Inspection on 19/06/08 for Colleton Lodge

This inspection was carried out on 19th June 2008.

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

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Colleton Lodge 12/06/09

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Colleton Lodge Colleton Crescent Exeter Devon EX2 4DG Lead Inspector Dee McEvoy Unannounced Inspection 19 & 25th June 2008 09:00 th Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 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 Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 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. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Colleton Lodge Address Colleton Crescent Exeter Devon EX2 4DG 01392 275456 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) Guinness Care and Support Ltd Vacant Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Mental disorder (Code MD) The maximum number of service users who can be accommodated is 10. 8th June 2007 Date of last inspection Brief Description of the Service: In October 2007 Devon Community Housing Society and Guinness Care and Support amalgamated with Guinness Care and Support being registered as the providers of this service in December 2007. The Home provides accommodation and support for up to 10 adults who have mental health problems. Colleton Lodge is an attractive, large detached building standing in its own grounds near the centre of Exeter. It has large gardens and its own small car park. The home has an airy entrance hall, with two lounges and a dining room. There are three single bedrooms on the ground floor, and the home’s main kitchen. The first floor includes seven single bedrooms with some WCs and two bathrooms. There is a WC and bath on a mezzanine landing between the ground and first floors. There is a semi-basement with an office, food stores, the home’s laundry and a smoking lounge. Among the stated aims of the home are to provide a safe, supportive and structured environment where individual needs of the service user will be met and optimum independence will be encouraged and supported. All places at this home are purchased under a block contract with Devon County Council at a set fee of £5476.28 per place per week. Copies of the home’s inspection reports are available in the entrance hall. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. As part of this key inspection the manager sent us an Annual Quality Assurance Assessment (AQAA), which was not fully completed. The AQAA contained general information about the home and the people living and working there. Prior to this site visit surveys were sent to people living at the home asking for comments and feedback, but none were returned to us. We also sent 5 surveys to staff and all were returned completed. We (The Commission) spent just over 12 hours at the service, over a period of two days. To help us understand the experiences of people at this home, we looked closely at the care planned and delivered to three people. Where possible we spoke with these people in depth. We also spoke with staff about their knowledge and understanding of people’s needs. Most people living at the home were seen or spoken with during the course of our visit and four people were spoken with in depth to hear about their experience of living at the home. Time was also spent observing the care and attention given to people by staff. We also met and spoke with two visiting health care professionals about the care provided here. Comments and views have been included in this report and helped us to make a judgement about the service provided. A tour of the building was made and a sample of records was looked at, including medication records, care plans, staff files and some safety records. What the service does well: A core of long serving care staff know the people living here well and work extremely hard to meet the aims of the home (See what they could do better). The service has good links with the local Recovery and Independent Living Team, who support some people to learn new skills and develop their abilities to become more independent. The home works with other health professionals to ensure people have access to good health care services. Two professionals felt the home coped well with some people with complex mental health issues. There was a relaxed atmosphere at the home, one person told us, “The atmosphere is good…friendly”. People said that they could generally choose how they wish to spend their day and that the daily routine at the home was flexible. People are supported to maintain relationships with family and friends. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 6 People are protected from abuse by staff who fully understand the procedures they must follow if they have any concerns. Good recruitment procedures are in place, which ensure new staff are suitable to work with people living at the home. What has improved since the last inspection? What they could do better: Care plans need to be updated to reflect the needs and goals of each person living at the home. People need to be more involved in the planning of their care and support to ensure their needs are understood and met. People living at the home should receive care in a person centred way from staff who are appropriately trained in rehabilitation and recovery techniques. There should be a more structured approach to the care provided to enable and promote independence for people. The home has been asked to enable people living in the home to engage in a wider range of social, educational and occupational activities. Aspects of the management of medication need to be addressed to ensure that safe practice is maintained. The home was not clean or well maintained in parts. Basic requirements for hygiene, such as soap and paper towels, were not freely available. The home needs to be thoroughly cleaned, redecorated and refurbished to ensure people have a comfortable and safe home to live. The number of staff on duty and the skills and experience of the staff do not always meet people’s needs. The organisation must take steps to recruit and retain a permanent team of staff to ensure that people living in the home receive good continuity of care as is reasonable to meet their needs. One health professional told us they would like to see more permanent and additional staff on duty in order to “…improve consistency”. The current management arrangements are adequate in the short term, but to ensure people benefit from a well run home, additional management support is recommended, and better communication between senior managers within the organisation and the people living and working at the home. The home needs to fully implement the systems for monitoring and improving the quality of the service to ensure it is meeting the aims of the Statement of Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 7 Purpose. A suitably trained person should confirm the safety of gas and electrical systems. 