CARE HOME ADULTS 18-65
Brendon Lodge 27 Southleigh Road Warblington Havant Hampshire PO9 2QG Lead Inspector
Michael Gough Unannounced Inspection 6th June 10:15 Brendon Lodge DS0000066261.V338755.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 Brendon Lodge DS0000066261.V338755.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. Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Brendon Lodge Address 27 Southleigh Road Warblington Havant Hampshire PO9 2QG 023 9249 8585 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) dolphin.homes4@btconnect.com Dolphin Homes Limited ** Post Vacant *** Care Home 9 Category(ies) of Learning disability (9), Mental disorder, registration, with number excluding learning disability or dementia (9), of places Physical disability (9) Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home may admit service users 16-18 years of age within the categories of mental disorder, learning disability and physical disability. 25th August 2006 Date of last inspection Brief Description of the Service: Dolphin Homes Limited has been the registered provider of a residential care home at Brendon Lodge since April 2006. The service provides accommodation and personal care for up to nine young adults who have a learning disability, mental disorder and/or physical disability, the main house accommodates 6 service users and is designed for service users who have a physical disability and those who require close support. There is also a bungalow, which is separate to the main home and has its own staff team and this can accommodate up to 3 service users who are more mobile and who can access the community independently. The home is situated near to Havant town centre shops and amenities. The current scale of charges is £1,200 - £1,600 per week with additional charges for external activities such as cinema trips, hairdressing, personal toiletries, papers and holidays. Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report details the evaluation of the quality of the service provided at Brendon Lodge and takes into account the accumulated evidence of the activity at the home since the last inspection in August 2006. The inspection took into account the homes Annual Quality Assurance Assessment (AQAA); and evidence for this report was obtained from reading and inspecting records, touring the home and from talking to service users and staff and the inspector was also able to observe the interaction between staff and service users. The inspector received 3 comment cards back from service users and one from relatives. On the day of the visit he had the opportunity to speak with 2 service users, 2 members of staff, Dolphin Homes director of care and the homes manager who assisted the inspector throughout the visit. The home is registered to provide support for 9 service users and at the time of the inspection there were 7 service users living at the home. What the service does well: What has improved since the last inspection?
Since the last inspection a great deal of work has been carried out by the new manager of the service. Needs assessments are reflected in individual service users plans and risk assessments have been put in place. Staff training has taken place on adult protection matters and staff receive regular supervision. The home has a development plan in place to improve the quality of services provided in the home. Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 6 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. Brendon Lodge DS0000066261.V338755.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 Brendon Lodge DS0000066261.V338755.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): 2&4 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 there will be a detailed assessment of their individual needs before they move into the home and they can visit the home before making a decision whether to move in or not. EVIDENCE: There have been 5 new service users admitted to the home since the last inspection and all had a needs assessment carried out before they moved to the home. The homes manager and Dolphin Homes director of care carry out assessments and go to visit the service user before they move to the home. This was confirmed by a service user spoken with on the day of the inspection and also from comment cards received from a relative, which was returned to the inspector. The home uses an assessment form to obtain any relevant information and Social Service assessments are also undertaken and were on file at the home. The information gathered is used to make up the service users plan of care. Service users are able to visit the home before moving in and one service user spoken to said that when she came for a trial visit she did not want to leave, she said that she was able to stay for a meal and was able to have an overnight stay to make sure that she liked the home before making a decision whether to move in. Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 9 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 assessed needs and personal goals are set out in their individual plan of care and service users are involved in the care planning process. Staff at the home respect service users rights to be involved and make decisions about their day-to-day lives and service users are supported in this process by staff at the home. Service users are supported to take responsible risks as part of their independent lifestyle EVIDENCE: Care plans were seen for 3 service users and these were comprehensive documents that gave staff clear information on what support was required and how and when this should be given. There was information on the service users routines in the mornings, afternoon and evenings. Service users were involved in the care planning process as much as possible and care plans were person centred. Service users spoken to were aware that they had a plan of care that helped staff give them the support they need. Care Plans seen reflected the aspirations and goals of service users and were written clearly and could be followed easily.
Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 10 Recording was noted in the relevant sections of the care plan and this was very time consuming for staff and they said that if they wanted any information on how the day had been for a particular person then they would have to read each section to get a full picture. This was discussed with the manager and director of care who said that they were looking to update all of the care plans used by the home and the inspector was shown an example, which had been developed and had good input from the service user. It was agreed that the recording in care plans could be improved and the home will be looking to improve the recording process in the new care plans. Any changes to daily routines and appointments were recorded in the house diary and this informed staff who then looked in the relevant section of the individuals care plan, where more detailed information was recorded. Service users were actively involved in the decision making process in the home. Service users were consulted on all aspects of their lives and their wishes were respected and acted upon. The inspector was informed that the home held weekly service user meetings and these were found to be helpful. All staff know each service user very well and service users are able to express their views and wishes to staff who then ensure that their wishes are acted upon. On the day of the visit there were only 2 service users at the home and it was clear that they are able to make their own decisions and staff respect their wishes and views. While the inspector was at the home one service decided that she would like to go shopping and staff supported her to do this. Of the 7 service users living at the home 2 were out with staff, 1 was at college, 1 was at day school, and 1 at a day centre and 1 was accessing the community independently. One of the service users has her own transport through the mobility scheme and there is also a mini bus with wheelchair access to enable the other service users to go out into the community. Each service user’s plan seen had risk assessments in place for identified risks and these were seen in care plans viewed and included risks associated with accessing the community, laundry and cooking, use of bathroom, toileting, self injury, driving and use of transport and swimming. One service user who is epileptic has a risk assessment in place for support when having a seizure, this gave clear information for staff about the action they should take and this risk assessment had been drawn up with the help of the GP. There were also generic risk assessments for the home and all risk assessments identified the risk and gave information for staff on how the risk could be minimised. Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 11 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 are encouraged and supported to be part of the local community and to be involved in appropriate activities. Service users benefit from support to maintain social contacts and daily routines at the home respect service users rights and responsibilities. Meals at the home are flexible and service users benefit from a healthy diet. EVIDENCE: 1 Service user at the home goes to school 5 days per week, 2 attend a local college 4 days per week and 1 service user is waiting to enrol at college. 1 service user attends day service 4 days per week and another service user is looking to obtain employment and has an interview to be a volunteer at a local country park. The home provides a range of activities in and outside the home and these include bowling, arts and crafts, cooking and relaxation. The inspector spoke with one service user who was full of praise for the activities provided and those who completed questionnaires were also happy with the activities provided. Service users are encouraged to be part of the local
Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 12 community and are supported to be aware of what events are happening locally - they regularly go shopping, visit local pubs and cafes and attend community events in the local area. The home keeps a record of the activities service users are involved in. Service users are supported to maintain and expand their social networks. Families visit on a regular basis and some service users go to their parents house for visits and overnight or weekend stays. Service users are encouraged to invite their friends to their house for visits and for meals. Daily routines in the home promote service users independence as much as possible and service users are involved in all aspects of the day-to-day running of the home. Staff were observed knocking on doors before entering and seeking permission to enter their rooms. Staff were observed interacting with service users and their preferred form of address was used. The 2 service users spoken to said that they were happy at the home and liked being involved in decision making. Mail is given to service users unopened and staff support them with their mail if requested. Service users are able to access all areas of the home and are able to choose if they wish to be alone in their rooms or be in the company of other service users and staff. Service users are involved in the planning of meals at the weekly service user meetings and staff provide support to ensure service users have a balanced diet. The home makes up a weekly menu after the meeting and there is always a choice of meal options and service users enjoy take away meals and also like to go out to eat. Food shopping normally takes place twice a week with top up shopping being done on a day-to-day basis. Service users are involved in shopping trips to buy food for the home. Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 13 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. Service users receive personal support in the way they prefer and service users physical, emotional and health needs are met. The homes policies and procedures with regard to medication provide protection for service users. EVIDENCE: Care plans for individual service users gave information on personal care needs and this is offered by care staff of the same gender wherever possible. There is information showing that service users are involved in decisions about this and it was confirmed by the service users spoken to. There was information on what support service users required in the mornings and evenings and also information on individuals personal care skills so that staff could offer the correct type of support. The staff team are flexible round the times when service users want their personal support and there are no set routines, however some service users have a daily routine to help with consistency. Service users are registered with a number of different GP’s at the local health centre and dental checks are also carried out at the health centre although one service user has her own dentist in the community. Eye tests
Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 14 are conducted by a visiting optician service. Service users are supported by a district nurse service from the local health centre and service users have access to the local learning disability team and other relevant health care professionals. Staff at the home monitor service users health and they support service users to attend any appointments. The home has policies and procedures in place for the receipt, storage and administration of medication. The home uses a monitored dose system from a local pharmacist and all staff at the home have undertaken training in medication administration procedures. Generally the home has clear information for staff for administering when required medication, however one service user is prescribed rectal diazepam for the control of seizures but this is only to be administered by attending paramedics. This is a controlled drug and is stored appropriately, however there are no guidelines for staff for the recording of this medication if it is administered. This was discussed with the homes manager and the director of care who stated that they would ensure that guidelines were drawn up for staff. The inspector was confident that this would be done and therefore no requirement was made on this occasion. None of the service users at the home self medicate. Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 15 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. Service users are protected by a simple, clear and accessible complaints procedure and the homes policies and procedures help to protect service users from any form of abuse. EVIDENCE: The home has a clear complaints procedure and this includes timescales for the complaint to be addressed and gives details of how to contact the CSCI. A copy of the complaints procedure is displayed at the home and is available in service users files. The home keeps clear records of any complaints made and there have been no complaints since the last inspection. Service users spoken with were aware that there was a complaints procedure and said that they would speak to a member of staff if they were unhappy. Staff members were aware of the homes complaints procedure and said that they would support any service users to make a complaint. All staff have received training in the protection of vulnerable adults and said that they would talk to the manager if they had any concerns, they were aware that they could go above the manager if they felt that this was appropriate and knew that Social Services would take the lead in any adult protection issues. Service users spoken to said that they felt safe at the home. The home keeps some monies for service users and this is kept in the safe in the manager’s office and only she has the key to this safe. If there are any planned activities or service users need money available over the weekend or when the manager is not available she will sign out any money to the shift
Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 16 leader who would place this in another safe and only shift leaders have access to this. Any monies in this safe would be signed over at the end of each shift to the next shift leader and clear records are kept of any transactions. The inspector discussed the issue of service users money with the manager and also the director of care and he was informed that comprehensive arrangements have been put in place to protect service users. Brendon Lodge DS0000066261.V338755.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 & 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 a well-maintained environment and service users have access to comfortable indoor and outdoor facilities. The home was clean, pleasant and hygienic and free from offensive odours and this provided a pleasant environment for service users and staff. EVIDENCE: Accommodation is provided in two buildings. The main house is a two-storey building and has 6 bedrooms all of which are ensuite; there is a lounge, dining room, large kitchen and a conservatory. The home has a lift, which provides access to the upper floor of the home and this is wheelchair accessible. There is also a bungalow, which has 3 bedrooms, a lounge/dining room, kitchen and an enclosed rear garden; the bungalow is designed for more independent living. The main home has a separate laundry room, away from areas where food is prepared, stored, cooked or eaten. This is equipped with an industrial washing machine and industrial tumble drier. In the bungalow there is a domestic
Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 18 tumble drier and washing machine situated in the kitchen in a domestic setting. Staff at the home support service users with their laundry. Brendon Lodge DS0000066261.V338755.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 good. This judgement has been made using available evidence including a visit to this service. Staff employed at the home have the competencies and qualifications required to meet service users needs. Service users are protected by the home’s staff recruitment procedures and they are supported by trained and supervised staff. EVIDENCE: The home employs a total of 14 care staff, plus the home’s manager. All of the staff employed have obtained or are being supported to obtain at least NVQ2 and service users benefit from being supported by a dedicated and qualified staff team. The home operates a 12 hour shift system and this suits the staff that work at the home and also service users. In the main house there are a minimum of 3 care staff on duty between 0700 and 1900 and between 1900 – 0700 there are 2 awake staff on duty. The bungalow has its own staff team and 1 staff member is always on duty throughout the day and night. The home has a robust recruitment procedure and staff records were inspected for 3 staff members. These all contained the required information including CRB/POVA checks and 2 references.
Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 20 Training records were inspected and staff at the home have completed training in infection control, first aid, food hygiene, fire awareness, manual handling, medication practices, nutrition, care practices and managing behaviour. The home has an effective induction procedure, which covers in house procedures and also induction and foundation training in line with the “Skills for Care” guidelines. The manager ensures that all staff are appropriately supervised and supervision records were available on files, staff receive regular supervision at least 6 times per year and this was confirmed by staff spoken to at the home. Brendon Lodge DS0000066261.V338755.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home and there is an effective quality assurance system in place. There are appropriate controls, policies and procedures in place, which help promote the health and safety of service users and staff. EVIDENCE: The manager has been in post for approximately 8 months and was previously the registered manager of another service operated by Dolphin Homes. She has achieved NVQ at level 4 in care and the Registered Managers Award and has applied for registration with the CSCI. Each resident has a named key-worker who works closely with the service user concerned, they are involved in decisions about the service provided for their particular key resident and have supported them to complete satisfaction surveys.
Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 22 Residents, relatives, appropriate healthcare professionals and care managers are included in 6 monthly care reviews and these reviews are also used to monitor how the home is meeting its aims and objectives. Regular monthly regulation 26 visits are carried out and there are weekly service user meetings and this is another opportunity to obtain service users views. The director of care said that she was looking to publish a quarterly newsletter to families and other interested parties There are policies and procedures in place to ensure safe working practices in the home and all care staff undertake statutory training, which includes health and safety, food hygiene, first aid and manual handling. The home has a new style accident book and the fire logbook was inspected and all required testing had been carried out. Certificates were available for annual testing of equipment and services. Fire equipment was last tested in September 06, Gas equipment tested in August 2006, Electrical wiring in March 06 and hoists and lifts in April 2007. Brendon Lodge DS0000066261.V338755.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 X 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 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 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 3 X Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 24 No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brendon Lodge DS0000066261.V338755.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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
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