Inspection on 08/10/08 for Chescombe Lodge

This inspection was carried out on 8th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chescombe Lodge 24/11/06

Chescombe Lodge 09/02/06

Chescombe Lodge 23/05/05

Chescombe Lodge 15/02/05

Chescombe Lodge 31/08/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chescombe Lodge Westbury Park Bristol BS6 7JE The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this full assessment a ‘key’ inspection. Lead inspector: Nichola Grayburn Date: 0 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. They reflect the This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Chescombe Lodge Westbury Park Bristol BS6 7JE Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Under 65 13 Number of places (if applicable): Over 65 0 The Chescombe Trust Mr Kevin Johnson Care Home 13 01179735197 01179706903 chescombe@johnson1.demon.co.uk Additional conditions: May accommodate up to 13 persons aged 18-65 years Date of last inspection: Brief description of the care home: Chescombe Lodge is operated by the Chescombe Trust and is registered to provide accommodation and personal care to 13 people, aged 18 – 65 years. The home aims to help people with complex issues and behaviours and provide a comfortable homely environment. Chescombe Lodge is a large building that requires high maintenance and is not entirely suited to its stated purpose. It has spacious grounds and blends in well with the local area. It is close to local facilities and amenities and has ready access to public transport. Fees are between 610 pounds and 2067 pounds per week dependent on the needs of the individual. Additional charges are made for a range of services detailed in the homes brochure. Information about the home can be obtained from the home manager. 2 4 1 1 2 0 0 6 Care Homes for Adults (18-65 years) Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was Chescombe Lodges Key Inspection. It was unannounced and took place over two days. Before we visited, we looked at the information we have in our office. The service returned their Annual Quality Assurance Assessment (AQAA) in May 2008 and forms part of this report. We carried out an Annual Service Review in June 2008, which did not change our inspection programme. Surveys were sent to the home for the manager to distribute. 5 surveys were returned from people living in the home. 4 of them were completed with support from a member of staff. The home manager informed us that they arranged a residents meeting to give out the surveys. The manager gave us a list of the people who did not wish to complete the form or do not have the capacity for understanding. 7 relatives and 4 members of staff also completed and returned Care Homes for Adults (18-65 years) Page 5 of 30 surveys. The results form part of this report. During the inspection, we did a tour of the home, spoke with the registered manager, other managers, and staff, read records regarding peoples plans of care, staffing documents, and the running of the service, had lunch with people living in the home and staff, and observed care practices What the care home does well: What has improved since the last inspection? What they could do better: Record keeping could be improved to show who has written the document and when to show that care practices match the plans of care. Key worker monthly reports need to reflect accurately what the person has done over the previous month. This will also ensure that people’s needs are met, in particular, the things that are most important to them (non-negotiables). Reshresher training needs to be arranged to ensure that staff are up to date with current practice. Advice needs to be sought to ensure that people are receiving their medication at the right times, particularly when they are away from the home. Consideration should be given to how to promote independence and privacy for people who aren’t able to use the locks on their doors. Risk assessments must be reviewed to reflect current health needs. Fire doors need to be fitted correctly to make sure people are safeguarded against fire as much as possible. Care Homes for Adults (18-65 years) Page 6 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 30 Details of our findings Contents Choice of home (standards 1 – 5).......................................................................... 9 Individual needs and choices (standards 6 – 10) ................................................... 11 Lifestyle (standards 11 – 17) .............................................................................. 13 Personal and healthcare support (standards 18 – 21) ............................................. 16 Concerns, complaints and protection (standards 22 – 23) ....................................... 18 Environment (standards 24 – 30) ........................................................................ 21 Staffing (standards 31 – 36)............................................................................... 23 Conduct and management of the home (standards 37 – 43) ................................... 25 Outstanding statutory requirements..................................................................... 27 Requirements and recommendations from this inspection ....................................... 