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. The summary of this inspection report can be made available in other formats on request. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 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 Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admissions procedure includes opportunities for people to visit to get to know to the home; this helps to ensure that people’s care needs can be met before a decision is made to move in. EVIDENCE: People living at the home told us that they had not been given any information about the home or seen the Statement of Purpose before moving in. However, people told us they had been given the choice to move to Colleton. Records showed that people are invited to visit and have overnight stays before deciding to move in. The AQAA shows that if a referral is appropriate then an integration programme is established to help people settle at the home. One person has been admitted to the home since the last inspection. Copies of the pre admission assessment information for this person could not be found by care staff or the care services manager. Following the inspection the care services manager told us this information had been sent to other professionals assisting the person to access independent living accommodation. Discussion with the care services manager and a visiting mental health professional confirmed that the mental health team undertake thorough assessments and this information is shared with the home to ensure that people are appropriately placed at Colleton Lodge. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 10 One visiting professional told us that the home had supported people with “very complex needs”. Previous CSCI reports show that detailed assessments are developed before people are admitted to the home to help ensure that people’s needs are recognised and can be met by the home. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from living in a home where their daily choices and decisions are respected. Risks to their well-being and safety are assessed but care plans are not sufficiently detailed to ensure that their identified needs or areas of risk are fully met by all staff. Not all personal information is kept appropriately. EVIDENCE: We looked at three people’s care files to help us judge how care is planned and delivered. Care files contain a lot of detailed and useful information about people’s support needs, which has been provided by heath and social care professionals. Excellent summaries of people’s care needs and individual risks, including triggers and early warning signs of deterioration, have been provided by a psychiatrist. The local Recovery and Independent Living Team also help people to plan individual goals and provide a great deal of support to people living here. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 12 The home’s care plan format includes individual goals and action for staff to take to assist people to meet their goals, although actions were not specific and there were no timescales for achieving goals. For example, the aim for one person was to use social facilities and build social networks. The action for staff was to “encourage to use community facilities”. There was no detail about which facilities the person may want to access or the support needed to achieve this. This person told us that permanent staff at the home were “brilliant, caring and friendly” and that they were well supported by them. However this person said bank and agency staff “didn’t have a clue” about their support needs. The care plan described how this person could become aggressive when provoked or when they had been drinking alcohol. One of the actions staff were instructed to take was to call the manager, but he no longer works at the home. This should be reviewed. Another person’s care review highlights that they are becoming “more abusive” but this has not been reflected in the care plan or risk assessment, and there were no details for staff to manage such behaviour. Daily notes show that this person sometimes does not return to the home at night. We also saw that they leave the building on occasion at night via a fire exit. One staff member told us this posed a security and fire risk. There are no instructions for staff to follow should this happen. A permanent member of staff told us that if this does happen, because this person is vulnerable, the mental health team and police are contacted. This is not written down to ensure that agreed procedures are followed by all staff working at the home, such as agency or bank staff. One person living at the home has a medical condition, which requires monitoring and a special diet. There is nothing in the care plan to guide staff about this. We found that permanent staff were well informed about people’s individual history, characteristics and needs. However, the duty rota shows that agency or bank staff may be working at the home with no support from permanent staff. One agency carer and one bank carer on duty during our visit told us they hadn’t seen the care plans at the home but they were given a verbal handover. Another wrote, “I work through Bank and it seems I’m not on the ‘need to know plan’”. Care records need to be as informative as possible to ensure that all staff working at the home can deliver a consistent service to the people living here. One visiting health professional felt that care plans at the home were not fully reflective of individual aims/goals and said that due to staff shortages the key worker system at the home was “…not working well at present” (refer to standard 33). Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 13 Three people living at the home told us they had not seen their care plan and were not aware of the content. A visiting professional told us that monthly meetings are held with people living at the home to review their care and talk about issues but no record was kept of these ‘reviews’. People living in the home told us that they are encouraged to make decisions on a day-to-day basis about their lives. One person told us, “I can go out when I like. I have lots of freedom here”, another person said, “I can choose how to spend my time”. During our visit we saw that people were free to come and go and there were no unreasonable restrictions in place. People are provided with a house and room key and have freedom of access throughout the day. One person was aiming to move on to more independent living and had been fully involved in the plans for their discharge from the home. However, two other people were unsure about their plans for the future and told us they had not been consulted about their long-term goals or plans. One person told us, “I would like to think I could move on from here into my own place but no-one has discussed this with me”. A staff member told us (via survey), “Service user are not able to be given the encouragement to help them move on”. People are encouraged and supported to manage their own finances; all but one person at the home handles their own money. We looked at how the home supports this person and the arrangement in place for ensuring money is secure. A good record is kept of each transaction and receipts were available to show how this person’s money was used. The money and records are kept securely. Some risks to people’s safety, such as smoking, have been considered and there are guidelines for staff to follow to reduce risks without infringing on people’s independence. However, not all risks are considered, for example, what to do about unexplained absences. Individual daily records are maintained but some personal information is also recorded in a diary/‘communications book’. This practice does not take into account the Data Protection Act. Anyone wishing to see their records would also have access to personal information held about other individuals. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While some people receive support to develop personal skills and achieve their personal goals, there is not enough support from within the home to ensure that all have the opportunity to do this. Daily routines are flexible and the meals provided are varied and on the whole, satisfactory. EVIDENCE: The local Recovery and Independent Living Team visit several people at the home weekly to enable them to access the community, to develop their independent living skills and generally build people’s confidence. A visiting health professional told us that people could be better supported and enabled by the home to develop social and independent living skills. Another professional felt that due to “staff shortages” and a lack of an effective key worker system people were not given the opportunity to learn and use practical life skills. One professional commented, “The high use of agency staff Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 15 means that people are just monitored and maintained. There is no real progress with individual goals”. Some people are motivated and independently access the local community and activities. One person enjoys working in a voluntary role at a local garden centre and uses local facilities like the swimming pool on a regular basis. People use the local pubs and shops frequently too. Another person told us they like to visit town regularly and enjoy visits to the Quay. We were told that several people visit local day centres/support groups. They can choose to drop in when they feel the need. One staff member told us, “Some people are more motivated than others. Some people need more encouragement and one to one support to achieve things. We just don’t have the time to do this at the moment”. We spoke with people about activities within the home, one said “None here that I know of”, and another person told us the only activity they were aware of was a game of scrabble with staff. Another person told us they were “bored” and that there was nothing much to do at the home. One person told us they would be very interested in having a patch of garden to cultivate and grow vegetables but this hasn’t happened. The garden is very overgrown in areas and needs attention. There appears to be limited opportunities for people to be involved in vocational training and employment schemes. When asked what the service could improve, several staff told us (via surveys) that they would like to provide more activities and one to one time for people. Staff comments included, “More one to one activities between staff and residents and more outings etc. Therefore more money!” - “More money Re activities. Day trips/meals on a one to one basis with designated service user” - “To enable more people to get out in the evening we need more staff to do this” and “Frustration at lack of staff to enable social outings, such as a visit to the Quay for instance, which is just a stones throw away!!” The AQAA shows that people are encouraged to maintain family contact, two people visit their family on a weekly basis, and two other people have regular visitors at Colleton Lodge. One person has weekly supported visits from their child. One person told us how important it was to be in contact with family and we saw this person enjoying time with a special visitor. People