Inspection on 10/05/06 for Corben Lodge

This inspection was carried out on 10th May 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Corben Lodge 07/06/07

Corben Lodge 08/11/06

Corben Lodge 06/03/06

Corben Lodge 27/07/05

Corben Lodge 05/01/05

Corben Lodge 01/06/04

Corben Lodge 01/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Corben Lodge Moorings Way Milton Portsmouth Hampshire PO4 8QW Lead Inspector Ms Jan Everitt Unannounced Inspection 10th May 2006 09.30 Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 1 Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 2 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 Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 3 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. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Name of service Corben Lodge Address Moorings Way Milton Portsmouth Hampshire PO4 8QW 023 9273 1941 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) www.portsmouthcc.gov.uk Portsmouth City Council Mr Michael Paul Collinge Care Home 19 Category(ies) of Physical disability (19) registration, with number of places Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 5 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate up to 19 male and female service users in the PD category between 18 and 65 yeas of age. 6th March 2006 Date of last inspection Brief Description of the Service: Corben Lodge is a local authority run home situated in a residential area on the eastern side of Portsmouth. The home, built over twenty years ago, is a purpose built single storey building with 24 hour staffing originally aiming to provide rehabilitation to enable adults with a physical disability to achieve greater independence and to move on into specialist housing provision in the community. At the time of this inspection there was a high proportion of permanent residents, one of whom spoken to had lived at Corben Lodge for over 18 years. The remaining accommodation was offered to people living in the local community to receive short stay, respite care, weekend programmed care, and one person was staying in the purpose built rehabilitation flat at the home. In addition there are some care packages available for people living in the community who may need use of Corben Lodge facilities, for example assisted bathing, in order to sustain them living independently. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The site visit to Corben Lodge, which was unannounced, took place on the 10 May 2006 and was attended by two inspectors and one inspector attended the second day, 11th May. The registered manager and deputy manager assisted the inspectors throughout the visit. The staff and senior practitioner on duty at the time were also available. The visit to Corben Lodge formed part of the process of the inspection of the service to include all the key standards for the year 2006/7. The focus of this visit was to support the information gathered prior to the visit. The judgements made in this report were made from information gathered prior to the visit, pre-inspection information submitted to the commission by the manager, from previous reports, the service history and analysis of the accident/incident reports referred to as Regulation 37 reports, reports sent to the CSCI by the local authority service manager, who undertakes the monthly visits and reports, correspondence with the home and contact sheets that record all contacts that appertain to the home. The records of management meetings held between CSCI and Portsmouth City Council, the registered providers, with references to issues and concerns that had been continually highlighted as needing attention since the local authority homes had been registered and came under the Care Home Regulations, were also taken into consideration when judgements were made. Further evidence was gathered at the two-day site visit. The inspectors toured the building and spoke with most of the residents and a number of staff. Visitors were also spoken with, to ascertain the level of satisfaction with the services delivered to their relatives accommodated in the home. Three relatives were spoken with over the phone and the care manager for two of the residents was also contacted to obtain his views of the home. Twelve comments cards were received from service users who, in the main were very satisfied with the care and services they receive in Corben Lodge. The inspector viewed a sample of care records, spent time observing practices and speaking with residents. The atmosphere in the home was relaxed and the staff were observed to work autonomously with clients whose activities of daily living routines they were familiar with. The staff were observed to interact well with the residents they worked with. The ethos and overall care delivered in the home was good but care plans did not document a programme of enablement. The requirements and recommendations made in the previous inspection have been complied with in most areas but further discussion on some issues is in the main body of the report. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 7 What the service does well: What has improved since the last inspection? The Statement of Purpose has been amended and does not purport to provide rehabilitation programmes for service users. Staffing levels were appropriate for the number of clients in residence at the time of this visit and for the stated purpose of the service. A policy for same gender care has been formulated since the last inspection. A number of windows and patio doors have been replaced around the building and some redecoration has taken place. The care planning system has been designed by the policy planning officer for the local authority and it was about to be introduced and training was being planned for all staff. The final draft of the new medication policy is now in use, a copy was evident in the home. The medication training for some of the staff that administer medication had been undertaken and another date was established for the remainder of senior staff. A new blister pack system for dispensed medication for the long stay residents is in place and new trolleys are being delivered to the home to provide appropriate storage for this system. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 8 What they could do better: A service user guide must be completed and distributed to all residents and potential service users in a format that is appropriate to their level of understanding. The homes philosophy to promote independence and choice must be reflected in the development of each unit to allow residents to undertake activities of daily living and to practice their living skills if they are attending an external rehabilitation programme elsewhere in the community. Long-stay residents should also have the opportunity to maintain their existing living skills if they so choose. The care records must be organised and document detailed current assessments and information about the residents and must inform day-to-day practice. Care plans must identify the health, social, recreational, psychological and emotional needs of the residents. Care plans must reflect the personal goals of the residents both short-term and long-term. All historic information must be archived. Areas of the home identified during the visit must be risk assessed and strategies documented to manage the risks. A self-medication policy must be formulated to enable residents to have the choice of managing their own medication within a risk-assessed framework to promote their independence. All staff including ancillary staff must be given adult protection training to gain understanding of what constitutes abuse. The registered manager must take responsibility to formulate a process for quality assurance and the auditing of all the systems, records and practices of the home to ensure service user’s health and welfare are maintained. The manager needs a process of seeking the views and opinions of the service from residents, relatives and professionals who use the services of Corben Lodge. The upkeep and maintenance of the fabric of the home must be monitored and maintained to an acceptable standard. The areas of the home that are designated for communal space for the residents must be made fit for purpose and available should residents choose to use these areas. The infection control procedures at the home must be reviewed to reflect the appropriate management of soiled pads stored in bedrooms. