Inspection on 14/11/07 for Anita Jane`s Lodge

This inspection was carried out on 14th 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Anita Jane`s Lodge 29/03/10

Anita Jane`s Lodge 14/04/09

Anita Jane`s Lodge 24/11/08

Anita Jane`s Lodge 29/04/08

Anita Jane`s Lodge 09/07/07

Anita Jane`s Lodge 15/06/06

Anita Jane`s Lodge 22/09/05

Anita Jane`s Lodge 12/04/05

Anita Jane`s Lodge 07/10/04

Anita Jane`s Lodge 05/04/04

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

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

CARE HOME ADULTS 18-65 Anita Jane`s Lodge 126/128 Uppingham Road Leicester Leicestershire LE5 0QF Lead Inspector Ruth Wood Unannounced Inspection 14 November 2007 9:00 th DS0000006432.V352390.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 DS0000006432.V352390.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. DS0000006432.V352390.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Anita Jane`s Lodge Address 126/128 Uppingham Road Leicester Leicestershire LE5 0QF 0116 276 8071 F/P 0116 276 8071 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) Samalodge Limited Mrs Lois Fletcher Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places DS0000006432.V352390.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may continue to accommodate a named person who falls within category LD as detailed in variation application number 49808. 9th July 2007 Date of last inspection Brief Description of the Service: Anita Jane’s Lodge is a care home providing care for sixteen adults with mental health difficulties, in addition it provides a respite service (short stay) for up to one service user and offers a day care service. There are eight single and four shared bedrooms all without en-suite facilities, located on the ground and first floor. There are bathing/showering and toilet facilities on both the ground and first floor. Communal areas consist of a lounge and dining room/recreational room and kitchen on the ground floor. Anita Jane’s Lodge has a large rear garden, which incorporates a patio area. Information as to the service offered is located on site in a document referred to as the Statement of Purpose. The location of the Commission for Social Care Inspection’s, Inspection Reports could not be determined. Fees at the home are currently £297 per week. DS0000006432.V352390.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the last unannounced visit to the home (09/07/08) the Commission sent out a form to the registered manager known as the Annual Quality Assurance Assessment (AQAA) which when completed provides detailed information which the Commission uses as part of the inspection process. This was not returned to the Commission by the due date neither was it submitted following a reminder letter. It could therefore not be used to inform the previous inspection process. The AQAA was finally submitted to the Commission two days prior to this unannounced visit. The information supplied in this document has been used to inform the inspection process and this report. The inspection visit took place on a weekday between 9am and 3:15pm. The focus was on how the needs of three service users were met; this included detailed examination of their support plans, discussion with staff and the manger as to how they met the person’s needs and where possible discussion with the person themselves. Discussion was also held with three other service users about what it was like to live in the home and with three staff members about the training and support they receive to do their jobs. Staff interaction with service users was also observed. Medication, staff training and recruitment records were examined and all communal areas and three service users’ bedrooms were viewed. What the service does well: What has improved since the last inspection? Sixteen requirements and five good practice recommendations were made at the previous inspection; of these eight requirements and one recommendation have been met. Signed agreements are in place on service users’ support plans outlining the restrictions placed on their consumption of cigarettes. Agreements are also in DS0000006432.V352390.R01.S.doc Version 5.2 Page 6 place giving permission for staff to enter service users’ bedrooms to clean them. Service users said that following complaints about the food the quality and variety had improved although it did depend on which of the staff were cooking. Service users spoken with also said that they had access to food when they were hungry. Efforts have been made to promote the complaints procedure in the home and respond to any concerns raised by service users. The support plan of one service user showed how they were supported to manage their diabetes and the service user confirmed that they were satisfied with the support they receive in this area. Staff training in diabetes has also been arranged. Stair carpets have been replaced and the rear garden has been cleared making it accessible to service users. One service user is now using part of the rear garden as a vegetable plot. A valid certificate of employers liability insurance is now displayed. What they could do better: At the previous inspection it was identified that documentation outlining the services provided by the home (The Statement of Purpose and Service Users’ Guide) must be improved. Although both of these documents have been updated and new copies have been distributed to service users they still do not contain full information concerning the terms and conditions of living in the home. When examining service users’ support plans it was noted that some service users had been given verbal &/or written warnings about their behaviour. The terms and conditions of living in the home should include information about any restrictions placed on service users’ behaviour and any sanctions imposed by the home, which may affect their residency. The registered person must also make sure that a copy of the most recent inspection report is available to service users and visitors to the home. Considerable