CARE HOME ADULTS 18-65
Charnwood Lodge Woodhouse Lane Nanpanton Loughborough Leicestershire, LE11 3TG Lead Inspector
Steve Hunnybun Unannounced 26 April 2005 10:00am
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Charnwood Lodge Address Woodhouse Lane Nanpanton Loughborough Leicestershire LE11 3TG 01509 890184 01509 891446 charnwood.lodge@craegmoor.co.uk Lansdowne Road Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant Care Home 18 Category(ies) of MD Mental Disorder (18) registration, with number of places LD Learning disability (18) Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: No person falling within category MD may be admitted to the home unless that person also falls within category LD – i.e. dual disability. Date of last inspection 22nd November 2004 Brief Description of the Service: Charnwood lodge is registered for eighteen service users with learning disabilities and associated challenging behaviour. The registration includes those with mental health problems in addition to their learning disability. The property is a large building set in extensive well-maintained grounds. A programme of renovation and decoration has been carried out and has greatly improved the living accommodation for service users, both shared and private. The home is divided into two units, Elm and Oak each with its own manager and staff team. Through the renovation programme the units now have their own office, which are accessible for service users. The home has a shared activity room that is used for day care activities. Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over seven hours and was the first statutory inspection this year. Four service users files were looked at, three service users, two staff and the registered manager spoke with the inspectors. Two service users showed the inspectors round the building. The inspection was on the whole positive with good feedback coming from the residents. Thirteen comment cards were received from residents and three from relatives these were very positive, any negative comments were discussed during the inspection. Comments included; ‘I feel very safe’, ‘my privacy is well respected’ and ‘I feel very happy’. What the service does well: What has improved since the last inspection?
The statement of purpose was required at the last inspection and is now present. The home is now informing the commission of notifiable events under Regulation 37. All residents now have assessments using the same tool. Care plans and risk assessments have been completed and are very useful documents. All medication charts examined had been signed to indicate medication given. The broken windows and torn wallpaper have been repaired.
Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 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. Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,5 Although residents have information regarding the home in the form of a statement of purpose, this is not yet in a format that is accessible. There are currently no contracts on file between residents and the provider. Residents may not be aware of their rights and responsibilities within the home. The piece of work mentioned in evidence below aims to rectify this. Resident’s needs are assessed comprehensively enabling staff to meet such needs. EVIDENCE: The home now has a statement of purpose that meets the requirements of National Minimum Standard 1. All files tracked contained assessments, completed using an Activities of Daily Living format these were very comprehensive documents and one resident who spoke with the inspectors stated that her assessed needs were being met. All assessments had recently been reviewed and this had been recorded. None of the files looked at contained contracts between the resident and the home’s provider. This was discussed with the manager who stated that she is in the process of producing resident’s packs in a form that is accessible to people with learning disabilities. A local university are providing support and advice for this piece of work. The packs will contain resident’s guides, terms and conditions and contracts. Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 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 standard(s) 6,7,9 Residents’ needs are assessed and they are aware of the outcome of such assessments. Residents’ are enabled to make choices and decisions about their lives. Residents are supported to take risks and this is recorded in their files. EVIDENCE: All files tracked contained very useful care plans. These had been based on assessments of needs and had been reviewed. They were very user focused; the inspectors spoke with a resident who stated that her needs are being met according to her care plan. Residents who spoke with the inspectors stated that they are given choices in areas such as leisure activities, day care activities and the décor in their rooms. All files tracked contained very useful risk assessments. These were crossreferenced to the care plans where appropriate. In conversation with service users it was clear that they are aware of their risk assessments and have contributed to them. Risk assessments had been reviewed and any necessary changes made and recorded. Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 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 standard(s) 12,16,17 Activities are provided for residents that meet their needs. Residents’ rights and responsibilities are recognised. The food is generally good although there appears to be a lack of choice regarding a low fat option. This could mean that service users are not able to eat healthily. EVIDENCE: All residents who spoke with the inspectors stated that they are able to engage in activities that are appropriate to their needs. Two spoke of art and craft activities and several were about to go to the pub. Residents are enabled to access a range of day care activities both on-site and external. Service users were observed moving freely throughout the home on the day of the inspection. The statement of purpose sets out their rights and obligations and staff appear to recognise this. Residents stated that the food is good although one stated that a low fat option is not offered. There was no cook present on the day of the inspection, care staff prepared lunch. The meal appeared tasty and nutritious. Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 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 standard(s) 18,19,20 Residents’ care and health needs are recorded comprehensively and staff aim to meet these needs individually. Medication is not stored or recorded appropriately which could result in a resident being given medication incorrectly or that which is contaminated. EVIDENCE: The inspectors spoke with three residents during the inspection. They all stated that their needs are met in a way that they prefer. It was clear that what residents told us matched their care plans. Residents’ health care needs are recorded in their files and they are supported to access any health care services they need. All appointments are recorded along with any outcomes or advice. Medication records were examined and the medication cupboards were checked. A number of residents are on PRN (as required) medication. Records were examined for these and each resident has a PRN procedure. These had been completed but only said ‘when agitated’ or ‘when upset’ rather that specifying what to observe when making a decision about giving medication. In one residents file it was evident that she had been given medication designed to calm her down when she asked for it, without any other apparent reason for administration. The manager and staff were asked about this and they were
Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 Page 12 clear that the resident knows when her anxiety levels were increasing and she needs medication even if she shows no observable signs of this. The resident is taking far fewer tablets now than she has in the past. A doctor has overseen all of this. The same resident is prescribed an inhaler for asthma. She has an emergency ‘reliever’ and on the day of the inspection she went out, leaving the inhaler at the home. Staff were asked about this and stated that the resident has a puff of the inhaler before she goes out if she feels she will need it. This is unacceptable as this particular medication is designed to relieve an existing attack not to prevent a future one. The medication cabinet on Oak unit was clean and tidy, however the one on Elm was untidy and dirty a bottle of Lorazepam tablets was found in Elm that was marked ‘no longer needed’. These should have been returned to the pharmacist. The kitchenettes in which the cabinets are situated and medication is prepared were both unacceptably dirty and untidy. Both floors were very sticky and there were spilt drinks on the work surfaces. Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 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 standard(s) 22,23 Residents are aware of whom to raise concerns with and feel that they will be listened to. The home takes all reasonable steps to protect residents from harm and acts appropriately when it is suggested that harm may have taken place. EVIDENCE: All residents that spoke with the inspectors stated that they are aware of the complaints procedure and whom they should speak to if unhappy about the service. One resident stated that other residents are abusive to her but that she feels that staff are supportive and helpful. A member of staff who spoke with an inspector appeared aware of vulnerable adult procedures including the Multi-Agency Vulnerable Adult Protection document No Secrets. Recently two vulnerable adult issues have been raised at the home. These were discussed during the inspection and the home acted appropriately in both cases. Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 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 standard(s) 24,25,30 The home is suitable for its purpose. The small lounges ensure that residents do not have to socialise in large groups, which may give rise to conflict. Residents are able to personalise their rooms so that they meet their lifestyle. However the issues detailed below need addressing in order to ensure the safety and comfort of the resident who showed the inspectors her bedroom. The kitchenettes need cleaning immediately as they could present a health hazard. Medication is dispensed in these rooms and drinks are made for residents. EVIDENCE: Residents who spoke with the inspectors stated that they like the environment of the home. One resident stated that she does not like a lot of noise and has a room on the top floor, which enables her to withdraw and spend time in a quiet environment when she wishes. The home is located in a large building and benefits from a number of small lounges in which small groups of residents socialise. One resident showed the inspectors her room. The room was homely and appeared comfortable and she stated that she had been able to personalise it. The room was painted a neutral colour but the resident said that she would choose the colour when it is decorated. The resident pointed out some concerns in the room; the windowpane is cracked, the resident would like a
Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 Page 15 bedside lamp but only has one socket so would need another one fitting or her room re-arranging. The water from the hot tap ran cold despite the tap being left to run for some time. The light in the corridor outside the room was not working. The home was generally clean and tidy on the day of the inspection but the kitchenettes on the units were unacceptably dirty. Both floors were sticky and there were drinks spilt on the work surfaces. The worktops were also covered in clutter and untidy. Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Staff are appropriately trained to meet residents needs. EVIDENCE: The inspector spoke with staff and the manager who stated that they receive a comprehensive package of training. Staff are registered for appropriate NVQ awards and new staff follow a useful induction programme. The manager runs weekly training events with half the staff supporting residents while the other half attend that training. Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 Residents feel their views are listened to. EVIDENCE: Residents who spoke with the inspectors stated that they feel their views are listened to. Throughout the day staff, including the manager, were willing to talk with residents and happy for them to talk with the inspectors. Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x 2 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 2 x x x x 1 Standard No 11 12 13 14 15 16 17 x 3 x x x 3 2 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Charnwood Lodge Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x x x C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 20 Regulation 13(2) Timescale for action The home is required to ensure 30th June that all information regarding the 2005 administration of PRN medication is recorded in residents care plans and on PRN procedures. The home is required to ensure On receipt that all medication is stored of report. appropriately and that unneeded medication is returned to the prarmacist It is required that areas used for On receipt the preparation and storage of of report. medication are kept clean and tidy. The home is required to ensure On receipt that the two kitchenettes are of report kept clean and hygienic. Requirement 2. 20 13(2) 3. 20 13(2) 4. 30 13(3) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 1 5 Good Practice Recommendations It is recommended that the residents guide is produced in a form that is accesible to people with learning disabilities. It is recommended that all residents have contracts in their files.
C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 Page 20 Charnwood Lodge 3. 4. 17 25 it is recommended that healthy options are available at all meals. It is recommended that the problems with the bedroom, as outlined in evidence, standard 25, are dealt with. Charnwood Lodge C51 S1794 Charnwood Lodge V222124 260405.doc Version 1.30 Page 21 Commission for Social Care Inspection The Pavilions 5 Smith Way Grove Park, Enderby Leicester, LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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