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 9 The manager must take the responsibility and be sure that all staff have received appropriate training and specific training appertaining to the client group they care for. Staff must be trained or reminded of the management of hazardous substances and of the appropriate storage of such substances. 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. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 10 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 Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 11 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, & 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service and discussion with the manager. The Statement of Purpose generally reflects the services offered in the home. The home continues not to provide a service user guide for potential residents and families. The home fails to adequately assess clients referred to the service prior to admission and relies on information and needs assessment from the care Manager. EVIDENCE: The manager produced a copy of the most recent Statement of Purpose sent to the Commission following the previous inspection. The document has been amended and does not state that a rehabilitation service is provided, which it does not. It states that ‘if required, specialist rehabilitation workers can use the facilities to enable people to regain their independence’. This does not happen, however, this report demonstrates that a number of service users have aspirations to move to independent living and inadequate provision is being made to enhance their daily living skills. An occupational therapist visits the home twice weekly only to assess the mobility of clients for moving and handling and does not actively take part in any rehabilitation programmes for the clients. However, the statement of purpose does describe an area of the home as a rehabilitation flat. A service user who is anticipating living independently occupies this area but the flat is not being used for rehabilitation Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 12 purposes and on the day of the visit the kitchen was being used as storage space, therefore the description of this area of the home is misleading. The local authority must decide the direction, focus and the future purpose of the service which must be clarified and then be accurately reflected in the Statement of Purpose. A service user guide is in the process of being produced and is still not available to all service users and potential service users. Three relatives spoken with over the telephone confirmed that the three service users had been initially been admitted for short term respite care but had become permanent residents subsequently and they had therefore not seen the service user guide or statement of purpose before admission to help inform their decision making. The home provides a mix of residential and short stay accommodation with a view to support some residents to rehabilitate back into independent living. However the package of care for residents wishing to rehabilitate back into their own home is dependent on the care management assessment and a view from the homes perspective. Only limited support or intervention is provided by occupational therapist (OT), Physiotherapist (physio) and specialist health care teams and skilled staff to provide this specific service, despite having some residents who have expressed a wish to move on, or go back home. The home is not currently meeting their needs. The social worker for a number of service users was spoken to and he described the admission criteria to Corben Lodge to be ‘tight’. His care needs assessment is shared with the home when referring for admission. He described some emergency admission situations when an assessment was not undertaken by the home because of the situation. He has a high regard for the work undertaken in Corben Lodge but acknowledges that active rehabilitation does not take place. At the time of the visit the pre-admission assessment document was being reviewed. The manager described the assessment as the referral and needs assessment that comes from the care manager and the home, if necessary, seek further information from them but they do not routinely go out to assess the clients themselves, only in exceptional circumstances. At the time of the site visit the manager reported that the home had not admitted any service users since the last inspection in March and there were fourteen service users in residence. Service users relatives were spoken with over the telephone. All reported that their relatives had initially gone to Corben Lodge for respite care and had been there for some time before being assessed as a long stay resident. They were happy with the facilities but one relative said that he felt it was not used to its full potential. Two of the three relatives spoken with reported that they did not anticipate their relative moving on to another place, whilst one reported that his son had aspirations of living independently in a supported environment. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 13 Prospective residents are encouraged to visit the service and trial one day, building to over night and weekend stays. 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 & 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service, case tracking records and discussion with the service planning and development officer. The home does not have care plans that are clear, factual and identify the service user’s wishes, aims and goals for their future in consultation with the service user, their relatives/advocate. The home does not fully protect residents from the potential environmental risks. EVIDENCE: A sample of four residents personal plans were viewed, however the inspectors had difficultly ascertaining how and if the residents are supported appropriately as the personal plans are cumbersome, hold too much information with historic information, do not follow in order of assessment, implementation, monitoring and evaluation and are not agreed or signed by the resident/service user. This makes the personal plans inaccessible to the residents/service users. The home did not record care plans stating service user’s goals, aspirations or any programme for working towards reaching those goals. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 14 The manager introduced the service planning and development officer responsible for implementing the new care planning processes and documentation. She has recently returned from long-term absence and is currently tailoring the documentation to meet the services needs and then she will give guidance and training to the senior staff that will then implement the system. A requirement from the previous inspection required that the care plans be reviewed to reflect current and ongoing needs and short and longterm goals, with a timescale, which has been exceeded. Discussion will take place with senior Commission for Social Care Inspection managers to determine if the service can have an extension on this. The new documentation appears to be robust in as much as it follows from the assessment process, identifies strengths and needs, life history, interest and hobbies and has a good system for monitoring and flagging up concerns. One of the residents spoken to said they were aware they had care plans. However the manager must take responsibility for the poor standard of documentation and accessibility of documentation, having been in post since 2002 and not addressing them earlier. Care planning documentation must be addressed as a priority. However, to avoid it becoming a paper exercise and to ensure the manager is confident that staff are aware of what they are doing, it was