told us the daily routine at the home was flexible. People told us they could get up and go to bed when they wanted to. Although meal times are set and people usually eat together in the dining room, people told us they could choose to have their meal at another time. Two people told us they liked the food and two said they didn’t always like the food. Their comments included, “I enjoy the food”, “The food is OK. I mostly like it”, “Some food is alright. Some is not nice” and “The food could have Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 16 more flavour”. One person told us one staff member “…does a really good roast on Sunday!” Everyone spoken with said they could ask for something different if they didn’t want the main meal. Some people have an opportunity to shop and cook meals with support from the local Recovery and Independent Living Team. One staff member told us that shop and cook days for people had “…gone by the way…” recently due to staffing levels. Meals are served at set times and there is a four week menu, which staff told us is developed with people’s likes and dislikes in mind. A list of people’s preferences is kept in the kitchen and permanent staff know people’s likes and dislikes well. On one day of our visit staff prepared a fresh salad and most people appeared to enjoy this. During the day people were helping themselves to drinks and snacks. One person told us that snacks were not available after 21.00, we were told, “Staff say “too late now”” Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living here can feel confident that they will get the help they need to maintain their personal care and their healthcare needs will be met. Medication practices are generally safe, but some practices and storage arrangements do not fully protect peoples’ health and welfare. EVIDENCE: People living here manage their own personal care with support and prompting from staff when needed. Care plans identify what kind of prompting and monitoring people need. We saw that people choose their own clothes, hairstyles and make up, and their appearance reflects their personality. This helps to maintain people’s dignity and independence, and encourages them to express themselves. Care files looked at show that people have access to various health professionals, such as GP, well woman clinics, specialist nurses and the community mental health team, including psychiatrists. The home has established close links with the local Recovery and Independent Living Team who visit daily to support various individuals. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 18 Mental health professionals have provided the home with a record of “early warning signs” which could indicate that people’s mental health may be deteriorating. Two permanent staff were knowledgeable about what to look for and how to monitor and report these changes to outside professionals. A psychiatrist recognised the support given to one person and said the person was “…doing well at Colleton”. We looked at the way the home manages medication. Medicine is stored in a secure cabinet. The home did not have any controlled medication on the day of the inspection but facilities for storing these medicines correctly are not available and will need to be provided if prescribed at any time. We looked at the Medication Administration Records (MAR) for three people. Two people were prescribed medication with variable doses to be given “when needed”. There were no instructions on the MAR or in care plans to guide staff when to give this medication and there was no accurate record of the actual dose given. We saw two gaps on one MAR, which had not been signed by staff, and no codes had been used to indicate why the medication had not been given as prescribed. Two permanent members of staff told us they had received training about how to manage medicines safely, although training records sent by the provider to us could not confirm this. The care services manager told us that bank and agency staff used at the home would have the necessary training to ensure the safe running of the home. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most people are confident that they can raise their concerns and staff will listen to them. Staff knowledge and understand of the principles of adult protection helps to protect people from abuse. EVIDENCE: Three people said they knew who to raise any concerns or complaints with; people generally identified a permanent member of staff and felt that they would listen to them. One person told us they had raised concerns in the past with the manager and things had improved. Another person told us they did not know who to speak with if they were unhappy or had a concern and said, “I would just run away”. The home has a complaints procedure, a copy of which is on the notice board for people to refer to. The home has not received any complaints since the last inspection, and no complaints have been raised with the Commission about this service. Two permanent staff told us they had received adult protection training to help them recognise abusive or poor practice. Both were clear about their responsibility to challenge and report any concerns to either the management of the home or outside agencies. One member of staff said they would like refresher training to ensure their practice and knowledge was up to date. Training records showed both members of staff had received training in 2006. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 20 The AQAA tells us that all staff are aware of the alerter’s guide, and have seen the no secrets video, and completed the protection of vulnerable adults course. People living at the home told us permanent staff were “brilliant, friendly, and caring”. People were less happy about the attitude of some bank and agency staff. One person told us, “One carer who works here sometimes is snappy and grumpy”, another person said, “Some staff are not unkind but their tongues can be harsh. They are not physically rough”. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are provided with a secure and accessible place to live but parts of the building are not very homely or clean. Better infection control precautions are needed to ensure basic hygiene standards can be maintained. EVIDENCE: Since the last inspection progress had been made for completing some of the agreed and much needed environmental work at the home. As agreed with the Commission the entrance hall of the home has been re-carpeted, although it was noted that the carpet was stained and heavily soiled in places. The stair carpet has also been replaced but is stained and dirty. One person living at the home told us, “The carpets are filthy, really atrocious…” The basement area is still in need of re-decoration, as is the smoking room, which is a very unpleasant room. Chairs in this room are stained and dirty. Paintwork is chipped along hallways and walls are dirty. One staff member said, (via survey) “The place is in dire need of redecorating”. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 22 The care services manager told us that the home was waiting for a quote to have the smoking room re-decorated and that new chairs were being stored ready to put into the smoking room once finished. No planned maintenance and renewal programme for the fabric and decoration of the home was available during our visit. We asked that this be sent to the Commission. To date we have not received this. We saw some ‘repairs requests’ to fire doors, which were not closing properly and a request to fix a loose cistern. Staff told us these jobs had been seen to. A request to fix the grill and clear the gutter had not been addressed. Everyone has their own bedroom and two people told us they particularly liked their rooms. We were invited to visit one and could see that the space had been personalised. Bathroom and toilet facilities are adequate but not very pleasant. The ground floor bathroom had dirty tiles and two dirty and mouldy bath mats. The ground floor toilet was clean but had a very unpleasant smell. Two toilets on the first floor were dirty and smelly. The communal dining room and lounge are bright and pleasant. There is a ‘quite room’, which is storing the chairs for the smoking room and appears to be un-used. There is a computer for people to use in this room but staff said it was not used and they were not sure who could use a computer. There is a mature but overgrown garden around the house. One person would like to be able to use the garden to grow vegetables but said the garden needs to be cleared first. We spoke to the care services manager about this. She said she would contact a local garden centre to assist. She would like to motivate people living at the home to get a “garden working party” together to maintain and develop the garden. One person complained about the garden chairs saying they were “very dirty”, which they were. This person was also unhappy about the state of the ‘back yard’, which was littered with debris and cigarette butts. The home was not clean, hygienic or free from offensive odours. No domestic staff are employed at the home, people living here and the care staff are responsible for the cleaning. Staff told us it is difficult to motivate people sometimes and difficult to find the time to clean with current staff shortages. We found faeces on one of the chairs in the lounge. Once brought to staff’s attention it was removed to be cleaned. Floors and surfaces were dirty, with the exception of the dining room and kitchen. The laundry room had been replastered but not finished so the walls were not impermeable or easy to clean. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 23 Four of the bathrooms/toilets we visited did not have any hand washing soap/liquid or towels to dry hands. This puts people at risk of infection and does not promote basic hygiene. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current level of staffing restricts the ability of this service to deliver person centred support. The high level of agency staff means that care is not delivered in a consistent way. A lack of specialist training means that staff may not have the skills needed to support people to achieve their potential. People are protected by the robust recruitment practice followed at the home. EVIDENCE: The AQAA highlights staffing issues as a barrier to improvement, stating, “we are currently finding it difficult to employ new staff”. There are currently three permanent full time staff working at the home and three permanent part time staff. On the first morning of this inspection two temporary staff (one agency and one bank) were on duty. Although both were fairly experienced in working within the mental health field, one had spent “5 or 6” shifts working at the home and the other (a bank member of staff) had spent one previous shift at the home. This is far from ideal. A psychiatrist mentioned in one person’s review that staff changes were making him/her “anxious”. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 25 We were also told that the home is trying to reduce the impact of poor recruitment and retention by using regular bank and agency staff who are known to the residents. Two visiting health professionals told us about their concerns regarding staffing levels and the use of agency staff, one said, “Staffing levels are a big issues. They have decreased the number of staff on duty”. This professional told us that staff did not appear to have the time to escort people out, or support people with daily living skills. People living at the home, outside professionals and staff were not confident that agency staff were sufficiently familiar with people’s needs. One professional told us, “The last agency staff I spoke to didn’t know the service users” and “The knock-on effect on staff and service users is that morale is low”. One person told us they didn’t know any of the agency staff and said they would prefer to talk to familiar staff about any problems or anxieties. Another person said they would like “…more kind and understanding staff”. One staff member commented, “Another consequence of low permanent staff members