Inspection on 09/07/07 for Anita Jane`s Lodge

This inspection was carried out on 9th July 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 16 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 14/11/07

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 Linda Clarke Key Unannounced Inspection 9th July 2007 09:30 Anita Jane`s Lodge DS0000006432.V340611.R02.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 Anita Jane`s Lodge DS0000006432.V340611.R02.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. Anita Jane`s Lodge DS0000006432.V340611.R02.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 Anita Jane`s Lodge DS0000006432.V340611.R02.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. 15th June 2006 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 Inspections, Inspection Reports could not be determined. Information as to the fees payable could not be determined. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process consisted of pre-planning the inspection, which included viewing the previous Inspection Report and any information received since the last Inspection. The unannounced site visit commenced on the 9th July 2007 and lasted 1 day. Prior to the unannounced site visit, the Commission for Social Care Inspection (CSCI) sent out to the Registered Manager a form known as a Annual Quality Assurance Assessment (AQAA) which when completed provides detailed information which the CSCI uses prior to a site visit to the home as part of the Inspection process. The AQAA provides information regarding the provider’s views as to the performance of the service, information about service users, the number of staff employed and the training they receive. The document also provides information as to the maintenance of equipment in the home, details of policies and documents and information relating to complaints. The AQAA was not received by its due date, neither was it submitted following the sending out of a reminder letter which stated it is an offence under Regulation 24 of The Care Standards Act 2000, not to return the document. The CSCI will determine whether to take action in relation to the failure to return the document. The Commission for Social Care Inspection uses the information regarding service users supplied in the AQAA to send out Service User Surveys to the individuals named, and to their relatives, in this instance as the AQAA was not returned surveys were not sent. The focus of the inspection is based upon the outcomes for the service users. The method of inspection was ‘case tracking’. This involved identifying service users with varying levels of care needs and looking at how these are being met by the staff at Anita Jane Lodge. Three service users were selected and discussions were held with two of them, additionally two service users who were not part of the ‘case tracking’ process were spoken with. The method of case tracking included the review of service users’ individual care records, discussions with staff of various delegated responsibilities within the home and reviewing records. The Registered Manager was not available on the day of the site visit, due to being on holiday, but a brief telephone conversation was held with her. The Senior Carers and carers on duty did not have access to all the documentation necessary to support the inspection. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Service users and prospective service users would benefit from documentation supplied by the home being reviewed, in order that it reflects all the information required and enables prospective service users and service users already living at Anita Jane’s Lodge to have a clear understanding as to the services offered, to understand how they can contribute to the development of the home, and how to raise concerns. Service users rights need to be actively supported and encouraged, and restrictions placed on them such as access to food and their cigarettes. Aspects of their daily lives such as they time they wish to get up or go to bed need to be re-examined to ensure that the home is operating in a manner that benefits the service users, and that any restrictions placed are in the best interests of the individual and are agreed by them, health and social care professionals and documented. The care and support offered to service users could be improved by the introduction of person centred care plans, which focus on the views, aspirations goals and abilities of the service user and are written from their prospective. Care plans need to incorporate all aspects of the service users physical and mental health. Service users need to be offered opportunities to be involved in the daily running of the home, and could include maintenance of the garden, shopping, meal preparation etc. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 7 Staff need to receive training relevant to the mental health needs of service users to ensure that the care they provide is appropriate and to access training regards to person centred care plans, supported by training on equality and diversity. Service users need to know that staff are able to spend quality time with them in order that their aspirations and goals can be met, and that their valued as an individual whose rights are respected and acted upon. Staff need to understand that a key part of their role is to support service users, and supporting service users extends beyond the boundaries of their personal hygiene and the provision of meals and the cleaning of the home. Service users would benefit from improvements to the environment to create a homely feel to the home, this could be achieved by the introduction of items into the home such as pictures, photographs, plants etc. this again should include the views of service users, with service users being encouraged to take an active part. Service users need to be confident that they can influence the development of the home by being encouraged to express their views and contribute to its day to day running. 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. Anita Jane`s Lodge DS0000006432.V340611.R02.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 Anita Jane`s Lodge DS0000006432.V340611.R02.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 and 5. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Information supplied by Anita Jane’s Lodge is not sufficient to enable individuals to make an informed decision as to whether the home can meet their needs. EVIDENCE: Anita Jane’s Lodge has a document which details information about the home, this is given to all service users upon admission, and in a majority of cases was kept in a plastic sleeve within service user bedrooms. When asked some service users said they had received information whilst others said they hadn’t. The information provided is not sufficient to meet the Regulations nor does it provide information in sufficient detail to benefit prospective service users in establishing as to whether the services offered by Anita Jane’s Lodge is appropriate to their needs. Service users whether already residing in the home or considering a placement are entitled to expect access to two documents referred to as the Statement of Purpose and the Service User Guide. Both documents should provide information as to the services offered by the home, the accommodation and facilities, the experience and training of the Registered Provider (owners), the Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 10 Registered Manager and staff, and information as to the fees that are payable including the terms and conditions of occupancy and include a copy of the homes Complaints and Fire Procedure. In addition views of service users already residing within the home should be included. A copy of the most recent Inspection Report should also be made available. On the day of the site visit, there was no evidence that the Inspection Report was available to visitors, service users or staff, service users and staff spoken with both confirmed they had never seen an Inspection Report completed by the Commission for Social Care Inspection. The Statement of Purpose and Service User Guide need to be updated, and submitted to the Commission for Social Care Inspection, and distributed to existing service users and be available to visitors and prospective service users. As part of the site visit the records of three service users were viewed as part of the ‘case tracking’ process, neither of the records viewed contained a copy of the initial assessment identifying the needs of the service user to determine as to whether Anita Jane’s Lodge was appropriate. Staff on duty were unaware of where assessments were located. One service user confirmed that they had been admitted to the home following discharge from hospital and that the process had been hurried. The assessment and admission process could not be determined. Service users were asked as to whether they had a Contract detailing the terms and conditions of their occupancy, some said they thought they had but when asked said they didn’t have a copy, whilst others said they did not have a Contract. The Contract should be part of the Service User Guide. Anita Jane`s Lodge DS0000006432.V340611.R02.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 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users cannot rely upon the information detailed in their care plans to give an accurate account of their needs nor does it reflect their goals and aspirations. Service users are not supported to make decisions, which affect their daily lives. EVIDENCE: As part of the Case Tracking process, the care plans of three service users were viewed, the care plans are a set document used by Anita Jane’s Lodge, and were designed to incorporate information about the service user, which included information as to their previous life, social and leisure interests, and tick box assessments with regards to mental and physical health, areas of risk and a care and action plan section. Care plans provided minimal information about the service users mental health, stating the service users diagnosis, supported by minimal information as to how the condition affects the service user i.e. hearing voices. The care Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 12 plan did not provide any information as to how the individual’s mental health impacted on their daily lives, or the role in staff in offering support and guidance. Care plans focused heavily on service users personal hygiene and the cleanliness of their rooms. All care plans contained a signed agreement by the service user confirming the days that staff could clean their room. One service user said, “It’s very strict, you have to keep your room tidy and have a shower or bath regularly.” Service users spoken with confirmed that their care plan is reviewed by their Keyworker every month with them, with a detailed review taking place every six months, in most instances the service user signs the care plan to confirm that a review has taken place, service users said that they were happy with the content of their care plan. The care plan review process is often repetitive in that information is transferred from one month to another with little additional information contained. The care plan does not set or detail goals and aspirations of service users with regards to their day-to-day lives, and therefore the review process in the main is linked to the service users ability to maintain their personal hygiene. The care plan of one service user identified that they were Diabetic, and would need support with their diet, the care plan did not say as to how this was to be achieved. A conversation heard regarding the service user identified that the service user has routine blood tests to monitor the service users Diabetic condition, the Keyworker of the service user was asked as to the frequency of these checks who then advised she thought it was every two weeks, there is no information in the care plan which advises staff that these monitoring tests are to take place or their frequency. Daily notes of a service user indicated they had undergone a twenty four hour monitoring of their heart, however the following review of the service users care plan made no mention of the test. In addition to care plans and daily notes copies of comprehensive reviews were in service users files, which were conducted in the main by health care professionals, and included the service user and Registered Manager of Anita Jane’s Lodge. The review minutes identified aspects of the service users mental health and well-being, which included potential risks to the individual service user and others, such as self harm/suicide, their vulnerability and potential to harm others, information as to potential risks were not incorporated within the care plan of the service user nor were their any risk assessments in place acknowledging the potential risk and how the risks were to be managed. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 13 Service users would benefit from the introduction of person centred plans, which places the service user as the central key figure and is written from their prospective, focusing on their abilities and needs including their goals and aspirations, a proactive and trained staff team could support service users to improve their quality of life. Observations identified that a majority of service users who smoke have to ask staff for their cigarettes, the cigarettes being kept in the office with each service user having a book recording the number of cigarettes the service user has purchased and how many have been distributed. There is no agreement in the care plan that service users have agreed to this arrangement. Service users spoken with confirmed that staff respect their confidentiality. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 14 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 and 17. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users have limited access to leisure and recreational pursuits outside of day care provision. Service users access to food is restricted and they are unhappy with the quality and variety of meals provided. EVIDENCE: Care plans of service users which were viewed and observations on the day of the site visit revealed that a majority of service users access various placements during the day, which include clubs for individuals with mental health needs, where activities are offered such as art and craft, gardening etc. Service users access these activities by taxi, public transport or walking. Service users spoken with said very little happens within the home, a list of proposed trips was located on the wall of the dining/recreational room, Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 15 however no dates have been planned for these trips, care staff on duty confirmed that one trip had taken place that being to Twycross Zoo. Daily records of service users provided little insight into their recreational pursuits, but care staff advised that as they leave the home independently they are not in all instances aware of their activities. Daily records did identify that one service user had visited a park with another service user, whilst one service user had been shopping. One service user said that the Manager had asked them if they wanted to go on holiday, however as not everyone wanted to go they wouldn’t be going. One care plan identified that a service user likes to attend Church however discussions with the service user revealed that since moving to the home they hadn’t attended Church as they were unfamiliar with the area. The care plans of service users detail family and friends and indicate if there is contact between themselves and the service user. One service user when asked as to how they spent their day said, “I don’t go out with staff, I watch television, not much else to do”. One service user who was accessing respite care was in bed reading, other service users spent time in their rooms some asleep, sitting in the lounge or smoking in the ‘shed’ which is located in the courtyard, this being the designated smoking area for service users. The dining/recreational room has a pool table; service users were not using this on the day of the visit. There was little interaction between service users and staff, interaction being in the main brief conversations when a service user departed or returned home, or when service users asked for cigarettes. Staff training was taking place on the day of the site visit which was held in the dining/recreational room, which meant it was not accessible to service users. The staff training meant that their lunch which, was to be beans on toast was changed to a selection of sandwiches to facilitate service users eating in the lounge, this decision was made by staff and service users were not consulted but advised. A number of staff were spoken with on the day of the site visit, some indicating that they believed service users had a good standard of life, and said they offered good quality care. Some staff spoken with felt that they have minimal if no quality time with service users, and that the focus of the home was getting people up in the morning and promoting the personal hygiene of service users, the focus on their day was then to prepare and cook meals, and clean and complete paperwork. Staff spoke of the cleaning regime of the home and the expectations on them as staff. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 16 The lounge provides a large television, and service users have televisions and stereos in their bedrooms. Service users have a key to their bedroom, a majority choosing to lock their bedroom however staff have keys to override the locks, there is no agreement in place with regards to staff accessing a service users bedroom without their permission, with the exception of the agreement for the cleaning of their bedroom. On the day of the site visit the majority of the bedrooms were seen, the care worker did knock on service users doors, but did not wait for an answer before going in, when asked as to this practice the care worker said she thought the service user was not in their room. Care plans do not detail the involvement of service users in housekeeping tasks; in line with the promotion of their independence and choice to control their home environment and daily lives, there was no evidence of service users being involved in the purchasing, preparation and cooking of food. On the day of the visit it was noted that service users were discouraged from accessing the kitchen during the preparation of lunch. Service uses were asked how menus were decided those who attended service user meetings said they are discussed in the meetings. Service users were also asked as to their views on the food; in the main they were highly critical. There comments included: • • “Good not too bad, you get sufficient, the quality could be better and there could be more variety.” “Meals