suggested that a sample ‘ideal’ care plan be produced and staff receive specific training on how to produce a care plan and how they must be person centred and inform their practices. The inspectors met with a resident who said she felt her decisions, wishes and choices are respected by the staff. She informed the inspector that she received information about activities and menus as these are displayed on the residents’ notice board for all see. She said staff respect her dignity and privacy and that she is well supported to do the things she wishes to do. The home provides a daily choice of activities both in house and out. A displayed menu plan provides a choice of fresh foods and vegetarian options. If the resident does not wish to have what is on the menu then an alternative of their choice is provided. The inspectors met with a resident who complained that they were unhappy with a particular aspect of his care and physical health, he felt he was being forced to comply with the wishes of others rather than his own. The manager informed the inspectors that steps had been taken to address the resident’s concerns through the review process however, the decisions had gone against the residents individual wishes. The manager must consider how they can meet and manage the resident’s specific wishes and health care needs. The manager gave an example how the home is currently meeting the needs of a resident who could pose a potential risk to other residents. The resident is currently being supported in a separate part of the home, supported by two female staff and/or one male member of staff and is not left unattended with other residents. The same resident has severe epilepsy and despite considering a personal alarm system, to alert staff of the residents needs at Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 15 times when he is on his own, this has not been introduced and the resident has to have a member of staff with him when he has a bath in case he has a seizure and is closely monitored at night. This resident wishes to move on to independent living therefore the service should be considering how they can support this in identifying the potential risks and ways in which they can be minimised. The care manager spoken with described how he had reviewed this service user recently and the plans for this client to go through thorough a comprehensive multidisciplinary assessment with a view to his going to live in the community with support. A relative spoken with the on the phone reported that his son wished to live a more independent life and has been promised a flat or to a more community living environment. This has been discussed for over the past year but nothing has come of it and commented that it was ‘about the cost’. One of the residents spoken with reported that he had been receiving physiotherapy twice a week to help with his mobility so that he could go home but the staff at the home did not allow him to use the walking aid he had brought to the home. The inspector spoke to the care manager for this man who described the situation and reported that his condition had deteriorated and he could no longer manage at home because of his immobility and has now been assessed as a wheelchair user. He was reviewing the situation and supporting this client to be transferred to a rehabilitation flat located in Portsmouth from which he would be allocated a flat or community accommodation for more independent living and more appropriate to his needs. When the inspector spoke to the client his perception of the situation did not reflect that nor did his care plans identify this plan. The manager reported that the occupational therapist attends the home weekly to assess moving and handling risks of the clients. The home has recently been subject to refurbishment of its windows and external doors. The inspectors found the thresholds of the newly fitted patio doors to be a potential tripping hazard for residents with limited mobility and to those who use aids to assist them to get around. The manager is required to address the tripping hazard with out delay and risk assesses the hazard. The inspectors also observed and spoke to the manager about the patio areas outside the double doors of each lounge area on the wings. The stones are uneven and weeds growing between them and the whole area looks neglected and not pleasant to sit in. The home appears to have a reticence in supporting residents to take acceptable risks as part of achieving a more independent lifestyle. A relative reported that his son wishes to take a risk to allow him to become more independent when getting out of bed but health and safety guidance and risk assessments indicate that a hoist must be used which causes frustration to the service user. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 16 Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 17 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): 11,12, 13, 14, 15, 16 &17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has made some improvements to provide opportunities to develop service user’s personal skills, however, the home must strive to make further improvements in developing skills. The home does well to support the residents in activities of their choice and to further their education and to maintain links with their families and the local community. The home provides a varied and wholesome diet to choose from, however, staff must receive training on specific dietary needs. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 18 EVIDENCE: The home has made some improvement to provide opportunities to develop personal skills. The service users spoken with were generally satisfied with the care and services in the home and said they were supported to participate in community life. One young client spoken with said that he was out at college two days of the week and chose to spend time in his room when he was not out but commented that he was ‘always out somewhere’. This client’s mother was spoken with and she said that she was happy with the care her son received and that he came home some weekends. She also said her son would like to live independently but this was not realistic. A number of other clients go out to day centres regularly and another lady client said she attends college for drama and has undertaken various courses at college over the years and is encouraged to do so. The manager, as part of the requirement to provide opportunities for activities in the home, has introduced cooking sessions for the residents to join in if they wish. The inspector had the opportunity to speak with the lady who was visiting the home to supervise the cooking sessions. She reported that she gave the service users the opportunity to participate in the planning meeting which would include menu planning, shopping and the cooking of a meal, not all took the opportunity but a small group did attend. One resident informed the inspectors that on Wednesday she is supported down to the local shops to pay her paper and magazine bill. The home has excellent facilities to support rehabilitation and develop independent living skills, however, there was no evidence to demonstrate residents were supported to do their own washing, cooking, preparing snacks etc other than in a planned activity and not as part of their activities of daily living. The service has a fully furnished flat with a kitchen, separate lounge and bedroom and bathroom with all the facilities required for independent living. The resident occupying the flat has requested to move into independent living however he is not supported to develop personal skills. This was discussed with his care manager who reported that he is to attend a day centre twice a week for rehabilitation to learn living skills and that he will eventually move to a rehabilitation flat for a period of time, with multidisciplinary input, to undertake a programme of rehabilitation and be assessed and from there to independent living accommodation. There was no evidence to suggest that in between the rehabilitation sessions, the client is encouraged or is able to practice living skills. The