CARE HOME ADULTS 18-65
Cherry Lodge 14 Lynton Road New Malden Surrey KT3 5EE Lead Inspector
Michael Stapley Unannounced Inspection 11th October 2005 09:30 Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 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 Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 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. Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Cherry Lodge Address 14 Lynton Road New Malden Surrey KT3 5EE 020 8296 9188 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) Mr Younoos Jeetoo Mrs Kay Jeetoo Mr James Emmanuel Kwabena Safo Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st July 2005. Brief Description of the Service: Cherry Lodge is a residential care home for nine adults with learning disabilities. It is located in New Malden, close to local shops and had good transport links with trains to London and buses to Kingston Town Centre and other surrounding areas. The Registered Persons have produced a Service Users Guide that includes the aims and objectives of the home. Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This home was inspected under the National Minimum Standards Care Homes for Younger Adults. The inspection took place over one day on 11th October 2005. The home still does not have a permanent manager. There is currently an acting manager who is supported by a consultant Mike Hale. The home must ensure a permanent manager is in post without further delay and seek registration with the CSCI. Records examined included service user plans; care manager needs assessments and risk assessments, medication records, complaints, staffing records, health and safety and fire records. Previous requirements and recommendations were discussed with the acting manager. What the service does well: What has improved since the last inspection? Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 6 The acting manager is now using the staff meetings at the home to improve communication amongst the team and discuss basic care values. Staff members have improved their skills and knowledge by attending a number of training courses. Care plans have been reviewed in consultation with service users and now include all the elements of standard six. In addition the acting manager has introduced Person Centred care plans for all service users. The home has a complaints procedure both in written and pictorial form that has now been developed in the form of a video. There have been improvements in the environment with refurbishment and redecoration taking place. At the last announced inspection concerns were expressed that after 8.00pm there was only one member of staff on duty at the home. The acting manager has after discussions with service users care managers and the inspector for the home ensured that an extra member of staff is on duty until 9.00pm. The acting manager and registered provider will need to monitor the home to ensure that there is sufficient staff on duty from 9.00pm onwards. What they could do better:
The registered providers have yet to appoint a permanent manager who is qualified and experienced to manage the home. Given that a requirement was made during the course of the announced inspection of 21st July 2005 it is disappointing to note that the registered providers have yet to submit an application to the commission for the registration of a permanent manager. This is essential if the home is to develop sound working practices and gain a clear vision for the future. A requirement has therefore been made that such a manager is appointed without further delay. Although Personal Centre Care Plans have been introduced for service users only the acting manager has undertaken specific PCP training. Although the home has developed a training programme there needs to be training that is relevant to service users with learning disabilities. Some of the staff also need to undertake medication training. While the home has become far more focused on the service users some of them still do not have access to an Advocate. The home should therefore make sure an advocate is available at the request of service users. The home has developed a quality assurance system by seeking the views of service users, parents, care managers and other interested parties. The acting manager is in the process of evaluating the responses from which plans can be made to further develop the project. The home has yet to carry out an annual audit in line with Standard 39. Requirements have therefore been made in respect of this standard. Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 7 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. Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 8 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 Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 9 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): 1 and 4. The home has an up to date Statement of Purpose that clearly sets out its aims and objectives, its services and facilities and terms and conditions for service users. The home has produced a service users guide in an easy to read format that is accessible to service users. (Standard one) The home invites prospective service users to visit the home prior to making a decision as to whether to move in on a permanent basis. (Standard four) EVIDENCE: The home has an up to date Statement of Purpose that contains all the information as laid down in Schedule One of the Care Regulations 2001. The home has produced a service user’s guide in a format that is accessible to service users. It contains all the information laid down in standard 1.2. It covers the terms and conditions for service users residing at the home, the fees charged and the cost of any ‘extras’ It also contains details of the homes complaints procedure and how to contact the Commission Social Care Inspection. A copy of the last inspection report is made available to service users and their families. The service users guide and complaints procedure are both written in a format that is accessible to service users. Any prospective service user has the opportunity of visiting the home prior to moving in on a permanent basis. Such visits are planned on an individual basis and can include an overnight stay. Such visits give the prospective service user his family and care manager the opportunity of meeting the staff and other
Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 10 service users. The home ensures that all service users have as a minimum a three-month ‘settling in’ period followed by a review. Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 11 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, 7, 9 and 10. Service user care plans contain all the information required as per standard six. Staff at the home have all the information they require to satisfactorily meet the needs of the service users. Service users have individual risk assessments and risk management strategies carried to enabling them to participate in activities in the home and in the community with appropriate support. Staff respect information given to them by service users and their respective families. All service users and their families have access to the homes` policy on confidentiality. EVIDENCE: Service user individual care plans are comprehensive and contain all the elements of standard six. Care plans contain a pen portrait of the service user, weekly activities, health needs and communication skills. Service users and their respective families are involved in drawing up such plans as outlined in standard 6.6. In addition service users have a key worker and evidence of key working was duly noted. The home has become far more service user focused. Service users are encouraged to become far more involved in the home. House meetings are service user led and support is given to establish opportunities for paid employment. The acting manager explained that the home has moved
Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 12 towards Person Centred Plans where ownership of the plan is given to the individual service user. While this is to be commended it was noted that only one member of staff had undertaken Person Centred Planning training at the home. Service users files sampled at random all had individual risk assessments and risk management strategies. Service users are encouraged to make their own decisions within the context of risk assessment. All service users have individual choice although the home has had some difficulties in providing an independent advocate for individual service users where desired, although it is evident that service users are empowered through group meetings and key working. The home has a confidentiality policy that is available to service users and their respective families. Service users are aware that all information about them is handled in a sensitive manner and that confidences are kept. Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 13 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): 15 and 16. Service users have appropriate personal, family and sexual relationships. The home promotes independence for service users and encourages individual choice and freedom of movement. EVIDENCE: Family and friends are encouraged to visit Cherry Lodge at any reasonable time, although the home does ask that arrangements are planned in advance to ensure the service users have not gone out on a prearranged outing. Service users have plenty of opportunity of making new friends and can see their friends in private in their own room. Staff support service users in maintaining positive relationships. The acting manager informed the inspector that one service user had recently wanted to stay overnight at her boyfriend’s house. The home had been supportive to the service user and did not seek to discourage such relationships. The daily routines at Cherry Lodge promote independence and choice. The routines of the home seek to maximise independence. There are no restrictions whatsoever placed on service users (save for those agreed in the care plan and/or contract). Service users have a key to their own room and a key to the
Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 14 front door of the home if you wish, subject to a risk assessment. Service users are free at all times to spend time alone or join in an activity. The home has introduced Personal Care Plans and such plans seek to promote individual choice at all times. Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Personal care is carried out in a way that residents prefer so that dignity and choice are maintained. The home has not provided staff with appropriate medication training placing service users at risk and harm. EVIDENCE: Health records are maintained for each service user. Service users records examined during this inspection demonstrate that the service user had access to routine health checks and specialist health care. Significant events and accidents are recorded and monitored. All service users are registered with a local General Practitioner. The home employs the Boots blister pack system and the local pharmacist visits the home to offer advice. The staff team at the home now keep an individual record of incidents on service user’s files. Staff members monitor service user’s health and maintain up to date records. All of the staff team have received in house medication training. However this is not ‘accredited’ training. The home must ensure that all staff that give medication undertake such training as a priority. All medication records were found to be satisfactory at the time of the inspection. Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. There is a complaints policy and procedure, which facilitates good access to the complaints system for the residents, their family or their representatives. The home has the appropriate policies in place to ensure the protection of vulnerable service users. EVIDENCE: The home has a detailed complaints procedure. A pictorial format of this procedure has been developed and provided to service users. In addition this procedure is available in video format. The Acting Manager advised that there had been no complaints since the last announced inspection. Evidence showed that previous complaints had been dealt with in a satisfactorily manner. There are also policies and procedures in place regarding the protection of vulnerable adults. The acting manager has drawn up a flow chart in order that all staff are aware of the action to be taken in regard to adult protection. The homes acting manager stated that the staff team had all undertaken adult protection issues. The staff team are aware of the action they must take if they need to report an incident. Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 29 and 30 Service user’s bedrooms provide privacy and reflect individual interests and preferences. The home is homely, bright and clean with the necessary adaptations in place, thus providing the service users with safe, comfortable surroundings that meet their needs. EVIDENCE: The home is a two story building in a residential road. It is situated in New Malden and is close to local shops and amenities. There is a large communal lounge on the ground floor as well as a kitchen/dining room. The furniture is domestic, flame retardant, and of reasonable quality. The home does not have a lift and all service users are ambient. There has been some improvements in the décor of the home since the last inspection and there is an ongoing programme of planned refurbishment. Since the last inspection some of the carpets have been replaced throughout the home. The home was very clean and hygienic and free from offensive odours through out on the day of the inspection and systems are in place to control infection in accordance with relevant legislation and published professional guidance.
Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 18 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, 35 and 36 Staff at Cherry Lodge has the skills and qualities to meet the needs of the service users. Staff receive training and qualifications appropriate to their role within the home. The retention of staff has improved the consistency with which service users needs are being met. Staff training has resulted in staff being more confident in their work with the service users and adopting a teamwork approach. However these improvements may not be maintained unless a permanent manager is appointed to the home who will need to monitor the training needs of the staff group. EVIDENCE: The staff at Cherry Lodge consist of six core staff, excluding the day-to-day manager. Two staff have completed NVQ level 3, while two staff are completing level 2. The home therefore exceeds the 50 per cent that are to have as a minimum an NVQ level qualification by 2005. The home offers training opportunities to staff at all levels within the home. New members of staff complete an induction programme covering various subjects including health and safety, fire drills, and introductions to service users and other staff. The induction programmes are signed, dated and kept on staff files. Criminal Records Checks are completed before a new member of staff can begin work in a home. The home still does not have a permanent manager. The registered provider must appointment such a manager who is experienced and qualified. The said
Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 19 person must complete all documentation and register with the CSCI without further delay. Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 20 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, 39 and 42. The home still does not have a permanent manager, which could hinder the development of the home. The home has systems in place to ensure that service users are listened to. Systems are in place to ensure that Health and Safety within the home is properly managed. EVIDENCE: Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 21 The registered provider has yet to appointment a permanent manager. The acting manager completes a monthly manager’s report and this is discussed with the Directors of the home and efforts are made to meet any concerns or improve the service. The home has an annual development plan and a business plan for 2005-06 that was both seen during this inspection. However there was no evidence of an annual audit. A member of staff said that she was well supported she said that the home is running very well with good management and a positive staff team. Records required for the safety and well being of service users are in place including accidents, water temperatures, complaints, incidents, food records, fire records, staff and service user’s case files, medication records. Fire drills are now up to date and a fire risk assessment is in place. The residents are beginning to see the benefits of a stable staff team and a continuity of approach this generates. However for residents and their advocates these developments need to be consolidated and built on in order for them to be confident that their best interests are safeguarded, their views are taken into account and the home is well managed. The system for consultation with service users, families, stakeholders and other interested parties is reasonable and the quality assurance system has now been developed to include service user, relatives, staff and outside professional questionnaires. The results of which are currently in the process of being analysed by the acting manager. Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X 2 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 2 X 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 X 3 3 2 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X X 2 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Cherry Lodge Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 1 X 2 X X 3 X DS0000013379.V254787.R01.S.doc Version 5.0 Page 23 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 The registered person must ensure that all staff receive specialist training in learning disabilities and other training appropriate to the work they undertake in the care home. The Registered Provider must ensure that service users are supported to make decisions by the provision of information, assistance and communication support, informed by professional assessments and guidance, to include access to advocacy. The registered person must ensure that all staff who administer medication undertake accredited training. The Registered Provider must ensure that a suitably qualified professional such as an occupational therapist, assesses the service users concerned, the home providing aids, adaptations and equipment as recommended, specifically to address transfers from chairs, use of the stairs, and access to the garden and front door.
DS0000013379.V254787.R01.S.doc Timescale for action 31/12/05 1 YA3 18(1) 2 YA7 12(2) 31/12/05 3 YA20 18(1) 31/12/05 4 YA29 23(2) 31/12/05 Cherry Lodge Version 5.0 Page 24 5 YA35 18(1) 6 YA37 8 7. YA39 24(1) (Partly meet but the home must provide a written report following this assessment.) The registered person must ensure all staff receive equal 31/12/05 opportunities training, race equality and anti-racism training The registered provider must ensure a permanant manager is appointed to the home and 08/10/05 submit his/her name for registration with CSCI without further delay. The registered person must ensure that an internal audit 31/12/05 takes places at least annually. 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 Cherry Lodge DS0000013379.V254787.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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