Inspection on 09/02/06 for Chescombe Lodge

This inspection was carried out on 9th February 2006.

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 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 08/10/08

Chescombe Lodge 24/11/06

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 08/07/2008.

CARE HOME ADULTS 18-65 Chescombe Lodge Westbury Park Bristol BS6 7JE Lead Inspector Karen Walker Unannounced Inspection 9th February 2006 09:30 Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chescombe Lodge Address Westbury Park Bristol BS6 7JE 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) 0117 9735197 0117 9706903 The Chescombe Trust Mr Kevin Johnson Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 16 persons aged 18 - 65 years Date of last inspection 23rd May 2005 Brief Description of the Service: Chescombe Lodge is operated by Chescombe Trust and is registered to provide accommodation and personal care for up to 16 persons, aged 18-65 years, in the learning disability category. The home accommodates people with a variety of complex needs, some of whom display challenging behaviour. The aim is to provide a comfortable and homely environment in which individuals can be supported to participate in community living. The home itself 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, the Downs, and has ready access to public transport. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector spoke with the manager and four other staff members including the cook. Residents were happy to talk with and show the inspector their bedrooms. Documentation was also examined in respect of them. A tour of the building was undertaken to ensure the environmental requirements made at the last inspection had been met. Many improvements have been made. Documentation was examined relating to the policies and procedures for the home including health and safety and staff management. The Trust have recognised the difficulties of compatibility with this resident group due to their complex needs and challenging behaviour and have tasked the manager to find alternative properties or land to accommodate smaller resident groups who are more compatible. This is now underway and some land has been identified. There are currently 3 vacancies at the home and the management team confirmed no admissions would be made due to the relocation plans. This is good practice. What the service does well: Residents benefit from a motivated staff team who have the competencies needed to support a group of residents with highly complex needs who also display behaviours that challenge. The staff team are also commended for their commitment to national vocational qualification training at all levels, and their hard work and consequent achievements. Key training has been provided to staff in the management of challenging behaviour; good documentation and recording systems are in place. There is excellent information in place to aid staff in supporting residents with highly complex needs. Staff are well trained and clearly very committed to the care of the residents’. Low staff turn over means that residents benefit from a stable competent staff team. Staff are constantly seeking ways to include residents’ in key decisions about their lives for e.g. a goal plan entitled ‘life is a journey and you can choose Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 6 where you go and how you get there, reads “written after discussion about what he would like to get from life”. There is also reference to key documents relating to human rights and positive intervention. One resident was helping the fire officer with the checking of the fire system and was delighting in the task shouting ‘more more’. Care plans are person centred and concentrate on positive reputations ensuring negative judgements are not made about residents. What has improved since the last inspection? What they could do better: Residents will benefit from Essential Lifestyle Plans that are signed and dated to ensure an appropriate review takes place. Reviews are needed with regard risk assessments and the manager explained that these would soon be reviewed on a three monthly basis. One resident requires a risk assessment to support his epilepsy to ensure all staff are aware of the risks and act in a consistent manner with regards epilepsy management. All medication that has not been given must be recorded with details as to why. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 7 All cooked food must be appropriately labelled and stored. 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. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 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 Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 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): 1,2,3,4,5 Prospective residents have the necessary information needed to make a decision about where to live and are offered a trial period. They are confident that their needs will be assessed and any risks identified. All residents have costed contracts in place in respect of them. EVIDENCE: There is an up to date statement of purpose in place that sets out the aims, objectives and philosophy of the home and its services and facilities. It has all the information required to ensure residents have the information they need to make a choice about where to live. One staff member has been working on the document in an attempt to make it more ‘user friendly’. The last resident to move in did so on a staggered basis, visiting first for tea and then overnight. The contracts detail a probationary period. This enables the resident to decide if he likes the home and the team to review the placement to determine whether they can meet the assessed needs. Care plans are drawn up based on the original assessments and associated risk assessments are put in place. Where possible it was noted that some of the residents had signed their own documentation. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 10 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): 6’7’8’9’ Residents’ benefit from clear care plans and associated risk assessments that allow them to be as independent as possible. Residents are able to make their own decisions with differing degrees of input and understanding but are fully supported by the staff team. EVIDENCE: The information contained in the care planning folders seen was detailed giving a full picture of the individual’s strengths and needs. One staff member said she carried out the care plan reviews with her key-person present and always shared information with him. It was required at the last inspection that a re-assessment of need take place for one person carried out by the appropriate placement authority. It was evidenced that this had been requested in writing and followed up but as yet the authority had not carried out the assessment. The manager is ‘chasing’ this request. Currently the episodes of significant aggressive behaviours are fewer and the team continue to provide one to one support. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 11 There were ‘positive reputations’ in place alongside details of the person’s rituals and routines. Two folders contained clear detailed information on managing behaviours that are seen as challenging. There was clear guidance on the use of physical restraint reminding staff that ‘physical engagement should not be used unless there is immediate danger’. There was also guidance in place from the psychologist to support staff in the management of aggressive behaviours. Personal care needs choices and preferences were recorded alongside detailed communication information. Care folders encompass the holistic care needs of the residents. There are detailed risk assessments and these were discussed with the manager. It was agreed that a risk assessment is needed to support one person with his epilepsy; this will ensure staff are aware of the risks and are consistent in their approach to epilepsy management. One manager said the residents have regular meetings and are able to make their concerns or comments known. The minutes evidence that action has been taken to ensure that requests are met i.e. the manager confirmed that a request had been made to open the ‘hatch’ from the kitchen to the dinning room to allow residents to see the food before making a choice of meal. It was confirmed that this was working well and had progressed to residents also pouring their own drinks with support. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 12 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 Residents have the appropriate opportunities to develop and maintain friendships and close relationships. EVIDENCE: One resident confirmed that he was going to a relative for an Easter break and said “im looking forward to it and I wont eat too many eggs!” The statement of purpose highlights the support that can be provided by the home in order to ensure relatives and friends maintain contact. The manager said ‘we are able to provide transport to the relatives and provide a quite place at the home for them to visit. We can also take the resident to them and provide staff support’. It was confirmed that some friendships have been made within the home and residents have required extra support to express and understand their feelings. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 13 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): 20,21 Medication practices at the home are assessed by the management team and errors investigated. There are currently no records of residents wishes in the event of their death. EVIDENCE: It was noted that residents had their medication regimes reviewed by the consultant on a regular basis. Where needed the consultant has phoned the home on a weekly basis for feedback. One staff member was able to explain the medication system and had this as his area of responsibility. Whilst it was noted that all the correct documentation was in place staff had not signed the medication administration record to show an omission. Two carbamazepine tablets were found by the staff member and no explanation as to where they had come from. All medication that has not been given must be recorded with details as to why. Whilst carrying out a ‘as and when’ (PRN) medication stock check it was noted that there were two diazepam tablets short. This was feedback to the manager who said she was aware of this and was investigating the cause. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 14 The manager said that as the home move towards the implementation of essential lifestyle plans the ‘wishes of the residents in the event of their deaths’ will be recorded. The manager and the care manager are planning to review all care plans and documentation at least 3 monthly in addition to the key-worker monthly reviews that already take place. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 15 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 Steps are being taken to protect residents from harm and abuse. An agreement has been made to purchase land to ensure residents live in a smaller more group compatible setting. EVIDENCE: At the last inspection there was a significant level of recorded incidents of behaviours that challenge, it was therefore agreed that an internal form could be used to record incidents which would filter out the inappropriate reports being sent to the CSCI. This has worked well and the inspector is kept well informed. It is noted that the amount of incidents and residents involved vary from month to month and records show steps are taken to address any issues relating to challenging behaviour incidents. At the last inspection it was noted that the registered manager has addressed the identified training need concerning the management of challenging behaviour. Positive feedback about the training was received. The manager confirmed that all staff with the exception of one night staff member has completed positive intervention training. Although she has significant experience she will be booked onto the next course. It was noted that there are positive statements in place regarding behaviours that challenge and one statement reads,” ensure there is a distinction between behaviour and the person i.e. the behaviour is unacceptable but the named individual is accepted as a person”. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 16 The registered manager is involved with and attends regular protection meetings with the local Social Services lead officer. This professional contact will enable him to share his valuable experience and gain from the joint agencies involved for the benefit of the home. At the last inspection it was noted that Staff members spoken with were aware of the ‘abuse’ policy and of the ‘whistle blowing’ policy. Both were viewed on this occasion. Staff members were clear of their accountability and responsibility and said they would always advocate on behalf of residents and make their concerns known. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 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): 24-30 Although residents live in a home that is not ideally suited to its stated purpose individual bedrooms suit their lifestyles and meets their needs. Plans are underway to meet residents’ needs in smaller homelier accommodation. EVIDENCE: Chescombe Lodge is set back from the main road and blends in well with the local community. It has large grounds, which are used by residents. There are some areas requiring attention, e.g. the fishpond. The premises are a listed building, which is not entirely suited for its stated purpose. It requires high maintenance and is subject to significant wear and tear instigated by residents’, some of whose challenging behaviour results in damage to décor. Chescombe Trust has been looking for alternative premises for some time and there is recognition that the building is not entirely appropriate for its use. It is hoped that a suitable piece of land will soon be secured. The manager said all residents’, relatives, care managers and appropriate others would be consulted and individual needs assessed. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 18 The inspector toured some of the environment and noted that two bedrooms seen were individualised and suitably decorated. There are plans to move one bedroom to the ground floor to support a residents mobility needs. work has been done to the room to ensure it meets with environmental requirements i.e. a washbasin has been installed and radiators have been covered. There are ample bathrooms and toilets available to residents and the necessary equipment is in place as recommended by the physiotherapist or occupational therapist. The dinning area has been redecorated and has new washable flooring. All of the requirements made with regards to the environment have been met. The kitchen area was examined and found to be clean and tidy. The cook explained there is now a system in place to ensure the area is deep cleaned with the two cooks and the night staff having areas of responsibility. She feels this works well. It was noted that there are still some cooked foods being stored in the freezer without labels, this was discussed and must be addressed. The home was observed to be clean and tidy on the day of inspection and one of the residents was pleased to be helping with the vacuuming. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 19 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): X EVIDENCE: These standards were fully assessed and met at the last inspection and have not been reassessed. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 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): 37-43 A sound management team supports the residents and staff. EVIDENCE: The management team work together to ensure the smooth running of the home. Staff are aware of the lines of accountability within the home and each support worker has a co-ordinator assigned to them. Staff spoken with at the last inspection said they felt supported through supervision. It was positive that members of the management team now work on the ‘floor’ to allow staff to have a proper handover. The assistant and the acting manager both confirmed they had a national vocational qualification 4 in management. The acting manager also has her Registered Managers Award (RMA). This is excellent and ensures a well-developed management team who can support each other as well as the rest of the staff team. Records were examined in respect of residents’ and these were found to be generally clear and well written. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 21 It was recommended that resident and relative questionnaires be sent out routinely to ensure service satisfaction. This can be broadened to staff to gain their views and ideas on the service. Chescombe Trust was first set up in 1991 by parents concerned at the lack of facilities available for younger adults with a learning disability. The Trustees continue to carry out monitoring visits (regulation 26 visits) on a monthly basis as per legislation. The induction policy was examined and induction records evidence ‘skills for care’ induction is used appropriately. It was explained that a consultancy agency is used to support the home with policies and procedures and with generalised risk assessments. COSHH risk assessments were seen to be in place. Policies and procedures were varied and included: The GSCC code of conduct Management of aggression Confidentiality Whistle blowing Medication Concerns and complaints Protection from abuse Health and safety Social activities The fire system was being checked on the day of inspection much to the delight of one particular resident that was supporting the fire officer with his tests. The fire logbook was in order and it was noted that all staff now receive the training as directed by the Fire Service. It was noted that all staff would now receive 3 monthly fire drills. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 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 Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 2 3 3 3 3 3 3 3 Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 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. 1 Standard YA9 Regulation 13(4)(b)(c) Requirement Timescale for action 01/03/06 2 YA20 Schedule 3(I) 3 YA30 13(4)(c) Put in place an epilepsy risk assessment to ensure staff consistency with epilepsy management and an awareness of the risks involved in accessing the community, using public transport or other vehicles etc. All medication that has 01/03/06 not been given must be recorded with details as to why. Ensure all cooked food is 01/03/03 appropriately labelled and stored. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA21 YA43 Good Practice Recommendations Ensure that the residents’ wishes in the event of their death are recorded and views sought if necessary from family members. Resident and relative questionnaires to be sent out routinely to ensure service satisfaction. This can be broadened to staff to gain their views and ideas on the service. Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Chescombe Lodge DS0000026531.V280049.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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