home has made some progress in providing activities within the home. Recorded evidence of the outcome of the activity demonstrates the home is complying with the previously made requirement. Information provided on the residents notice board, activities going on in the home and positive interactions between the residents and staff was observed by the inspectors. Activities, observations and information collated from residents and the manager indicate the following activities are taking place. Music and singing, Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 19 Arts and crafts, Gardening, (currently running a competition on who can grow the most potatoes). Raised flowerbeds, sensory areas and individual plots. The inspectors saw this. Going out for meals Large screen TV, DVD player Evidence of Individual interests and hobbies. Farms, cars, knitting. Certificates of achievement displayed on a bedroom wall and discussion with a resident identified the resident enjoyed computer studies and regularly attended college. Another resident regularly visits schools to talk about his disability. On the whole he said he is well accepted. The inspector received a comment on a service user survey saying that trips out are always subject to transport and staffing levels. Another comment was that staff often try to organise service user’s activities but are interrupted by buzzers from other residents. The inspector spoke to a relative about the activities and opportunities of social interaction at the home, he commented that he thought they it was ‘alright’ and some staff in particular are very good and will ensure the service users have social times, but sometimes the impression he formed was that ‘all the staff sit in the office and left the residents out in the big lounge on their own when perhaps they could be having some sort of social reaction with them’. On the day of the visit there was evidence of family support and input and residents maintaining contacts with family and friends. The service users’ relatives who were contacted spoke highly of the service and said they were involved with their relatives care as much as they chose to be and were allowed to be, taking into consideration the wishes of the client. The manager reported that families are involved in the home life and a number participate in the entertainment and social life of the home. Responses on the comment cards received from relatives by the inspector indicated that they were always made welcome at the home. Service users have unrestricted access to all parts of the home. The home has one main lounge area and each wing of the home has a small quiet lounge area. These areas are not used and in one particular wing the area has become a dumping ground and storage area for equipment and boxes of all sorts. The manager reported that service users do not use this area. This was discussed with the manager that the area would not be readily accessible as a sitting area even if the service users chose to sit there and that it must be made available for them to have the choice. The long stay clients have routines for their going out and the activities of daily living and the inspectors found it difficult to case track their care needs or whether they were living a life that met their expectations and aspirations. The service has a full and a part time cook. The inspectors were informed that the service users discuss menus with the cook at resident’s meetings, the Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 20 cooks get to know the residents likes and dislikes and any special dietary requirements from the staff and the residents themselves. The menu for the day is displayed on the resident notice board in the main dining room and one resident with whom the inspectors met with, could confirm what was on the menu for that day. The cook orders fresh foods from local grocers and butchers. Photographs of residents participating in a healthy eating day demonstrate the home takes an interest in the resident’s personal health and dietary requirements. The cook confirmed that the home will cater for special diets although they do not get specific training, information is obtained from booklets and guidance provided by the hospital. The manager must ensure his staff are trained to understand therapeutic diets that relate to resident’s health care needs i.e. diabetes. Residents can buy or bring in their own foods if they wish. The inspector spoke to the service users who reported that the food was good. A relative spoken with reported that the food and menus had improved a great deal as at one time it was not good and looked unappetising. Another service user’s relative reported that his son watches his diet, being wheelchair bound, he does not want to become overweight and will eat salads rather than high calorie meals. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 21 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): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in a way they prefer. The service users health, emotional and psychological needs are not fully met. The storage of medication must be reviewed to ensure that it is stored in an appropriate trolley to enable the administrating practitioner to visit each person with the trolley and maintain the procedures that underpins the new policy. Service users are not encouraged to maintain their own medication to selfmedicate as part of their programme for independent living. EVIDENCE: A personal care policy is now in place as required from the previous report and was viewed by the inspector. A service user spoken with confirmed that she receives care only from female carers, as is her preference, which is documented on her records. The service users have access to members of the primary care team who visit the home on request. The occupational therapist visits the home weekly and Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 22 one client was receiving treatment from a physiotherapist. There is a separate record maintained in the care plans of when any member of the primary care team attend the home to give medical intervention. A service user requested to speak to the inspector at the end of the first day of the site visit. He reported that he was very unhappy with having a urinary catheter inserted and that it was causing him pain and distress. This was discussed with the manager in the presence of the client and it was advised that a GP should be consulted. The following day the manager reported that he had encouraged the client to ring the GP himself and subsequently the twilight district nurse came and removed the catheter. All this was recorded in the care plan for this man. The service user reported to the inspector the next day that he was far more comfortable. His care manager also discussed this situation with the inspector and reported that there are problems with continence management for this particular man and that it is not always easy to rationalise with him his inability to be independent with continence management. In general, service user’s rehabilitation needs are not met by a multidisciplinary team in the home and clients are only referred to a specialist professional practitioner to visit the home when a crisis arises or as part of an assessment process. The staff spoken to demonstrated that they understood the health care needs of the clients in residence. One staff member had recently received training to gain knowledge and understanding of epilepsy. One client who was resident at the time of the site visit is a severe epileptic and is prone to frequent seizures. The management plan for this man is to call the paramedics if his fit extends for a long period. The policy in the home is that no staff can undertake the administration of medication that is invasive. The manager reported that the ambulance service is always very responsive to their calls. The inspector discussed the likely hood of staff receiving training and being deemed competent to undertake such tasks in the case of an emergency, the manager was reticent to take this suggestion forward. The care plans viewed at this site visit did not identify clearly how service users emotional, psychological needs were met or whether there was any professional intervention in place to meet their needs. The manager reported that one young service user was displaying uninhibited behaviours to the opposite sex. There was a need for his needs to be given consideration, but they were not being addressed. This young man hopes to eventually live independently in the community and therefore his exhibiting behaviour must be considered when planning discharge. The inspector observed that a severely disabled young person with no verbal communication skills was able to understand her carer’s sign language to her and was able to communicate with her freely. The carer reported that she had learnt sign language many years previously and she was one of the few carers that could communicate with this service user. This is to be commended for meeting this young persons needs. