Inspection on 11/12/07 for Astral Lodge

This inspection was carried out on 11th December 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Astral Lodge 01/02/07

Astral Lodge 29/11/05

Astral Lodge 01/09/05

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 Astral Lodge 2 Cumnor Road Sutton Surrey SM2 5DW Lead Inspector David Pennells Key Unannounced Inspection 11th December 2007 12:15p Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Astral Lodge Address Astral Lodge 2 Cumnor Road Sutton Surrey SM2 5DW 020 8642 1884 020 8661 7974 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) Astral Lodge Limited Mr Bennie Darkey Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0) of places Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability and dementia - Code MD 2. The maximum number of service users who can be accommodated is: 17 (seventeen) 1st February 2007 Date of last inspection Brief Description of the Service: Astral Lodge is a care home providing mental health nursing care for to up to a maximum of seventeen adults (two of whom would share a double occupancy room) who have enduring mental health problems. The home currently has a variation to provide care to two service users who are over 65 years of age. The home provides 24-hour mental health nursing support to all service users, with care staff support provided under the nursing staff members supervision. The ethos of the establishment - established since June 1996 - is self-help within the understanding / context of the psychological and other social and physical needs of each individual. Accommodation is extensive and provided over two floors; a large lounge, a dining room are provided. There are fifteen single and one double bedroom (currently singly occupied), situated over both floors of the home. Two toilets are situated on each floor, with a bathroom on the first floor and a shower room situated on the ground floor. The home has a relatively small, but pleasant, garden - through which there is a route to the 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 DS0000019072.V348344.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We visited the home during the lunchtime, afternoon and early evening on an ordinary weekday - the visit being unannounced. The proprietor / manager, Mr Darkey was on site and was able to assist us in assessing the current service at the home alongside reviewing requirements and recommendations that had been made at the last inspection in February 2007, ten months previous. The pre-inspection information provided in the AQAA was also used during this visit. It was encouraging to notice a significant number of improvements - this leading to a reassessment of the rating of the home, from adequate to good. During our visit other staff members were met, as well as the majority of those using the service. Feedback from the latter was the usual positive report and it is clear that those using the service are very much ‘at home’ in Astral Lodge. What the service does well: What has improved since the last inspection? The inspection visit this time revealed a significant reduction in the number of requirements set at the last inspection, this reflected by the remaining number of requirements (3 instead of 13) and 2 instead of 5 recommendations. This is Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 6 outcome has ‘turned around’ the disappointment felt during the last visit; we felt that the proprietor / manager and staff had taken note of the issues raised at the last visit, and the overarching feeling from this present audit is one of encouragement and renewed interest; the outcomes in this report now lead to a reappraised and increased rating than was awarded for the home last time. The home’s Statement of Purpose and Service User Guide have been revised and quality assurance processes - through surveying service users and other stakeholders has resulted in positive reports from both those using the service and those commissioning the care. Improvements to the premises have included replacement of worn out and potentially unsafe carpets and the refurbishment of all the home’s shower and bathrooms and toilet facilities. The smoking room, since the introduction of anti-smoking legislation, has also been transformed into a care manager / Deputy’s office - where more space can be provided for meetings and 1:1’s for those using the service - who will benefit from this potentially increased personalised care and attention. Staff will also benefit from the opportunity to have their 1:1’s in this space, away from the ‘hubbub’ of the main office. Staffing issues covered have ensured that sufficient care staff members have started training to achieve the basic NVQ Level 2 in Care; the ‘Skills for Care’ Common Induction Training standards have been obtained and are ready to be introduced when new staff members commence. Staff 1:1 supervision has been more formally introduced and regularly provided - to support staff to develop their skills-base and develop the service provided. Hot water monitoring is now maintained fastidiously on a weekly basis, and the emergency lighting throughout the home has been professionally checked. Fire risk assessments have also been improved to ensure the regular monitoring of the fire routes / exit doors. 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. The summary of this inspection report can be made available in other formats on request. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users can expect to find adequate detail in documents provided by the home to make an informed choice when they decide whether to reside at the home. Such documents are supplemented by the opportunity to visit the home on a visit / short stay basis, and find out about the home before confirming their stay as permanent. The home ensures the appropriate service is provided to each individual based on both their own - and other professional’s - assessments. EVIDENCE: The home’s basic information documents - the Statement of Purpose and Service User Guide have been revised and updated, this leading to a greater level of contemporary information being available to prospective users of the service. New admissions made at the home since the last inspection visit had totalled three - all male - all of which were still resident at the home. Three files of people using the service were randomly chosen and examined; full Care Programme Approach (‘CPA’) Assessments were. These documents gave a full picture of the situation, and the information had been translated into a care plan with associated risk assessments for the individual’s time at the home. