Inspection on 24/08/05 for Cypress Lodge

This inspection was carried out on 24th August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cypress Lodge 18/08/09

Cypress Lodge 04/10/07

Cypress Lodge 06/09/06

Cypress Lodge 13/02/06

Cypress Lodge 18/03/05

Cypress Lodge 22/09/04

Cypress Lodge 23/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Cypress Lodge The Witheys Whitchurch Bath & N E Somerset BS14 0QB Lead Inspector Sarah Webb Unannounced 24 August 2005 09:15 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cypress Lodge Address The Witheys Whitchurch Bath & N E Somerset BS14 0QB 01275 891909 0117 9716716 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Neil Bradbury Mr Lee Janes PC Care home only 10 Category(ies) of LD Learning disability (10) registration, with number of places Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate 3 named persons under the registration categories MD & LD (because of their mental health needs as well as their learning disability). May accommodate people age 18-64. May accommodate up to 6 people in the building known as Cypress Lodge. May accommodate up to 4 people in the building known as Willow Cottage. Date of last inspection 18-Mar-2005 Brief Description of the Service: Cypress Lodge is an establishment owned by Mr Bradbury consisting of 2 properties, one named Willow Cottage and the other Cypress Lodge. Willow Cottage is registered to provide personal care for 4 people with learning disabilities; Cypress Lodge is registered to provide personal care for 6 people with learning disabilities. Both properties are situated on the same site, in a small cul-de-sac in a residential area of Whitchurch. The houses are within walking distance of local shops and there are transport routes to other local amenities and facilities. To the front of the property there is a garden with a pond; the back door leads to a rear garden and patio area, and access to Willow Cottage. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out as an unannounced inspection and took place over a period of 1 day and a total of 6.5 hours. The inspection methods used included record checks, case tracking, interviews with staff, the registered manager, and discussion with 1 service user. One of the two requirements from the last inspection is unmet whilst the other has almost been met but is still within the allocated timescale. One of two recommendations has been met. What the service does well: What has improved since the last inspection? Since the last inspection the standard of the décor has improved providing service users with an attractive and homely place to live. The new management structure ensures there is a consistent approach in the running of the home. The grounds have been well maintained involving consultation with neighbours. Staff appraisals have been implemented. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, & 4 Comprehensive accessible information is available for current and prospective service users in order to make a decision as to whether the agency is able to meet their needs. The home meets the needs and preferences of individuals through assessment review and consultation procedures. Prospective service users can ‘test drive’ a placement in order to make an informed choice. EVIDENCE: Both the Statement of Purpose and the accessible Service User’s Guide are in place and containing detailed information and meeting all of the requirements as outlined in the regulations. There were comprehensive and detailed assessments in place for a new service user implemented by both funding authority and the home. Through the homes assessment process that included several meetings with all appropriate agencies involved with the individuals care, the manager said the home was able to offer a placement. The individual has visited the home for both interim visits and overnight stay in order that they meet existing service users and staff and are able to make an informed choice regarding the placement. In order to meet this persons needs, arrangements have been put in place Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 9 currently to increase staff. The manager said this is to be reviewed on a regular basis. Staff continue to be supported through a specialist service in supporting an individual with a specific communication programme. It was evident that the home is meeting the care needs of the individuals; this was demonstrated through care planning and the home’s system of review. Observation of positive interaction between staff and service users demonstrated an understanding of both the staff role and individuals needs. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 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 standard(s) 6, 7, & 9 There is a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet the assessed needs of individuals. The home encourages individuals to make decisions regarding their lifestyle. Individuals are supported to take risks as part of an independent lifestyle. EVIDENCE: The home has continued to review individuals care plans on a 6 monthly basis. Those care plans observed were all up to date and had been reviewed, signed and dated. This is good practice. Information available for staff included behavioural aspects/triggers points and diffusing techniques, risk assessments, timetables and programmes, medication, life skills record, incident reports, monthly health checks, monthly keyworker reports. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 11 Risk assessments had been completed and reviewed on a regular basis. There were risk assessments in place for those individuals who presented behaviour that challenges- these were also linked into the care planning system. It was evident through documentation, that there are opportunities for individuals to make decisions with regard to their lifestyle. Protocols are in place for an individual to be supported in accessing the community independently. There has been no change to the practice of supporting individuals with their finances. There are individual practices in place for different service users regarding accessing their monies and there were signed records of financial transactions. There were comprehensive working guidelines for staff to follow and controls in place to monitor practice. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 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 standard(s) 12, 13, & 16 The home offers opportunities for individuals to take part in appropriate social and educational opportunities in order to enhance their lifestyle. The meals in the home are good offering both choice and variety and involve individuals in making choices. EVIDENCE: It is evident, through documentation and discussion with staff, that service users continue to be offered differing opportunities to be involved in meaningful activities both at the home and externally. Service users are able to access both of the organisation’s day centre and working farm. There was a record of activities offered externally and ongoing life skills programmes offered internally. All staff are involved in liaising with colleges and the attendance of service users on differing courses. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 13 It was evident through observation of records and discussion with staff that the home continues to offer opportunities for social interaction within the community through visits to local facilities. Documentation in place indicated that the home has systems in place to record meals offered to service users including individual food charts. Menus evidenced that a varied diet is offered and the quality of food is a prime consideration. There is no change to the practice of service users being involved in making daily choices in order to follow their individual food preparation programme. People are involved in discussion and can opt to have something different from what has been cooked. It is evident that there is a flexibility in making choices and it is an expectation that not all people will want the same food. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 The health needs of individuals are well met with evidence of multi disciplinary working taking place on a regular basis. Those individuals who need support with personal care receive this support in the way they prefer and require. The systems for the administration of medication are good with clear arrangements in place to ensure service users medication needs are met. EVIDENCE: There is no change in that all service users bar two are independent with regard to their personal care. Staff may need to give prompts to remind individuals on some aspects. One person continues to use a wheelchair when accessing the community, and uses a walking frame and other specific disability equipment in the house that has been provided through the support from specialist services. There were records in place documenting how individuals are supported with their personal care needs. One person has a hearing impairment and another a visual impairment. There is no change regarding service users accessing the local Health Centre. Monthly health checks, and all visits to the dentist, optician and chiropodist are recorded. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 15 The Community Learning Difficulty Team continue to provide an input to the home in supporting individuals through specialist services such as Community Psychiatric Nurse, Occupational Therapist, Dietician, Speech Therapist and Physiotherapist. Individuals are supported and medication is reviewed 6 monthly by consultant psychiatrist and psychologist. The home has a medication policy. Records indicated that some individuals have consented to being supported with their medication. Records evidenced that discussion takes place with specialist services in relation to those individuals who may not have the capacity to agree to health care intervention. Medication is kept secure in a filing cabinet in both homes. Medication was assessed at Willow |Cottage. The administration of medication was recorded appropriately as where all balances. There are procedures in place to dispose of unwanted medication. The manager has received medication training from Boots. He in turn trains staff during their induction in the administration of medication. The manager also said that regular medication updates are discussed at staff meetings in order to ensure there is a consistent approach. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 The home has a satisfactory complaints system with evidence that service users views are listened to and acted upon. The home ensures the safety and protection of individuals through appropriate measures. EVIDENCE: There have been no complaints since the last inspection. There has been no change in relation to the home’s complaints procedure; this is displayed in symbolised format in the home and includes the stages in responding to a complaint made including timescales. The home has procedures in place to consult with both staff and individuals regarding concerns and complaints. Processes continue to be in place for individuals to have 1:1 time with their key workers in order to discuss any issues individuals may have. The majority of service users are able to make their concerns heard verbally. The home has an adult protection policy in place. Staff continue to be trained through the organisation in the protection of vulnerable adults by a manager within the organisation. A CRB log was in place identifying CRB clearances received on staff members, the relevant ID number, and the outcome. The home has a policy on challenging behaviour and physical intervention. This complies with the DOH guidance. Staff are trained in Non Abusive Psychological and Physical Intervention (NAPPI) by a trainer within the organisation. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 17 The home complies with the CSCI by providing Regulation 37’s if any form of physical intervention is used with service users. A record is also kept at the home of any incident. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 29 & 30 Recent investment continues to significantly improve the appearance of the home creating a comfortable and safe environment for those living there. Specialist equipment is in place for an individual in order to support his independence. The home has benefited from a regular cleaner in order to maintain the cleanliness of the home. EVIDENCE: Both properties are situated on the same site, in a small cul-de-sac in a residential area of Whitchurch. A private driveway off the cul-de-sac leads to both properties. The houses are within walking distance of local shops and there are transport routes to other local amenities and facilities. The home has continued with a redecoration programme of Cypress Lodge. The lounge is still in the process of being redecorated; this is still with the required timescale from the last inspection. All bedrooms have now been decorated in Cypress Lodge and also two in Willow Cottage. The only area in Willow cottage that is in need of improvement Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 19 is in the kitchen where a drawer needs to be replaced. All other areas are still not in need of redecoration due to the home still being in good decorative condition. One person continues to use a wheelchair when accessing the community, and uses a walking frame and other specific disability equipment in the house that has been provided through the support from specialist services. A cleaner continues to be employed on a daily basis for 3 hours and it was noted that the home has benefited from this change with an improvement to the general cleanliness of the home. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, & 35 The home needs to set out an action plan for the training of staff in relation to National Vocational Qualifications. The home has well documented recruitment procedures in order to ensure the safety of individuals. Staff receive appropriate training related to individuals needs. EVIDENCE: The home will not meet Standard 32.6 regarding 50 of care staff achieving a National Vocational Qualification level 2 by 2005. Currently there are no care staff that have been registered for this qualification, but are completing LDAF; on completion of this they will then be registered for NVQ Level 2. Although the manager has explained verbally how the home is to approach the need for all staff to be qualified through a National Vocational Qualification, a requirement is unmet for the home to set out in detail in an action plan how this is to be met. The manager is qualified as a National Vocational assessor and is in the process of completing level 4. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 21 There were clear induction processes in place. Those staffing records seen included 2 references, CRB correspondence, statement of terms and conditions, and 3 month probationary documentation. It was evident through observation of training records that all staff are up to date with statutory training requirements of fire, manual handling, food hygiene, and first aid. Other training course attended included mental health, epilepsy, and diabetes. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 41 & 42 The new management structure ensures there is a consistent approach in the running of the home. There are procedures and protocols in place in order to ensure the health, safety and welfare of both service users and staff. EVIDENCE: The only change to the staff team is the newly appointed assistant manager. Both the manager and assistant manager said this new structure has helped to provide a consist approach in the management of the home. It was evident that the manager has had opportunities to put written guidelines for procedures in place in order to guide staff in ensuring good practice is carried out. Fire records indicated that appropriate checks of all fire equipment are carried out regularly and that staff attend regular fire training. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 23 Those records seen, such as Gas Safety certificate, water temperatures, electrical testing, and accidents were up to date. Other records seen have been included in the section of this report. Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x 3 3 Standard No 11 12 13 14 15 16 17 x 4 3 x x 3 x Standard No 31 32 33 34 35 36 Score x 2 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cypress Lodge Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x 3 3 x D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 25 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. 2. Standard 35 Regulation 18 Requirement Set out how staff are to be trained through national vocational qualifications Timescale for action 31/12/05 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 NONE Good Practice Recommendations Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 26 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cypress Lodge D56 D05 S8195 CypressLodge 238599 240805 Stage4.doc Version 1.30 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!