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 23 The home has received the final draft of the new Portsmouth City Council medication policy. The home has a blister pack system for those clients who are long stay. For the respite care residents, the boxes, bottles etc. that they are dispensed in are taken to the home, an audit of what is brought in is documented and signed for by the receiving staff, then when the resident goes home another audit takes place and the responsible person collecting the resident for discharge will sign to agree the numbers of tablets etc, that are returned to them. The inspector spoke to two parents who were collecting their daughter. They showed me the process of this system and how the medication is signed in and out. They reported that they had never had any problems with this system. The inspector observed the morning medication being distributed. The deputy manager was undertaking this and was seen to take the blister pack from the locked cupboard, dispense the medication into a pot and take the pot to the appropriate service user and then sign the MAR sheet as being administered. The system of administration and the position of the drug cupboard were discussed as being a long-winded procedure. The home is taking delivery of a drug trolley that will be used to take around the home to administer medication to individuals. The deputy manager reported that the cupboard positioned in the office is not ideal and that medicine trolleys will be positioned on an inner wall and locked to that wall in a designated part of the home and will be taken out of the office completely. At the present time the controlled drugs cupboard is within the drug cupboard in the office and that will remain there. There were no service users receiving controlled drugs at the time of the site visit. The inspector spoke to the newly appointed senior practitioner who has responsibility for the ordering and co-ordination of medicines. He described his process and reported that he always views the prescription sheet before going to the pharmacist for dispensing to ensure the correct medication has been ordered and that the home will not receive unwanted stocks of ‘as needed’ drugs. Self-medication was discussed with the manager. He reported that a selfmedication policy and procedure is being developed. The inspector suggested that this was the way forward for the clients wishing to be more independent and an integral part of the preparation and rehabilitation for those clients who wish to move into the community to independent living. The inspector spoke to one of the service users and asked how she received her medication. She expressed a wish to self-medicate. This was discussed with the manager who reported that this client’s memory was not good. It was discussed that this is all part of the risk assessment and should be tested on long stay service users who wish to manage their own medication. The inspector was shown a training programme on management of medication, which evidenced that two dates had been identified for all senior staff to receive training within those two dates. This training was being accessed through the local authority. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 24 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including viewing documentation and records. The home has policies and procedures to protect service users from abuse. Staff training needs to extend to all staff employed in the home. The home has a complaints procedure that service users and some relatives are aware of, they feel that their complaints will be listened to and responded to within an appropriate timescale EVIDENCE: The complaints policy makes clear the procedure for how service users and their relatives/advocates can make a complaint. The inspector received six relatives comment cards. One out of the six acknowledged their awareness of the procedure. Two refrained from completing this question and the other three indicated that were unaware of how to complain. The manager must ensure that the complaints policy is readily available. The home maintains a log of complaints, which the inspector viewed. One complaint had been logged recently and the deputy manager was investigating this. The process so far is that the service user has been interviewed and the staff member is being interviewed imminently, within the constraints of the human resource department’s policies. The service user is being reassured that his complaint has been taken seriously and is being dealt with. The inspector saw the documentation of these records and procedures have been followed appropriately. A number of service users were asked what they would do if they wanted to complain. They all said they would say to the care staff or the senior staff if they wanted to complain about anything. Relatives spoken to over the phone said unreservedly that they would go to the manager if they Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 25 wanted to complain about anything. One relative said she had complained once and was very satisfied with the quick response she had received. Another relative reported that she has a complaints leaflet and would know how to go about complaining if ever there was a need but she considered her sister was cared for very well and the staff understand her communication difficulties. The inspector viewed the adult protection policy, which guides how the home should deal with allegations of abuse. The manager talked through procedurally how he would deal with a situation. The manager described three levels of abuse training provided for the staff. Abuse training is not covered in the induction to care programme, which is workbook based and is in the process of being reviewed and updated in line with the skills council induction programme. A number of staff spoken with have received some training in adult protection but more training must be given to all staff to include ancillary staff also. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 26 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, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service and touring the home, speaking with service users. The home does well to provide a spacious and clean environment for the service users to live in. Further improvements are needed to the aesthetic appearance in the respite care/short stay rooms. Improvements are needed in procedures for infection control and safety. Equipment is not stored appropriately and communal space must be usable and fit for purpose. EVIDENCE: The inspectors toured the premises. The home is single storey and purpose built to accommodate people with physical disabilities and is spacious, clean, bright and airy, and is divided into 4 sections identified by a colour code. There is a separate flat accommodation next to the kitchen area and away from the other bedroom areas. There have been decorative improvements to some areas of the home and new furniture and carpets have been bought. The home appears to have plenty of storage rooms, however the inspectors found some areas of the communal space in the home to be inappropriately storing unused furniture and activity equipment and could not