CARE HOME ADULTS 18-65
Concord Lodge Kellaway Avenue Horfield Bristol BS7 8SU Lead Inspector
Sandra Gibson Unannounced Inspection 3rd February 2006 09:30 Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 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 Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 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. Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 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 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) Bristol City Council Mr Glyn Short Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. May accommodate 6 persons aged under 65 years. Date of last inspection 25th August 2005 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. A safe haven Service is in the process of being developed 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 DS0000037289.V263551.R01.S.doc Version 5.0 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 9:45am and 1:15 pm. The inspection focussed on general care and welfare of residents and the changes to the service provided. The registered manager and team manager were consulted and a range of different records was 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 information provided to residents has developed since the last inspection with a result that prospective residents and their representatives are better informed about the services Concord Lodge provide before they move into the home and whether or not their individual needs can be met. The admission process has improved since the last inspection, which ensures that prospective residents individual needs are identified and assessed before they move to the home. The care planning system in place has improved since the last inspection. Attention has been given to the completition of care plans with residents and their representatives. This now ensures that all residents’ needs are identified and met. The physical environment in the home has improved considerably since the last two inspections. Concorde Lodge now provides a comfortable, clean and safe standard of accommodation. Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 6 Residents, their representatives and staff are beginning to benefit from the development plan in place for the home, which ensures that residents’ best interests are protected. Please also see judgements below 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 DS0000037289.V263551.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 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 the following standard(s): 1,2,3, The information provided to residents has developed since the last inspection with a result that prospective residents and their representatives are better informed about the services Concord Lodge provide before they move into the home. The admission s process has improved since the last inspection, which ensures that prospective residents individual needs are identified and assessed before they move to the home. EVIDENCE: The statement of purpose has been further developed to include the current service of medium term assessment and the two new services Concord Lodge wish to provide, namely a safe haven and respite facility. The service user’s guide has also been further developed since the last inspection. It was observed that photographs and plain English have been used to ensure greater access to residents and their representatives. A sample of needs assessments was examined and was noted to be satisfactory. It was pleasing to see that they were more detailed than those seen at the last inspection and that they had been dated and signed. Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 9 The inspector heard how an emergency placement had been made following the last inspection, which had been unsuccessful, and the person had to be moved again the next day as a result of the physical environment not meeting the person’s needs. The manager explained that as a result of this poor practice a checklist to guide social and health professionals had been developed to assist with coordinating the information required about a prospective service user being placed in the Concorde Lodge. It was noted that this checklist was in the process of being piloted and was due to be reviewed in a few weeks. Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 The care planning system in place has improved since the last inspection. Attention has been given to the completition of care plans with residents and their representatives. This now ensures that all residents’ needs are identified and met. EVIDENCE: A sample of care plans was examined .It was observed these care plans had been signed by the resident or their representative. It was also noted that the care plans were of a good standard and contained the detailed information required by staff to support each individual’s complex needs. One resident seen during the inspection indicated that she felt comfortable with the staff providing her care and well supported with her personal care needs. It was observed that the resident had chosen to have a spar footbath that morning. Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 11 During the inspection the inspector heard about several residents who had made very good progress in developing skills in activities of daily living whilst living at Concord Lodge. The inspector saw the progress made in the case files and the key workers confirmed this. The inspector examined the risk assessments in place for these residents and noted that they are regularly reviewed and kept up to date. Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected during this unannounced inspection. They were all assessed except NMS 15 at the last inspection conducted on the 25th August 2005 and were found to be met. EVIDENCE: Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The medication administration system has improved since the last inspection. However the security of some of the medication held on the premises is not satisfactory as it may not safeguard residents or staff. EVIDENCE: A sample check of the medication administration records was conducted and they were noted to be up to date and accurate. It was observed that following a recommendation made at the last inspection; staff and residents no longer share the same homely remedy supply of paracetamol. However, it was also noted that despite a requirement of the last inspection there was still no suitable secure medication cabinet in place for controlled medication or medication to be treated as controlled. Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The system for dealing with complaints and the arrangements for protecting residents from harm have improved considerably since the last inspection. However some further improvements are needed to ensure that residents are listened to and are protected at all times from risk of harm. EVIDENCE: Bristol City Council complaints procedure is in place. This procedure has been translated into a pictorial format for the benefit of residents, which was seen in several residents’ bedrooms. A complaints investigation was recently completed in this home. One of the outcomes of the investigation was a new internal complaints procedure for staff members to follow. This procedure was observed during the inspection and it was noted that it did not comply with Bristol City Council “whistle blowing” policy and procedure. The homes complaints and compliments log which is maintained by the manager was examined it was noted that there were no new complaints logged since the last inspection. There is a copy of ‘No Secrets in Bristol’ held in the home. Staff training records confirmed that protection of vulnerable adults training has commenced in this home, but there is still a number of staff to complete this training. Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 The physical environment in the home has improved considerably since the last two inspections. Concorde Lodge now provides a comfortable, homely, and safe standard of accommodation. EVIDENCE: Further building work and refurbishment has taken place since the last inspection which has lead to considerable improvement in the environment for the new respite facility and also further improvement in the main part of the home for residents who receive medium term care. Following a tour of the communal areas and bedrooms it is the inspectors opinion that Concord Lodge is now a much more comfortable homely place to live and that the manager, team manager and staff team have worked very hard to create this new environment. The home was noted to be cleaned to a good standard and smelt fresh through out. The manager explained that all physical / environmental adaptations and equipment are provided where possible as identified in an individuals needs assessment/ care plan. Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 16 The staff team have access to an established office in the centre of the home and the manager’s office is now in an annex in the grounds of Concord Lodge where the Bristol intensive response team and also located. The refurbishment to the safe haven facility was completed prior to the last inspection and was observed to be of a high standard. The known subsidence is being carefully monitored and it has been patched up in several places since the last two inspections. Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 Residents’ are starting to benefit from a more effective staff team. However, attention must be given to managing this time of change in order to ensure the staff team continues to develop and be effective. EVIDENCE: Staff are aware of their roles and responsibilities and staff morale has improved since the last inspection. There is evidence to confirm that the staff team is well managed by the manager with support from the team manager and that further progress has been made since the last two unannounced inspections. The team manager of the home who was present during the inspection confirmed this. Regular supervision and staff meetings continue to take place in the home. However it was noted that the recommendation made at the last inspection to hold regular staff team days had not yet taken place despite the manager agreeing that he thought it was a good idea. Continued progress has been made with NVQ training and specialist training. The staff development plan has recently been reviewed by the manager and plans for a rolling programme of training put into place. ` Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43 Residents, their representatives and staff are beginning to benefit from the development plan in place for the home, which ensures that residents’ best interests are protected. The management of health and safety records has improved since the last inspection. However further development is required to ensure that residents and staff are protected from risk of harm. EVIDENCE: The registered manager and team manager 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. It was noted that residents who had been living at Concord Lodge long term are currently being supported by the staff team in consultation with residents and their representatives to move onto more suitable long-term accommodation. Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 19 Medium term placements are being offered to new residents. The respite facility is now complete but the safe haven facility is not yet operational, as the new staffing team have not yet been appointed. This information was confirmed at the time of the inspection. Following the last inspection the management team held a meeting with the staff team in November 2005 to discuss 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. The manager stated that there was written evidence to confirm that the staff team, residents and relatives were now aware of the changes that were taking place in the home. The inspector examined a sample of records, which are maintained for the protection, and safety of residents and staff. It was noted that following requirements made at the last inspection all periodic tests and training were up to date and accurate However it was observed that fire risk assessment in place was now out of date as a result in the changes in the physical environment throughout Concord Lodge. Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 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 2 3 3 x X Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 2 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 2 X 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Concord Lodge Score X X 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 2 3 DS0000037289.V263551.R01.S.doc Version 5.0 Page 21 yes 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 YA20 Regulation 13(2) Requirement 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. This requirement is on going from the last inspection conducted on the 25th August 2005. The registered manager must ensure that any internal complaints procedure for staff to use must comply with Bristol city Council Whistle Blowing Policy and Procedure made under the complaints procedure is fully investigated All staff working at Concord Lodge must attend the Adult Protection Training provided by The Local authority Adult Protection Coordinators A fire risk assessment must be completed following the changes to the home developed Timescale for action 30/04/06 2 YA22 22 30/04/06 3 YA23 13(6) 31/07/06 4 YA42 23(4) 30/04/06 Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 22 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 YA33 Good Practice Recommendations Manager and staff team should review changes to services provided within six months and affect on staff team and staffing levels Concord Lodge DS0000037289.V263551.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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