work is still needed to ensure that the needs of people living in the home are effectively met. The assessments completed by the registered manager and support plan documentation must take account of service users’ support needs in relation to their mental health conditions; staff must also receive training in this area to enable them to deliver that support effectively. Support given should also take account of service users’ aspirations to live independently and ensure that opportunities for developing and maintaining independent living skills are facilitated. The registered person must also ensure that staff have sufficient time allocated to support and interact with service users, in addition to their domestic and catering duties. Service users must be supported to take reasonable risks with assessments being made according to each individual’s needs and abilities and appropriate DS0000006432.V352390.R01.S.doc Version 5.2 Page 7 support being provided to minimise identified risks. This should include an assessment as to whether individual service users are capable of managing their own medication. New staff coming to work in the home must receive an induction preparing them to work in the home. A suitably qualified and experienced worker should also supervise them until their induction is complete and they should not escort service users away from the home unaccompanied, again until their induction is complete. The lock on the medication cabinet needs repairing or replacing so that medication can be accessed when required and reasons must be documented for any gaps in the medication administration record. A quality monitoring system must be implemented to ensure that service users’ views fully inform the running of the home; service users should also be made aware of advocacy services to enable them to access support to express their views, should they need it. Finally the registered person must ensure that they inform the Commission of any occurrence such as the death or serious illness of a service user, as outlined in the appropriate Regulations. 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. DS0000006432.V352390.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection DS0000006432.V352390.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is poor Pre-admission assessment is poor meaning that people’s needs are not fully understood and therefore cannot be effectively met. Further improvements are needed in the information available to service users to enable them to make an informed decision about living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A social worker’s community care assessment and an assessment completed by the registered manager are in place for the most recently admitted service user. The latter is very brief outlining only physical health and personal care needs. The assessment contains no information about the service user’s mental health needs or the support that they require in this area. Discussion with the manager and examination of the service user’s records indicate that they had visited the home prior to moving in and that this is a normal part of the admission process. One single room is designated for respite or trial stays. An individual placement agreement is in place for this service user as well as the other two service users whose assessment documents were examined. The statement of purpose and service users’ guide have been updated to include much of the basic information required to enable service users to make an informed decision about living in the home with two key exceptions: DS0000006432.V352390.R01.S.doc Version 5.2 Page 10 • Firstly service users said they had not seen the report from the previous inspection visit and there is no evidence that it has been made available to them or to visitors to the home. Secondly two of the three service users’ files examined contain references to either verbal or written warnings given by the home in response to behaviour deemed inappropriate. There is no information in service users’ contracts with the home as to under what circumstances these ‘warnings’ will be issued or the consequences arising from them. The appropriateness of this system should be assessed and if retained, the terms must be made clear to all service users and form part of the terms and conditions of living in the home. • Copies of the service users’ guide have been distributed to all service users in a standard written format. Consideration should be given to producing the service users’ guide in alternative formats to make it accessible to those who may not be able to access standard written English. DS0000006432.V352390.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is poor Support plans contain little information about service users’ support needs in relation to their mental health or their goals and aspirations; this makes it difficult for staff to support them effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three service users’ support plans examined focus on personal care and physical health needs with some reference to interests and social activities. Plans contain little or no information about how to support service users to manage their mental health or the way this impacts on their daily lives. Plans contain signed agreements relating to restrictions enforced by care staff on the number of cigarettes that they consume; these require dating. Plans do not contain any information about rehabilitation or about developing or acquiring independent living skills. One service user said that they hoped to move out of the home to live independently again, but there seemed to be no plan in place to enable them to acquire the skills and experience necessary to do this. As stated at the previous inspection service users would benefit from the introduction of person centred plans, which are written from the perspective of the user, focussing on their abilities and needs including their goals and aspirations. DS0000006432.V352390.R01.S.doc Version 5.2 Page 12 Risk continues