CARE HOME ADULTS 18-65 Eleanor Lodge 25 Camborne Close Delapre Northampton NN4 8PH
Lead Inspector Sara Morrison Unannounced 4th April 2005 15:00 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. Eleanor Lodge Version 1.10 Page 3 SERVICE INFORMATION
Name of service Eleanor Lodge Address 25 Camborne Close Delapre Northampton NN4 8PH 01604 764583 01604 768920 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) Northamptonshire County Council Mrs Sally-Anne Greenfield Care Home 20 Category(ies) of LD Learning Disability (20 places) registration, with number of places Eleanor Lodge Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That 25a is a separate facility providing respite services for up to 3 service users within the Learning Disability Category. The Unit to have its own dedicated staff team. 2. That 25b is used to provide an assessment service for up to 3 service users within the Learning Disability Category and to have its own dedicated staff team when in use. Date of last inspection 6th September 2004 Brief Description of the Service: Eleanor Lodge is a purpose built home providing care and support for up to 20 adults with leaning difficulties, and is run by the Local Authority. The home is situated within a housing estate, with access to local amenities and transport. The home is divided in three distinct service areas, providing accommodation for assessment, respite and longer-term care. Assessment and respite are provided for a maximum of three people at any one time in houses 25a and 25b which are linked to the main unit by a door.The longer term care is sub divided into three areas each with its own lounge/dining rooms, kitchen, bedrooms and bathroom. These areas 4 people in a first floor flat geared towards independence; 5 people in the ground floor west wing and 5 people in the ground floor high support unit. Eleanor Lodge Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 5 hours during the afternoon and early evening and was unannounced. The inspection included a tour of all the communal areas in the building; inspection of some care records, medication and financial records; discussion with four of the eight staff on duty, discussion with five service users and the manager. What the service does well: What has improved since the last inspection?
The facilities, decoration and furnishings are much improved. The bathrooms all have modern good quality fittings; the bathroom on the ground floor has been adapted for people with mobility problems. The kitchens have been modernised and provide good facilities for service users to cook and prepare their food. Most of the lounges and dining areas have been improved and all are now very comfortable rooms that are nice to be in. In the large communal area there are lots of seating areas with coffee tables, soft lighting, cushions, ornaments and pictures that provide a very pleasant place to be. The manager now has a person to help her with the running of the home and they have worked hard to ensure service users and staff are happy. Eleanor Lodge Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Eleanor Lodge Version 1.10 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 Eleanor Lodge Version 1.10 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) 2 The individual needs of service users are assessed prior to them coming to live at the home. This ensures that all aspects of their physical and mental health needs are identified and where necessary guidelines are written for staff to follow in order to meet the needs. EVIDENCE: There is a file for each service user that has a comprehensive assessment document that is completed and highlights all aspects of physical and mental health needs. The service user signs this. The document includes a section for self help skills, focusing on service users’ abilities rather than disabilities. Service users said that they are confident that staff are aware of their needs and the assistance they require. One service user spoke about the management of her diabetes and said she is satisfied in the way in which staff help her with this. Discussion with staff demonstrated that they are knowledgeable about each service user and know how to assist them. Eleanor Lodge Version 1.10 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 Staff are aware of how individual needs of service users are to be met and gave good accounts of the action to take to meet the needs. However this was not always confirmed in writing presenting an opportunity for inconsistency in carrying out a task. EVIDENCE: Service users said they were satisfied that staff know how to assist them and are consistent in how they undertake particular tasks. It is evident that the staff do know service users well and have good communication with each other. However in two cases the information about particular needs was not available or not easy to find. The assessment for one service user detailed that she has diabetes and that guidelines have been produced for managing this. The guidelines were not in the service users file although a member of staff later located these in another part of the office. There was a reference in the assessment for another service user that he has an artificial feed delivered through a tube in his stomach at night as a supplement to his poor dietary choices. There was no other written
Eleanor Lodge Version 1.10 Page 10 information about this in his care plan for example food he particularly likes or dislikes, or guidelines for staff in how to encourage him to eat. Staff were observed to encourage service users to be independent and take risks in their lives. The upgrading of the kitchens within each area means that service users can learn and improve their skills in daily living, such as cooking and laundry. Service users’ files included a risk assessment tool that had been completed according to the skills and abilities of individuals. Eleanor Lodge Version 1.10 Page 11 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) 16 and 17 Service users are encouraged to be as independent as possible and are supported in a manner that protects their privacy and dignity. The evening meal looked and smelt appetising and was enjoyed by service users. EVIDENCE: Five relatives commented on their satisfaction with the service their relative receives. Everyone said they felt welcome in the home and were able to be private when they visited. The relatives considered that they are kept informed of important matters and are appropriately consulted. Service users were observed to move freely around the house and were respectful to each other. Relationships between service users and staff were positive; staff encouraged and enabled service users rather than taking over and controlling what they were doing. The cook prepares the main meal, which is then taken to the domestic style kitchen of each area. Staff and service users complete the meal preparation. Breakfast, drinks and snacks are all prepared in the smaller kitchens in each