be used for their stated Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 27 purpose. The manager claimed there is not enough storage space, however better housekeeping in some of the stock rooms would allow for extra storage. During the tour of the building the inspectors observed on 3 occasions cupboard doors unlocked that specifically stated they should be kept locked. The food storage was one and another stored equipment and cleaning materials. The home accommodates long and short term care residents and the manager would like to adapt one of the wing areas into a rehab facility, however currently the two existing services provided share the same facilities including staff resources. It must be acknowledged that staff would need training and support to effectively support a rehabilitation programme for service users. The home has recently been refurbished with new windows and external doors to some areas of the home, including the dining room/lounge that leads out to a pleasant courtyard garden. The inspectors observed that the threshold was raised and poses a risk to the residents. The manger was informed that this must be addressed and in the interim a risk assessment undertaken on all exits where new doors have been fitted. Other areas of the environment identified as a concern: 1. The external cladding is broken and weather worn in some areas. 2. The gardens are poorly maintained and pose a risk to the residents, tripping hazard from weeds and moss growing between flagstones. 3. The greenhouse used by residents has broken windows panes and is in general disrepair. Service users, who are resident in the home, have rooms that have been tastefully decorated and furnished with quality furniture and furnishings and personalised to reflect their individuality, hobbies and interests. One resident spoken to at the time of the visit was very pleased with her room. Another service user told the inspector that he has purchased all his own furniture and had the room to his taste. However, for service users accessing the service for respite care, the rooms are basic and in some cases lack a homely appearance. The rooms are furnished with quality furniture, however aesthetic improvements such as pictures are required. The facilities to support residents/service users with their physical disabilities are very good, with overhead tracking, low light switches and waist height plug sockets, handrails throughout the building, raised toilet seats, mobile hoists and automatic doors. Residents who freely enter and exit the building have a tagging system on their chairs that activates the front door. All the rooms meet the required standard size to assist residents with mobility difficulties. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 28 At the time of the visit the homes boiler was being repaired. Individual thermostatic controls have been placed on radiators, however the manager explained the pipe work was not compatible for this and therefore the pipes need replacing. The home was an appropriate temperature and service users reported they were comfortable. Kitchen equipment designed to be height adjustable and which has been installed in three kitchen areas around the home is not being used to its potential as a rehabilitation aid to teaching and practicing living skills. As discussed before the home has not the staff or the resources to use these areas effectively as part of programmed rehabilitation. The inspector felt this was a wasted facility and missed opportunity for service users whose goals are to live independently. A care manager spoken with reported that two of the clients at the home are attending an outside day centre for rehabilitation, with a view to moving into the rehabilitation flat in Portsmouth, but these clients are unable to continue with the programme when they return to the home. The home offers a clean, pleasant environment, however the manager must pay particular attention to minimise the risk of cross infection. The inspectors found overflowing sanitary bins in a service user’s room and the manager’s response to this was confused and conflicted with appropriate procedures and could only explain that the bins were only collected from the rooms by the waste disposal contractors once a week. The inspectors reiterated that this was unacceptable practice and left service users vulnerable to infection and that carers must take responsibility for ensuring bins are appropriately emptied and cleaned as part of the holistic care of the service user in meeting their needs. The home has two sluicing areas, however the practice of soaking bedpans and bottles does not meet the demand of the home and therefore the manager must consider alternative solutions for appropriately and efficiently cleaning them. The inspectors observed a cleaning agent left in the laundry area unattended and not locked away in a cupboard as per COSSH guidance. This was discussed with the manager. The home employs a separate cleaning staff that is adequate to maintain a good standard of cleanliness in the home. The housekeeper was spoken with and she said she had received training in health and safety issues and they she was aware that all her cleaning materials and trolleys must be locked away when not in use. She reported that she considers the home maintains a good level of cleanliness throughout the 7 days of the week. Relatives spoken with were satisfied with the environment and considered it to be clean and homely. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 29 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): 32, 34, 35 & 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff are supervised and given mandatory training but need to be provided with more service specific training appertaining to the client group in residence. Service users are supported by the home’s recruitment policies and practices within the limitations of what information the human resource department will share and what records are maintained in the home. The appropriate staffing levels necessary for the home to meet service user’s needs, remain unclear in relation to the purpose of the home, which states that rehabilitation is not provided. EVIDENCE: At the time of this visit staffing rotas were viewed. The manager reported that that morning there were fourteen service users in residence. There was the unit manager and deputy manager on duty with one ‘senior practitioner’ plus four care staff. One extra staff member was on duty because there was a respite care service user who needed one to one carers whilst in residence. Staffing levels would suggest that this was sufficient for the number and dependency of the service users at the time of the site visit. However, this staffing level would not meet the needs of the service users if there were active rehabilitation programmes in place. The manager reported that agency Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 30 staff continue to be used when necessary but that it has lessened of recent but there were two agency staff on duty at the time of the site visit. The home has two vacancies at the current time and the home’s own staff are given first option of extra shifts, but agency are employed to cover sickness, maternity leave. The manager reports that it is difficult covering staffing rotas as some of the staff have fixed term contracts to work specific hours and that leaves them less flexible to work at times to meet the service’s needs. The manager was asked if he thought he had enough staff to meet the service user’s needs. He reported ‘yes’ but we could always do with more staff’. Service users were asked if they thought there was enough staff about, one said ‘yes but some staff are better than others’. Two parents were spoken with and asked about their relative’s care, they could not praise the service enough and said they do not know what they would do without this respite service and that the staff were excellent. Senior staff were observed to be office based and not actively involved with the care of the service users. The home employs separate ancillary staff to maintain the cleanliness of the