28 Care Homes for Adults (18-65 years) Page 8 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Chescombe Lodge would assess potential people prior to moving into the home, and regularly review their care within the service. People have up-to-date contracts stating the terms and conditions of living at Chescombe Lodge. Evidence: There have been no new people moving into Chescombe Lodge since the last inspection. The majority of people living in the home have lived together for a number of years. The Annual Quality Assurance Assessment (AQAA) stated that the homes Statement of Purpose has been updated, which now includes a statement on diversity within the service. When the service moves, this document will be completely revised. The AQAA also told us that the service is reviewing the admissions process. When the new premises are completed, it is planned that there will be six more places within the service. From the care plans read, it was clear that assessments and reviews take place on a regular basis. As written within the body of this report, some peoples needs are being met, and some peoples specific needs are not being met. Examples were given to the managers during the inspection. Care Homes for Adults (18-65 years) Page 9 of 30 The surveys returned from people living in the home told us that they were asked if they wanted to move into the home, and that they received enough information to make an informed decision. Four out of the seven surveys from relatives told us that the service always meets the needs of their relative. Three people felt the service usually meets the needs of their relative. The AQAA told us that people have individual contracts in place. Three were seen in peoples care files. For those with capacity to understand their contract, these should be signed by the person. Care Homes for Adults (18-65 years) Page 10 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have clear informative plans of care in place. People are involved as much as possible in making decisions about their lives, and are generally supported to take risks. Evidence: Three peoples care files were read. People have an individual care folder, hygiene support files, and daybooks. There is one manager who is responsible for the plans of care. These are well written, informative and clear. They inform staff how to support the person, how to communicate, what their rituals and routines are, their likes and dislikes, their priorities and non-negotiables, and their spiritual and cultural needs. These are reviewed regularly. However, these need to be named, signed, and dated. Behaviour strategies are written for people who may display behaviour, which challenges staff. These detail preventative actions, responsible actions, triggers, patterns, and helpful actions. These, again, are informative and clear. Key worker reports are written on a monthly basis. These were read for the same three people. The format was changed in May 2008. Many of these do not reflect what the person has been doing, and the achievement of goals were not accurate. Care Homes for Adults (18-65 years) Page 11 of 30 Again, specific examples were given to a manager during the inspection, and discussed with the Registered Manager who will be reviewing the purpose of these. Residents meetings are held and the last five minutes from the meetings were read. Issues such as activities, future plans (for example Halloween), and meals are discussed. Risk assessments are in place and individual assessments are carried out for specific activities prior to people doing them. Some assessments are in need of being fully reviewed. For example, one person who has epilepsy has a risk assessment in place stating that they have a seizure approximately once a month. No changes had been recorded since 2006, but had been recorded that it had been reviewed at regular intervals. The last review was in June 2008. There was no seizure chart in the persons care file, and when we asked a manager about it, we were told that the person had not had a seizure for the past three years. These need to be fully reviewed to ensure that staff are updated with peoples current needs. Care Homes for Adults (18-65 years) Page 12 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have individualised lifestyles, which suit their needs, routines and preferences. People are offered a wide range and choice of meals. Evidence: People living in the home have individualised lifestyles, which suit their needs, routines and preferences. Chescombe Lodge as two vehicles, which they use for activities. At the time of this inspection, one was being used by three people who were on a holiday, the other one is always used between 8 am and 2 pm by one person and their support worker. Some people use the local bus networks to access the community. Chescombe employs a Day Services Coordinator and we spoke with them about the various activities on offer. Daily and weekly activity sheets record what people have been doing, and some of these were read. The AQAA also told us about the different activities. On the first day of inspection, everyone stayed in and used the facilities inhouse. We were told that this was due to being slightly short staffed, and both vans being unavailable. The second day of the visit, everyone had gone out doing various things. There is a day services room within the home where people can do crafts, a computer room, and a newly purchased computer console is very popular. Other Care Homes for Adults (18-65 years) Page 13 of 30 activities include canoeing, sledging (at the ice rink), swimming, walking, baking, weaving, cycling, cinema, discos, and visits to the local pubs. Some people go to the local colleges and learn new skills such as computer skills, cooking, and independent living. There is no specific life skills day but some people are learning daily living skills in-house. The service has purchased a domestic washing machine, which some people are starting to use. Some people help with some tasks around the home, such as vacuuming. However, it was discussed how some people could be more involved around the home and looking after their rooms. There is a holiday policy in place, which is in plain English. It explains what the person has to pay for and what Chescombe Lodge will pay for. As written earlier, three people were on their holiday during