Inspection on 01/09/05 for Astral Lodge

This inspection was carried out on 1st September 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Astral Lodge 11/12/07

Astral Lodge 01/02/07

Astral Lodge 29/11/05

Astral Lodge 13/12/04

Astral Lodge 10/09/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Astral Lodge 2 Cumnor Road Sutton Surrey SM2 5DW Lead Inspector David Pennells Unannounced 01 September 2005, 13:50 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Astral Lodge Address 2 Cumnor Road, Sutton, Surrey, SM2 5DW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8642 1884 020 8661 7974 astrallodge@btimternet.com Astral Lodge Limited Mr Bennie Darkey Care Home 17 Category(ies) of Mental disorder, excluding learning disabilty or registration, with number dementia (17) of places Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Two service users over the age of 65 may be accommodated for as long as the service fully meets their needs. Date of last inspection 13.12.04 Brief Description of the Service: Astral Lodge is a care home providing mental health nursing care to up to seventeen adults (two of whom would share a room) who have enduring mental health problems. The home currently has a variation to provide care to two named service users who are over 65 years of age. The home provides 24hour nursing support to all service users, with additional care staff support provided under the nursing staff’s supervision. The ethos of the establishment is ‘self-help’ - within the understanding of the psychological and other needs of each individual. Accommodation is extensive and provided over two floors; a large lounge, a dining room and separate smoking room are provided. There are fifteen single and one double bedroom (currently singly occupied) sited over both floors of the home. Two toilets are situated on each floor, a bathroom is on the first floor and a shower room is situated on the ground floor. The home has a relatively small but pleasant garden, through which is a route to the external laundry facility. There is car parking for three on the hardstanding at the front of the house, with more spaces available at the side of the building. The home is very close to Sutton town centre (five minute walk away), with its associated excellent transport links and all shopping and leisure amenities. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector spent four hours at the home meeting the proprietor and spending time engaging with service users and staff. During this period he was able to tour the premises, review the administrative conduct of the home and issues arising from the last inspection report with the proprietor - as well meeting and talking to individual service users and conducting a ‘collective interview’ with eight of the fourteen current service users. Five outstanding requirements and two recommendations have been brought forward from the previous visit report. Two new requirements are set (one ‘converted’ from a previous recommendation) – the first relating to checking hot water outlets regularly at baths and showers – thus avoiding the risk of scalding - the second relating to ensuring that sufficient staff members are currently trained in First Aid to ensure adequate cover in the home at all times. What the service does well: What has improved since the last inspection? Premises-wise, the hallway of the home has been re-carpeted and the kitchen has had cupboards refitted. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 6 The proprietor has ensured that records relating to Criminal Records Bureau declarations are properly and rigorously kept. Training for care staff in understanding mental health has been found and started for this sector of the home. Fire alarm checks have become more accurate and systematic - in the home more accurately recording tests. Staff appraisals are now being introduced to all care staff; this will ensure that staff have an active input into their personal / professional development, and hopefully ‘pay off’ in staff being encouraged to request and use regular supervision slots (which until now have been a little lacking). What they could do better: 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. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 4 & 5. Prospective service users can expect to find out adequate detail to make an informed choice when try to decide whether to reside at the home, this supplemented by the opportunity to visit and find out about the home before confirming their stay. The home ensures the appropriate service is provided to each individual based on both their own and other professional’s assessments. EVIDENCE: The home has a Statement of Purpose outlining the aims and objectives of the home, and detailing the facilities and services it provides. The Statement of Purpose now includes all the information detailed in Schedule 1 of the Care Homes Regulations (2001). The home has also developed a Service User Guide that is written in a format / language suitable for service users and contains all the elements of Regulation 5. A Statement of the fees is available on request though not published within the Guide. No new admission s had been made at the home since the last inspection visit; at the previous inspection visit, a randomly chosen - and relatively new service user’s file was selected and examined; a full Care Programme Approach (‘CPA’) Assessment was available - and full hospital-based assessments also. These documents gave a very full picture of the situation pre-discharge from hospital, and the information had been translated into a care plan with Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 9 associated risk assessments for the individual service user’s time at the home. All needs had been clearly identified - and it was gratifying to see that the service user’s relative had been involved in the process, too. All admissions are usually very carefully planned. Short visits (accompanied or otherwise) are followed by overnight and weekend stays; one newer service user had confirmed they had stayed a night or two to ‘get the feel’ of the house. Placements are reviewed after four weeks (longer if necessary) - and are not confirmed as permanent placements until a CPA meeting takes place after six months of placement. The home rarely admits emergency or shortterm placements, due to the potential of disruption to the ‘finely balanced’ community culture at the home. All service users are subject to a local authority three-way contract. The Registered Provider has inserted key contract terms into the Service User’s Guide; each document is signed by the service user and the Registered Provider - thus committing them both to the local rules / terms & conditions at the home. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 & 9. Service users can be confident that the home will provide a care plan, based on current assessment, and reflecting a service user’s rights to exercise choice and autonomy both inside and away from the home, within a risk-assessed context. EVIDENCE: Care Plans are in place for each service user, which clearly states the focus and purpose of any intervention / assistance provided. The Care Plan is reviewed regularly with the service user; the regularity depends upon changing needs; the longest gap would be one month. Each service user has a Registered Mental Health Nurse as key worker, and an associate care worker also allocated, to provide the more direct / personal contact. Each service user also has a CPA (Care Plan Approach) Review meeting at least annually, and more frequently if needs change. Service users reported that they feel both well cared for and “individually treated” at the home. “Everyone is particularly care for.” stated one individual. When interviewed, service users stated that they were able to express their opinions and to be individually themselves – staff had a clear understanding and sensitivity to the characteristics of each. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 11 The home holds regular monthly meetings where there’s space to express opinions and to make community decisions. Minutes of these meetings were seen and indicated meetings that are effective, open meetings. The proprietor or deputy also takes notes of these meetings to ensure the home has a clear record and evidence of topics discussed and their outcomes. Clinical risk assessments are undertaken for each service user in relation to their mental health. The recording of all risk assessments appeared clear and logical; assessments were on file for service users detailing concern over specific behaviours or activities. Many areas of practice noted in the home during the inspection have been risk assessed - and are duly recorded; such as: service users going out against the advice of staff when mentally unwell; some service users holding their own cigarette lighters and lighter fluid - some having these items looked after by staff. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, 16 & 17. A service user at the home can be assured that they will be encouraged to participate in the life of the home and beyond as an individual, being encouraged to participate in in-house and community-based opportunities and leisure activities. Relatives and friends of service users can be assured of a positive welcome at the home; their participation in the life of the home being welcomed to broaden horizons and maintain family / friendship links. Meals at the home are provided in good quantity - with a nutritious and attractive menu being provided. EVIDENCE: The home promotes the independence of the service users as a key area of its focus. Many of the service user’s mental health inevitably affects their ability to participate in independent activities; staff members have to work with service users to motivate and enable them to achieve as much as practicable. Within the home, most service users undertake or participate in doing their own Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 13 laundry; to this end, the ‘laundrette’ in the garden provides domestic size equipment. Most service users are independent in going out of the home, undertaking personal shopping, visits to libraries and other community facilities. All service users have London Transport ‘Freedom passes’ – this enabling them to access public transport. Staff members can support service users on outings to shops, local pubs and restaurants, to swimming, bowling and the cinema. Service users are supported to use public transport for small group outings, and a minibus or coach is provided for large group outings to places of interest and the seaside. Staffing levels in the home are adequate to enable staff to support service users on such outings. The home does not provide a holiday for