Inspection on 25/08/05 for Concord Lodge

This inspection was carried out on 25th August 2005.

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

The inspector 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

Concord Lodge 27/02/07

Concord Lodge 03/02/06

Concord Lodge 16/12/04

Concord Lodge 10/08/04

Concord Lodge 10/12/03

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 Concord Lodge Kellaway Avenue Horfield Bristol BS7 8SU Lead Inspector Sandra Gibson 8.45am 25 August 2005 Unannounced 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. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Concord Lodge Address Kellaway Avenue Horfield Bristol BS7 8SU 0117 9243037 0117 9243066 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) Bristol City Council Mr Glyn Short Care Home for younger adults 6 Category(ies) of LD Learning disability, for 6 people registration, with number of places Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate 6 persons aged under 65 years. Date of last inspection 16 December 2004 Unannounced Brief Description of the Service: Concord Lodge is registered to provide personal care and accommodation for up to six persons (male and female ) who are under 65 years of age and who have a learning difficulty. The staff team aim to provide a specialist facilitiy for people with particularly complex needs. The service is in the process of being divided into three areas: Medium term asessment for individuals who challenge current service provision, working in a holistic way to reduce the impact of the challenging behaviour on each persons life and support residents to develop their skills and move on towards a more independent setting. This is the only registered service at the moment. A Safe Haven Service is in the process of being registered for people who cannot be easily accomodated with others and would benefit from interim specialist support to reduce challenging behaviour. The staff at Concord Lodge will be working in partnership with the Bristol Intensive Response Team to provide this service and finally a respite service is also in the process of being developed to provide a short break to people with complex needs and sometimes challenge.The staff will be working in partnership with the Bristol Adult Placement Team and the Day Services Community Resource Team. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place mid week between the hours of 8.45am and 3.30pm. The inspection focussed on general care and welfare of residents and three were spoken to at the visit. Several staff members were consulted including the team manager and a range of different records were examined including care files, health and safety, complaints and quality assurance records. . What the service does well: What has improved since the last inspection? The process of improving the physical environment of the home has started since the last inspection with attention to the subsidence and redecoration with the result that the residents of Concord Lodge benefit from a reasonably comfortable, clean, safe standard of accommodation There has been an improvement in the morale of staff since the last inspection which has been observed through the monitoring of staff roles, responsibilities and training needs by the manager and senior staff during supervision. Following the last inspection there are now established recruitment procedures in place for the protection of vulnerable adults. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 6 What they could do better: 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. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.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 Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.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) 1,2,3,5 Information provided to prospective service users and their representatives has improved considerably since the last inspection. However, further development of this information and greater involvement of residents and their relatives in the needs assessment process must take place to ensure that residents and their representatives can make an informed choice about whether Concord Lodge can meet their individual needs. EVIDENCE: The statement of purpose has been developed to include the current service of medium term assessment and the two new services Concorde Lodge wish to provide, namely a Safe haven and Respite facility. There is currently no up to date service users guide in place. The samples of needs assessments seen were good but it was noted that they had not always been dated or signed and a few assessments were noted to be lacking in detail. A sample of contracts was seen and these were noted to be up to date and accurate. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.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) 6,7,8,9 On the whole the care planning system in place is good but further attention needs to be given to the completition of care plans with residents and their representatives to ensure that all residents’ needs are identified and met. Residents are well supported by the staff team of Concord Lodge who enable them to take risks so that they reach their own highest evel of independence and achievement. EVIDENCE: A sample of care plans were examined and on the whole they were noted to be of a good standard. However, it was observed that some care plans had not been signed by the resident or their representative. Therefore there was no information to confirm that they were accurate. During the inspection the inspector met a couple of residents who had made very good progress in accessing the toilet independently and choosing to wear different clothes to their regular choice during their stay at Concorde Lodge. The inspector saw the progress made in the case files and this was confirmed by the key workers. The inspector examined the risk assessments in place for these residents and noted that they are regularly reviewed and kept up to date. This is good practice. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 10 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) 11,12,13,14,16,17 Concord Lodge provides service users with the opportunity to experience a stimulating and varied lifestyle where various informal activities are regularly made available. Meals are well managed and provide daily variation, good nutrition and social contact for residents. EVIDENCE: One resident who was on holiday from the day centre s/he attends on a regular basis. The resident and key worker said that they were going shopping that day for the service user to choose her/his own training shoes. The resident said that “s/he was looking forward to going shopping with (the) key worker “ and appeared very relaxed in the company of that staff member. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 11 Records confirmed that this resident enjoys various activities at the day centre such as art groups and music. The resident showed the inspector her/his bedroom which accommodated all her /his personal items including DVD collection and musical instrument which the resident was happy to play. Another resident was seen relaxing in his/ her room looking out of the window at the birds and observing the visitors to the home, whilst also looking at magazines of his/her own choice. The resident made the decision to spend that morning in their room but the plan for later in the day was for this resident to be escorted on a walk which is a favourite past time. The inspector also heard how another resident enjoys electronics and works in a training unit once a week. A communal lunch is provided for residents unless a risk assessment states otherwise or the service user is unwell. However, it was understood that at the time of this inspection the communal meal was under review due to residents’ changing lifestyles. Following the outcome of this review the main meal may be served in the evening. This meal is held in the dining room. The inspector had the opportunity to taste the lunch and noted that it was of a very high standard and provided choice and a range of fresh ingredients. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.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 Residents’ physical care and health care needs are fully met and personal care is delivered in a way that meets the individuals’ assessed needs. The medication administration system was on the whole satisfactory, but further safeguards in the security of the medication held on the premises must be put in place to protect service users and safeguard staff. EVIDENCE: Records confirmed that health professionals such as General Practitioners, Psychiatrists, opticians and chiropodists are contacted at the appropriate time. It was also noted that resident are assisted to attend regular hospital appointments such as the eye clinic, well woman clinic and speech therapy. The medication administration records were noted to be up to date and accurate except that it was observed that staff and residents share the same homely remedy supply of paracetamol which was not accurately recorded. It was also noted that there was no suitable secure medication cabinet in place for controlled medication or medication treated as controlled to be stored if required in the future. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.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) 22,23 The system for dealing with complaints and the arrangements for protecting residents from harm are not satisfactory which place residents at possible risk or harm. EVIDENCE: Bristol City Council has a complaints procedure that has also been translated into a pictorial format for the benefit of residents. This pictorial format was seen in one of the residents’ bedrooms. It was observed that there are some residents that are unable to verbally communicate their discontent directly. Consequently these residents may have to rely on staff being aware of when they are not happy with a situation which may increase their vulnerability. An allegation of abuse that had not been followed up satisfactorily was found during the inspection. This was confirmed through examination of the home’s complaints and compliments log that is maintained by the manager. A requirement was therefore made to investigate this allegation further. There is a copy of ‘No Secrets in Bristol’ held in the home. And staff training records confirmed that protection of vulnerable adults training has commenced but it was noted that an intake of new staff during the last year have not yet been provided with this training. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.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) 24,25,26,27,30 Residents benefit from an improved physical environment that provides a reasonable comfortable, clean and safe standard of accommodation. However further improvement is necessary to ensure greater comfort for and safety for both residents and staff. EVIDENCE: The home is suffering from subsidence, there is little natural light in some areas of the home. Particularly in the corridors and bathroom facilities. The known subsidence is being carefully monitored and it has been patched up in several places since the last inspection. Great efforts have been made by the staff team to make Concord Lodge homely. The inspector heard how staff have been involved in painting parts of the home themselves to reduce the cost of painting and decorating so that any money saved can be spent on other updating work. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 15 Building work has taken place since the last inspection which has to date been concentrated on the” Safe haven” emergency bed facility at the front of the house. This work has lead to some improvement in the environment but further work needs to be completed in the home in order that the proposed respite facility will meet the national minimum standards. Three residents’ rooms were seen and it was noted that they are personalised and reflect individual tastes and hobbies. All communal areas were seen and were observed to be comfortable, clean spaces where residents looked relaxed with in the home surroundings. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 16 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) 32,33,34,36 There has been an improvement in the morale of staff since the last inspection which has been observed through the monitoring of staff roles, responsibilities and training needs by the manager and senior staff .This ensures that residents’ are starting to benefit from a more effective and better trained staff team. However, further improvement is required to improve the quality of life for residents. There are now established recruitment procedures in place for the protection of vulnerable adults. EVIDENCE: Staff are aware of their roles and responsibilities. However, staff morale continues to be affected through disagreements about the delivery of personal care and the distribution of tasks within the team. The inspector was informed that this situation has been ongoing for some time but was made worse after the re-evaluation of job descriptions by the City Council. However, it was noted that there was evidence to confirm that these difficulties are being well managed by the manager and senior staff team and that further progress has been made since the last inspection. This was confirmed by the team manager of the home who was present during the inspection. Regular supervision and staff meetings take place in the home. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 17 The inspector was informed that progress has been made with NVQ training and a staff development plan was in place that was currently being reviewed by the manager. All staff recruitment files are currently held in Social Services and Health personnel department. However there are arrangements in place for this situation to be resolved with the Commission for Social Care Inspection and for the information to be held in the home. There was evidence in place to conform that all staff now have Criminal Record Bureau checks in place and all new staff also have Protection of Vulnerable Adults register checks completed before they are employed in the home. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 18 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) 38,41,42,43 The management team have a development plan in place which needs to be further developed and explained to the residents, relatives and staff to ensure that resident’s rights and best interests are protected The management of health and safety records is reasonably good. However further improvement is needed in respect of ensuring fire safety records are up to date to ensure that residents and staff are fully protected from risk of harm. EVIDENCE: The team manager is very supportive to the manager of the home and together they are in the process of developing new services through the proposed Safe Haven bed for emergency care and a respite facility in partnership with the Bristol Response Team. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 19 However, there was a lack of clarity at the time of the inspection about how the new staff team would function and what effect the new services would have on the day to day functioning of the care home. There was also no information to confirm that the staff team, residents and relatives were aware of the planned changes. The inspector examined a sample of records which are maintained for the protection and safety of residents and staff. It was noted that the majority of these records were up to date except for the fire log where it was observed that weekly fire alarm checks were not being conducted and it was not clear if night staff were receiving three monthly fire safety training. The fire risk assessment was noted to be in place but had not been reviewed since July 2004. Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 20 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 1 2 3 x 3 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score x 3 2 3 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Concord Lodge Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x 2 x x 3 1 3 D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 21 ? 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 1 Regulation 4 Requirement A copy of the Statement of purpose must be made available to all prospective/permanent residents and their representatives A service user guide must be developed in a format that is accessible to prospective/permanent residents The needs assessment must give clear detailed of needs assessed.During the assessment process there must be appropriate consultation with the resident or theirrepresentative of the resident If controlled medication or medication that must be treated as controlled medication is used in the home it must be stored in a metal cupboard which complies with regulations and guidance issued by The Royal Pharmaceutical Society. There must be an accurate record of medication held at all times. The registered manager must ensure that any complaint made under the complaints procedure is fully investigated Timescale for action 25th November 2005 25th November 2005 25th November 2005 2. 1 5 3. 2 14 4. 20 13(2) 25th February 2005 5. 6. 20 22 13(2) 22(3) immediate immediate Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 22 7. 23 13(6) 8. 24 23(2) 9. 10. 11. 42 42 24 24 All staff working at Concord Lodge must attend the Adult Protection Training provided by The Local authority Adult Protection Coordinators A programme of planned maintenace work and refurbishment/ decoration must be sent to CSCI Fire alarm checks must be carried out weekly All night staff must have three monthly fire safety training 26th February 2006 25th December 2005 immediate 25th November 2005 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. 3. Refer to Standard 7 20 33 Good Practice Recommendations Residents and/or their representatives must be involved in drawing up care plans where possible and if not possible this should be recorded A separate supply of homely remedies should be used for residents and staff It is recommended that a staff team day is held on a regular basis facilitated by an external trainer to help resove some of the conflict within the team to improve staff morale and increase the effectiveness of the team The manager should ensure that all staff and residents/ represenatives are kept fully up to date with any changes to the service and have strategies in place for those concerned to voice their concerns and to affect the way the service is developed The fire risk assessment should be reviewed annually 4. 38 5. 42 Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 23 Commission for Social Care Inspection 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 Concord Lodge D56_D05_S37289_ConcordLodge_V245960_250805_Stage4.doc Version 1.40 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!