to be poorly managed within the home with some apparent risks not being acknowledged or assessed and the response to other identified risks being a universal ‘blanket’ response with no distinction being made between different service users’ abilities or needs. No risk assessment was conducted before a recently admitted service user joined a group outing with five other service users and two staff members; staff had little information as to the level of support this service user was likely to require. Conversely the majority of service users are checked every hour by the waking night staff member as the manager states she is “scared to leave them” fearing that they may smoke in their rooms. There are no individual risk assessments in place relating to this and this practice does not appear subject to reassessment. Information about advocacy services displayed on the notice board is out of date and there is no evidence that any individual or group in the home uses such services. DS0000006432.V352390.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14, 15, 16, 17 Quality in this outcome area is poor Service users have some access to leisure and recreational pursuits outside of their day care provision but there is little support for people to develop independent living skills. Service users are satisfied with the quality and variety of food served. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of minutes of service users’ meetings indicate that there has been extensive discussion about the quality and variety of food served in the home and that efforts have been made to respond to service users’ complaints. At the previous inspection there was evidence that food was locked away and that service users did not have ready access to this. The Provider in his response to the report disputed this and such restrictions were not observed on this visit. One service user stated (unprompted) that if they got peckish they usually went to get some ‘Weetabix’ with milk; another service user was observed to be eating fruit from the fruit bowl. A small kitchen area has been installed in the dining/activities room and this has the ingredients for making tea and coffee. Several service users also have kettles in their own rooms and DS0000006432.V352390.R01.S.doc Version 5.2 Page 14 purchase their own tea and coffee for their personal use. One service user said that they ask staff for fresh milk from the kitchen when they need some. Service users variously described the food as good or excellent and one service user described Sunday dinner as “beautiful”. They explained that there had been some problems with the food but now people had made suggestions about new things to have on the menu and these had been put in place. They also commented that some of the staff could cook better than others and that this affected the quality of the food served. Menus seen showed that a suitable alternative was available for the service user who could not eat beef due to religious and cultural reasons. Service users are involved in a variety of activities during the day, including attending specialist day and drop in centres. One person attends temple with their support group. One service user is undertaking an Open University course and has recently sat an examination. Several service users said that they go out to local shops and cafes either alone or with other people who live at the home. The manager said that service users go out alone to day care activities and to local shops and that she and the staff did not always know where they were. Staff interaction with service users is limited, particularly during the mornings as staff have a series of domestic tasks to complete. Staff do play board games with service users at other times and one service user said that they enjoyed playing dominoes. The home’s garden has been cleared and one area is now being used as a vegetable plot by one service user. The garden is now accessible to service users and a table and chairs have been placed outside for people to use. There appears to be little opportunity for service users to develop their independent living skills within the home although some said that they helped to keep their own rooms tidy. The majority of domestic tasks are carried out by staff including personal washing and ironing. One service user who is looking to return to independent living said that they just left their washing and ironing for the staff to do. Formal, signed agreements are now in place saying that staff can gain access to service users’ rooms so they may clean them. Several service users spoke about the time they spend with their families and other people close to them. Relatives and friends can visit service users at the home and service users also visit their relatives at their home. DS0000006432.V352390.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is adequate Service users have access to appropriate healthcare provision but there appears to be little acknowledgement of service users’ personal preferences about how their personal care or medication needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users have access to health care including reviews carried out by professionals such as consultant psychiatrists. Evidence that service users visit chiropodists, opticians and dentists on a regular basis is on file and this was confirmed through discussion with service users. Letters on service users’ files indicate that they have access to routine health screening appointments. Access to a bereavement counsellor was arranged for one service user who experienced a recent personal loss. This represents good practice. The care plan of a service user with diabetes contains information about their type of diabetes and the way their condition is managed. Staff said that they test the service user’s blood sugar levels on a weekly basis and that they attend a local clinic for their annual health check. This was confirmed through discussion with the service user. Training had recently been arranged for staff