service users, as this is not included in the fees charged to local authorities, however service users who can pay for – or who have financial assistance from family members – can be escorted by staff members on holidays or weekend breaks (the last escorted holiday was to Italy in August 2005). In-house activities at the home include regular parties, quizzes, pool, video evenings and barbeques. One computer ‘buff’ has space in the basement for enjoying his equipment. Almost all service users have television and radios in their rooms. Service users often spend time in their own rooms, regarding them as their own personal space - a little like an independent ‘bed-sit’. Some service users attend Church services - and the home has monthly visits from the local Anglican Vicar (the Bishop of Croydon visited in the last year). The home is very welcoming of visitors - either family or friends. Links with family members are noted on individual care plans. The home does not have a designated visitor’s room; however there are two lounge areas, one of which is the smoking room. The fact that all current service users have their own private bedroom can be of advantage, though there will be times when the use of the bedroom is inappropriate to receive visitors. The home also has a dining room - and the computer room in the basement is available for use by service users, thus providing other ‘communal’ areas where guests could be taken. Service users reported that food provided at the home was ‘very good’ certainly the evening supper appeared nutritious and appetising - some service users having an alternative menu. All three staff members who undertake cooking duties were credited with being co-equal in skill - or at least having their own ‘specialities’. The proprietor spoke of a future intention to create a social / ‘rehabilitation’ facility in the existing garage area of the home. Some service users are able to make snacks with support from staff members; this is an area the home hopes to develop further. Most service users do not use the kitchen alone, this being a risk-assessed activity. Some service users do assist in the kitchen - a hygiene risk assessment is essential to ensure that Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 14 food safety conditions are upheld - for the benefit of all who eat at the home. Others assist in the general communal routines of laying and clearing tables, etc. Service users, in the main, have kettles and a fridge in their bedrooms; this enables a degree of independence and expression of individuality. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 & 21. Service users can expect to be encouraged to maintain their personal and physical and mental health as much as possible, whilst the staff will provide such assistance as is appropriate / needed (including assistance with medication) to ensure their health and general wellbeing. Service users could be certain of appropriate support and assistance at the end of their life – though further consultation would lead to a more personal focus and personalised service. EVIDENCE: Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 16 All, except one service user (who retains their own previous local GP), are registered with the same General Practitioner, locally, at the Robin Hood Lane Practice. Most service users have come to the home from a distance away (only two are ‘Sutton placements’) - so the majority have had to register with the same local GP. The home enables access to optician, dentist and (occasional) chiropody appointments; the principal aim being to encourage service users to engage with ‘ordinary’ services outside the home - in the wider community. Three admissions noted through ‘A&E’ in the last twelve months related to a service user with a specific epileptic condition. Service user’s mental health is very closely monitored in the home. Most have the same psychiatrist, who visits the home on a weekly basis. The local GP practice and then pharmacist have a ‘fax relationship’, which ensures the swift and speedy making up and delivery of prescribed medication. The nursing staff members administer the medication at the home. The recording of the administration of medication was consistent. The local advising pharmacist has provided accredited training in the handling and administration of medicines. No controlled drugs were used on site. Most service users are generally independent in their personal hygiene / care though some need encouragement / prompts. Staff involvement in personal care is to encourage and support service users to maintain their independence and self-esteem, whilst being honest about personal hygiene and selfpresentation. The home currently retains only very basic information concerning the issues of ‘last wishes’. Basically, all this current declaration clarifies is whether a service user opts for burial or cremation, and states significant people to be contacted. The inspector strongly recommends that the home develop a pro-forma to elicit greater detail concerning steps that a service user may wish to be taken if they are suddenly taken ill / have an accident, or pass away (including religious / cultural / personal aspects). It may well be that next-of-kin should be involved in this process also - but only with the service user’s consent; it also may well be that the individual’s wishes (as can be the case) sit at variance with the next of kin - or the next of kin may not be sensitive to the details that the service user reveals. A fuller proforma than the current one (‘wishes pro-forma05’) would be greatly beneficial. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23. Service users are confident that the management will handle comments and complaints swiftly and appropriately. Service users can be assured that they will be protected from the possibility of physical, financial or any sort of abuse. EVIDENCE: There is a clear complaints procedure for the home. The procedure indicates that service users can complain to the Commission at any point during the ‘inhouse’ complaints process. The proprietor / manager stated that there had been no complaints received in the last inspection year. The home’s (revised) Adult Abuse and Protection procedure was available at the time of the inspection visit, to back up the local authority procedure booklet / folder, which was also in evidence. Over half the staff have now attended Adult Protection training. Safe keeping of cash and / or service user’s valuables was previously discussed and examined with the proprietor. All records for each service user are now being recorded separately. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 & 30. The home provides a warm, safe and comfortable environment for service users to feel ‘at home’ which can meet their individual needs and promote their independence. EVIDENCE: The home is situated in an ordinary street - in an ordinary part of Sutton, quite close to the centre of the town - with easy access therefore, to public transport links (train and busses) and all commercial and community services. The house was generally clean, safe and comfortable. Most bedroom sizes meet the National Minimum Standards with the exception of two bedrooms. The Commission has no concerns about the suitability of these two rooms for the service users. The only double occupancy room continues to be singly occupied. The one en-suite room is occupied, appropriately, by one of the two service users over the age of 65 – the home has a variation to the registration (which is for 18-65’s) allowing them to remain in the home for as long as the home can meet their needs. Bedrooms are decorated to a reasonable standard; service users are consulted prior to the work regarding the decoration of their rooms. Bedrooms are Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 19 redecorated on a revolving cycle of priority - heavy smokers gaining advantage over non-smokers with a more frequent redecoration plan to keep rooms attractive and clean. A room occupied by a ‘challenging’ client had deteriorated to a poor condition; the owner stated that it will be refurbished once (soon, apparently) this service user had ‘moved on’ to a more suitable placement. All other rooms seen by the inspector contained a variety of personal furniture and fittings reflecting the individual’s personality. The inspector again recommends a review of the fluorescent lights provided in bedrooms - research has suggested that it is not conducive to eyesight / positive mental health. The home provides four toilets (plus a staff toilet, additionally), a bathroom and a shower. These facilities are somewhat lower than the recommended standard, however this is a standard that has been revised by the Department of Health, and as an ‘existing home’ the current level of facilities are now accepted. The home has a very large and comfortable lounge, a second ‘lounge’ room that is used as a smoking room, and a large dining room - with adequate tables and chairs. As previously mentioned, it is regretted that there is no Visitor’s Room – but this is ‘compensated for’, to some extent, as there are currently no double rooms in use in the house, and the basement offers another social area for service users. The service user group still has no specific identified ‘disability needs’ (Standard 29) at present; the home therefore has no need to make adjustments of a specific nature to ensure the best use of the premises by the occupants. This may become the case as time moves on - and the home should be mindful of this element from time to time - to check compliance with the ‘spirit’ of this standard. The home was generally clean, and free from odour at the time of the inspection visit. The general presentation of all areas was satisfactory. The home employs a cleaner for five days a week - though service users are encouraged to keep their own private areas (bedrooms) clean and have the personal right to restrict access to such rooms. A high proportion of the service users are (almost inevitably - in mental health services) heavy smokers, the smoking room has a ventilation system that minimises the effect of the smoke. The clothes washing facilities are domestic in size, which fits with the home’s ethos of encouraging the service users to do their own laundry. There was an amount of personal laundry ‘out on the line’ on the day of the inspection – and service users were being encouraged to plan their washing times. These machines do not have a sluice facility; however soiled laundry is a very rare in the home, and an appropriate policy and staff training is in place. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35 & 36. The home provides a stable and competent staff team - which provides a suitably appropriate service to the community of residents at the home. Senior staff members are appropriately trained to run the home - with care staff now undertaking a more mental-health focused training to work alongside the nursing staff. Further development of care staff’s expertise in understanding mental health issues will benefit the service users – especially when they are ‘in crisis’. The home implements a full recruitment process, thus ensuring the safety, protection and wellbeing of service users. The implementation of a full Induction process – on line with the new ‘Skills for Care’ format – would benefit all at the home, both current and new staff. Support to members of staff, both through the holding of regular staff support meetings - and providing individual staff supervision - would improve the service provided, through enhancing communication between staff in general and by encouraging their training and self-development. EVIDENCE: Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 21 Job descriptions for all staff are available on file. Both care and nursing staff have a clear understanding of their roles and were observed to perform them professionally. Care staff work closely with the nursing staff in their key working roles; all decisions and concerns are dealt with by nursing staff. Evidence of the maintenance of nursing staff’s NMC registrations are held on file, and care staff members have been issued with the General Social Care Council’s ‘Code of Conduct’. The home has a clear policy and procedure on working with volunteers and / or students. Care staff members have worked in the home, or similar, for a number of years and all have previous care experience. The inspector was informed that three carers are currently undertaking NVQ training at level 2 (with two nearly completed), and one - the senior - is already qualified at this level. The home is required to achieve the National Minimum Standard of at least 50 of care staff being trained to this level by 2005; if the three trainee staff members ‘stay the pace’ then the figure will be attained within the required timescale. Staffing is provided at the home to a level of a minimum of a qualified nurse and a care assistant during each night, and generally a nurse with three care assistants during the day (reducing to two care assistants and a nurse after 6.00pm). During the weekdays, a cook and cleaner are employed for eight and six hours respectively. Staffing levels continue in accordance with the Notice set by the previous Registration Authority. As most service users are fairly independent, much care work is low-key, supporting service users to participate in daily activities and escorting those needing support to access community facilities. A requirement set concerning staff meetings being held more regularly and being properly recorded was made all the more necessary by the proprietor and staff not being able to find the staff meetings minutes records during the inspection visit. Such records must be made more accessible and open to all staff members – as well as being available for inspection. Although individual staff member training records were seen, there was again no evidence of a corporate assessment / plan to inform training mapping for the future. The proprietor confirmed that two carers were undertaking a local council ‘Introduction to Mental Health & Risk Assessment’ course – but clearly more training in issues of mental health is need for the remaining non-qualified staff. The issue concerning staff training in First Aid is covered under the ‘Health & Safety’ standard (42) in this report. A requirement for care staff to undertake Induction & Foundation Training to TOPSS specification has now been superceded in that the training organisation is now called “Skills for Care”, and the Foundation training has now been amalgamated with the induction sequence and is called Common Induction Standards for Adult Social Care – this must be introduced to ensure that all Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 22 care staff members have a core underpinning knowledge base from which to work. Concerns about the slow introduction of individual staff supervision last December - though tinged by optimism - (but also the precautionary inspection requirement) have still not been fully resolved as yet. The proprietor was unable to evidence consistent supervision input to staff members; those seen were infrequent and not up to the national minimum standard frequency of six times a year. Appraisal documents were seen this time, and the proprietor confirmed that these had been handed out to all staff members – with the aim of these appraisals being conducted soon – and, threfore, hopefully giving an impetus / ‘kick start’ to the supervision process. Both the requirement about staff member supervision and staff meetings being held and minuted are especially important – as one of the supervision notes actually seen mentioned a concern about the need for “increasing communication for / between staff”. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 42 & 43 Service users can be confident that the home is well run – with their views and comments being taken on board in regard to the quality of the service provided. The safety of service users is generally well protected, though the number of staff trained in First Aid should be increased to ensure round-the-clock cover. The house is maintained and run in a safe and appropriate way – though the observation and recording of hot water temperatures is to be improved to ensure that all protection is being regularly monitored, to avoid the risk of scalding. The home appears to be effective in its service and financially viable; the viability should be evidenced through the accountant’s production of a development plan, which is available to the Commission. Evidence of such long-term viability will instil confidence in the service user group that the home is an environment on which they can rely. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 24 EVIDENCE: The Home is registered as a Limited Company – Astral Lodge Limited. The responsible individual, who also manages the home, is a Registered Mental Health Nurse; he has in the past completed the Certificate in Management Studies. He has extensive experience of managing care establishments; and has worked in the home since it was established in 1996. The service users at the home were indeed quite confident that their views are taken into account when it comes to the review and development of the home. The ‘team’ of service users that the inspector interviewed were clear in their opinions about the way in which the home was run – and the way in which they felt the home supported them. Generally the home has good regard to the maintenance and servicing of equipment within the home, ensuring the health & safety of service users. One area noted to be in deficit was the number of staff with a First Aid qualification. There should be sufficient staff so trained that there is always - on site, night and day - a worker who has a current First Aid qualification; it was clear that the rota was not covered seven days a week in this way. A requirement is placed on the proprietor to ensure that First aid training is stepped up. The home’s Business & Financial Plan – a copy of which was ‘promised’ to the Commission at the last inspection in December 2004 – was due to be collected, fortuitously, by the Proprietor from his Accountant on the evening of this very (unannounced) inspection visit day. It is hoped that this requirement may now be satisfied. Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 N/A 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 2 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Astral Lodge Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 x 3 3 x 1 2 G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 26 Are there any outstanding requirements from the last inspection? YES 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 33 Regulation 12(1) (5) Requirement Staff meeting minutes must be accessible to staff - including details of discussions and decisions made - thus allowing absentees to ‘catch up’ on such processes. (Timescale of 15.04.05 not met.) The registered person must develop a staff training and development programme which should include specific training for care staff in mental health. Timescale of 30.11.04 not met.) Timescale for action 30.10.05 2. 35 18(1)(c) 30.10.05 3. 35 18(1)(c) Induction and Foundation 30.10.05 Training (now to be known as Common Induction Standards for Adult Social Care) to Skills for Care specification - must be introduced to ensure that all staff members have a core underpinning knowledge base. (Timescale of 15.04.05 not met.) The registered person must 30.10.05 ensure that all staff members employed at the care home are offered formal supervision, which must be recorded. This 1:1 process should occur at least six Version 1.30 Page 27 4. 36 18(2) Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc times per year (36). (Timescale of 30.11.04 not met.) 5. 42 13(4) A new requirement: Staff training must be provided to ensure that the house is covered by a member of staff currently trained in First Aid. 30.10.05 6. 42 13(4) Hot water outflow checks must 01.09.05 be undertaken and recorded on a regular weekly basis - to ensure that all taps with valves can be monitored and observed for variance / failure. Special attention must be paid to areas of high risk - such as bathrooms and showers. The registered person must 30.10.05 furnish top the Commission local office a copy of the Home’s current business & financial plan. (Timescale of 15.04.05 not met.) 7. 43 25 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 21 Good Practice Recommendations That the home should construct a pro-forma which eleicits greater detail concerning wishes of each service user should they be taken seriously ill or pass away. That the home should review the provision of fluorescent lighting throughout the house, as this is not always according to some research - the most appropriate for their wellbeing. (A previous recommendation.) That a policy and procedure for ‘Pressure relief’ be created and introduced to the home’s compendium of documents. (A previous recommendation.) G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 28 2. 25 3. 40 Astral Lodge Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 29 Commission for Social Care Inspection 8th Floor, Grosvenor House 125 High Street Croydon CR0 9PX National Enquiry Line: 0845 015 0120 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 Astral Lodge G53 G53 S19072 astrallodge V222617 010905 stage 0.doc Version 1.30 Page 30 - 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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