Inspection on 20/10/05 for Colwill Lodge

This inspection was carried out on 20th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Colwill Lodge 12/06/07

Colwill Lodge 05/05/05

Colwill Lodge 05/10/04

Colwill Lodge 22/04/04

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 Colwill Lodge Leypark Walk Plymouth Devon PL6 8UE Lead Inspector Tina Maddison Unannounced 20th October 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Colwill Lodge Address Leypark Walk, Plymouth, Devon, PL6 8UE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01752 768646 01752 776255 Plymouth City Council Andrew Rowing-Parker Care home 12 Category(ies) of Learning Disability (12) registration, with number of places Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1) Service Users Age 18 - 65. 2 Service Users with Learning Disabilities who may also have physical disabilities or sensory impairment. Date of last inspection 05/05/05 Brief Description of the Service: Colwill Lodge is a respite care home that provides short term personal care and accommodation for up to 12 people who have a learning disability and who may also have a sensory impairment or physical disability. It is owned by Plymouth City Council and provides a respite service for approximately 50 to 60 people overall. The home is located at the end of a cul de sac in the residential area of Estover in Plymouth. This is close to pubs, shops and other local amenities. The home was opened in 1997 and is a detatched bungalow. The home has eight single bedrooms and two shared rooms, none of which have en suite facilities. There are, however, bathing and toilet facilities close to bedrooms and communal areas. There are two lounge areas, one of which is designated as a quiet room, a dining room that is also used for various activities, and a sensory room. There is a call bell system throughout the home. There are attractive, spacious gardens that are accessible to service users. Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced at 1415, and the report should be read alongside the previous inspection report of the 5th May 2005. A tour of the home was undertaken, and discussions took place with the Registered Manager, staff and service users. Records and documents were seen for a variety of topics. What the service does well: What has improved since the last inspection? What they could do better: Service users money is still being kept in a pooled suspense account. Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 6 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. Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,5 Prospective service users are able to use an appropriate comprehensive service users guide and statement of purpose to help them be sure that Colwill Lodge will be able to meet their care needs when they require respite care. EVIDENCE: The home continues to offer a detailed statement of purpose and service users guide to prospective service users. These documents are being reviewed to make them more focused on person centred planning and there are plans to produce them in a video form. Service users visit the home prior to their first respite stay. Colwill Lodge, as a provider of respite does not accept emergency admissions, and these procedures are documented in detail. Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9. Service users can be assured that staff will enable them to be as independent as possible and they will be encouraged to safely participate in all aspects of life in the home. EVIDENCE: Service users plans that were seen were holistic and comprehensive, and staff interviewed during the inspection knew where to find them and felt that the information contained was useful and helpful to enable them to carry out personal care tasks. One service user interviewed commented that he did a variety of activities when staying in the home, and could “do what he liked”. Risk assessments are on files and contain an appropriate balance of risks and personal independence. Although many of the service users have limited communication, it was observed during the inspection that staff communicated with them sensitively and appropriately using verbal gestures and knowledge of individual ways of communicating needs. Service users personal money is still currently kept in a suspense account that is not interest bearing. A discussion with the Registered Manager evidenced that plans are in place to keep the money on an individual basis, bearing in mind the small sums of money concerned. The Inspector is concerned that one service user has been living at Colwill Lodge for eighteen months, and there are still no firm plans in Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 10 place for a permanent placement. As Colwill Lodge is a temporary respite care centre this issue should be addressed by Social Services. Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14,17 Service users can enjoy a range of activities that are available to all. Personal development is encouraged and meals provided at Colwill Lodge are nutritious and varied. EVIDENCE: As much as possible within a respite setting, personal development is encouraged and documented in service users files. Service users spoken to confirmed that a range of activities are available to them, and they enjoyed taking part in activities such as trips to the cinema and bowling. The home has a photo album of all the activities that were enjoyed by service users during the summer. A mealtime was observed during the inspection, and service users commented that they liked the food and there was always plenty. The mealtime was observed to be a unhurried relaxed occasion, with good quality food and special diets catered for. Staff assisted service users to eat in a dignified and helpful manner. Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 Service users can be assured that staff will treat them with respect and their personal care needs will be given in the way that they prefer, and their health care needs will be met. EVIDENCE: Service users files contained details of moving and handling preferences, and these preferences were observed to be carried out during the inspection. Medication was observed to be checked in and out during each respite stay. No medication is retained in the home when a service user is not in residence. The Registered Manager continues to work towards a new medication policy and procedure. Staff that dispense medication have received appropriate training. Medication records are up to date and correctly recorded. Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Service users can be confident that their concerns will be listened to, taken seriously and acted upon. The homes vulnerable adult procedure is robust which will ensure the protection of service users. EVIDENCE: The Commission for Social Care Inspection has not received any complaints since the last inspection. The home had received one complaint that had been resolved. It is advised that the outcome of any complaints made to the home are recorded. There is a complaints procedure prominently displayed, and service users confirmed that they knew how to complain and who to. Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,30. Colwill Lodge is decorated and furnished generally to a good standard. It is clean and warm, the gardens are accessible and pleasant which overall creates a comfortable and safe environment for service users. EVIDENCE: The premises are accessible to all of the service users that use the service. On the day of the inspection the home was found to be comfortable, well furnished and clean and warm. Some bedrooms would benefit from redecoration and this work is planned and should be undertaken in the near future. All bedrooms are single rooms, and wherever possible, service users are allocated the same bedroom at each respite stay. Their photograph is displayed on their bedroom door so they know which room is theirs for their stay. A sensory garden is being constructed in the grounds, which will benefit the service users. Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,35. Care staff numbers are adequate to meet the needs of the service users. The home has a consistent staff team who are committed, caring and appropriately skilled to provide care to service users. EVIDENCE: Observation of staff during the inspection and from discussions with them evidenced that staff clearly understood their roles and responsibilities. Staffing rotas evidenced that adequate numbers of staff are on duty in the home at all times. Currently Plymouth City Council currently has a freeze on recruitment, and staff are helpfully undertaking additional hours. Agency staff are being used when this is not possible. Discussion with the Manager and staff confirmed that staffing levels are flexible depending on the needs of the service users. Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,42. Colwill Lodge is managed by a very competent and experienced Manager. There is a clear management structure operating in the home that is clearly effective. The health, safety and welfare of service users are promoted and protected. EVIDENCE: It is clear that the management approach at Colwill Lodge is positive and inclusive. Service users, carers and relatives and staff are encouraged to voice any ideas or issues informally or through supervision and meetings. A quality assurance system has been developed and customer satisfaction leaflets are due to be sent out shortly. Records are well kept and accessible, and all policies and procedures are up to date and easily located. Health and safety continues to be a priority in the home, and health and safety practices described and observed were found to be satisfactory. All accidents and incidents had been reported and documented. Detailed risk assessments had been carried out for all safe working practice topics. Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 17 Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x x 3 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x x x 3 x x 3 Standard No 31 32 33 34 35 36 Score x 3 x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Colwill Lodge Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x 3 x D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 19 no 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 Regulation Requirement Timescale for action 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 YA7 YA6 Good Practice Recommendations The use of a pooled suspense account to manage personal money belonging to service users, should be reconsidered, and an alternative system devised. A long term plan of care should be devised for the service user who has resided at Colwill Lodge since May 2004. Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon, TQ13 7UP 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 Colwill Lodge D52-D04 S31052 Colwill Lodge V241958 201005 Stage 4.doc Version 1.40 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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