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 9 All needs had been clearly identified in specific care plan goals - and where relevant, relatives had also been involved in the process. All admissions are usually very carefully planned. Short visits (accompanied or otherwise) are followed by overnight and weekend stays to ‘get the feel’ of the house. Placements are reviewed after four weeks (or 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 (though one was again undertaken this year), due to the potential disruption to the ‘finely balanced’ community culture at the home. Respondents to the CSCI questionnaire confirmed that they had received sufficient information about the home at the point of placement. 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. Of the population at the home, three of the sixteen were female - the mix of service users - male and female, young and older, strong and (quite) frail brings about a mixed community ‘feel’; the women are all (coincidentally, but helpfully) located on the ground floor, relatively close to each other. Of those using the service, all were white, excepting one male of Asian derivation. Placements have been commissioned by Sutton, Croydon, Surrey, Lewisham, Southwark, Hounslow and Hammersmith & Fulham local authorities. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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: Daily records complemented the Care Plan for each individual, which is informed by a full comprehensive assessment of need, which covers all salient points for each individual. These Plans clearly stated the focus and purpose of any intervention / assistance to be provided. The Care Plan is reviewed regularly with the service user; the regularity depends upon changing needs; the longest gap generally being a month. Each service user has a Registered Mental Health Nurse as ‘key worker’, and an ‘associate care worker’ is also allocated - to provide the more direct / personal care and contact. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 11 Each person using the service has a CPA (Care Plan Approach) Review meeting at least annually, and more frequently if needs indicate the need and precipitate such a review, or if a more frequent regime has been agreed. Clinical risk assessments are undertaken for each service user in relation to their mental health - including emergency and relapse planning. The recording of all risk assessments was clear and appropriate; assessments were on file for service users detailing concerns over specific behaviours or activities. Many areas of behaviour have been risk assessed - and are appropriately recorded; for example: service users going out against the advice of staff when mentally unwell; service users holding their own cigarette lighters and lighter fluid - some having these items looked after by staff. The proprietor spoke of his future intention, still, to create a social / activity / ‘rehabilitation’ facility in the existing garage area to the rear of the home. One long-standing resident, respondent to the CSCI questionnaire, stated: “I have been here for [x] years -my only hope is that I can stay here for good.” Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users at the home can be assured that they will be encouraged to participate in the life of the home and beyond - promoting the ethos of being an individual, through being encouraged to participate in both 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 community / family / friendship links. Meals at the home are provided in good quantity - with a nutritious and attractive menu being provided, and opportunities for self-catering through inroom catering. EVIDENCE: Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 13 For many people using the service, their mental health inevitably affects their ability / capacity to participate in independent activities; staff members have to actively work with each person to motivate and enable them to achieve as much as is practicable. The home aims to positively promote the independence of those using the service as a key area of its focus. Inside the home, most service users participate through doing their own laundry and other domestic chores; the ‘laundrette’ in the garden now has good, robust ‘domestic’ washing and drying equipment. Many, however, are independent in going out of the home, being able to undertake personal shopping, library visits, and other community activities. Staff members support service users on local outings to the shops, local pubs and restaurants, and to enjoy swimming, bowling and the cinema. Each individual has a London Transport ‘Freedom pass’, this enabling them to access public transport and opportunities farther afield. Day trips to popular seaside destinations have been enjoyed. In-house activities at the home include regular quizzes, pool, video evenings, parties, and barbeques. Almost everyone has television and radios in their rooms - many also having kettles and drinks-making facilities. A good number spend time in their own rooms, regarding them as their own personal space something like an independent ‘bed-sit’. There is clearly an element of ‘pride’ expressed by a number of people using the service in their own space. Some service users attend Church services - and the home has monthly visits from the local Anglican Vicar, and also visitors from the local Parish community. The sole Hindu service user chooses not to practice their faith. The home is very welcoming of visitors - either family or friends. Links / contact with family members are noted on individual’s care plans. All current users of the service have their own bedroom - which can be of advantage, though there will be times when the use of the bedroom is inappropriate for receiving visitors, and then the ex-smoking room is usefully available as private space for them. People interviewed again reported that food provided at the home was ‘good’ meals are served according to a rolling menu, but some service users have an alternative menu - to their own preference which can include meeting cultural or religious needs. All staff who undertake the cooking duties were credited with having good culinary skills - and were praised and valued. Service users assist in the general communal routines of laying and clearing tables, etc. In the main, most have kettles and a fridge in their bedrooms; this enables a degree of independence and expression of individuality. Some people do assist in the kitchen; a hygiene risk assessment being essential to ensure food safety rules are upheld - for the benefit of all who eat at the home. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service can expect to be encouraged to independently maintain their personal, physical & mental wellbeing as much as is possible, whilst the staff will provide such assistance as is appropriate / needed (including assistance with medication), to ensure their continued good health. EVIDENCE: Health Assessments under the ‘Health of the Nation’ initiative are in place for those using the service, providing clear care-planned approaches to physical health and mental health needs. Most service users have come to the home from a distance away (a relatively few are local ‘Sutton placements’) - so the majority have had to register with the same local GP. Admissions noted through ‘A&E’ in the last twelve months again related to a service user with a specific epileptic condition, where checks are advised following a major episode. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 15 Medication procedures have been previously examined; the process of administration was observed - a number of people appearing at the office ‘on time’ for their medication when required. Medication administration records were checked on-the-spot and found to be in order, consistently maintained and up-to-date. The nursing staff members - present in the home 24 hours of the day - manage all the medication administration. The local advising pharmacist has provided accredited training in the handling and administration of medicines. No controlled drugs were being used on site. 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 vast majority of those using the service are generally fully independent in their personal hygiene and care needs - though some need encouragement / prompts to keep ‘up to standard’. Staff members’ engagement in individual personal care is to encourage and support them to keep control and maintain their independence and self-esteem, whilst having to be sensitively honest about the achieved standard of personal hygiene and self-presentation. Feedback in a questionnaire stated: “ I am please with all that staff do for us…. any of the staff will help you.” The home enables access to optician, dentist and (occasional) chiropody appointments; the principal aim, again, is always to encourage people to engage with ‘ordinary’ services outside the home, in the wider community. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service remain confident that the management will handle comments and any complaints made both swiftly and appropriately. People using the service can be assured that they will be protected from the possibility of physical, financial or any form of abuse. EVIDENCE: There is a clear and comprehensive complaints procedure for the service. The procedure indicates how those who use the service can be in touch with the Commission at any point during the ‘in-house’ complaints process if they are dissatisfied. The proprietor / manager has again clearly stated in the AQAA that there had been no complaints received in the last inspection year. People using the service have indicated they know of the Complaints Procedure. The home’s Adult Abuse and Protection procedure has been relatively recently revised to ‘back up’ the LB Sutton (the ‘host’ Local Authority) procedure, which was also in evidence. Staff members have undertaken training provided by the London Borough of Sutton now focusing on the ‘Safeguarding’ heading. The safe keeping of cash and valuables process was examined with the proprietor. Records for each service user are kept separately; a few people have individual savings accounts with HSBC (with individualised statements being received by each service user) - and weekly personal allowance records are kept appropriately with the required countersigning. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 17 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, 28 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides warm and comfortable communal and private spaces for people living in the home, which meets their individual needs, and promotes their rights to independence. Refurbishment has improved the general feel of the premises, enabling everyone to feel comfortable in a pleasant clean home. Bathrooms and toilets are in a generally much improved decorative condition which now would encourage a positive attitude towards personal hygiene, and encourage pride in the accommodation in general. EVIDENCE: The general impression given at the home is one of a cared for (but not ‘too precious’) environment, which is a homely and a welcoming space. Accommodation is extensive and provided over two floors; a large lounge, a dining room are provided. There are fifteen single and one double bedroom Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 18 (currently singly occupied), situated over both floors of the home. Two toilets are situated on each floor, with a bathroom on the first floor and a shower room situated on the ground floor. The home has a relatively small, but pleasant, garden - through which there is a route to the laundry facility. Refurbishment of the stair carpet and flooring on the first floor level, alongside the refurbishment of the bathroom, shower room and toilets has radically changed the ‘feel’ of the home, again - for the better. The smoking room has now been converted into an office / meeting room space. The environment has transformed from the unattractive smoking room, and has now joined the other (previously non-smoking) communal rooms close by in being a space that all can use when needed. The home has adopted a no smoking policy in all its communal spaces since the introduction of the antismoking legislation in mid-2007. The dining area and sitting room were, as ever, pleasant and comfortable. Some rooms occupied by service users were also well kept and attractive in décor - whilst others, principally due to mental ill health and negative habits, were of a more unkempt standard. 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 DS0000019072.V348344.R01.S.doc Version 5.2 Page 19 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, 34, 35 & 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service provides a stable and generally competent staff team. Care staff will benefit soon from mental-health focused training and vocational training to NVQ level 2 is now ensuring that they will work more knowledgeably alongside their nursing staff colleagues. Ongoing training, especially in understanding mental health issues, will benefit the service users – especially when they are ‘in crisis’. The home implements a full recruitment process, this ensuring the safety, protection and wellbeing of people using the service. The current introduction of the induction process, based on the new ‘Skills for Care’ format, will benefit new staff - and could be of benefit to present workers. Support to members of staff, both through the holding of staff support meetings - and providing individual staff supervision - has improved the service provided, through enhancing communication between staff in general, and by encouraging a focus on their training and development. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 20 EVIDENCE: People using the service [as ever] commented on the pleasantness, the kindness and helpfulness of all the staff members at the home. We noted a positive tone of community togetherness throughout the visit. Staffing is provided at a ratio of a constant member of nursing staff to three care workers during the working day, reducing to working with two care assistants beyond 5pm, and from 8pm to 8am there being a nurse and a care worker available - both remaining awake throughout the night. Staff training has achieved a new focus since the last inspection visit, with three care workers now undertaking their NVQ in Care at Level 2 (the Assessor visiting staff during our visit) and one staff member now undertaking this focus at Level 3. Staff training in the new Mental Capacity Act was being planned, along with other focuses for the near future, to enhance the care staff members’ knowledge in mental health issues. Staff must also be formally qualified in current First Aid competences (see section 42) - to ensure that not only daytimes but also night shifts are covered; this will then complement the other staff members who have this training and provide such cover during the day. The registered provider has still to develop an overarching staff training & development matrix - that includes a focus on specific training for care staff in mental health - and focusing on ensuring that care staff work through to achieving their NVQs. Induction & Foundation Training (now known as Common Induction Standards for Adult Social Care) to Skills for Care specification - has been obtained by the proprietor / manager and will be used for new staff members starting at the home. It was agreed with the manager that the current staff group could probably benefit from also working through this process, to ensure they all have a basic ‘core’ knowledge base. Staff members employed at the home are now also starting to receive formal supervision - from seniors or the manager. Although this 1:1 process was not ‘up to speed’ the hope is to raise the frequency to six per year. Staff meetings had been held - and minuted - but at a frequency of less than a minimum of six per year - preferably held on a regularly spaced basis. It is hoped by staff that now a meeting space is available, this will become a routine that is easier to achieve. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 & 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those using the service can be confident that an adequately qualified and competent person runs the home. They can expect their views and comments to be taken on board in regard to the quality of the service. The house equipment is serviced & maintained in a safe and appropriate way – which ensures the maximum safety of service users. 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 home is effective in its care service, though a previous request for evidence of viability of the service and a projection of long-term development of the home - in a business & financial plan - must still to be finalised and communicated to the Commission. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 22 EVIDENCE: The proprietor, 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; having both managed this home for over seven years and possessing ten year’s previous management experience in other mental health settings. Quality Assurance measures taken by the home now revolve around a questionnaire being circulated to service users and also to a broader span of stakeholders. We saw feedback from a number of commissioner’s, responding to the questionnaire that evidenced a high satisfaction with the service being provided. Questionnaires left by the inspector with those using the service resulted in five being returned - most being individually completed, and evidencing a positive attitude towards the service provided. People aged from the 30 - 39 age bracket to the 80 categories expressed opinions. Describing it as the ‘best home in Sutton’, with other comments such as ‘1st rate home’ and ‘It’s just great living here’, leading us to believe that a positive attitude is held by those who best know what it is like to live at the service. The manager was singled out as a good manager and carers were also described as ‘good staff’ and ‘ very nice carers…’. ‘The carers are great to be with…’ describes something of the sense of community sensed at the home. . Relating to health and safety issues, more staff training must be provided (most easily to the nursing staff) to ensure that a member of staff is trained in First Aid to cover the rota for the house on a continuous ‘24/7’ basis. Some care staff members have undertaken ‘First Aid awareness’ training more recently. Checks on the home’s fire alarm systems, extinguishers, emergency lighting and other relevant house-related maintenance issues were found well in order. The weekly monitoring of hot water temperatures has now been regularised in bath and shower rooms, to ensure that any variation can be noticed - to protect against the risk of scalding. The proprietor has previously been required to provide a Business & Financial Plan – evidencing the service’s intentions to ensure continual refurbishment / improvement to the fabric of the home, and keeping ahead of the demands of wear and tear on the fabric of the home. Although the proprietor had achieved much in this last ten months, the service must evidence their intention to ‘keep it up’. The proprietor stated that the Plan was being formulated by his accountants and would be sent to the Commission once it had been finalised. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 23 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 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 2 Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 24 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 YA35 Regulation 18(1)(c) Requirement You must continue to develop a clearer written staff training and development programme that includes specific refresher training in all aspects of mental health - for all care staff. Timescale for action 30/04/08 2. YA42 23(4) A member of staff trained in First 30/04/08 Aid must be provided at nights to ensure that the house is covered at all times. The home’s Business & Financial plan must be finalised, and a copy sent to the Commission. 30/04/08 3. YA43 24 & 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 YA33 Good Practice Recommendations Staff meetings should be increased to a minimum of at least six per year - if not more. DS0000019072.V348344.R01.S.doc Version 5.2 Page 25 Astral Lodge 2. YA34 The proprietor should consider repeating / renewing CRB checks for those who were checked prior to the introduction of PoVA checks - to ‘regularise’ the staff member’s checks to the current ‘enhanced’ level. Astral Lodge DS0000019072.V348344.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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