home, the laundry and separate kitchen staff. The training matrix viewed identified that 10 care staff have undertaken their NVQ level 2 training and at the present time 5 are undertaking it. Discussion with the manager confirmed that once the current staff have achieved their NVQ level 2, the home will then have 50 of care staff trained to that level and a number to NVQ level3. A carer spoken with reported that she has applied to undertake her NVQ level 2 starting September, but she has not had that confirmed. The inspector also established from the matrix that staff are supported to attend mandatory courses, however courses relating to the specific needs of the residents are very poorly attended such as epilepsy, challenging behaviour and abuse awareness to name but a few. The inspector evidenced a certificate to demonstrate one member of staff had undertaken specific training in epilepsy. The manager reported that the training department supplied this matrix and he did not consider that it reflected all the training. He was advised to produce his own training matrix specific to the home to identify all the significant training staff have undertaken in the last 5 years. The manager must not rely on the training department to produce a training matrix for his staff, he must take responsibility to ensure that his staff receive appropriate training. The inspector spoke with the P/T cook. The cook informed the inspector that she had worked for the home since December 2005 but had many years experience in working in the catering environment. She has an existing certificate in food hygiene and will be going on health and safety and moving and handling training soon. However, her knowledge of special diets such as diabetes is guided by booklets and information provided by the hospital. The manager is advised to send the cook on training courses linked to her specific role such as diabetes, nutrition and healthy eating, and other specific training related to her role. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 31 The manager must also ensure staff receive training in care planning and the use of the new documentation to be implemented within the given timescales. A sample of four staff records was viewed. The P/T cook The handyman A long-term member of staff A newly appointed member of staff. There remains some confusion on what records should be held in the home, the manager informed the inspectors that a directive from the Commission for Social Care Inspection was that they did not have to hold records in the home but that they could be held centrally with Human Resources. The inspectors informed the manager that this would be clarified. All files viewed did provide e-mail evidence that all staff had a clear CRB, however no indication if a POVA had been applied for. The newly appointed member of staffs file indicated her start date was on the 14th November 2005 but did not get a CRB clearance until 20th December 2005. The manager said the member of staff was going through her induction period at the time and did not have unsupervised contact with residents. One of the files had an employment detail checklist. This indicated that the member of staff had a CRB, had provided ID, completed an application form and 2 references obtained, however there was no evidence of this format in the other three files. The manager said he did not get to see references, HR department approves these, and the inspector informed him that this was inappropriate. He reported that they were read out to him over the phone by HR department. The second day of the visit the administrator produced a list of all the personnel files she was going to the human resource department to obtain copies of and this was the explanation as to why the relevant information about each employee was not present in the home. This will be inspected again at the next inspection. Staff supervision does take place and is undertaken in a pyramid style from manager to senior care staff. The inspector spoke to three staff members and they confirmed that they receive regular supervision at which time training needs are identified. One carer said she felt disadvantaged with training and supervision when she was a temporary staff but now her contract is permanent she receives the appropriate training and supervision. All three staff confirmed they felt well supported within their roles by their supervisors. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 32 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, 39 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service and viewing records. The home is managed by a person who is qualified and experienced to run the home, however, the manager does not take full accountability to ensure the home is managed in the best interests of the service users. The manager has not developed an appropriate survey questionnaire for obtaining service user’s, relatives, advocates and other professionals involved in the service user’s care, opinions and levels of satisfaction with the service. The manager does not quality control systems in the home and therefore does not monitor the quality of the records maintained and the care services. Service users safety is compromised on occasions Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 33 EVIDENCE: The manager confirmed he has completed his NVA level 4 in management and is undertaking the registered managers award. The manager has been in this management post for five years. From the evidence collected from previous inspection reports and from viewing documentation it is apparent that the manager should have taken a more active role sooner in meeting the requirements from the previous inspection report. The registered manager should be taking more responsibility and accountability for the reorganisation and auditing of the care plans to ensure that the practices in the home have been prescribed by an appropriate person, are up to date and reviewed regularly with consultation of the service user/relative and that records confirm that planned care is being carried out and that the outcomes for the service users are documented. A relative spoken with confirmed that she considers the manager very approachable and would not hesitate if she wanted to speak with him. Staff also confirmed that the home is run in an open manner and the senior staff are available should they need guidance. The manager does not undertake internal audits on systems within the service. The manager reports that the senior practitioners undertake internal audit but the results could not be viewed. The manager reports that there are service user’s meetings every four weeks, at which time service users can voice their opinions and suggestions on how they would like to service to run. Records of these meetings are maintained. A service user survey has been distributed but this needs to be distributed more widely to include relatives, advocates, and other professionals involved in the service user’s care. Furthermore respite and short-stay service users/relatives should be included in this survey. The CSCI received six comment cards back from relatives. The general comments were very positive the one indication that information may not be readily available to all the relatives is that they did not know how to make a complaint. Four out of the six cards received felt that they were not consulted or kept informed of matters affecting relative’s/friend’s care and not consulted on their care. The manager would do well to undertake a service user/relative/advocate satisfaction survey and analyse the results to identify where improvements can be made and monitor the standards of the service. The inspector spoke to five relatives in all and generally they were satisfied with the care their relative was receiving but one or two comments from the relatives indicated that there were aspects of the life style led by some service users that would suggest that they needed to be enabled and consulted more about their hopes for their future. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 34 The reports from the Regulation 26 visits by a representative of the local authority have not been consistently received by the CSCI. The manager must ensure this is undertaken. The inspector viewed the fire logbook and which indicated that appropriate checks were undertaken on equipment. Pre inspection information received indicated that all systems for the home and other equipment have recently been serviced. There was no evidence to indicate that staff undertake fire training twice yearly but the manager reports the fire training is done in-house. There must be evidence that staff are receiving the training at least once a year from an accredited trained person. The report from the 6th March 2006 reported that the fire alarms were activated whilst the inspector was visiting the home and the staff demonstrated a good knowledge and took a calm and professional approach to the procedures and the evacuation of the building. The environmental risk assessment needs to be reviewed in light of the trip hazards identified on the newly fitted patio doors from the rooms. The door to the laundry room was found to be open and unsupervised and a cupboard storing COSSH substances was found to be unlocked. The manager must address this concern without delay. The inspectors randomly tested hot water outlets. The hot water outlet in a kitchen area, identified to the manager, was emitting extremely hot water and although there was a notice on the work surface to indicate this was very hot, a larger more prominent notice was recommended to the manager to be displayed. A risk assessment must be undertaken on this sink area. Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 35 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 1 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 2 25 3 26 X 27 X 28 2 29 2 30 2 STAFFING Standard No Score 31 X 32 1 33 X 34 1 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 X 1 X 1 X X 2 X Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 36 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 YA1 Regulation 5 & 12 Requirement The local authority must clarify the direction, focus and purpose of the service in terms of what the service provides and for whom. Once clarified the statement of purpose must be updated to clearly explain the exact purpose of the service. A Service User’s Guide must be distributed to all service users and made available to all potential service users and relatives/representatives. The assessment process for prospective residents must be reviewed to ensure the home accommodates only those people whose needs can be met, in accordance with the statement of purpose and the conditions of registration for the home. Assessments must be undertaken before admission. This was a requirement from the previous inspection with a DS0000044248.V289389.R01.S.doc Timescale for action 15/07/06 2. YA2 14(1) 31/07/06 Corben Lodge Version 5.1 Page 37 timescale of 30/04/06. 3. YA6 15(1)(2) Care records must be clear, factual, easily audited, organized and user-friendly working documents. They must reflect current and ongoing needs with agreed short and long-term goals and have evidence of service user involvement and agreement. This was a requirement from the previous inspection with a timescale of 30/04/06. The new care planning system must be implemented by the 31/08/06. Care plans must reflect personal goals and discharge plans for those service users on short-term /respite stay or who are in the process of being assessed for discharge to more independent living. This was a requirement from the previous inspection with a timescale of 30/04/06. 31/08/06 4. YA7 12(3) 31/08/06 5. YA9 14(4)(a) 6. YA19 12(1)(2) 7. YA20 13(2) The areas of the home 30/06/06 identified at the time of the visit and documented in the main body of the report must be risk assessed and documented strategies put in place to eliminate or lessen risk. Plans of care must be 31/08/06 formulated to meet the healthcare needs of the service users and in particular their emotional and psychological needs. A self-medication policy 31/08/06 must be formulated to DS0000044248.V289389.R01.S.doc Version 5.1 Page 38 Corben Lodge 8. YA20 13(2) 9. YA23 13(6) 10. YA24 23(2)(b) 11. YA28 23(h)(i) promote self-management of medication within a risk assessment framework. The home must take delivery of an appropriate trolley for the safe storage and administration of medication and be appropriately positioned within the home. The manager must ensure that all staff have received training in the Adult Protection procedure and have full understanding of what constitutes abuse and when the AP procedure must be instigated. The external cladding to the building needs attention and repair. The garden is in a poor state and must be maintained and made more pleasant for service users to use in finer weather. The patio areas outside the lounge areas around the home are uneven and have moss and weeds growing on the surface. This must be removed and made good, to ensure the safety of the service user, should they choose to use that area. The large greenhouse is in a poor state of repair and must be made good and smartened up to make it more aesthetically pleasing for the service users. A plan of action must be received by the CSCI within the stated timescales identified. The small lounge areas in each wing of the building must not be used as a storage area and must be DS0000044248.V289389.R01.S.doc 31/08/06 31/08/06 31/08/06 31/07/06 Corben Lodge Version 5.1 Page 39 12. YA30 13. YA34 14. YA35 15. YA37 cleared of rubbish and equipment and made fit for purpose and available to service users should they choose to sit in this communal space. 16 (2)(k) Waste bins in service user’s rooms used for soiled pads, must not be filled to overflowing and left for an undefined time until the waste disposal company remove them. The infection control policy and procedures must be reviewed to reflect the correct management of waste from the home. 19(a)(b)Schedule The registered manager 2 must take responsibility and ensure that all persons employed at the home have undergone appropriate recruitment checks and that he is satisfied these are satisfactory. Records and evidence of robust recruitment procedures must be maintained in the home for inspection. 18(1)(a) The registered manager must take responsibility to ensure that all staff undertake mandatory health and safety training and any specific training appertaining to the client group they care for. The registered manager must formulate a training matrix to enable training needs for individual staff to be identified and also what training has been undertaken by the staff. 24(1) The registered manager must take responsibility for the auditing and monitoring of the systems and care DS0000044248.V289389.R01.S.doc 31/07/06 31/07/06 31/08/06 31/07/06 Corben Lodge Version 5.1 Page 40 16. YA39 24(1) documents that underpin the practices in the home to ensure the service is managed to the benefit of the service users. The manager must seek, through a quality assurance process, the views and comments of residents, healthcare professionals; care staff/managers and relatives and other stakeholders of the services provided. Information gathered and analysed must be used to develop and improve the quality of service and the outcomes for service users at the home. This has been raised again as it has only been partially met. The registered manager must ensure that all substances hazardous to health are maintained within a locked environment when not in use. The registered manager must review the infection control policy to ensure staff are aware of good practice recommendations for the control of infection. A more prominent notice of warning of ‘very hot water’ must be displayed at the water taps identified as emitting scalding hot water. 31/07/06 17. YA42 13(3)(4) 30/06/06 Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 41 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 42 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Corben Lodge DS0000044248.V289389.R01.S.doc Version 5.1 Page 43 - 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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