Inspection on 21/07/05 for Cherry Lodge

This inspection was carried out on 21st July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cherry Lodge 20/06/08

Cherry Lodge 13/07/07

Cherry Lodge 25/10/06

Cherry Lodge 16/05/06

Cherry Lodge 11/10/05

Cherry Lodge 04/11/04

Cherry Lodge 13/05/04

Cherry Lodge 08/01/04

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Chatsworth Care - Tudor Lodge

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Cherry Lodge 14 Lynton Road New Malden Surrey KT3 5EE Lead Inspector Michael Stapley Announced 21 July 2005 09:30 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. Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 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 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 Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 041104 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 G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 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 21st July 2005. There has been a change in management at the home in the last year. 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 and registered persons. What the service does well: What has improved since the last inspection? Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 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 although they need fine tuning to include all the elements of standard six. In addition the manager Person Centred care plans for all service users. The home has a complaints procedure both in written and pictorial form which has now been developed in the form of a video. There have been improvements in the environment with refurbishment and redecoration in the process of taking place. What they could do better: The registered providers have yet to appoint a permanent manager who is qualified and experienced to manage the home. This is essential if the home is to development sound working practices and 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 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. Staff also need to undertake rectal diazaphem training. While the home has become far more focused on the service users they 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, however this needs to be further developed by establishing the views of parents, care managers and other interested parties. Requirements have therefore been made in respect of this standard. In addition concerns were expressed that only one member of staff was on duty between the hours of 8.00-10.00pm. Please contact the provider for advice of actions taken in response to this Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 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 standard(s) 2, 3 and 5 The home provides good information and introduction opportunities for prospective service users to make an informed choice about moving to the home. Contracts between the home and the service users do not contain all the information required under standard potentially reducing the rights of the residents of Acorn Lodge. Staff at the home have not had appropriate training for working with service user’s with a learning disability and those service user’s who are epileptic. This could clearly have an impact on the delivery of the service to residents at the home. EVIDENCE: The home has a preadmission procedure including a resident’s charter. Service users are only admitted to the home once a full assessment of their needs; compiled by their care manager or other relevant person has been received. An assessment for the homes most recent service user was seen on the service users file. The assessment was completed by a care manager and included additional assessments from other professionals. While the home has a training programme including NVQ training there is know evidence to suggest that staff have received training for the particular client Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 10 group they are working with. Staff should receive specialist training for service users who have a learning difficulty such as that provided by LADAF. There has been some progress in improving contracts between the home and the service users. Contracts now stated that all residents would have a three month ‘settling in’ period of residence at the home. However they did not contain all the information as required under standard 5.2. The home must accordingly amended service users contracts as at present there is the potential for their rights to be reduced. Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 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 standard(s) 6, 7 and 9. 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. 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 evidenced 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 towards Person Centred Plans where ownership of the plan is given to the individual service user. While this is to be commended it was Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 12 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 not provided an independent advocate where desired, although it is evident that service users are empowered through group meetings and key working. Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 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 standard(s) 12, 13, 14 and 17 The daily routines and house rules promote residents’ rights and encourage independence. Service users are given opportunities to engage in age appropriate activities with an emphasis on using community based facilities. Dietary needs are catered for and a balanced diet is provided, to ensure a nutritious diet based on personal preferences. EVIDENCE: The home is supporting service users to access appropriate activities through the activity programme. The service users access local parks, cafes, theatres, local leisure facilities and shops. In addition to swimming, gym and library. The staff team are available to support service users while accessing community resources and paid employment. Service users spoken to stated that they enjoyed the activities on offer at the home. Although service users do not at present have access to a computer the manager explained that this is under consideration at present. Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 14 Weekly menus were constructed with the aid of the service user’s personal choice, advice from service user’s families and the experiences of the staff. One service user said that he enjoyed what he had to eat at the home. Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 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 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 who give medication undertake such training as a priority. Staff at the home have also not had Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 16 rectal diazaphem training which is essential given some of the service users are epileptic. All medication records were complete at the time of the inspection. Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 17 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 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 said that one complaint had been made since the last inspection. Evidence showed that this complaint had been dealt with satisfactorily. There are also policies and procedures in place regarding the protection of vulnerable adults. It is suggested that the home draws 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 G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 18 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, 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. Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 19 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 G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 20 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 and 36 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 team work 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 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. Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 21 The home does not have a permanent manager. The home must appointment such a manager who is experienced and qualified. The said person must complete all documentation and register with the CSCI without further delay. Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 22 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) 37, 39 and 42 The home 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: The home has yet to appointment addition there was no evidence of an annual audit. 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. In addition there was no evidence of an annual audit. 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. Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 23 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 although the quality assurance system should include service user, relatives, staff and outside professional questionnaires. Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 24 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 x 3 3 x 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 3 2 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x x 3 Standard No 31 32 33 34 35 36 Score x x x x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cherry Lodge Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x 3 x G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 25 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 YA3 Regulation 18(1) 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 at 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. The registered person must Timescale for action 301105 2. YA7 12(2) 310805 3. YA20 18(1) 311105 4. YA29 23(2) 310805 5. YA35 18(1) 311105 Page 26 Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 6. YA37 8 7. YA33 16(2) 8. OP39 24(1) ensure all staff receive equal opportunities training, race equality and anti-racism training The registered provider must ensure a permanant manager is appointed to the home and submit his/her name for registration with CSCI without further delay. The Registered Provider must ensure that staffing arrangements at the home are reviewed to ensure reasonable access to the facilities in the home including the kitchen, and support evenings after 8pm, and weekends away from the home when there are currently only two staff on duty, a copy of the review sent to the Commission for Social Care Inspection (CSCI). A quality audit system, including an annual development plan must be in place to assess whether the aims and objectives of the home have been met and:The home must implement a professionally recognised quality assurance or ‘join up’ their own quality assurance tools into a cyclic quality assurance system. 310805 Immediate requiremen t issued on 250705 311105 9. 10. 11. 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. Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 27 Refer to Standard Good Practice Recommendations 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 © 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 Cherry Lodge G53-G53 S13379 CherryLodge V211781 210705 Stage 0.doc Version 1.30 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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