CARE HOME ADULTS 18-65
Cavendish Lodge 41 Leam Terrace Leamington Spa Warwickshire CV31 1BQ Lead Inspector
Kevin Ward Unannounced Inspection 1st March 2006 08:00a Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 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 Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 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. Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cavendish Lodge Address 41 Leam Terrace Leamington Spa Warwickshire CV31 1BQ 01926 427584 01926 427584 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) Rethink Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th May 2005 Brief Description of the Service: Cavendish Lodge is a nursing home for eight people with mental health problems, which is part of the Rethink Organisation (formerly NSF). The Home is situated within walking distance of the town centre and local parks. The home aims to provide a supportive residence in which eight people with enduring mental health problems can have a sense of belonging, be treated with respect and exercise choice in their daily lives. Each individual is encouraged to participate in activities suited to their own needs and wishes, to access local resources and facilities and to manage social and familial relationships beyond the home. Through the long term development of trust between service users and staff, the fostering of hope and focus upon strengths, the home endeavours to enable people to approach their potential and to achieve some recovery in the quality of their lives. Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and time limited. The inspection focused mainly on reviewing the home’s progress to meet the requirements made at previous inspections. The inspection involved talking with all the service users living at the home as well as meeting with the manager and staff on duty. The inspection also involved looking at a number of records and documents, including sampling care plans and health notes, recent staff files, training records and the home’s policy file. What the service does well: What has improved since the last inspection?
Suitable regard was seen to be given to respecting people’s confidential information. Lockable storage cabinets were seen to be in place for the safe storage of confidential information and service users records were stored away when not in use by staff, during the inspection. Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 6 In the last inspection report concerns were expressed about the cluttered condition of the medication room. Since that time positive action has been taken to purchase new lockers for staff to keep their belongings in another room. The medication room was seen to be tidy and well ordered at this inspection. 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. Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 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 Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 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 the following standard(s): The key standards under this section were assessed at the last inspection, 5/5/05 and were not assessed on this occasion. EVIDENCE: Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Service users needs are regularly reviewed with their involvement and the support of relevant professionals so that there needs are properly planned for and met. EVIDENCE: Service users care plan files were seen to contain ample evidence to indicate that the home meets involves service users and professionals to plan and review individual’s needs. A clear record is retained to confirm the dates that care plans are reviewed by the home and satisfactory records are retained of frequent reviews, involving the consultant psychiatrist and other staff from the community mental health team. Care plans and risk assessments are in place containing clear guidance to advise staff regarding the advice and support that service users require. Suitable plans were seen on file, to assist a service user who is planning to move on to other accommodation to develop her independent living skills. Service users files are well organised and indexed, making it easy for staff to find relevant information, necessary for monitoring care and support. Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 10 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 the following standard(s): The key standards under this section were assessed at the last inspection, 5/5/05 and were not assessed on this occasion. EVIDENCE: Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 18,19 and 20 The home supports service users to meet their personal care and health needs and appropriate procedures are in place for administering medication safely so that people needs are met appropriately. EVIDENCE: Service users spoke very positively and with affection about the support they receive from staff at the home. One person said “they are all lovely” and another person said “ I can not fault them in any way”. Service users looked comfortable and at ease when approaching staff for help and advice and staff were seen to respond to service users in a friendly and helpful manner. Comments made by service users confirmed that they are free to go to bed and to rise when they wish to do so and are not restricted by institutional routines. The manager explained that all the current service users are able to manage their personal care needs independently with some prompting and encouragement; hence there is not a need for specialised equipment at the home. Service users’ review notes and letters on file provide evidence to indicate that the home works well with other health professionals. This includes regular reviews involving a consultant psychiatrist and community nurses.
Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 12 One service user has appropriately been referred for an Occupational Therapist Assessment to support her wishes to move on to more independent living accommodation. Entries in service users health records indicate that people are being appropriately assisted to make use of local community health services, such as dentist, opticians, chiropodist and well person checks and screenings. Since the last inspection action has been taken to provide staff with personal lockers so that their personal belongings to not have to be stored in the area containing the medication cupboards, to avoid unnecessary clutter. This area was found to be well ordered and tidy, as were the contents of the medication cabinet. Suitable arrangements are in place for the safe storage of medication and controlled drugs, where necessary. A sample examination of medication records confirmed that medication is being properly recorded and accounted for. A contract was seen to be in place for the safe disposal of unused medication. At the time of the inspection none of the service users living at the home were holding their personal medication. The manager stated that a risk assessment was to be devised shortly to increase the involvement of a service user in handling her own medication, in preparation for her move on to a more independent living situation. Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 13 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 the following standard(s): The key standards under this section were assessed at the last inspection, 5/5/05 and were not assessed on this occasion. EVIDENCE: Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 24 Minor works are necessary to improve some areas of the home so that it is made more clean and attractive for people to live in. EVIDENCE: Only the downstairs of the home was inspected on this occasion. A full inspection of the accommodation took place at the last inspection. Whilst overall the communal areas are reasonably well furnished and comfortable a small number of matters were brought to the attention of the manager to address. The smoking room is need of cleaning and the carpet in the hallway is stained and worn and in need of replacement. The doors and woodwork in the hallways are also in need of re-painting where the paintwork has yellowed. Work has been carried out to plaster and decorate part of a ceiling in one person’s bedroom that was identified as needing attention at the last inspection. Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 34 The home provides suitable training opportunities so that staff are equipped to meet the needs of the people living at Cavendish House. Increasing the number of staff trained in adult abuse would bolster the arrangements in place for the protection of vulnerable adults. There are minor shortfalls in the information held at the home, necessary to confirm that full and correct vetting procedures for the protection of vulnerable adults have been followed. EVIDENCE: Comments made by staff indicate they are provided with access to a good range of training opportunities and are supported through an organisational induction programme when they first start at the home. The home’s training records were seen and discussed with the manager, providing evidence that staff are receiving training in mandatory health and safety related areas of practice, such as first aid, fire safety and food hygiene training, as well as care practice issues. A number of training course certificates were sampled as verification of training carried out. Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 16 The manager explained that four of the current staff team members have completed adult abuse training, leaving 8 staff untrained in his subject. The manager reported that two staff have completed NVQ level 2 courses and that two others had completed training to level 3. Qualified nurses are also employed at the home. The recruitment files of three staff employed since the last inspection were examined. All three files contained evidence to confirm that new candidates are properly interviewed prior to being employed at the home. One service user confirmed that he takes a part in some staff interviews. All three staff files were seen to contain information to confirm that references and Criminal Record Bureau checks have been appropriately carried out. One person’s file did not contain a copy of their proof of identification, as required. The manager explained that she has not recently made use of agency workers at the home. Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 Arrangements are in place for the manager to receive appropriate training to equip her for role in ensuring that service users benefit from a well run home. Fire safety records are incomplete to verify that equipment is tested so that service users and staff are properly protected for fire in the home. EVIDENCE: The manager explained that she has just started the Registered Managers Award. This qualification is necessary to qualify her for her role as registered manager at the home. The manager explained that she intends to complete this training during the next 10 months. Comments made by staff confirmed that they receive regular planned one to one supervision and are provided with access to a suitable range of training opportunities. Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 18 An examination of the home maintenance records confirms that gas and electrical equipment is being appropriately checked and maintained by contractors. Contracts are also in place for clinical waste and returning unused medication. Fire safety maintenance records were seen to confirm that fire safety equipment is being maintained in safe order at the home. On the day of the inspection the manager was unable to locate the log of alarm and lighting tests carried out at the home recently so it was not possible to verify that these checks have been routinely carried out recently. There is an outstanding recommendation from a fire officer’s visit, 11/2/05 for new locks to be fitted to two doors in the boiler house area of the home. Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 19 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 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 1 x x x x 2 x Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 20 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. 1 2 Standard YA24 YA34 Regulation 16(2)(c), 23(2)(d) Schedule 4,6(b) Requirement Take action to replace hallway carpets, paint hallway doors and clean the smoking room. Ensure that a copy of staff identification is retained on file at the home, in all instances, when new staff are recruited to the home. The manager is required to complete training for the Registered Managers Award and to inform the Commission for Social Care Inspection when she has achieved this qualification. Take prompt action to fit appropriate locks in the boiler house, as recommended by the fire officer, 11/2/05. Ensure records of alarm and lighting tests are kept available in the home for inspection. Timescale for action 24/07/05 14/02/06 3 YA37 9,2 (b) I) 30/05/06 4 YA42 23(4)(c) (i)and(v) 10/03/06 Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 21 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 YA32 Good Practice Recommendations Increase the number of staff trained in vulnerable adult abuse. Cavendish Lodge DS0000004390.V285221.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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