Eleanor Lodge Version 1.10 Page 12 area. The mealtime during the inspection was relaxed and sociable and afterwards service users said they had enjoyed the food. Eleanor Lodge Version 1.10 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 The systems for the administration of medication are good with clear and comprehensive arrangements in place to ensure service users’ medication needs are met. EVIDENCE: A senior member of staff explained the medication system. There is a robust procedure for the ordering, stock control, administration and disposal of medication. Stocks of medication are kept to a minimum and are securely stored. Records are maintained and show a clear audit trail from the point of ordering through to disposal. Some medication on the administration record specified take ‘as directed’ by your doctor with no information as to what this meant. Wherever possible this should be referred back to the Doctor via the Pharmacist for clarification of the instructions. Service users said staff accompany them to the Doctor if they ask for this support and give them their medication regularly. Eleanor Lodge Version 1.10 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The complaints process is good, there is information readily available to service users and evidence that concerns are resolved promptly. EVIDENCE: There was information for service users about how to raise concerns and service users confirmed that they would speak to staff if they had any problems and would talk to the manager if necessary. It was evident that service users know the manager and felt free to talk to her at any time. The records show that there have been several concerns raised at stage 0. All of these were resolved and did not go to the next stage. Eleanor Lodge Version 1.10 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The standard of the environment is good providing service users with an attractive and homely place to live. EVIDENCE: Since the last inspection there have been major improvements to the premises. In particular the bathrooms and kitchens are now well decorated with good quality fixtures and fittings. Baths and showers have been replaced improving accessibility and independence for service users. One service user was very excited to show off the bathroom that he uses. Care has been taken to ‘dress’ the rooms for example in the bathrooms towels and accessories are coordinated. Several lounges and dining areas have been upgraded and provide a contemporary, comfortable atmosphere. Throws and cushions have been utilised on furniture that was still good but no longer fitted with the colour scheme. Soft lighting, curtains, coffee tables and ornaments have been used to create interest and a ‘homely’ feel to the rooms. Furniture has been creatively arranged in the large ‘high support’ area to create small seating areas that were seen to be well used by service users.
Eleanor Lodge Version 1.10 Page 16 There was a high standard of cleanliness and hygiene in all areas. Service users said they were delighted with the improvements. One person who has restricted mobility said that she was now able to be more independent in the bathroom. A member of staff said that the improvements in the environment have boosted the morale of the staff, she said she didn’t realise how much the previous poor environment was affecting everyone. Eleanor Lodge Version 1.10 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Staff morale is much improved; there has been a focus on team building and training resulting in an enthusiastic staff group who have sound values and who work positively together to improve service users’ quality of life. EVIDENCE: Since the last inspection a team leader has been appointed to a minimum oneyear post. The manager and team leader have developed a unit plan. Staff are in general allocated to work in one for the four areas of the home and a team day for each team was planned for the week following the inspection. It is the intention that each team will develop its own plan for the forthcoming year that links to the unit plan. The staffing situation has improved through recent recruitment and although the home is still using some agency staff this has reduced. A team day was held in November 2004 and the task/ responsibilities of staff were highlighted and agreed by all who attended. This list builds on the job description for each level of staff and is a practical guide of who does what. Training has been on going and the manager was pleased to report that the target of 50 of the staff achieving a National Vocational Qualification (NVQ) at level 2 in care has been achieved. New staff are automatically being put
Eleanor Lodge Version 1.10 Page 18 forward for the Learning Disability Award Framework (LDAF) training, the manager and team leader are both assessors for this award. Eleanor Lodge Version 1.10 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 and 39 After a period of upheaval due to the refurbishment the manager has a clear development plan and vision for the home, which once fully implemented will empower and enable service users to exercise more control over their lives. EVIDENCE: The manager has been dedicating a lot of time to day-to-day operation and running of the unit. It is agreed that her presence in the unit was extremely important during the recent works and previous low morale within the staff team. The appointment of the team leader will assist the manager in the overall, development of the service and will allow for some duties to be delegated. The manager has developed a unit plan and it is the intention that each staff team should develop a plan for each area that is linked to the unit plan. Practical steps have been taken by the manager to implement a file for each area that contains the area plan; an inventory of items, complaint and compliments forms, team meeting agendas, general message and a social
Eleanor Lodge Version 1.10 Page 20 event/activity log. The activity log is an at a glance reference for the activities both in house and in the community that a service user has participated in, there is a comment box to detail specific information, for example where an activity is offered but not taken up. The system for monitoring the home by the organisation has been developed and implemented since the last inspection. Members of Northants County Council Quality Team are now carrying out two out of three of the monthly visits. A tool has been developed and there has been one visit by the Quality Team. The manager said she felt that this review of the home was very thorough and is a positive step in quality monitoring. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 3 x x x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No
Eleanor Lodge Score Standard No 24 25 26 27
Version 1.10 Score 3 x x x
Page 21 6 7 8 9 10
LIFESTYLES 3 x x 3 x
Score 28 29 30
STAFFING x x 3 Standard No 11 12 13 14 15 16 17 x x x x x 3 3 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 3 x Standard No 37 38 39 40 41 42 43 Score x 3 3 x x x x Eleanor Lodge Version 1.10 Page 22 NO 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 Regulation Requirement None made. Timescale for action 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 made. Good Practice Recommendations Eleanor Lodge Version 1.10 Page 23 Commission for Social Care Inspection 1St Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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