the inspection, and other people and staff told us about previous and future holidays. These are taken both abroad and within England. The majority of people living in the home have regular contact with their family and friends. Six out of seven relatives told us on their survey that staff always helps their relative to keep in touch with them. Relatives, and staff, told us about how staff drive people to them to ensure that they can spend time with each other. It was observed how people can get up when they wish. Staff record when people go to bed and this showed that there is no set bedtime. People can choose whether to spend time with each other or on their own. In the bedrooms we saw, people have their own entertainment systems. Some people do not get along with each other, and we were told about this from staff and people living in the home. Incident records and residents meetings also evidence this. Staff are very aware of certain relationships and support both parties. People can come and go from the house as they like, and it was observed how people can access the gardens when they want to. Some people, who are able, have keys to their rooms. It was discussed with the Registered Manager, how alternative locks should be sought for those who cannot use the current locking devices. The menus were read and talked about with staff and people living in the home. Chescombe Lodge employs three part-time chefs. The menu is done on a 4-weekly rota. A manager told us that peoples likes and dislikes have recently been updated. Residents meetings and people told us that they are asked what they would like on the menu, and are given two choices for both lunch and dinner. We saw that the choice is also offered in a pictorial format. Some people have dietary needs, which are met. There is a good range of meals offered, for example, sausage casserole, lasagne, fishermans pie, roast dinner, jacket potatoes, chilli, and soup. What people eat is recorded on a daily basis. People are supported to eat as healthily as possible. Care Homes for Adults (18-65 years) Page 14 of 30 People can have drinks and snacks when they want, but they need a member of staff to get it for them. Some people have facilities in their room to make drinks. We ate lunch with people on the second day, and briefly observed lunch on the first day. It was unrushed and flexible to meet people’s routines. Care Homes for Adults (18-65 years) Page 15 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience Judgement: People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care is not always carried out according to the persons plan of care. Medication procedures are generally robust, however, some checks had not been carried out. Evidence: The AQAA told us that in the past 12 months, the service has introduced Health Action Plans. Three of these were read, and are still in development. It was clear from the records that external professionals are involved in peoples care, and advice is sought when necessary. However, it was noted in one persons key worker report that a health issue had been identified but no follow up action had been taken. The details of this were given to a manager during the inspection. Peoples hygiene support records show that peoples personal care is not being carried out as detailed according to their plans of care and their non-negotiables. In order to retain peoples anonymity, specific examples were discussed with the Registered Manager during the inspection. This was disappointing as the plans of care are of a high standard. Immediate action was taken to rectify the identified issues. Generally, peoples health appointments are recorded. However, the frequency of the appointments does not always correspond to the frequency stated in peoples plans of care, for example, one person should see their dentist every six months, but the last recorded appointment was in October 2007. Care Homes for Adults (18-65 years) Page 16 of 30 Everyone has a designated Key Worker. People told us what their role is and how they help. We were told that in the near future, managers will have key groups of people and this structure will hopefully ensure that peoples needs are met more effectively. People are weighed on a regular basis. It was discussed with a manager, and how it could be viewed as institutional practice. We were told that it is done privately, and people can refuse. Records were seen and it was clear that not everyone is weighed and people do refuse. The medication system was inspected with a manager. The service uses a blister pack system, and holds other medication separately. There are no controlled drugs kept in the home. Training for staff is carried out internally. One of the managers assesses staff after going through the different medications and observations. No one in the home looks after their own medication, but some people do when they go home. Peoples capacity to consent is recorded in their plans of care. Medication reviews take place with peoples General Practitioner or Psychiatrist. We have not received any notifications regarding administration errors, and the manager knew what to do in case it did happen. The Medication Administration Records were complete, apart from one persons lunchtime medication. It transpired that this medication is not administered twice a week as the person is away from the home, and is unable to look after it themselves. Staff are investigating this, in consultation with the persons GP. Eight people have medication, which is administered as and when necessary (PRN). A spot check of two peoples medication was done and the number of tablets corresponded to the recorded amount. There was a bottle of liquid diazepam prescribed to one person, but there was no record of it. An immediate requirement was not made as immediate action