been no issues with this and that they are used in moderation. Nonetheless it was agreed that it would be useful to produce some guidance to staff about possible scenarios around service users’ alcohol consumption, linking this to any relevant terms and conditions of living in the home if appropriate. All service users spoken with said that they liked the food served in the home. Service users were observed choosing when and what to eat. Some people elect to eat in the lounge rather than the dining room. People with special dietary needs are catered for in a consistent and appropriate way. In some cases part of the food budget is devolved to service users so that they can do their own budgeting, shopping and cooking, with support as needed. Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 & 19 Personal care support is provided in a flexible and individual way according to each person’s needs and preferences. Healthcare needs are met through appropriate liaison with health professionals and documentation of the outcomes. EVIDENCE: Staff offer personal care support according to each service users’ preferences. Care plans refer to respecting choice as well as encouraging independence. Service users were dressed very individually and were clearly able to express their own personalities. A new format for recording healthcare notes has been devised. Those viewed appeared to be full and up to date. Some people are taking increasing responsibility for organising their own appointments. Discussion and records provided evidence that the team liaises appropriately with healthcare professionals around medication issues. A controlled drugs cabinet has been obtained, although at the time none were in use. Medication administration records appeared to be in order, although there were a few gaps where the appropriate code (in this case ‘social leave’) had not been inserted. The manager said that he would address this. Some staff are doing training in the safe handling of medicines and the manager intends for all staff involved in administration to do this in due course. It was agreed that the Commission’s pharmacy inspector would be invited to fully inspect this area, this being standard procedure for a recently registered service.
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The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Service users’ views are listened to and appropriate action is taken when they raise issues and concerns. Procedures are in place to help protect service users from harm and abuse. EVIDENCE: The manager said that he had talked with family members about their right to complain. He has also reiterated this to service users, who each have a copy of the complaint procedure. One service user has made a complaint. The procedure was followed and the issue was resolved at the level of discussion with keyworkers. One service user raised an issue related to name-calling. The manager described the work the team has done around raising service users’ awareness of discrimination and prejudice. Further input is planned which will include a workshop for staff and service users. The home has procedures around the protection of vulnerable adults and prevention of abuse. Staff were aware of the whistle blowing policy and said that they would not hesitate to raise concerns through appropriate channels. Service users spoken with indicated that they felt safe in the home. Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 28 & 30 Abbeymead Lodge is homely and comfortable. Bedrooms are personalised and the communal areas are being used imaginatively and flexibly. The home is clean and hygienic, helping to make it a safe and pleasant place to live. EVIDENCE: Abbeymead Lodge is spacious and homely. Décor is bright and the home is warm and well-ventilated. Furniture and fittings appear to be of good quality. Each person has a single en-suite bedroom. Service users reported that their beds and chairs were comfortable and that they liked their rooms. All areas of the home seen were clean and hygienic. Staff and one service user have had training in infection control. The home has three lounges and a conservatory, as well as other communal space. The use of some shared areas has changed in accordance with service users’ ideas for the best use of each room. There is a large back garden. In the last report it was recommended that all radiators be fitted with accessible, individual controls, particularly those in bedrooms. At the time of the inspection some work was about to be done around this. Some work was also due on attending to some peeling paint in one person’s en-suite bathroom. Some aids and adaptations are being provided for one service user in accordance with their assessed needs and personal choice.
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The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 & 35 Recruitment and selection procedures help to protect service users from unsuitable carers working in the home, though some missing documentation needs chasing up to make sure that staffing records are complete. Staff are well-trained and further progress has been made towards bringing everybody up to date with core training. EVIDENCE: Service users spoken with praised the staff. One person said that staff were looking after them well. The team has grown since the last inspection but there has been very little staff turnover. Selected staff records included all of the required information apart from one file having no documentary evidence of a CRB check having been done. The manager said that he would have had a call to confirm that the person’s check was satisfactory and would then have expected a memo from head office. Written confirmation that CRB/PoVA clearance has been obtained needs to be on file in the home. The inspector may at some point visit head office to check a sample of CRB certificates and clarify aspects of the procedure. The manager described training undertaken and further training booked for the near future. This should bring the staff team up to date with mandatory training (besides some newer staff in certain areas) although the inspector explained that the requirement to do so will still stand until this is completed.
Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 17 Some in-house training takes place around a medical condition experienced by one person. Staff spoken with demonstrated an understanding of this and referred to an information file kept in the office. They also described watching a video about the condition with the service user as well as having close consultation with a dietician and other healthcare professionals. Training has taken place about autistic spectrum conditions and aspergers syndrome. This was cascaded to the rest of the staff team by a senior carer. The manager described progress towards the majority of staff becoming qualified in NVQs in care. He is also aiming for all staff to have access to LDAF accredited induction and foundation and has approached a local provider about this. There was a discussion about the level of appropriate physical contact. The manager confirmed that this has been thought about on an individual basis, including consideration of both staff and service users’ potential vulnerability in this area. The inspector suggested ongoing review of this issue and discussing it in a staff meeting to explore people’s views, perceptions and any concerns. Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 & 42 Both formal and informal systems are in place for establishing and responding to service users’ views. Health and safety is well-managed in the home. EVIDENCE: Copies of reports made under Regulation 26 are being forwarded to the Commission each month. These are very thorough and informative. The manager said that there are occasional residents’ meetings. Service users are free to raise anything, although sometimes this has presented issues around people’s confidentiality and personal circumstances which require skilful handling. Service users spoken with felt that the staff, manager and directors listened to them and took notice of what they said. Routine health and safety checks are in place. The inspector suggested adding the appropriate temperature range to the form used for recording checks of hot water temperatures. A recent report from the Fire Officer has been acted upon, including making safe the high number of leads/sockets in one person’s bedroom. One outstanding point from the report needs addressing; the fitting of non-slip surfaces on an external escape.
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This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 4 x 3 x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x 3 x 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Abbeymead Lodge Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 34 Regulation 17 (2). Sch. 4 (6) f. 19. 13 (3) (4) & (5). 18 (1) c (i). 23 (4) d. 23 (4) c (iii) Requirement Ensure that all staffing files evidence that a satisfactory CRB/PoVA check has been obtained. Ensure that, as far as possible, all staff are up to date with mandatory training (deadline of 31/03/05 partially met; further training booked for near future). Fit suitable non-slip surfaces to the external fire escape as identified by the Fire Officer in a recent report. Timescale for action 30/06/05 2. 35 30/06/05 3. 42 30/06/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 16 20 Good Practice Recommendations Issue some guidance to staff about possible scenarios around service users’ alcohol consumption, linking this to any relevant terms and conditions of living in the home. Devise a policy on self-administration, including a risk assessment and monitoring format and reference to the need for a lockable space in the person’s room for the medication.
D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 21 Abbeymead Lodge 3. 4. 5. 24 27 35 6. 35 Ensure that all radiators have individual (and accessible) controls, particularly those in service users’ bedrooms. Attend to the peeling paint in one service user’s en-suite bathroom. Aim for all staff to undertake LDAF accredited induction and foundation training and to have access to units at levels two and three (either as stand-alone units or as part of achieving a certificate). Review on an ongoing basis the balance of appropriate physical contact with service users taking into account potential vulnerability of both staff and service users. The issue could be discussed at a team meeting to explore peoples ideas and perceptions as well as any concerns. Abbeymead Lodge D51_D03_S62092_Abbeymead Lodge_V222112_190405_Stage4.doc Version 1.30 Page 22 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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