Inspection on 07/11/07 for Allswell Lodge

This inspection was carried out on 7th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Allswell Lodge 95 Gander Green Lane Sutton Surrey SM1 2EP Lead Inspector Lee Willis Key Unannounced Inspection 7 & 8th November 2007 11:00 th Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Allswell Lodge Address 95 Gander Green Lane Sutton Surrey SM1 2EP 020 8642 2896 020 8642 2896 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Allswell Care Services Ltd Anthony Benjamin John Miller Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category 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: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 5 N/A Date of last inspection Brief Description of the Service: Allswell Lodge is a privately owned residential care home for generally ‘middle aged’ adults with moderate learning disabilities. The service currently provides personal support for three females, but has the capacity to accommodate up to five people of either gender. Anthony Miller is the registered manager of the home and has been in operational day-to-day control of the service since it opened in June 2007. This detached chalet bungalow is situated in a residential suburb of Sutton. The service does not currently have its own transport, but it does hire a vehicle a couple of times a week and is within five minutes of walk of a local train station and several bus stops. There are also a small number of local shops within easy walking distance of the home and Sutton town centre is less than a mile away. The home has five single occupancy bedrooms all with en-suite toilets and bathing facilities. Communal areas are all located on the ground floor and include a main lounge, separate relaxation room, an open plan kitchen/dinning area, large entrance hall, cloakroom, and laundry. There is also a small office and staff toilet/shower facilities on the first floor. There is amble space for parking vehicles in the front drive. The garden at the rear of the property has been paved over to make it wheelchair accessible. This area is well maintained and contains a number of recently planted shrubs and a newly built decking area. The home has developed clear information to help prospective service users and their representatives understand what facilities and services the home offers. The service currently charges £1,500 to £2,000 a week for each placement. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 5 Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. From all the available evidence gathered during the inspection process the Commission for Social Care Inspection (CSCI) has judged the service as having significantly more strengths than areas of weakness. Key standards are generally met and the management have responded well to problems identified with regards staff recruitment. We spent ten hours in the home over two separate visits. We spoke to all three of the people who currently live at the home, the owner, the newly registered manager, and three members of staff. We looked at records and documents, including all the care plans for the three people who live there and the home’s User Guide. The remainder of this site visit was spent touring the premises. All three of the people who use the service completed our ‘have your say’ surveys about life at the home with the support of staff who work there. The manager also completed an Annual Quality Assurance Assessment (AQAA) to tell us about this new service, how it makes sure of good outcomes for the people using it, and any future developments being planned. What the service does well: Feedback received from a number of staff working at the home was very positive. Typical comments included “Allswell provides a homely environment for people who live there”, and “the relatively new manager is very approachable, supportive, and professional”. We feel this new service is particularly good at ensuring prospective service users are given every opportunity to spend time in the home meeting the other people who already live there, the staff team, viewing their bedroom and communal areas, and generally being helped to feel welcomed and comfortable in their new surroundings. Staff also maintain excellent daily records. The information contained in each service users daily diary notes is extremely detailed and enables anyone authorised to inspect them to determine whether or not the personal, social, dietary, and health care they receive is sufficient to meet their unique needs and wishes. The owner has clearly put a lot of money into making this new home ‘fit’ for purpose and as a result it is decorated to a very high standard, and all the furniture and fittings are of good quality. The layout of the home has clearly been designed to provide small group living where people who use services can Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 7 enjoy maximum independence in a discrete non-institutional environment. An Occupational Therapist wrote in the homes compliments book following a recent visit, “I am very impressed with the physical layout and design of Allswell Lodge, which is both practical and pleasing on the eye”. Also, having a selection of communal areas means the people using the service have a choice of places to sit quietly, and/or meet with family and friends. It was positively noted that 100 of the homes existing staff team have either already achieved an National Vocational Qualification level 2 or above in care or are course to complete this award by next year. What has improved since the last inspection? What they could do better: All the positive comments made above notwithstanding there remains a number of significant areas of practice that the proprietor must take action to improve the lives of the people who use the service, as well as keep them safe: All the people using the service must be supplied with an up to date ‘standard’ form of contract that sets out their terms and conditions of occupancy, which includes details about the provision of food, fees payable for services provided, and arrangements for the payment of such fees. This will ensure people who use the service and their representatives are clear about what facilities and services they can expect to receive and how much they will be charged for them. The way in which the home notifies the Commission about the occurrence of ‘significant’ incidents and or events involving people who use the service must be reviewed. This is to ensure the way staff deal with such incidents/events is made more open and transparent. All the people who are ‘authorised’ to handle medication in the home must have access to up protocols regarding its safe receipt. This will ensure all the people who use the service receive the correct levels of medication. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 8 The people who use the service and their representatives should have access to easier to read versions of the homes complaints policy. This will ensure people who use the service and their representatives know how to make their views known about the homes operation if they are dissatisfied with any aspect of it. As the manager is the appointee for a person who uses the service records kept of all incoming and outgoing payments must be independently audited/monitored at regular intervals. This will ensure the risk of people who use the service being financially abused is minimised. The homes washing machine must have a sluicing facility to deal with soiled laundry. This will ensure the risk of infection is appropriately managed in the home and people who use the service and kept safe. Infection control training must be provided for all staff who work at the home. All staff who work in the home must be involved in at least one fire drill every six months (we recommended once a quarter). This will ensure the safety of the people using the service. An Immediate Requirement Notice was issued at the time of the second site visit for this serious breach to be addressed within 24 hours. Dead locks fitted to doors/gates positioned on fire escape routes must be replaced with more suitable locking devices that can be opened more easily by staff in an emergency. This will ensure the safety of the people using the service. Radiators in the home must be assessed for the risk they present the people using the service and include the action to be taken to minimise any identified risks. This will also ensure the safety of the people using the service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 & 5 People who use the 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 this service have good information about the home in order to make an informed decision about whether the service is right for them. People’s needs are fully assessed prior to admission so the individual, their representatives, and the home can be sure the placement is appropriate. The homes current arrangements for charging service users for the facilities and services provided are not particularly transparent and will need to improved to enable people to make more informed decisions about whether or not they are getting value for money. EVIDENCE: A copy of the homes latest Statement of Purpose and Guide were produced on request. These documents clearly set out the objectives and philosophy of this new service and what the people who would be using it could expect to receive. However, the document was not clear what the age range of people intending to use the service should be (i.e. generally ‘middle aged’ adults and over). Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 11 When the home up dates its complaints procedures to make them more service user friendly (i.e. accessible), carries out its first annual quality assurance audit, and receives its first CSCI inspection report the proprietor should make this information more widely available by including it in the User Guide. The User Guide is available in an ‘easy to read’ format, which is illustrated with all manner of colourful pictures, symbols, and photographs making it more accessible to the people who live at Allswell Lodge. Assessments had been completed for all three people who had recently come to live at the home. Having examined the admissions process for all three of the people at the home, case tracking confirmed good practice. The new manager told us they had recently visited a prospective service user at their home and undertaken a thorough initial assessment of their care needs. He demonstrated an extremely good understanding of the importance of assessing whether or not a prospective new service user would be compatible with the others already living in the home. The manager also provided us with three good examples of occasions when he had recently taken the decision to decline referrals on the grounds of ‘incompatibility’. A member of staff spoken with at length was able to describe the homes admissions procedures and the importance of making sure a new service user felt welcomed. Written admission documentation was excellent and included a copy of the care management assessment. Initial assessments undertaken by the home were sufficiently detailed to enable staff to meet the personal, social, and health care needs of all new service users. The manager confirmed all prospective new service users and their representatives are invited to visit the home before a decision about whether or not they would like to move in is taken. The manager also compiles a report following these visits, which he uses to assess the suitability of a potential placement, a practice that exceeds National Minimum Standards regarding introductory visits. Records showed it was custom and practice for the religious beliefs and/or spiritual needs (if any) of all new referrals to be ascertained before they moved in. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 12 The manager was able to produce bi-partite contracts that set out the terms and conditions of occupancy for all three people currently placed at Allwells Lodge. The home and the relevant funding authority have agreed to these contracts. Information contained at the back of the User Guide also referred to people’s terms and conditions of occupancy, but did not include any details about the provision of food, and what they could expect to be charged for facilities and services provided. Written contracts agreed between the home and people using the service (and/or their representatives) must be developed. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect what is important to the individual, their capabilities, and what support they need to achieve their personal aspirations. The people who use the service are encouraged to participate in the day-today running of the home and consulted about important decisions that affect their lives. In the main people who use the service are protected by the homes arrangements for assessing and management risk which promotes their independence and choice. Suitable arrangements are in place to ensure information about people who use the service is only shared with others on a ‘need to know’ basis, and that there confidences are kept. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 14 EVIDENCE: We looked at the care plans for two people living at the home. The plans were person centred and tended to ‘celebrate’ an individuals life experiences, as well as setting out clearly how their current personal, social, and health care requirements and wishes were to be met through positive interventions. One member of staff told us the relatively new care plan format was a good working tool that helped them deliver the support required by the people who using the service. The plans also contained a lot of individualised information to help staff deliver person centred care. Many actions recorded were very specific. For example when looking at personal care needs, care plans stated if the person preferred a bath or a shower, and exactly what support they would require from staff. One member of staff met was able to describe the care plan for the person they keyworked whose care we were case tracking. This knowledge means that service users can be confident that they will get support from people who understand their care needs. As previously mentioned in this report the manager was fully aware of the importance of capturing good information about people before they move in. Care plans viewed were clearly generated from information obtained during the admissions process, and included detailed information about peoples backgrounds and life histories. The manager confirmed that independent advocates had played an active role in placing all three people currently residing at the home. The home ensures that people who use the service are consulted on a regular basis to gather information about what they ‘want’ (e.g. On the first day of this inspection staff were observed using photographic aids to help service users choose what they wanted to eat for their lunch that day). The two care plans being case tracked included comprehensive risk assessments. The manager told us he had a positive approach to addressing safety issues. Risk management strategies sampled at random had clearly been developed in the context of supporting people who used the service to take ‘responsible’ risks as part of structured programme to promote their independent living skills and life choices. Documentary evidence was produced on request to show the home keeps detailed records of any ‘significant’ incident involving people who use the service. The vast majority of incidents pertained to a specific individual challenging the service whilst out in the wider community. This individuals care plan contained specific guidance to help staff deal with behaviours that challenged the service while they were at home, but was not sufficiently detailed to enable staff to minimise the likelihood of similar incidents occurring Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 15 in the wider community. This risk management strategy needs to be expanded upon. Furthermore, the manager confirmed we had not been notified about the occurrence of any ‘significant’ incidents that had occurred in the home since it opened. The manager told us he would remind his staff team to keep the Commission informed without delay (i.e. within 24 hours) about the occurrence of any significant event involving people who used the service. One member of staff spoken with at length demonstrated a good understanding of the homes dealing with challenging behaviour policy and were very clear what they should do when confronted with such incidents, both in the home and in the wider community. The home has a confidentiality policy in place and this information is also included in the User Guide. This ensures all the people who use the service and their representatives are informed of their rights regarding data protection and the sharing of confidential information. Staff met understood they could only share confidential information with others on a ‘need to know’ basis. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, & 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A good range of activities within the home and community mean the service users have various opportunities to participate in stimulating and motivating activities. People who use the service are actively encouraged to participate in household chores to enable them to maintain and develop their independent living skills. The home has excellent arrangements in place to enable service users families to continue there involvement in their loved ones lives and are kept informed about all social, leisure and recreational activities they participate in. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally wellbalanced meals. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 17 EVIDENCE: Care staff spoken to said they routinely supported people who used the service to participate in activities of their choice and were very clear this was an important part of their role. We saw a number of instances over the course of this two day inspection where people who used the service were being actively encouraged by staff to attend various educational and leisure activities in the wider community. Staff also seemed to have time to talk and interact with the service users. It was positively noted that staff roles, shift patterns, weekly activity schedules and care plans all take the social needs and wishes of the individual into account (i.e. person centred) and are clearly not task based. Staff spoken to had a good knowledge about what person centred care was and told us they received sufficient support from the manager to implement this approach. A member of staff who had a lot of experience working in other care homes told us “Allswell Lodge compared very favourably with other places they had worked because staffing levels allowed you more time to sit and chat with the service users, and support them with their activities” Care plans inspected contained detailed programmes designed to encourage people who used the service to maintain and develop their independent living skills. One member of staff was observed supporting an individual who used the service to set the dinning room table ready for their evening meal. A service user told us “staff help them to tidy their bedroom and wash up after meals”. Daily diary notes revealed people who use the service are actively encourage to practice their faith as specified in their care plans. Staff support all those services users who have spiritual needs to regularly attend services