Inspection on 06/09/06 for Cypress Lodge

This inspection was carried out on 6th September 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cypress Lodge 18/08/09

Cypress Lodge 04/10/07

Cypress Lodge 13/02/06

Cypress Lodge 24/08/05

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 & NE Somerset BS14 0QB Lead Inspector David Smith Key Unannounced Inspection 6 and 7th September 2006 09:30 th Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cypress Lodge Address The Witheys Whitchurch Bath & NE Somerset BS14 0QB 01275 891909 01275 892396 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) Mr Neil Bradbury t/a Bradbury House Organisation To be appointed Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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. 13th February 2006 Date of last inspection Brief Description of the Service: Cypress Lodge is an establishment 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. The current fee levels range from £1000.00 to £1750.00 per week, depending on the support needs of each service user. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit as part of a Key Inspection of this service. The inspector gathered information during this visit through discussions with service users, the Area Manager, Home Manager, Assistant Manager, Team Leader and Support Workers. Interaction and communication between staff and service users was also observed during the course on the inspector’s visit. Care plans and associated records were examined together with Risk Assessments, accident/incident reports, complaints log and health and safety records. The inspector was also provided with a tour of the home. Other sources of evidence have been used as part of the Key Inspection process. These include the home’s action plan in response to the last CSCI inspection, notifications of significant events and reports of the provider’s own monthly auditing of the service. The Commission also provided the home with a Pre-Inspection Questionnaire and Service User Survey Forms. The Questionnaire was completed and returned, together with five Service User Surveys. What the service does well: Each service user spoken with said they liked living in the home and were well supported by the staff team. Each service user questionnaire confirmed each person was satisfied with the service they received. Staff are provided with comprehensive information in order to carry out their duties and responsibilities and meet the needs of individuals. The home operates a thorough process to ensure all service users’ care plans are regularly reviewed and updated. The home actively seeks support from other professionals to help improve the quality of the service it provides to each person. Each service user is supported to take risks as part of an independent lifestyle. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 6 The arrangements in place to ensure individuals’ health needs are supported/ monitored are well maintained. What has improved since the last inspection? What they could do better: Medication administration procedures must be improved to help ensure the welfare and safety of each service user. Risk Assessments must be implemented for those individuals who are supported through restrictive interventions. This will help to ensure service users’ safety and welfare. The planned maintenance for the home must be completed. This will ensure a comfortable and homely environment for service users. All staff must be provided with both mandatory and specialist training, which includes appropriate refreshers/updates. This will ensure staff have the knowledge and skills to support each service user. All staff must be provided with regular supervision. This will help ensure they are supported to provide a good quality service to each person who lives in the home. The organisation must ensure an application for registration is submitted by the Manager as soon as possible to help ensure an accountable service for each person who lives in the home. Consideration should be given to improving the recording of incidents of challenging behaviour/physical interventions. This could benefit the review of service users’ support. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 7 The home should consider accessing specialist support in relation to service users’ sexuality and personal relationships support needs. This will help to ensure the welfare and safety of service users and staff members. The home should consider improving the collation and storage of service user records and staff personnel files. This would help to ensure an accountable service for all stakeholders. 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 DS0000008195.V304293.R01.S.doc Version 5.2 Page 8 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 Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 9 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. The quality in this outcome area is good. Prospective service users are provided with information they need to make an informed choice of where to live. EVIDENCE: The home has a comprehensive Statement of Purpose, which describes all aspects of the service including the home’s Aims and Objectives, Financial Arrangements, Services Provided, Complaints and Contracts of Residence. It was noted by the inspector that this document had been updated to include details of the newly appointed Manager, who has been in post for three weeks. This is good practice. There have been no new admissions to the home since the last inspection. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. The quality in this outcome area is good. Comprehensive care plans are in place that identify service users’ assessed needs and personal goals. There is a very effective process of review in operation. Service users make decisions about their lives and are given assistance as and when needed. The Risk Assessment process supports each service user to take risks. These are reviewed and updated regularly. EVIDENCE: Four service user care plans were examined in detail and these provided comprehensive information on the areas of support each person required. Care plans include a personal profile, Service User Plan, Weekly Timetable and medication profiles. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 11 There is a very effective review process in place. Annual review meetings are held with each service user, relevant Funding Authority, family members and staff. This is supplemented by the Monthly Keyworker Reports, which contain a summary of each service user in areas such as Lifeskills, Day Care, Trips, Free Time and Incidents. It was evident that all information recorded is used to review and update each care plan. These are reviewed every six months or sooner if service users’ needs change. The home provides a service for people who have complex needs, however all service users are encouraged and supported to make informed choices. Care plans clearly describe how to support each person with this process and what boundaries or limitations may be needed for some individuals. Service users spoken with told the inspector that they chose what they would like to do. If their choices are not immediately available or are not appropriate, staff will spend time explaining this and offer alternatives. The inspector observed this practice during his visit. Interactions between staff and service users were observed at various times during the inspector’s visit. These demonstrated the staff had a good knowledge of the support needs of service users and how to communicate effectively. Discussion between the inspector, service users and staff members also confirmed this. Each service user has a number of person centred Risk Assessments, which support them to take risks as part of their lifestyle. These form part of each person’s care plan and are subject to regular review. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15 and 17. The quality in this outcome area is good. Service users are supported to pursue activities which they enjoy, are tailored to their needs and which enable them to have a fulfilling lifestyle. Staff support service users to participate in their local community and to develop their potential. Service users are supported to develop/maintain family and personal relationships. Some service users may benefit from professional external support in some areas. The home provides healthy and nutritious meals. However, menu planning is due to be implemented to develop and improve this area. EVIDENCE: Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 13 The home continues to offer a structured and varied programme for each individual. Records examined show that service users are offered opportunities to develop independent living skills with documentation indicating the outcome of these sessions. There are a variety of opportunities offered to service users in relation to education and leisure interests. Service users access local colleges to attend courses of interest to them. They are also able to attend the organisation’s day care facility located at Bradbury House, a short distance from Cypress Lodge, and also placements at Bendall’s/Priddy Road Farm, a 236 acre site on the Mendip Hills. This site provides support to gain experience areas of Horticulture, together with daily cooking programmes, animal care, woodwork, walks and design/craft projects. Service users are also supported to use community-based facilities. Records examined show that service users are supported to go shopping, visit pubs, enjoy meals out, visit museums and enjoy trips to the coast. Holidays are arranged according to each service user’s preferences/needs and are supported by the staff team. During the course of the inspector’s visit, many service users were seen either following planned activities, such as attending college or going to the Farm, as well as others planning their free time with staff. Service users chose to go for walks, shopping trips and meals out. Service users spoken with and those that responded by completing questionnaires said they were able to choose courses or activities which they enjoyed. Staff supported them well in this area. Service users are supported to maintain close contact with their families and friends. Some regularly visit their families and visitors are welcomed to the home. During the inspector’s visit one service user went shopping with his father and another family visited the home to collect personal items for their relation who has moved to another of the organisation’s homes. Some service users do require support in relation to their sexuality or to develop/maintain personal relationships. It was apparent through discussions with the Area Manager, home Manager and Assistant Manager that the home is actively seeking external specialist support in this area. This is an extremely sensitive area to support people in and the inspector concurs that it would be appropriate to access specialist support/training to enable staff to facilitate a meaningful and safe programme. The home provides healthy and nutritious meals and promotes healthy eating with each service user, although this can be challenging at times. However, there is no formal menu planning in operation at present and this is currently being addressed. It is hoped that a formal menu plan can make best use of Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 14 seasonal foods and reduce the amount of waste. The manager told the inspector this will be implemented shortly and service users will be fully involved in this process. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 15 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 and 20. The quality in this outcome area is adequate. The care plans clearly explain the support each service users requires in relation to their personal and health care. Staff have a good knowledge of each service user and how to provide appropriate levels of support. A monitored dosage system of medication for service users is in operation. Medication administration, storage and staff training must be improved to ensure the welfare and safety of service users. EVIDENCE: The care plans in place for service users provided clear guidance for staff on how they should support those living at the home with their personal/health care. The care plans examined showed that service users were registered with a local GP, dentist, optician and chiropodist. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 16 Staff are required to compile monthly health checks for each service user as part of their Keywork responsibilities. These checks cover areas such as visits to the GP, Dentist, Optician and Chiropodist. There are also records of any injuries sustained and clear records of each service user’s weight. Other specialist services are accessed when an identified need arises. These are provided by Bristol South Community Learning Disability Team. Care records show the Consultant Psychiatrist and Psychologist regularly support the home. Contact with each professional is recorded and forms part of each persons care plan. Despite the recent staff changes, a core of experienced staff remains who have a good knowledge of service users health care needs. Staff would act on any concerns they have and the quality of the record keeping in this area would help identify areas of concern. The inspector observed staff interacting with service users within the home and it was evident that they are sensitive to the personal/healthcare and emotional needs of those using the service. The home uses the Boots Monitored Dosage System of medicine administration. Medication storage and administration was examined in Cypress Lodge during this visit. One service user had three tablets missing from their medication blister packs, with no clear record evident on the current medication administration sheets to explain this. This was discussed with a senior member of the staff team who confirmed that medication had been dropped/spoiled so the last tablets in this 28-day cycle had been dispensed in their place. They did agree this was not recorded on the current records but did show the inspector the previous month’s records where a record had been made. Staff meeting minutes record ongoing discussions within the team relating to poor medication administration. During the August 2006 meeting this had been described as being “farcical”. It is apparent that issues remain and the recommendation from the last inspection to provide staff with accredited training in relation to medication administration is therefore repeated in this report. The home must also ensure that any errors in dispensing medication are reported to the Commission in accordance with regulations. The mediation is currently stored within old filing cabinets, which are kept locked. The Manager told the inspector that new medicine cabinets would be ordered to replace the filing cabinets to improve storage facilities. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 17 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 and 23. The quality in this outcome area is adequate. The complaints policy and procedure is robust, clear and effective and there is every indication that service users feel their views are listened to and acted on. Clear reactive strategies are in place for each service user who presents challenging behaviour. Risk Assessments must be completed for each individual supported through restrictive physical interventions. The staff team are provided with training and support to ensure the welfare and safety of service users. Refresher/update training must be provided for some staff. EVIDENCE: The home has a comprehensive formal complaints policy and procedure in place to ensure that all stakeholders are listened to. The home also has a whistle blowing policy to enable staff to raise any concerns they may have. Each of the questionnaires completed by service users confirmed each individual knew how to make a complaint or who to speak to if they were unhappy. There has been one complaint, from a service user’s family, recorded since the last inspection. The records examined show that the complaint has been taken seriously, investigated in accordance with the complaints policy and the Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 18 outcome recorded. The home is currently awaiting a response to the outcomes of the investigation from the complainant. The home has clear guidelines in place for supporting service users who are distressed or presenting behaviours which may be perceived as challenging the service provided. Each care plan has details of known trigger points and the appropriate defusing techniques. Staff receive regular training in responding to these behaviours using the NAAPI system, which is accredited by the British Institute of Learning Disabilities. The home’s policy in relation to challenging behaviour has been written in accordance with the Department of Health’s Guidance on Restrictive Interventions. The home however is yet to develop and implement Risk Assessments in relation to individuals who require physical intervention as part of their behavioural support plan. These should be developed and implemented as soon as possible and the Requirement form the previous inspection report is therefore repeated. Staff training records show however that two members of staff should have been retrained in the NAPPI system in May and August 2006 respectively. Three members of staff are also due to be retrained this month. The Manager told the inspector that a training session has been planned to ensure any new staff or staff due refresher training would be provided. Staff record each incident of challenging behaviour. These records describe the incident, diffusing techniques used, staff members involved, timings and details of any physical interventions used. The manager then signs these records. Consideration should be given to improving/redesigning these forms as they fail to ensure staff always record antecedents, setting conditions and the exact time during incidents when physical interventions are used. An improvement in this area may provide additional protection for service users and staff and benefit the review of behavioural approaches by providing more information from staff regarding each incident. Staff are provided with training in relation to the Protection of Vulnerable Adults and are subject to Criminal Record Bureau enhanced disclosures. The home maintains records of all accidents and incidents. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 19 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 and 30. The quality in this outcome area is adequate. Although the home was clean and tidy, and the environment is currently being improved, the planned building/maintenance must be completed to maintain safety, comfort and provide a more homely environment for the service users. Each person has decorated and furnished their bedrooms to suit their individual tastes and needs. EVIDENCE: Cypress Lodge is a large house, set in its own grounds, which blends in well with the local community. In the grounds of the property is Willow Cottage, a home for four people with Learning Difficulties. The inspector viewed all communal areas of Cypress Lodge and Willow Cottage, together with service users’ bedrooms where appropriate. All communal areas of both the homes were clean and tidy on the days of the inspectors visit. All of the service users’ bedrooms were clean and tidy and were personalised with individual belongings, pictures and photographs. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 20 The home employs a member of staff to clean both homes. They work on a part time basis and were seen working on both days of the inspectors visit. Each of the service users spoken with and those who responded by questionnaire said they liked the environment and that it was always ‘fresh and clean’. A new kitchen extension has been built on to Cypress Lodge. This is tastefully decorated and had been fitted with good quality fixtures and fittings. The old kitchen area remains and is now used solely to support service users with learning or developing independent living skills, such as cooking or laundry. The communal areas of Cypress Lodge have recently been redecorated, whilst the communal areas of Willow Cottage were being painted during the inspectors visit. It was apparent that the planned maintenance was in progress, but will take some time to complete. The inspector did recognise areas within both homes which required attention. Examples being cracked/split panels in two bathrooms, lack of sufficient dining room chairs and lack of curtains in the lounge/dining room of Cypress Lodge, ceiling /tiling within the old kitchen area requires completion. Discussions with the Manager and Assistant Manager confirmed all of these areas, plus other works, have already been identified and will be attended to as part of the planned maintenance programme. The inspector accepts that this visit to the home occurred whilst the home is being refurbished and improved and is confident that when completed, the service users will be provided with a much-improved home environment. The Manager has agreed to provide a copy of the planned maintenance for the homes, together with a schedule of works. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. The quality in this outcome area is adequate. Staff have a clear understanding of their role and responsibilities in order to meet service users needs. Service users are supported by an effective staff team who have a good knowledge of their support needs. The home’s recruitment policy promotes both individual’s rights and their safety. Staff are provided with training opportunities, however some training requires completion/updating and staff training records need to be updated regularly to accurately reflect the training they have received to enable them to support service users. All staff must be supervised on a regular basis and a clear record maintained in their personnel files. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 22 EVIDENCE: There have been recent changes within the staff team, however a core of experienced staff remain who have a good knowledge of each service user and they support needs. Staff were observed interacting with service users and discussions with staff showed they had a good knowledge of service users and how to offer them appropriate support. Service users spoken with told the inspector that they liked the staff team and were well supported by them. Each service user who responded by questionnaire said they were always treated well by the staff team. Staff spoken with told the inspector that recent events have had an impact of the staff team. The Manager who had been in post for some time has moved on to manage another of the organisation’s services. Also, some experienced staff have also moved to other homes. Staff feel this is a period of change but also told the inspector they had been well supported by the Assistant Manager and Team Leader during this time. The recruitment of new staff to fill the current vacancies is in progress and two new Support Workers will commence in post once they have provided satisfactory Criminal Record Bureau Disclosures. The staff team meets monthly. All meetings are recorded and appropriate subjects are discussed in order to guide and direct staff practice. Records of meetings show that attendance levels are generally high. Staff are required to sign to confirm they have read the minutes of each meeting. The home operates a robust recruitment process and the records examined included application forms, job descriptions, two satisfactory references, documents confirming proof of identity, induction checklists, training records and Enhanced CRB Disclosures. Staff are provided with a variety of training opportunities, provided either by the organisation or external training providers. Records examined showed that staff are provided with mandatory training such as First Aid, Food Hygiene and Protection of Vulnerable Adults. More specialised training includes epilepsy, mental health, NAPPI, Diabetes and LDAF. These training records however showed that some staff have not completed all mandatory training and others required refresher training in some areas. The inspector found it difficult to track staff training records as the staff-training matrix stored on the computer had not been updated, the manual system also Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 23 in use did not correlate with the computer records and the training records within staff personnel files were incomplete. The training matrix in use in the home must be regularly updated. This will ensure all staff are provided with training to maintain or update their knowledge and skills to enable them to provide support to the service users. It could also provide the manager with a useful tool in tracking all staff training requirements, if it were to be kept up to date. Copies of all training certificates could also be included within staff personnel files to evidence the training courses they have attended. Staff are formally supervised during 1:1 meetings with their line manager. It was however noted by the inspector that staff are not being provided with regular supervision. Whilst the inspector acknowledges the recent changes within the team is a major factor, it is important to re-establish regular supervision meetings as staff spoken with feel these sessions are valuable and support them in their roles. The Manager told the inspector that this issue was being addressed and that regular supervision meetings would be reinstated for each staff member. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 and 43. The quality in this outcome area is adequate. The home has effective procedures in place to provide service users with the support they require. The organisation must ensure an application for registration is submitted by the Manager. The ethos of the service remains clear and this is communicated throughout the service. Service users are encouraged and supported to express their views regarding the service they receive. Record keeping within the home is designed to ensure the rights and best interests of service users are safeguarded. However, improvements are required in some areas. The health, safety and welfare of the service users is promoted and protected. The home has now improved fire procedures and protocols in order to ensure the health, safety and welfare of both service users and staff. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 25 EVIDENCE: Since the last inspection the Registered Manager has left the home, to manage another service within the organisation. The new Manager, Miss King, has only been in post for three weeks and is currently being inducted into the home. She supported the inspection, together with the Assistant Manager who has been effectively managing the service since the previous Manager left the home. The inspector spoke with the new Manager at length and it was evident that although they are new to the home and currently employed on a probationary period, they are clear on their role and have already identified several areas where either improvements can be made or new ideas implemented. They are enjoying their induction, which is being supported by an experienced manager within the organisation who works at Cypress Lodge for two days each week. The organisation must ensure an application for registration is submitted by the Manager as soon as possible following successful completion of the probationary period. The home supports service users with complex needs and the ethos is to ‘encourage independent living within the scope and abilities of each service user’. Both the manager and staff spoken with remain clear on these points and it is evident that some service users have made significant progress since moving into the home. Service users’ views are sought but due to their complex needs this is a challenge for the service. The recent introduction of regular ‘self advocacy’ sessions appears to be successful. During these sessions service users have a 1:1 discussion with a staff member with whom they have a good relationship or who knows them well. Each service user is encouraged to express their feelings in relation to the home and support provided as well as other issues personal to them. Staff spoken with feel this is a positive development. Service users spoken with said the staff listen to their views. Those who responded by questionnaire said the staff either ‘always’ or ‘usually’ listened and acted on what they said. The registered provider’s representative makes regular visits to the home, and produces a comprehensive report of his findings, which is send to the Commission on a monthly basis. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 26 Management systems and structures are in place, but their use has become inconsistent. The record keeping is generally of a good standard, however there are exceptions to this. Care plans and most other documentation relating to service users are well organised and easy to access. Staff training records require improvement, as mentioned previously in this report, as well as staff personnel records and some details of service user review meetings and/or additional correspondence relating to them. At present these records are stored within ‘drop files’ in one of the offices. It was apparent that a significant amount of this documentation could be suitable for archiving, or alternatively be filed in a more systematic way. This would enable much easier access to records and help to ensure that only information which is current/relevant is readily available. The Manager told the inspector she had already identified this as an area which needed to be improved upon. There are recording systems in place to support Health and Safety within the home, which are being used consistently. Records examined included generic health and safety checks, COSHH products, risk assessments, water outlet and fridge/freezer temperature recording. All of these records were in order and checks were up to date. During the last inspection an immediate requirement was made for the home to review its fire safety procedures. The inspector therefore examined records of fire drills, fire alarm system checks, fire fighting equipment checks and found these to be in accordance with the Avon Fire Log guidance. The home has also introduced regular fire instruction for staff by using a ‘Fire Awareness Questionnaire’ which covers areas as fire procedure, fire checks, fire extinguishers, break glass points and fire safety record keeping. Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 27 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 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 4 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 3 3 X 2 3 3 Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement Ensure medication administration procedures are improved within the home to ensure welfare and safety of service users. Ensure Risk Assessments are implemented for each service user who requires restrictive physical interventions. (This requirement is repeated 07/12/06 from the last inspection) 3. YA24 16(2) 23(2) Ensure the planned maintenance/improvements are completed to ensure a safe, comfortable and homely environment. Timescale for action 07/10/06 2. YA23 13(5) 13(7) 07/03/07 4. YA35 18(1) Ensure all staff are provided with mandatory and specialist training to enable them to support each 07/12/06 service user. All staff must be supervised on a regular basis and a clear record of each meeting be maintained. 5. YA36 18(2) 07/09/06 Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 29 6. YA37 9 Ensure an application for registration is submitted by the Manager. 07/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA20 YA23 YA15 Good Practice Recommendations Staff to receive formal training in the administration of medication. Review/improve the recording of each incident of challenging behaviour/physical intervention. Consider accessing specialist external advice/training to develop sexuality and personal relationships support for service users. Consider improving the collation and storage of service users records and staff personnel files. 4. YA41 Cypress Lodge DS0000008195.V304293.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 DS0000008195.V304293.R01.S.doc Version 5.2 Page 31 - 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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