are not very good they use cheap ingredients, the Manager does all the shopping, no one who lives here goes shopping, but I would like to.” “Meals are horrible just like slop, they’re not cooked properly, the meat is tough, we discuss this at meetings but nothing happens.” “We have to wait for set meal times, we have access to fruit, everything else we have to ask for.” “I keep food in my room so as I can eat between meals.” “You can’t help yourself to a snack you have to wait for it to be put out.” • • • • Observations on the day confirmed that all food was locked away; dry goods in the pantry, and frozen and refrigerated goods were in a shed located in the garden area. Staff on duty carried keys. Food stocks were viewed, a majority of the dry goods and refrigerated and frozen goods were a local supermarkets ‘value range’ with a few frozen items being from an alternative shop. A Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 17 member of staff on duty confirmed that fresh food comes in the form of potatoes and fruit all other vegetables and meat are frozen. Tea and coffee making facilities are available in the dining/recreational room, with service users accessing the kitchen to fill up the kettle with water. Powdered milk is used to make the tea or coffee, as the refrigerator is housed in the locked shed, external to the property, to which only staff have access. On the day of the site visit the main meal for the evening was a choice of Sausage Casserole or Beef Lasagne and Lemon Tart or Yoghurt, service users were asked in the morning as to their preference. During the course of the day it came to light that a service user who did not eat Beef on religious grounds had chosen Sausage Casserole for their evening meal, and the sausages contained Beef and Pork and therefore were not appropriate. The service user was told by staff who said “the sausages are Beef and Pork so you can have Chicken Kiev okay” to which the service user nodded saying “alright”. The Commission for Social Care Inspection received a complaint regarding the quality of the food, which had been forwarded to the Registered Provider (owner) to investigate using the homes Complaint Procedure. A very brief telephone conversation to the Registered Manager in the morning of the site visit said she had looked into the complaint and this had been resolved. The complaint investigation records into the complaint could not be viewed, as the Senior Care Workers on duty did not have access. There was no evidence in care plans as to why food supplies need to be locked away or that the views of service users had not been considered with regards to their taking part in the shopping, preparation and cooking of food. Information provided by the home in the form of their brochure did not advise prospective service users that access to food was restricted. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 18 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 and 20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users have access to appropriate healthcare provision, but do not in all instances are their health needs appropriately documented or supervised. EVIDENCE: Service users residing at Anita Jane’s Lodge require minimal personal care, and in the main require verbal prompts and guidance, this also means that specialist equipment such as hoists are not required. Care plans focus on the need for service users to maintain their personal hygiene. One service user said I always get up at 8am so that I can have a shower or bath, and I go to bed at 9pm, when asked why replied “there’s nothing else to do”, when asked if they ever had or wanted stay in bed later said “no, I need to get up to have a shower or bath”. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 19 Care plans do not reflect service users daily routines and preferences with regards to what time they wish to get up or go to bed, or provide any information as to the flexibility of the home to meet the individual needs of service users. Service users access to health care is recorded which include reviews carried out by Health Care Professionals including Consultants in Psychiatry, and visits to Opticians and Podiatrists. Records viewed showed no evidence of service users visiting a Dentist. Service users spoken with were happy with regards to their access to health care provision. The care plan of one service user stated they were Diabetic, discussions with staff revealed that the service user requires regular blood tests to ensure that their condition is managed appropriately, the need for such tests or their frequency were detailed within the care plan. A record of the tests was viewed and it was noted that the most recent test could not be carried out as the ‘test strips’ had ran out, when asked neither of the Senior Support Workers were able to confirm as to whether the ‘test strips’ had been ordered, both confirming that the ordering of medication etc was the responsibility of the Registered Manager. A service user earlier in the year had undergone a twenty-four hour monitoring of their heart, this was not detailed within the care plan nor was their information as to the results. Care plans detail the medication service users are prescribed, which is regularly reviewed by the Consultant Psychiatrist. There are systems in place in the home for the ordering and returning of medication with records kept. Staff advised they have received training on the administration of medication and medication records of the three service users case tracked were viewed and found to be in good order. The medication cupboard contained drugs, which were not prescribed that included an anti-histamine, pain relieving and indigestion preparations. When asked the staff on duty were not aware of how they came to be in the medication cupboard, and the care plans of service users viewed did not contain and guidance on the use of over the counter preparations. There was no evidence to suggest that the Registered Manager had considered that service users who live permanently at the home might be able to manage their own medication, an assessment of service users ability to manage their own medication should be undertaken in conjunction with the service user and relevant health care professionals, and be managed in such away as to manage risk. The service user accessing respite care confirmed that they are responsible for their own medication. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 20 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 and 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are not in all instances confident their concerns will be listened to and acted upon. EVIDENCE: The Commission for Social Care Inspection (CSCI) received an anonymous complaint in August 2006, the complaint highlighted three issues of concern: 1. The quality and variety of food was poor, mostly consisting of cheap foods, with very little meat except on a Sunday. 2. Staff have very little time to talk to residents, as they’re busy cleaning and doing paperwork. 3. The complainant is afraid to raise concerns with the manager, the home has house meetings but residents find it difficult to raise their concerns so they say nothing. The CSCI wrote to the Registered Provider (owner) asking for them to investigate the complaint using Anita Jane’s Lodges complaints procedure. The Registered Manager (who was on annual leave) on the morning of the site visit telephoned the home and had a brief conversation with the Inspector, the Inspector asked as to the complaint as detailed above, and the Registered Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 21 Manager said that she had looked into the concerns and that they had been resolved. The Senior Care Workers on duty did not have access to the complaint records and therefore the investigation into the complaint could not be viewed, nor could it be ascertained as to whether the home had received any complaints made directly to the Registered Provider, Manager or staff. Discussions with service users indicate that in their view the issues highlighted have not be resolved to their satisfaction, as indicated within previous sections of the Inspection Report. Service users were asked if they were aware of how to complain, all indicated that they would speak with the Registered Manager, when asked if there concerns were in relation to the Registered Manager who would they speak with, one said the owner of the home whilst others were unsure. The bedroom of the service user accessing respite had a copy of the homes Complaint Procedure on the wall. Current information about the service the home offers to which service users have a copy does not contain a copy of the Complaints Procedure. The Complaints Procedure should be supported by information on Advocacy services. Staff records indicated that some had received training in safeguarding adult procedures and protocols and when asked staff said if they had any issues of concern they would report these to the Registered Manager. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment of Anita Jane’s Lodge provides accommodation, which meets the needs of service users. EVIDENCE: Anita Jane’s Lodge provides a lounge to the front of the property, and a recreational/dining room to the rear, the dining room leads into the kitchen. There are two stairwells to the first floor; the home is a conversion from two semi-detached properties. Communal areas are decorated and furnished to an adequate standard and are functional in appearance and design. Floors have a carpet or alternative flooring whilst walls are painted. Furnishings consist of chairs, sofas and tables and provide in the case of the lounge a television, and in the dining/recreational room tea and coffee making facilities and a pool table. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 23 The environment does not appear to be designed to promote a home for service users to relax, traditional props used to create a homely environment such a pictures, photographs, ornaments and plants etc. are not provided. Service users were asked as to their views on their home; all said they were happy with the way it looked. The carpets of both stairwells were torn in places, the staff on duty said that the Registered Manager had said she was going to choose replacement carpets, but staff were not aware if this had been done or when the new carpets were to be fitted. A majority of bedrooms were viewed and were found to be personalised, more so in some instances. A majority of the bed linen was the same colour and design, suggesting service users are not in all instances given choices as to how their room reflects their personality. Bedrooms are single or shared, and located on the ground and first floor and are without en-suite facilities, bathing/showering and toilet facilities are also located on the ground and first floor. Anita Jane’s Lodge was clean and tidy with the exception to some stained carpets in communal areas. Staff spoken with confirmed there was routine to the cleaning of the home, which included the making of beds, vacuuming and cleaning of sinks and toilets on a daily basis, with additional ‘turn outs’ being pre-determined which involved all aspects of a service users bedroom being cleaned, such as skirting boards and windows etc. Anita Jane’s Lodge has a large rear garden, however the potential of this garden to provide a relaxing environment for service users to relax is not maximised. The garden is overgrown with long grass and weeds, roses and mature plants were planted and a large patio area provided, however there is no seating available. There is no involvement or encouragement for service users to maintain the garden and take a pro-active role in its upkeep. Anita Jane’s Lodge has a laundry room, and staff records detail they have received training in infection control. There is no evidence in care plans, which suggests service users are encouraged to be involved in the laundering of their clothing, which is a missed opportunity for the promotion of service users independence. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 24 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 and 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The deployment of staff and the extent of their duties expected of them do not enable service users to benefit from quality time with staff. Staff are qualified and trained in the delivery of personal care. EVIDENCE: The Senior Carer advised as to the number of staff employed being eleven care staff of which seven have attained a National Vocational Qualification in Care at level 2, representing 64 of the staff team. Staff spoken with confirmed that they had completed an application form and had attended an interview and provided references, and all had had to have a Criminal Record Bureau check undertaken prior to their employment. Staff confirmed that they had completed a booklet as part of their induction. The staff recruitment and induction records could not be viewed, as the staff on duty did not have access to this information. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 25 Staff confirmed the training they receive which in the main focused on topics relating to health, safety and welfare. Topics included fire awareness, moving and handling, infectious diseases and first aid, a refresher course for first aid was taking part on the day of the site visit. Staff advised they were in the process of undertaking training in Dementia, however service users residing at Anita Jane’s Lodge do not have a diagnosis of Dementia. Staff do not receive training in areas relevant to the mental health needs of service users, for example Depression, Schizophrenia or Paranoia etc., such training is necessary if staff are to have a clear understanding of the needs of the service users, and how their illness impacts on their quality of life and ability to take part in every day living tasks. Training in these areas would enable staff to accurately reflect the care needs of service users within their care plan and develop care plans in a way, which reflects the service users mental health, incorporating their views and aspirations and goals and offering support, in order that service users maximise their independence and take control of their lives. Staff would also benefit from receiving training in how to deal with service users who may become behaviourally challenging due to their mental health, techniques in diffusing situations would enable staff to react appropriately and minimise distress to the service user. There is a consistent staff team employed at the home, with a number of staff having worked there for many years, the staffing levels as advised by care staff, revealed that there are two members of care staff on duty in the morning (in addition the Registered Manager is usually on duty in the morning), with two care staff working in the afternoon and evening, and one member of staff on duty during the night. The staffing levels as identified in previous sections within the report do not enable staff to spend quality time with service users outside of overseeing service users personal hygiene and the completion of paperwork and undertaking duties related to house hold tasks. Staff spoken with confirmed that regular team meetings are held; however the minutes were not accessible to the staff on duty. Staff spoken with said that they receive regular supervisions by the Registered Manager which, were not scheduled and involved the Registered Manager observing their work. Staff additionally would benefit from a supervision which is scheduled in order that both parties can be prepared, the supervision should be used to discuss issues relating to the care staffs role within the home, to establish any training needs, to discuss the service users to whom they are key worker for and any other issues felt appropriate. Minutes of the supervision should be taken with both parties retaining a copy. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 26 Service users were asked as to their views on the care staff the following comments were made: • “My keyworker is very nice”. “The staff are alright, but are a bit bossy about keeping rooms tidy.” “Some staff are a bit ‘mardy’ and won’t help you” “Staff are polite and helpful, there’s a lot of office politics and staff ‘back stabbing’.” “Staff may snap and sometimes arrive on shift and say they want to go home as they’re ‘cheesed’ off.” “Staff are very nice and helpful, they’re never moody or abrupt.” • • On the day of the site visit staff were overheard talking as to their dissatisfaction with their rota the hours they were expected to work. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 27 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): 38, 39, 42 and 43. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Anita Jane’s Lodge is not run to benefit or promote the welfare and rights of service users, and the systems in place do not encourage choice and service user participation in aspects of their daily lives. Service users are not confident that their views will be listened to and acted upon. EVIDENCE: Prior to the unannounced site visit, the Commission for Social Care Inspection (CSCI) sent out to the Registered Manager a form known as a Annual Quality Assurance Assessment (AQAA) which when completed provides detailed information which the CSCI uses prior to a site visit to the home. The AQAA was not received by its due date, neither was it submitted following the sending out of a reminder letter, the Registered Manager (who was on annual Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 28 leave) on the morning of the site visit telephone the home and had a brief conversation with the Inspector, when asked about the AQAA the Registered Manager apologised saying she’d forgotten. As a result of the information not being supplied by the Registered Manager the Inspection process impeded, information in some instances requested on the day of the site visit was not accessible, as the Senior Care Workers had restricted access. The experience and qualifications of the Registered Manager, Mrs Lois Fletcher could not be ascertained as part of the site visit, this information should be detailed within the home’s Statement of Purpose. The Commission for Social Care Inspection uses the information regarding service users supplied in the AQAA to send out Service User Surveys to the individuals named, and to their relatives, in this instance as the AQAA was not returned Surveys could not be sent. Service users and staff confirmed that the Registered Manager facilitates service user meetings, however information previously detailed within the Inspection Report and comments received from service users suggests that service users have no confidence that issues discussed within these meetings will be acted upon. Service users made the following additional comments with regards