held at a local church. Records also revealed service users lead very active and fulfilling lives. Care plans contain weekly schedules that included a wide variety of activities, such as swimming, dance classes, massage, tea and coffee mornings, church events, shopping, and further education classes. Trips are also arranged outside of the home and records showed people who use the service had visited Brighton and Heavers castle over the summer. The manager told us next year people who use the service will have the opportunity to go on holiday with staff. Comments from people living at the home included “there are trips” and “I go out a lot”. The manager told us although the home did not have its own transport, the owner was planning to buy a minibus. It is believed this will support more trips out for individuals and allow more spontaneity as the weather allows. Nonetheless, as previously mentioned in this report people who use the service appear to live very active lives. Staff confirmed all the people who live at the Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 18 home have been provided with discounted travel cards that entitled them to free travel on public transport at certain times of the day. The home is also on a main line bus route and is within easy walking distance of a local train station. The manager told us the home operates an open visitors policy without restrictions. However, the positive attitude towards visiting times is not reflected in this policy, which is not available in an easy to read format. Main meals displayed on weekly menus were varied and nutritionally well balanced. One service user spoke with told us “meals were nice”. The lunchtime meal served on both days of the inspection could be clearly identified from the published menu for that day. All the meals served during these visits smelt extremely appetising and were well presented. Staff on duty told us people who use the service are actively encouraged to help plan the forth-coming weeks menu every Sunday. These menus are also available in easy to read pictorial formats to enable people to make informed decisions about what food they eat at mealtimes. Detailed records of all the food eaten by service users is maintained by staff to help them monitor diets. These records also revealed people who use the service have the option of choosing alternative meals if they do not ‘fancy’ the one published on the menu on any given day. The atmosphere before the evening meal was served on the second day of the inspection felt very relaxed and congenial. Clearly mealtimes are a positive social occasion and provide all the people who live at the home with a good opportunity to talk and interact with one another and staff. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, & 21 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique physical and emotional health care needs are continually recognised and met. In the main policies and procedures for handling medication are sufficiently robust to keep the people who use the service safe, although protocols for the receipt of medication into the home are unclear and need clarifying. People who use the service are confident that death will be handled with sensitivity, dignity, and respect. However, the home procedures for ascertaining people’s spiritual and cultural wishes regarding dying and death need to be improved to ensure these are taken into account as required. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 20 EVIDENCE: All the people who the service met at various times throughout the course of this two-day inspection were appropriately dressed for the season in wellmaintained clothes. As previously mentioned in this report the daily notes kept by staff contained good quality and very useful information regarding every aspect of service users lives, including peoples unique health care needs. These records showed people who use the service receive input from a variety of different health care professionals at regular intervals, including GP’s and community-based nurses. One member of staff spoken with demonstrated a good understanding of the personal and health care needs of the individual they had been assigned to keywork. The manager told us in the future everybody who lives at the home will have an individualised health care action plan that will set out in detail how often that person should be receiving input from a variety of health care professionals, including GP’s, dentists, opticians, chiropodists, physio’s, nurses ect. Documentary evidence was also made available to show the home had arranged for a suitably qualified Occupational Therapist (OT) to carry out assessments of the building and individual service users physical needs. As recommended in the OT’s subsequent report the home has developed manual handling guidance for staff and purchased suitable mobility equipment to meet this individuals assessed physical needs. The manager told us advice is sought from a community-based nurse regarding continence promotion. Staff spoken with demonstrated a good understanding of how important it was to ensure continence is always promoted in a dignified manner and people’s privacy respected. The home has an accident book that revealed none had occurred since it had opened. The home has policies in place for handling medication, although there are no recorded protocols regarding the receipt of medicines into the home. The manager was very clear what constituted good practice in this area and acknowledges he will need to establish procedures for staff to follow. Staff administer medication to people living at the home safely and keep accurate records of all medicines received, administered and returned to the dispensing pharmacist. No recording errors were noted on medication administration (MAR) sheets sampled at random. These records reflected current medication stocks held by the home on service users behalves, which were securely stored in a locked metal cabinet. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 21 The manager told us the service does not currently hold any ‘as required’ (PRN) or Controlled Drugs, but was aware of the procedures to be implemented to ensure staff were clear when and how to give this type of medication. Documentary evidence in the form of certificates of attendance were produced on request to show that sufficient numbers of the homes staff team had been suitably trained to handle medication on service users behalves. One member of staff spoken with at length was very clear that people who use the service should be actively encouraged to look after their own medication (so far as reasonably practicable). This same member of staff also demonstrated a good basic knowledge of how medicines are used, and how to recognise and deal with problems. The home has a copy of the Royal Pharmaceutical Societies old guidance on handling medication in a residential care setting and we recommend the service obtains the most up to date version of the guide. The home has a policy on ageing and death which makes it clear people who use the service will be supported to remain in the home if this is what the individual wishes and the staff can still meet their needs. The manager conceded that none of the wishes of the people currently using the service regarding ageing and death had been sought at any stage during the admissions process. We strongly recommend the service makes more a concerted effort to obtain this information at an earlier stage to ensure the ageing, illness, and/or death of someone who uses the service is handled, as the individual would wish. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the 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 homes arrangements for dealing with complaints and allegations of abuse are sufficiently robust and understood by staff to ensure people who use the service feel listened and safe. The services arrangements for managing the money and financial affairs of the people who use the service are not sufficiently robust and need to be improved to ensure they are protected from financial abuse. EVIDENCE: Records are kept of any concerns or complaints received and we saw that these were well maintained. The manager confirmed there has been no issues raised both verbally or in writing by people living there or their representatives since the home opened. The manager told us he welcomes ‘constructive criticism’ and would always follow up any concerns/complaints made. The complaints policy and procedure is displayed in the home and is part of the guide for the people living there. The manager acknowledges the current policy is rather ‘wordy’ and not that ‘easy’ to read or understand. The home should look at making sure that the complaints procedure is available in different formats as appropriate. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 23 All the care staff have either received mandatory training that teaches them how to recognise and report abuse or are booked to attend a suitable course by the end of the year (2007). There is an organisational procedure for staff to follow in the event of any allegations being made. The manager told us that none of the people who use the service had been subject to any safeguarding vulnerable adults referrals since the home opened. The manager also demonstrated a good understanding of the Local Authorities reporting abuse protocols and was able to produce a copy on request. The home has copies of the Department of Health ‘no secrets’ and its own whistle blowing policy for staff to follow if they witness or suspect abuse. This policy should be more conspicuously displayed in the home for all staff and visitors to see. The balances recorded on financial sheets kept for the people using the service matched the amounts being held by the home on their behalves. It was noted service users monies are individually stored in a secure place. However, the total amount of money held in the home at the time of this inspection was found to be excessively high and will need to be reduced as matter of urgency in order to minimise the risks associated with financial abuse. The manager told us that it was custom and practice for a record of all transactions to be kept, as well as receipts. None of the receipts sampled at random had folio numbers, which the owner conceded made auditing more difficult. The manager told us he was currently the appointee for one person who uses the service. This practise is acceptable providing no other independent agent is available and records of all incoming and outgoing payments are independently audited/monitored on a regular basis. The owner also conceded that the service had still not established a clear policy regarding whether or not staff should contribute to their own expenses when supporting people who use the service in the wider community. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29 & 30 People who use the 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 excellent condition of the décor, fixtures, and fittings in this relatively new care home means the people who use the service live in a very homely and comfortable environment. In the main the homes arrangements for controlling infection are sufficiently robust to ensure the people who use the service also live in a very clean and safe environment, although the washing machine is no capable of meeting standards for soiled laundry. EVIDENCE: People spoken to were happy with the environment. Comments in the homes compliments book included one from an Occupational Therapist who wrote following a recent visit, “I am very impressed with physical layout and design of Allswell, which is both practical and pleasing on the eye”. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 25 One person who uses the service told us they were “pleased with their new bedroom.” We saw that the home generally provides a very pleasant, comfortable and well maintained place for people to live. All the furnishings and fittings are new, are of excellent quality, and domestic in appearance. Staff also have a separate area for storing their belongings securely. Bedrooms seen were all personalised to the individual with many containing peoples own furniture and pictures. These bedrooms contained all the furniture and fittings necessary to meet the current occupants needs. However, it was noted that all the bedrooms are painted very similar ‘neutral’ colours and we recommended the home finds out whether or not the people who currently occupy them would like to choose other colours. It was positively noted during a tour of the home that the owner has established a second lounge where people who use the service can relax or meet their guests in private. The garden at the rear of the property has been paved over to make it wheelchair accessible, although the raised decking area in the far right hand corner will need to be fitted with a ramp. Call bell alarm systems have been fitted in all the bedrooms and as previously mentioned in this report moving and transferring equipment purchased based on the advice