and hence considerable reliance on bank staff and agency worker is the lack of consistency and continuity – which is tricky for the staff & potentially disruptive for residents”. On the whole people spoke highly of the permanent staff, one said that night staff were particularly kind. Most staff contacted (via survey) by us told us there were “sometimes” enough staff on duty to meet individual needs, one said there was never enough staff on duty. Their comments included, “There are sufficient staff for maintenance, but really require higher staffing levels to enable more in-house activities, or indeed outings, to take place”, “Without a manager care staff are taking on more managerial responsibilities. We have to shop and clean too. We have little time to spend with people”. Staff told us that it was very difficult for them to give people one to one attention, “…especially if one carer is out of the building with a service user. You can here alone with 7 or 8 people”. One person said staff didn’t have time to sit and just chat. Staffing levels have reduced since the last inspection because of the vacant manager’s post. The AQAA showed that a third of permanent staff had left since the last inspection. The care services manager told us that adverts for care staff had been put into the local paper and job centre and the home had vacancies of up to 160 hours a week. At the last inspection the homes recruitment procedures were inspected and found to be satisfactory. No new staff have been recruited since the last inspection. Three of the four staff responding via surveys told us they did not receive the relevant training to meet people’s needs. One wrote, “Need more mental Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 26 health training not learning disability or elderly”, another one wrote, “I think specific training on non-confrontational responses to aggressive behaviour (verbal & in action) should be included either in induction or as short course”. Two people living at the home told us they were frightened and upset by the aggressive outbursts, which happen from time to time within the home. People were not confident that all staff had the ability to diffuse difficult situations, one person told us, “Staff don’t do anything about it”. Other staff told us they would welcome training to improve their practice and knowledge. One staff member said they had requested specialist mental health training but added, “We have little opportunity for specialist training or development”. Staff training records were not available during our visits to the home. Following this inspection staff training were sent to the Commission. These show that staff generally receive mandatory training such as moving and handling, adult protection and fire safety. Training records did not indicate that any specialist mental health training had been delivered to staff and none was planned according to records. The AQAA shows that just over 50 of permanent staff have or are working towards a nationally recognised care qualification in care (NVQ2). Staff told us (some via surveys) that they do not receive regular supervision and support from a manager. Staff morale appears to be low and they are feeling un-supported according to the surveys returned to CSCI. We received several comments about the lack of support from “head office”. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management arrangements at the home in the absence of a registered manager are adequate in the short term. Systems to ensure the quality and safety of the service are not entirely robust. EVIDENCE: The registered manager left the home in May. A care services manager from Guinness Care & Support is currently supporting the home and aims to visit the home daily, although this is not always possible. We were told that a new manager had been recruited and would be taking up her post in August 2008. “There’s still too much difference between the working staff and managers” The AQAA tells us that on a monthly basis an advocate from the service user group holds a resident meeting excluding staff. We were told that people have Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 28 an opportunity to discuss issues in confidence but that where appropriate issues are discussed with the manager and actioned if necessary. No record of the meetings could be found at the home to demonstrate that people’s views and ideas had been listened to and acted upon. Three people told us they had not been asked about their views of the home, but the care services manager said that people living at the home and outside professionals had been sent questionnaires about the quality of the service. To date no responses had been received. As part of reviewing the quality of the service provided, a care services manager from Guinness Care and Support visits the home unannounced every month. They talk to people living at the home and staff about the quality of the service and provide a report on this visit to the manager and senior Guinness Care and Support managers. The AQAA did not provide information about maintenance and servicing of electrical circuits or gas appliances. We asked that certificates confirming systems had been professionally checked since the last inspection be sent to the Commission (This was an outstanding issue from the last inspection). To date we have not received confirmation that these safety checks have been undertaken. We saw evidence that portable electrical appliances had been safety checked (PAT) within the past year. The fire logbook was looked at and showed that regular weekly checks of the fire alarm are not currently being completed. The last entry for a fire drill and fire safety training for staff was 20 February 2008, but there was no record who actually attended the drill or training. Two staff said they had received fire safety training earlier this year. Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 29 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 1 2 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 2 LIFESTYLES Standard No Score 11 2 12 2 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 X Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES 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 YA20 Regulation 13 (2) Requirement You must review the arrangements for storing controlled drugs (including Temazepam), to ensure that, if such medicines are received into the home any time in the future secure storage facilities comply with current legislation. To make sure the home is a comfortable, safe and homely place for people to live, you must ensure that the home is kept in a good state of repair externally and internally. The designated smoking room must be re-decorated. You must make suitable arrangements to prevent infection and the spread of infection at the home. You must ensure that the home is clean and free from offensive odours. You must ensure that people have access to hand washing and drying materials (soap and paper towels) in order to promote basic standards of hygiene. You must ensure that sufficient DS0000071071.V364142.R01.S.doc Timescale for action 31/12/08 2. YA24 23 (2) (b) 31/12/08 3. YA30 13 (3) 31/08/08 4. YA33 18 (1) (a) 30/09/08 Page 31 Colleton Lodge Version 5.2 (b) staff are on duty to meet individual needs and encourage people to achieve their optimal potential. You must ensure that the use of temporary staff (bank/agency) does not prevent people from receiving a good continuity of care as is reasonable to meet their needs. 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. Refer to Standard YA6 Good Practice Recommendations To ensure that people get the support they need, you should ensure care plans reflect the needs of people and show how they are to be met, including their physical health needs and how people are to develop independent living skills. You should ensure that risk management strategies are in place and that all staff are aware of the action to take to reduce risks, for example, in the case of unexplained absences. You should ensure that an alternative method of maintaining records should be found so that all personal information can be kept confidential. You should ensure that people have opportunities to maintain and develop social, emotional and independent living skills. You should make arrangements to enable people living in the home to engage in a wider range of social, educational and occupational activities. A range of drinks and snacks should be available to people at all times. In order to ensure that the management of medication is safe and people are protected, the actual doses administered for medicines prescribed with a variable dose should be recorded. This will make it possible to audit that these medicines are being used as prescribed. Staff should have clear instructions about when to Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 32 2. YA9 3. 4. 5. 6. 7. YA10 YA11 YA12 YA17 YA20 administer “when needed” medication, such as sedatives. 8. YA23 People living at the home should receive the help and support they need from staff who have the appropriate attitudes towards them. Staff practice should be observed by suitably trained staff to ensure that all staff maintain a professional but friendly approach to people. This should be addressed in supervision. People should live in a comfortable, clean and homely environment. The garden should be tidied and cleaned so that people living there can enjoy a pleasant outside space, which would enable them to develop new interests and skills. You should send a copy of the planned maintenance and renewal programme for the fabric and decoration of the premises to CSCI, so that progress can be monitored. The laundry room walls should be water-resistant and easy to clean to ensure that the home is clean and hygienic. Staff should be provided with the training they need to ensure they have the skills and experience necessary for the tasks they are expected to do, including techniques for rehabilitation and recovery, to support people who want to re-establish more independent living. (Repeated from previous inspection) You should ensure that staff receive the training they need to help them meet the specialist mental health needs of the people living at Colleton Lodge. (Repeated from previous inspection) In order to ensure that staff have the necessary support to do their job well, and that their performance is monitored, they should receive regular supervision. To ensure people benefit from a well run home, additional management support is recommended, and better communication between senior managers within the organisation and the people living and working at the home. You should also apply for registration of the new manager to demonstrate that they have the required qualifications, experience and competency to run the home. An effective quality assurance and quality monitoring system, based on seeking the views of people using this service, should be implemented to measure success in achieving the aims, objectives and statement of purpose of the home. There should be an annual development plan for the home, based on a systematic cycle of planning action and review, reflecting aims and outcomes for service users. The registered manager should be able to demonstrate DS0000071071.V364142.R01.S.doc Version 5.2 Page 33 9. YA24 10. 11. YA30 YA32 12. YA35 13. 14. YA36 YA37 15. YA39 Colleton Lodge 16. YA42 year on year development for each service user, linked to the implementation of their individual plan. Action should be progressed within agreed timescales to implement requirements identified in CSCI inspection reports. (Progress has been made toward meeting this recommendation though not fully implemented) Evidence that equipment within the home has been properly maintained and safety checked should be available for inspection. • Gas safety certificate should be obtained and renewed annually • All portable electrical appliances should be tested annually (Repeated from previous inspection) Colleton Lodge DS0000071071.V364142.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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