to service user meetings: • • “Service user meetings are held every fortnight, I don’t attend anymore as issues aren’t actioned or followed through.” “I attend the meetings, but I don’t find them useful whatever is said goes out the back door.” A review of the way service users are requested to express their views needs to be undertaken as a matter of urgency, service users need to feel confident that any views they express will be acted upon without fear of repercussion or reprisal. A formal quality assurance process needs to be implemented which involves the service users and others involved in the health and welfare along with relatives. A report of the quality assurance process should be produced and it should contain an action plan as to how the service intends to improve and act upon the views of those who have taken part, a copy of the report should be available to all participants and to the Commission for Social Care Inspection. The fire records and maintenance of electrical and gas systems were viewed, all appeared to be maintained as detailed by the records. Staff receive training in issues relating to safe working practices, such as training in moving and handling, fire safety, first aid, food hygiene and infection control. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 29 The Insurance Certificate displayed in the entrance foyer with regards to the business premises was invalid, as the expiry date on the Insurance Certificate expired in January 2007. Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 30 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 1 2 X 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 X 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 1 15 X 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 X X 1 1 X X 3 1 Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 31 Not Applicable 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) 4(2) Requirement The Registered Person to produce a Statement of Purpose, which details all the information required by the Care Homes Regulations as detailed within Schedule 1. Timescale for action 09/10/07 2 YA1 5 (1) 5 (2) The Registered Person to supply a copy of the Statement of Purpose to the Commission. The Registered Person to 09/10/07 produce a Service Users Guide, which provides a summary of the Statement of purpose, terms and conditions of occupancy including information as to the fees, a contract for the provision of services, the most recent inspection report, a summary of the complaints procedure and the address and telephone number of the Commission. The Registered Person to supply a copy of the service user’s guide to the Commission and each service user. The Registered Person to ensure that the care plans of service users fully reflect and detail the DS0000006432.V340611.R02.S.doc 3 YA6 15(1) 09/10/07 Anita Jane`s Lodge Version 5.2 Page 32 4 YA6 12(4) 5 YA9 13 (4) 6 YA16 12 (4) 7 YA17 12 (4) 8 YA19 12 (1) 9 YA20 12(2) 10 YA22 22 (5) support they require with regards to their physical and mental health. The Registered Person to ensure that the dignity of service users is promoted and maintained and that restrictions such as the those posed on service users access to cigarettes should be agreed by the service user and be part of the care plan. 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 harm. The Registered Person to ensure that the dignity of service users is promoted and discussions are held with them as to who has access to their room in their absence. The Registered Person to ensure that the dignity of service users is promoted and that service users have access to food without having to ask staff permission. The Registered Person to ensure that service users, who have a diagnosed condition such as diabetes, have their health care needs met and monitored. The Registered Person to enable why appropriate through discussion with the service user, health care professionals and by the use of risk assessments service users management of their medication. The Registered Person to ensure that a copy of the complaints procedure is made available to DS0000006432.V340611.R02.S.doc 09/10/07 09/10/07 09/10/07 09/10/07 09/10/07 09/10/07 09/10/07 Anita Jane`s Lodge Version 5.2 Page 33 11 YA24 16 (2) 12 YA24 23 (2) 13 YA33 18(1) 14 YA35 18 (1) 15 YA39 24 (1) 16 YA43 25(2) all service users, and that the effectiveness of the procedure is monitored to ensure services are confident in its use. The Registered Person to replace the carpets or make safe the tears in the carpet of both stairwells The Registered Person to ensure that the external grounds are tidied and are accessible and safe to service users. The Registered Person to review the deployment of staff to ensure that service users have the opportunity to receive quality time and support from care staff. The Registered Person to ensure 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. 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. The Registered Person to supply to the Commission an up to date certificate of insurance for the registered provider in respect of liability insurance as detailed within the regulations and National Minimum Standards 09/10/07 09/10/07 09/10/07 09/10/07 09/10/07 09/10/07 Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA6 YA20 YA22 Good Practice Recommendations It is recommended that care plans be developed consistent with Person Centred Planning guidance and recommendations. It is recommended that the use of homely remedies be reviewed, in consultation with service users and their General Practitioners. It is recommended that information about advocacy services be detailed as part of the homes 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. It is recommended that care staff receive regular scheduled supervisions, providing an opportunity for both the Registered Manager and member of care 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 felt relevant. Such discussions should be recorded, with copies of the notes being held by both parties. 4 YA24 5 YA36 Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 35 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 Anita Jane`s Lodge DS0000006432.V340611.R02.S.doc Version 5.2 Page 36 - 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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