of input received from an OT. The owner told us no adaptations have been made to the home to meet the visual impairment needs of one person living at the home. We recommended the home contacts the Royal National Institute for the Blind (RNIB) to seek their advice about lighting; colour contrasting; tactile symbols; textural surfaces; padding of hazards that cannot be removed; subtitling facilities on televisions ect that may improve this individuals life. Records are appropriately maintained of the temperature of hot water emanating from all the homes water outlets on a weekly basis. The manager told us all the homes relatively new baths and showers had been fitted with fail-safe thermostatic mixer valves that prevented temperatures exceeding a safe 43 degrees Celsius. The home was very clean and hygienic on both days we visited. The manager told us the home has a contract for dealing with clinical waste, which is collected on a weekly basis. Staff met demonstrated a good understanding of the homes arrangements for disposing of clinical waste and how to appropriately control infection in general. In line with environmental health guidelines the homes laundry room is located in an area where food is prepared, eaten, or stored. The laundry room contains Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 26 a wash hand basin, plentiful stocks of latex gloves and plastic aprons, and the walls and floor are readily cleanable. However, the washing machine although capable of cleaning laundry at appropriate temperatures, it does not included a sluice cycle for dealing with foul/soiled laundry contrary to infection control standards. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34 & 35 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, sufficient numbers of very experienced and competent staff are employed on a daily basis to support the needs, activities, and aspirations of the people who live at the home. However, more staff need to receive infection control training to ensure they have the necessary knowledge and skills to effectively manage infection in the home. The homes recruitment procedures are sufficiently robust to minimise the risk of service users being harmed by people who are ‘unfit’ to work with vulnerable adults. EVIDENCE: We saw that staff were caring and spoke to individuals in a polite and respectful manner. Care staff we spoke to had a good understanding of what person centred care is. As stated previously, it was clear from the comments made by staff that they see supporting people who live at the home to meet Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 28 their social and emotional care needs as an important part of their role as carers. Staff spoken with told us they had each been given a job descriptions and a copy of the General Social Care Councils code of conduct, which set out their roles and responsibilities as carers. The manager told us keyworker roles are only given to those staff who are suitably experienced and understand their new responsibilities. One member of staff spoken with at length was very clear what their duties were as a keyworker. Documentary evidence was produced on request to show the homes policies and procedures are discussed at team meetings and that staff must sign to confirm they have read and understood them. On arrival one support worker and the registered manager were both on duty, which was adequate to meet the assessed needs of the three people currently using the service. The proprietor and the manager both told us that at present there would always been at least two members of staff on duty across the day, which would be increased to three if and when the home became fully occupied. The manager also told us he had a flexible approach to planning the duty roster and would regularly employ ‘additional’ staff at ‘peak’ periods of activity. Duty rosters sampled at random confirmed that ‘extra’ staff were regularly employed to enable people who used the service to pursue their leisure interests. At night the home employs one waking night staff and operates an ‘on call’ system where a designated senior member of staff can reach then home within 20 minutes to help deal with emergencies. The homes duty rosters do not identify these arrangements and will need to be amended to reflect which member of staff is designated ‘on call’ each night. As the home has been operating for less than a year all the staff working there are new. 50 of staff’s personal files were selected at random and examined in depth. Each of these files contained a job application form stating their full employment history; two written references; an up to date Criminal Records Bureau and Protection of Vulnerable Adults checks; a declaration of any offences committed; statement of health; photographic proof of their identity; and Home Office approved work permits/visas (where applicable). However, it was noted that several references were not printed on headed paper or included a company stamp as proof of there authenticity. The manager demonstrated a good understanding of the importance of obtaining up to date Criminal Bureau checks and Protection of Vulnerable Adults checks before allowing any new staff to commence working at the home, and has clearly learnt from previous mistakes made in respect of staff recruitment when the home was first opened. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 29 Staff spoken with told us they had all received a thorough induction before being allowed to commence working at the home. Documentary evidence was produced on request to show the induction process is linked to Skills for care and covered safe working practices, worker role, and the needs of the people using the service. The manager told us the homes only agency member of staff had also received an initial induction, but no records had been kept. Staff have access to a very good programme of training. The manager has carried out a training needs and strengths assessment of his entire staff team. Mandatory training is provided in a number of areas including fire safety, manual handling, first aid, food hygiene, and safeguarding adults and abuse training. One member of staff spoken with at length was very clear what action they would need to take in the event of the fire alarm being sounded. This member of staff was also very clear about their roles as a support worker and knew what was expected of them. Additional workshops are provided on specialist areas as previously mentioned and there is a strong NVQ provision with staff able to study for both the Level 2 and 3 qualifications. It was positively noted that in line with National Minimum Standards all the homes current staff team have either already got an NVQ Level 2 or above in care or are enrolled on a suitable course and hope to achieve this award by an agreed date. During a tour of the premises one member of staff was observed using Makaton sign language to communicate with a person who used this method of communication. The manager told us two members of staff had received Makaton training. Records also revealed that staff receive equal opportunities training. The manager conceded that none of his current staff team had attended an infection control course. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 30 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, & 42 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because a suitably qualified manager runs it. People know that their opinions are central to how the home develops and reviews their practice because there are good quality assurance systems in place. People using the service are being put at risk of harm because the homes fire safety arrangements are at present not sufficiently robust enough to safeguard them. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 31 EVIDENCE: The new manager has considerable knowledge and experience of helping to run residential care homes for adults with learning disabilities. Comments from staff about the management of the home included “very understanding and approachable” and “very supportive whilst remaining professional at all times”. The manager has achieved an NVQ level 3 in care and is currently studying for his Registered Managers Award and NVQ 4 in management. There are currently no meetings for people living at the home and we were told that this consultation was done informally on a day-to-day basis. We saw lots of examples of individuals talking with staff and being kept up to date. The home is commended for ensuring staff meetings are held on a monthly basis. This exceeds National Minimum Standards that requires homes to hold at least six a year. These meetings were always well attended by staff are cover a wide variety of topics including the changing needs of the people who use the service and worker roles and responsibilities. A formal quality management system is in place at the home, which the manager told would be used to look at all areas of the service and how it can be improved. The manager is aware that a full internal audit of the home has to be carried out at least once a year which takes into account the views of people who use the service and other major stakeholders (e.g. relatives, care managers, GP’s) about whether or not the service is achieving its stated aims and objectives. Progress on this matter will be assessed at the homes next inspection. The proprietor employs a business partner to carry out unannounced monthly visits of the home and to compile a report of their findings. These visits cover every aspect of life in the home and the subsequent reports were made available for inspection on request. The proprietor has purchased a comprehensive set of policies and procedures that will all need to be reviewed and developed to ensure they are relevant to home. A comprehensive fire risk assessment of the building has been undertaken and was made available on request. The homes fire records revealed that although the fire alarm system was being tested on a weekly basis in line with good fire safety guidelines no fire drills had been undertaken since the home opened in June 2007. The manager was reminded that all staff should participate in at least one fire drill every six months. An Immediate requirement Notice was issued at the time of this inspection form this serous breach of the Care Homes Regulations (2001) to be rectified within 24 hours. Fire doors tested at random on the ground all closed flush into their frames when released. During a tour of the garden it was noted a locked side gate blocked of a possible escape route in the event of fire. This side-gate had been Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 32 fitted with a dead-lock that staff would be unable to open ‘quickly’ in the event of a fire. It was positively noted the home has a sprinkler system installed. Up to date Certificates of worthiness were made available on request to show that suitably qualified engineers had checked the homes gas (Landlords) installations, electrical wiring, fire alarms, fire extinguishers, mobile hoist, and portable electrical appliances. None of the homes radiators have been covered and the manager has agreed to assess the risk this presents all the people who live at the home. During a tour of the kitchen it was noted that all items of food were correctly stored in line with basic food hygiene standards. A set of multi-coloured chopping boards was also found for the safe preparation of food. The home monitors and records the temperatures of fridges and freezers. COSHH products are securely locked away out of harms reach. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 4 3 X 4 4 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 4 25 X 26 3 27 3 28 2 29 2 30 2 STAFFING Standard No Score 31 3 32 3 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 3 3 X 3 1 X Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 34 N/A 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 YA1 Regulation 4(1)(c), Sch 1.5 & 5(1)(a) Requirement All the people using the service must have access to an up to date Statement of purpose and User Guide that contain accurate information about the age range of the people for whom the service is intended. This will ensure they have access to all the information they need to know about the home. Timescale for action 01/12/07 2. YA5 5(1)(ba), (bb), (bc) & (c) All the people using the 01/12/07 service must be supplied with an up to date ‘standard’ form of contract that sets out their terms and conditions of occupancy, which includes details about the provision of food, fees payable for services provided, and arrangements for the payment of such fees. This will ensure people who use the service are clear about what facilities and services they can expect to receive and how much they will be charged for them. Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 35 3. YA9 13(4)(b) & 17(1)(a), Sch 3.3(q) People who use the service must be able to access the wider community within an appropriate risk framework, which promotes their independence and choice. This will ensure the safety for the people using the service, staff, and people living in the wider community. The way in which the home notifies the Commission about the occurrence of ‘significant’ incidents and or events involving people who use the service must be reviewed. This is to ensure the way staff deal with such incidents/events is made more open and transparent. 15/11/07 4. YA9 37(1) 09/11/07 5. YA20 13(2) All the people who are 01/12/07 authorised to handle medication in the home must have access to up protocols regarding its safe receipt. This will ensure all the people who use the service receive the correct levels of medication. The people who use the service and their representatives should have access to easier to read versions of the homes complaints procedures. This will ensure people who use the service and their representatives know how to make their views known about the homes operation if they are dissatisfied and what they can expect in response. 01/12/07 6. YA22 22(2) Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 36 7. YA23 13(6) When the manager is made the appointee/agent for a person who uses the service records kept of all incoming and outgoing payments must be independently audited/monitored at regular intervals. This will ensure the risk of people who use the service being financially abused is minimised because the homes arrangements for managing finances are more transparent. The home must install a suitable ramp in the rear garden to enable all the people who use the service to access the raised decking area in the far right hand corner. The homes washing machine must have a sluicing facility to deal with soiled and or foil laundry. This will ensure the risk of infection is appropriately managed in the home and people who use the service and kept safe. The way in which the service draws up the duty rosters must be reviewed to make them more transparent regarding which members of staff are designated ‘on call’ at night. The way in which the service handles references must be reviewed to ensure the employer is satisfied on reasonable grounds as to the authenticity of any reference provided by a new member of staff. This will ensure the DS0000069620.V353548.R01.S.doc 01/01/08 8. YA28 23(2)(o) 01/03/08 9. YA30 23(2)(k) 01/01/08 10. YA33 17(2), Sch 4.7 01/12/07 11. YA34 19(4)(c) 01/12/07 Allswell Lodge Version 5.2 Page 37 safety of the people using the service. 12. YA35 13(3) Infection control training must be provided for all staff who work at the home. This will ensure the safety of the people using the service. All staff who work in the home must be involved in at least one fire drill every six months (we recommended once a quarter). This will ensure the safety of the people using the service. An Immediate Requirement Notice was issued at the time of the second site visit for this serious breach to be addressed within 24 hours. Deadlocks fitted to doors/gates positioned on a fire escape route must be replaced with more suitable locking devices that can be opened more easily by staff in an emergency. This will ensure the safety of the people using the service. Radiators in the home are not covered and must be assessed for the risk they present the people who use the service and include the action to be taken to minimise any identified risk. This will ensure the safety of the people using the service. 01/02/08 13. YA42 23(4)(e) 09/11/07 14. YA42 23(4)(b), (c)(iii) 01/12/07 15 YA42 13(4) 01/12/07 Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 38 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. Refer to Standard YA1 Good Practice Recommendations The people who use the service should have access to a User Guide that contains the homes most recent CSCI inspection report, a more service user friendly version of the homes complaints procedure, and stakeholders views about the service provided. The people who use the service and their representatives should have access to a far more easy to read version of the homes visitor’s policy. This will ensure people who use the service and their loved ones know they can see the people who are important to them when they want (so far as reasonably practicable). The people who work at the home should have access to the latest version of the Royal Pharmaceutical guidance on handling medication safely in a residential care setting. This will ensure they have all the information they require to handle medication safely in the home in order to protect the people who use the service from harm. The way in which the home obtains the views of people who use the service and their representatives regarding aging and death should be reviewed in order that the death of a person who uses/used the service is handled as the individual would wish. The way in which the home ensures people who work at the home know about ‘whistle blowing’ procedures if they witness or suspect abuse should be reviewed in order to make this information more widely available. The way in which the service manages the money and financial affairs of the people who live in the home should be reviewed to make them more open and secure. (E.g. Folio numbers should be recorded on all receipts obtained, and a maximum amount agreed regarding how much DS0000069620.V353548.R01.S.doc Version 5.2 Page 39 2. YA15 3. YA20 4. YA21 5. YA23 6. YA23 Allswell Lodge service users money should be kept in the home any one time). This will minimise the risk of people who use the service being financially abused. 7. YA23 The home should establish a staff expenses policy that clarifies whether or not staff are expected to contribute to their expenses when supporting people who use the service whilst out in the wider community, including residents holidays. People who use the service should be given the opportunity to choose what colour their bedroom is painted. The home should contact the Royal Institute for the Blind (RNIB) in order to seek their expert advice about how they could adapt the home to improve the lives of the visually impaired person who lives there. Induction training received by agency staff should be recorded and made available for inspection on request. All the homes policies and procedures should be reviewed and developed to bring them in line with the homes ethos and objectives. 8. YA26 9. YA29 10. 11. YA35 YA40 Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Allswell Lodge DS0000069620.V353548.R01.S.doc Version 5.2 Page 41 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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