members in understanding diabetes. DS0000006432.V352390.R01.S.doc Version 5.2 Page 16 The lock on the current medication storage cabinet is faulty and is difficult to open; the lock or the cabinet should be replaced. Medication received into the home and returned to the chemist is appropriately managed. A homely remedies policy is now in place, although currently no service users are taking such remedies. Medication records show some gaps in recording and no reason recorded for this. Some service users take ‘as required’ medication. Clear protocols should be in place on support plans stating for what reasons this medication can be given, by whom, and details of the medical practitioner who has agreed this regime. Documents (such as letters) on service users’ files indicate that medication is regularly reviewed. Staff administering medication have received appropriate training as evidenced by certificates. The registered manager said that she was looking to follow up the recommendation/requirement made at the previous inspection that service users should be assessed as to their competence to manage their own medication; this has not as yet been implemented. Great emphasis is placed on service users maintaining their own personal hygiene. The AQAA completed by the manager and provider prior to the inspection visit stated that, “ “In view of dealing with adults from 18-65 we have tried to discipline the residents in their personal and healthcare needs”. The registered person should ensure that the way service users manage their personal hygiene is arrived at through consultation with the person in question and not imposed on them by the manager or her staff team DS0000006432.V352390.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate Service users’ complaints are acted upon but the management of risk needs improving so that service users are protected without having their choices and rights unnecessarily restricted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users’ meetings minutes record discussion concerning complaints about the food in the home and how these have been addressed. One service user told the inspector that, “things have been sorted out now”. The complaints procedure (in a standard written format) is displayed throughout the home and in the service users’ guide. A complaints book and complaints boxes are easily accessible and used by service users; the book details the response taken to resolve individual complaints. Service users said that if they were not happy with anything they would speak to the manager and seemed confident in her ability to “sort things out”. However service users seemed unclear as to what they would do if the manager were unable to do so. Information on advocacy services is displayed but is out of date; there is no evidence that advocates have had any involvement with individuals or groups of service users. Staff display knowledge and understanding of the home’s whistle blowing procedures and their responsibilities under this. The manager said that she is trying to arrange for staff to receive training in safeguarding adult procedures, delivered by the local authority. The manager displayed a competent understanding of her responsibilities in this area. Recruitment records indicate that staff names are checked against the vulnerable adults register prior to them starting employment and criminal records bureau checks are obtained. DS0000006432.V352390.R01.S.doc Version 5.2 Page 18 This practice helps to prevent unsuitable people from working with vulnerable adults. To some extent there is a culture of over-protection within the home underlined by a poor understanding and management of risk. This does not allow service users to develop their independent living skills or fully exercise their rights to make choices about the way they live their day- to-day lives. For example all service users (with one exception) are checked on an hourly basis at night; there is no evidence that this practice has been individually risked assessed for all service users. DS0000006432.V352390.R01.S.doc Version 5.2 Page 19 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, 30 Quality in this outcome area is adequate The environment of Anita Jane’s Lodge provides accommodation that meets service users’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Replacement carpets have been fitted to both stairwells and the rear garden has been ‘cleared’ so that it is now accessible to service users. A table and chair have been placed outside and one of the service users is using part of the garden for a vegetable plot. Plans are currently in place to refurbish the main sitting room and discussion was held with the manager as to how to include the service users in the decisions with regards to the décor. It was suggested that this should be seen as an interesting opportunity for the service users to get involved in the home rather than as a task that needs completing as soon as possible. The home is clean and tidy throughout and care staff are involved in cleaning on a daily basis and all staff have received training in infection control. Much emphasis is placed on keeping the home clean and tidy, as the Provider and Manager state in the AQAA, DS0000006432.V352390.R01.S.doc Version 5.2 Page 20 “Our staff are very particular about cleanliness within the home as the residents tend to be very negligent and careless” Service users’ bedrooms are personalised although communal rooms would benefit from such additions as photographs, pictures and plants to make them appear more homely and inviting. DS0000006432.V352390.R01.S.doc Version 5.2 Page 21 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): 32, 33, 34, 35, 36 Quality in this outcome area is poor The current training and deployment of staff does not allow them to deliver support appropriate to the people in the home’s registration category. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were observed to be constantly busy throughout the inspection visit trying to complete domestic routines, prepare dinner, complete paperwork and responding to service users’ telling them they were going out or coming in. One service user was supported to attend an outpatient appointment by a staff member. There appeared to be little if any opportunity for staff members to spend time interacting with service users. The most recently employed staff member’s recruitment records contain a completed application form, two written references and evidence that their name has been checked against the Vulnerable Adults Register before starting work in the home. A Criminal Records Bureau check has also been applied for. The member of staff is still undertaking her induction but is working without direct supervision and has escorted service users away from the care home without being accompanied by another staff member. This contravenes the Care Home Regulation, which prevents new staff members being given excessive levels of responsibility before they have completed a full induction. DS0000006432.V352390.R01.S.doc Version 5.2 Page 22 A letter of urgent concern was sent to the Registered Person asking how they intended to ensure that they complied with the relevant Regulation. The induction material being used by the new staff member is inappropriate to the profile of the service users living in the home. It focuses on physical health care needs and would be more suitable for those engaged in work with older people. The induction contains no information on working with people with mental ill health. Seven out of the eleven care staff have obtained a National Vocational Qualification at level 2. Training received by staff focuses on health and safety issues such as moving and handling, fire safety and first aid. Staff have also undertaken a course in dementia although there are no service users with dementia at the home. Staff confirmed that they had received no training relating to supporting people with mental ill health or on how to respond to people whose behaviour may be challenging. The Provider and Manager recognise that improvement is needed in this area stating in the AQAA, “Our staff have become complacent in their attitude as we are dealing with adults between the ages of 18-65 who are mostly independent. We need to refresh staff training in dealing with individuals who have a mental disorder” The registered manager said that she is trying to arrange appropriate training in these areas. There is evidence that staff have access to supervision sessions with their manager but these appear to focus on staff’s competence in completing domestic and physical support tasks. Staff would benefit from regular scheduled supervision, which focuses on their support role within the home and how they work with people in a way that maintains their dignity, opportunities to make choices and develops their independent living skills. DS0000006432.V352390.R01.S.doc Version 5.2 Page 23 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, 39, 42 Quality in this outcome area is poor Anita Jane’s Lodge is not run to fully benefit or promote the welfare and rights of service users and the systems in place do not encourage choice or the service users’ participation in aspects of their daily lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has a National Vocational Qualification in care at level 2 and has just re-started studying for her Registered Manager’s Award having been unable to complete this due to personal reasons. She has managed the home for several years. Prior to the last unannounced visit to the home (09/07/08) the Commission sent out a form to the registered manager known as the Annual Quality Assurance Assessment (AQAA) which when completed provides detailed information which the Commission uses as part of the inspection process. This was not returned to the Commission by the due date neither was it submitted following a reminder letter. It could therefore not be used to inform the DS0000006432.V352390.R01.S.doc Version 5.2 Page 24 previous inspection process. The AQAA was finally submitted to the Commission prior to this unannounced visit but only after the inspector had rung the manager and reminded her of the requirement to do so. The information in the completed AQAA is very brief reflecting that there is no formal system for monitoring and evaluating the quality of the service provided in the home. A Quality Monitoring ‘package’ has been purchased but this has not been implemented. Service users’ meetings are held in the home and examination of the minutes and discussion with service users indicates that these are now viewed more positively than at the previous inspection visit with action being taken by the manager to respond to service users’ concerns about the quality of the food served. As part of the response to the previous inspection, the registered person was asked to produce an Action Plan. This contained a brief response to the requirements made and was returned after the due date, again following a telephone call from the inspector. Eight Requirements from the previous inspection have been met, two have been partially met and six are still outstanding. Examination of service users’ records indicates that the Commission for Social Care Inspection has not been notified of a number of incidents (including the death of one service user) which under the Care Home Regulations, the home is obliged to inform the Commission of. Staff receive appropriate training in all aspects of health and safety; fire, gas and electrical systems are appropriately maintained. A valid insurance certificate is now displayed in the foyer DS0000006432.V352390.R01.S.doc Version 5.2 Page 25 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 1 3 1 4 2 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000006432.V352390.R01.S.doc 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 1 15 3 16 1 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 1 1 X X 3 X Version 5.2 Page 26 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 YA1 Regulation 5 (1) (d) Requirement The Registered