was being taken. Staff had some problems returning the medication and the registered manager should confirm in writing that the medication has been returned to the pharmacy. Two tubes of cream had been opened but were not dated. Staff must remember to write when they were opened. Care Homes for Adults (18-65 years) Page 17 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to complain and feel that they are generally listened to. People are safeguarded from abuse. Evidence: Chescombe Lodge has a complaints procedure in place, which is in both text format and pictorial format. There are copies in each persons file. It explains the process of how the service will deal with the issue. However, it needs to include the timescales for when the complainant can expect a response. All five people living in the home who completed a survey stated that they know how to make a complaint and know who to speak with if they are unhappy. All seven relatives who completed a survey also know how to make a complaint, and when they have raised concerns, six relatives stated that the service has always responded appropriately. All four staff who completed a survey know what to do if someone has concerns about the home. Within peoples care files, there is information about how people communicate, and what they do when they are upset or angry. Peoples individual day books evidence peoples daily behaviour and emotions. We have not received any complaints from people living in the home, staff or members of the public. The AQAA (completed in May 2008) stated that there have been no complaints in the past 12 months. The complaints files were read. There had been complaints from staff prior to the AQAA being returned, and since May there were two complaints from people living in the home. Records show that action was taken in respect to staffs complaints. There was no record of the outcomes for the complaints made by living in the home. The forms need to have space to record the outcome of the complaint. Care Homes for Adults (18-65 years) Page 18 of 30 Chescombe Lodge looks after people who sometimes present challenging behaviour to staff and other people living in the home. We receive a summary of the incidents and restraints on a monthly basis. Incidents are recorded, and accidents forms are completed. These were read with one of the managers. Peoples day books were also read in conjunction with the forms. It was discussed how one incident should have been reported to the local safeguarding team to ensure that appropriate action be taken. Whilst discussing the incident, it was clear that the records of the event were not accurate, did not correspond to each other. Since the last inspection, there has been one referral to the safeguarding team, resulting in a referral to the Protection Of Vulnerable Adults (POVA) list. Staff undertake Studio III training which teaches staff about techniques to keep the person, and themselves safe. Restraint is the used as the last resort. The AQAA told us that there were 55 restraints in the past 12 months. When staff start working in the home, their induction includes basic training on the protection of vulnerable adults and safeguarding procedures. The AQAA told us that staff are given an information pack, which includes the Alerters Guide. The registered manager used to attend the lunchtime Safeguarding Adults discussion group when it was being held to keep abreast of changing and new procedures. We asked two managers questions regarding safeguarding and the processes. It was clear that they were aware of what constitutes abuse and who to contact if an incident were to occur. From the seven training files we read, five staff have not received specific training on safeguarding. Two staff were in need of refresher training as they last did it in March 2007. We were told that four of the managers have their Training for Trainers in Safeguarding certificate, and new training material has just been bought for staff to update their knowledge. It is recommended that staff attend the training offered by Bristol City Council. The management team have started doing unannounced spot checks in the evenings. From the three which have been done, managers found the night wake staff sleeping on duty on two occasions. Appropriate action was taken to ensure the safety of people living in the home. The registered manager said that these checks would continue on an ad hoc basis. The managers told us about the ways in which the service keeps people safeguarded from abuse, which include the whistle blowing policy, recruitment procedures, training and development plans, open door policy for both people living in the home and staff, residents meetings, supervision meetings with staff, one to one meetings with some people living in the home, and staff meetings. One person living in the home told us about their weekly one to one meetings with the care manager, which gives them an opportunity to discuss any issues they have. Care Homes for Adults (18-65 years) Page 19 of 30 Three peoples monies were checked and some of the financial procedures were discussed with a manager. The amounts held in peoples individual wallets corresponded with the recorded amounts. The Registered Manager is the appointee for everyone living in the home and the home looks after everyones cash. Everyone has individual bank accounts. It was advised that those people with large amounts of cash in their bank accounts, could have a savings account to benefit from higher interest rates. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home they are familiar with, and meets their needs, but the building is not ideally suited. Peoples bedrooms are personalised. The home is kept clean. Evidence: Chescombe Lodge is a large detached manor house situated on the edge of the Bristol Downs. Rooms are located on three floors, with offices on the top floor. There are two bedrooms on the ground floor, which are accessible for those who use a wheelchair. There are two large lounges, a reception area with comfortable seating, and a large dining room on the ground floor. Other shared areas include a table tennis room, a computer room, a day service room, and gardens around the home. People can access most of these areas when they want to. The home is close to local shops and the bus routes for Bristol. A tour was taken on the first day with a care manager. Despite people not being able to decorate the home in the normal way with ornaments and pictures etc due to some behaviours, the home does have a homely feel to it. Seven bedrooms were seen. All were personalised to the individuals taste and needs. It was evident that people can decorate their rooms as they wish. One persons flooring is in need of replacing due to it having holes and tears in. This was brought to the attention of the manager, who told us the following day that immediate action had been taken, and it was being replaced the following week. Care Homes for Adults (18-65 years) Page 21 of 30 There are sufficient numbers of toilets and bathrooms on every level of the home, and they were clean and well maintained. There is only one shower facility in the home. We were told by a manager that on a recent holiday, people had told staff that they liked showers and preferred them to baths. This was discussed with the registered manager who told us that this will be discussed in the next residents meeting. It has also been considered for the new development and shower facilities are being installed. Through our surveys concerns were raised by relatives, staff, and external health professionals about the layout of the building and its suitability for the people living in the home. Comments included, the present premises are not ideally suited to the client mix, the building is very old and difficult to adapt e.g. the stairs are very narrow, only one at a time, so no support can be given, and space not used as well as it could be, because of the layout of the house, it is difficult when challenging behaviour is shown. Plans and progress for the new development have been made since the last inspection. The aim is for the move to take place in 12-15 months. The trustees, relatives, and staff are aware of the move. People living in the home have not been told yet, but will be told on an individual basis when the time is right for that person. The home was clean and tidy on both days of the inspection. Surveys from people living in the home were mixed when answering the question is the home fresh and clean? Some people help with the cleaning, but the majority is carried out the domestic employee. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a committed understanding staff team, who are well supervised by the management team. People benefit from a qualified staff team, but refresher training in mandatory areas is needed so that staff are up to date with current best practices. Evidence: One relative wrote on their survey Chescombe has a core of experienced caring staff, many have been there for a long time which is good. Three out of seven relatives thought that the staff always have the right skills and experience to look after people properly, and three thought they usually do. Two out of five people living in the home told us on their surveys that staff always listen and act on what they say, three people ticked sometimes. There is a staff team of 23 who support people living in the home. Many of whom have worked at the home for many years. There are normally six or seven staff working from the morning to the evening, with two waking night staff until the morning. On the first day of the inspection, there were five staff working during the day, hence people stayed in-house to do activities. The service sometimes uses an external recruitment agency to cover shifts, but tends to use their internal bank staff. Over the two days of the visit, it was observed how staff interact and communicate with people living in the home. Peoples differing communication needs are respected Care Homes for Adults (18-65 years) Page 23 of 30 and understood. Staff told us on their surveys that the team usually passes on information about people well. Four peoples recruitment files were checked, and four other peoples Criminal Record Bureau checks were inspected. The monthly reports (under Regulation 26) tell us that spot checks are carried out on files and the necessary documents are in place. Surveys from staff told us that employment checks were carried out prior to them starting work. The files are well organised and have a contents page to ensure that documents are in place, and a progress form to record when documents were sent off and received. We found that one person had a reference missing, and this was discussed with a manager. When staff start working, they have a three-day induction. The training manager told us that this is going to be extended into the 12-week programme due to the amount of information people have to understand and digest. Induction records were read within staff files. Three out of four staff told us on their surveys that they thought their induction covered everything they needed to know. The majority of training is done in-house, and it was discussed with one of the managers. The service has just purchased a number of DVDs, which are interactive and have assessments at the end. The training files for eight staff were read, and we found most of the staff are in need of refresher training in some of the mandatory areas. None of the eight hold current manual handling certificates. The training manager is aware that training has slipped, and is in the process of developing a system to keep abreast of when staff need their annual refresher courses. A requirement has been made for a review of training needs. The AQAA told us 90 of staff have or are working towards their National Vocational Qualification Level 2 in care. Seven people have their NVQ level 3. Staff benefit from having internal NVQ Assessors who can support their work towards their qualification. From the training records seen, four people had achieved this qualification. Chescombe Lodge has held the Investors in People Award since 1999. Supervision notes were read in staffs files. Staff have supervision contracts in place ensuring that both parties know what to expect from the meetings. Records show that meetings take place regularly and issues arising from their work are dealt with appropriately. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a generally well managed home. Some records do not reflect current practice. People are generally safeguarded by the services health and safety procedures, however, more stringent checks would safeguard people more. Evidence: Mr Kevin Johnson is the Registered Manager for Chescombe Lodge. There are also four other managers: one Home Manager and three Care Managers. Each have their own responsibilities. We met with all but one of the managers during the inspection. A member of staff wrote on their survey that management is always available to see staff if they request it. With regard to the management of the home a relative added, “does an excellent job of day-to-day care”. An extension was agreed for the return of the AQAA. The assessment was completed well and detailed that the service does well, what has improved in the past 12 months, and the plans for the next 12 months. It is clear from the AQAA and from talking with staff that the management are aware of what improvements can be made and how they are going to achieve them. Care Homes for Adults (18-65 years) Page 25 of 30 Chescombe Lodge uses various quality assurance methods to ensure that people’s needs are met, and their views are listened to. These include monthly visits (under Regulation 26) carried out by Mr Johnson, unannounced spot-checks in the evenings, residents meetings, staff meetings, care reviews, Trustee Board meetings, and questionnaires are sent out to families on an annual basis or more frequently if necessary. As most people living in the home have regular family contact, issues and or concerns are dealt with immediately. The AQAA told us that the majority of the policies were reviewed in 2006 and 2007. These were not read during this inspection. As written in this report, record keeping needs some attention. In some cases, it was difficult to ascertain who had written care notes and reviews. Staff need to state their name, sign and date documents. Accident and incident forms need to be accurate and detail what happened. Key Worker reports and hygiene support records must reflect the care practices within the home. The fire, and health and safety records were read. A fire risk assessment is in place but needs to include procedures for those people who sometimes have poor mobility. Maintenance checks, such as the electrical circuits, portable appliance tests, and the heating system are carried out when necessary, and within the legal timeframes. Other records showed that the necessary checks on fire fighting equipment are done according to the fire authorities guidance. The service carries out regular fire drills. It was clear that any arising issues are followed up. The fire training schedule was read, and five staff are in need of fire safety refresher training. This must be included within the training review requirement made under Staffing One person’s bedroom door has a significant gap between the door and the floor. This means that the person is not fully protected in case of a fire. The Registered Manager took action after being told about it, and we were told that the door would be replaced as soon as possible. An immediate requirement was not made at the end of the inspection as we were assured that it would be completed by the following week, and confirmed in writing. However, a requirement has been made to ensure that it will be done and followed up at the next inspection. We were told that the Environmental Health department inspected the premises three days prior to this inspection, and they are awaiting the report. The home has current Employers Liability insurance. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The registered person must 12/12/2009 make arrangements to ensure that people living in the home receive their medication at the prescribed time. This is to make sure that people’s health needs are met and relates particularly to people who are away from the home when their medication is due. 2 35 18 The registered person must 30/11/09 review staff training needs to ensure that they receive timely refresher training in the mandatory areas. This is to ensure that staff knowledge is fully up to date. 3 42 23 The registered person must refit the fire safety seal to the bedroom door identified at the inspection. Page 28 of 30 Care Homes for Adults (18-65 years) This is to reduce the risk of harm to people in the event of fire. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 16 It is recommended that advice is sought from external professionals, for example, the Community Learning Disability Team, about the types of locks used on bedroom doors. This is so that the independence of individuals is promoted and enabled. People to be advised of the outcome of their complaint and any action taken by the home to resolve it. Timescales for dealing with complaints should be included in the home’s procedure. 2 22 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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