Person must ensure that a copy of the most recent inspection report is made available to service users The Registered Person must ensure that each service user has a copy of the full terms and conditions of living in the home, which, include any restrictions placed on behaviour and any sanctions imposed by the home, which may affect their residency. The Registered Person to ensure that the care plans of service users fully reflect and detail the support they require with regards to their physical and mental health. (Previous timescale of 09/10/07 not met) The Registered Person to ensure that where risks to health, safety and welfare of service users are identified, this is managed safely and identified within a risk assessment, including instances where a service users mental health puts themselves or others at risk, through self neglect or DS0000006432.V352390.R01.S.doc Timescale for action 30/11/07 2 YA5 5 (1) (ba) 07/12/07 3. YA6 15(1) 14/12/07 4. YA9 13 (4) 14/12/07 Version 5.2 Page 27 5. YA20 12(2) harm. (Previous timescale of 09/10/07 not met) The Registered Person to enable where appropriate through discussion with the service user, health care professionals and by the use of risk assessments service users’ management of their medication. (Previous timescale of 09/10/07 not met) 14/12/07 6. YA20 13 (2) 7. 8. YA20 YA33 13 (2) 18(1) The Registered Person must 30/11/07 ensure that the medication storage cabinet is secure and can be accessed when required. The Registered Person must 30/11/07 ensure that gaps in the recording of medication are evidenced. The Registered Person to review 14/12/07 the deployment of staff to ensure that service users have the opportunity to receive quality time and support from care staff. (Previous timescale of 09/10/07 not met) The Registered Person to ensure 31/01/08 that staff responsible for the care and welfare of service users, receive training relevant to the needs of service users with regards to their mental health including specific forms/types of mental health and associated training such as dealing with forms of aggression. (Previous timescale of 09/10/07 not met) The registered person must 14/11/07 ensure that until the identified staff member has completed their induction training they are supervised by an appropriately qualified and experienced worker. They must not escort service users away from the care home unless accompanied by an DS0000006432.V352390.R01.S.doc Version 5.2 Page 28 9. YA35 18 (1) 10. YA35 18 (2) (b) appropriately qualified and experienced worker. 11. YA39 24 (1) The Registered Person to establish a quality assurance system, which enables service users to comment as to the service they receive. An outcome of the quality assurance process should be produced and circulated to all relevant parties. (Previous timescale of 09/10/07 not met) The registered person must notify the Commission in writing without delay of any occurrence of the death of a service user, the outbreak of any infectious disease in the home, any serious injury to a service user, any serious illness of a service user, any event in the home which adversely affects the well-being or safety of any service user, any theft, burglary or accident in the care home or any allegation of misconduct by the registered person who works at the care home. 28/02/08 12. YA39 37 14/11/07 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 YA2 Good Practice Recommendations The statement of purpose should be made available in different formats so that is fully accessible to those people for whom standard written English may be difficult to understand. The registered manager’s assessment of service users’ needs should be more comprehensive and detailed and include information on the mental health of the service DS0000006432.V352390.R01.S.doc Version 5.2 Page 29 2. YA2 3. 4. 5. 6 7. YA6 YA6 YA7 YA16 YA18 8. YA20 9. YA22 user and the support they require in managing this. It is recommended that support plans be developed consistent with Person Centred Planning guidance and recommendations. Support plans should take account of service users’ aspirations to live independently and reflect the support that they may require to achieve this. Information about advocacy services should be updated and made available to service users. Opportunities for developing and maintaining independent living skills should be facilitated. The registered person should ensure that the way service users manage their personal hygiene is arrived at through consultation with the person in question and not imposed on them by the manager or her staff team Information as to under what circumstances service users should be given ‘as required’ medication should be placed on their support plan together with who has the authority to administer the medication and the details of the prescribing medical practitioner. It is recommended that information about advocacy services be detailed as part of the home’s complaints procedure, to ensure service users are appropriately supported. It is recommended that Anita Jane’s Lodge is refurbished to create a more ‘homely’ and ‘relaxing’ environment by introducing to the home occasional furniture, plants, pictures etc. Service users should be actively involved in the discussions and decisions about the décor in the home’s communal areas to ensure that this reflects their taste and choice. It is recommended that care staff receive regular scheduled supervisions, providing an opportunity for both the Registered Manager and member of staff to discuss issues relating to the work they are employed to undertake, to identify any training needs, to discuss issues affecting the welfare of service users, and other issues either party feel relevant. Such discussions should be recorded, with copies of the notes being held by both parties. 10. YA24 11. 12. YA24 YA36 DS0000006432.V352390.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 DS0000006432.V352390.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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