Inspection on 07/12/05 for Elgin Lodge

This inspection was carried out on 7th December 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elgin Lodge 22/03/07

Elgin Lodge 02/03/06

Elgin Lodge 14/02/05

Elgin Lodge 30/06/04

Elgin Lodge 22/02/04

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

CARE HOME ADULTS 18-65 Elgin Lodge 25 Elgin Drive Wallasey Wirral CH45 7PP Lead Inspector Karen Barry Unannounced Inspection 7th December 2005 09:30 Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Elgin Lodge Address 25 Elgin Drive Wallasey Wirral CH45 7PP 0151 639 3074 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) Pinpoint Developments Limited Mrs Jane Richardson Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2005 Brief Description of the Service: Elgin Lodge is registered to provide care support and accommodation for eight adults with a mental disorder. Bedrooms are situated on two floors and comprise of six single and one shared bedroom. Four of the bedrooms have en suite facilities and several rooms have views across the river Mersey. The home is a two storey detached property set in a residential part of the Wirral on New Brighton promenade. The home is within a five-minute drive of Liscard town centre, which has a good selection of shops, banks and a post office. A local bus service is within easy reach of the home. Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The staff at the home did not know that an inspection would be taking place until the inspector arrived. Time was spent in the office discussing and viewing various records with the manager. Time was then spent talking to residents and staff regarding their views of living and working within Elgin Lodge What the service does well: What has improved since the last inspection? Environmental issues raised within last inspection have been addressed These included; • Replacing the wallpaper within the shared bedroom. • Re decorating the toilet near the staff sleep in room / Visitors lounge. • Undertaking a risk assessment regarding the temperate of the hot water from the hand basin in the toilet next to the staff sleep in room. Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 6 Other areas of the home have also undergone redecoration in order to maintain, a high standard of living environments for residents, staff and visitors to enjoy. The staff and residents are very pleased with their efforts to brighten the staff sleep in / visitors lounge. Apparently the staff painted this themselves and some of the residents painted picture frames that the purchased from a car boot sale to enhance the appearance and ensure a welcoming room and relaxing environment was achieved. Staff members continue to receive well documented supervision, however this is now undertaken on a two monthly basis as recommend by the previous inspector. 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. Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 & 5 Resident’s needs are assessed before they move into the home to ensure they can be met. Clear detailed information provided to residents before they move into the home ensures that they and their families know that the home will be able to meet their needs. EVIDENCE: The statement of purpose and service user guides where viewed. These where found to provide very clear detailed information regarding all the services offered within Elgin Lodge. These alongside a small information leaflet clearly help prospective residents, their families or representatives make an informed decision regarding the suitable of the home and the staff in meeting their needs appropriately. The inspector examined three residents files evidence was found to confirm that residents needs were fully assessed by the home and other professionals prior to admission. Detailed risk assessments were also seen, these indicated what actions had been agreed to minimise risks to resident’s health and well being whilst promoting independence and choice. The registered manager stated that prior to admission being arranged prospective residents are invited to visit the home on a trial basis. These visits give the resident and their representative an opportunity to meet the staff team, other residents and view the facilities being offered. This in turn gives reassurance that needs can be met appropriately. Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 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 the following standard(s): 6,9 & 10 There is a clear care planning and risk assessment system in place to provide staff with the information they need in order to support and meet the needs of the residents. EVIDENCE: Observations and discussion confirmed that residents and if necessary health professionals are involved in the preparation of individual care plans and risk assessments. It was noted that these are regularly reviewed to reflect the changing needs. Residents files where stored within the main office, which is locked when not in use, protecting the residents rights in relation to the handling of their confidential information. Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 10 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): 11,13 &16 Staff encouraged residents to be as independent as possible in their daily lives, whilst maintaining and developing their social, emotional and communication skills. EVIDENCE: Residents and staff confirmed that they regularly make use of community services, for example, visiting local shops, pubs and restaurants. It was noted that many of the residents are now able to access these facilities without the support of staff. During the inspection one resident had been out shopping in the main town centre with a member of staff. He confirmed that although he went out to local shops independently he felt more confident using public transport with staff present than he would if he was alone. Residents where observed undertaking small tasks within the kitchen and discussing various outings and activities with the staff and each other. Activities and social events in and outside the home are encouraged to ensure each person hobbies and interests are addressed, this includes providing Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 11 opportunities to access therapeutic or supported employment if the individual resident agrees this would be beneficial. The home had an unrestricted visiting policy between the hours of 10am and 9pm. Residents can entertain their visitors within the main lounge or if they wish to have a private meeting the can use their bedroom or the visitors lounge upstairs. Observations indicate that residents were treated with respect and dignity at all times by staff members. Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 12 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 Staff members have a wealth of knowledge and experience of working within Elgin Lodge and appear to have formed very good relationships with the residents to ensure they receive the right levels of support and assistance to meet their needs. EVIDENCE: Residents within Elgin Lodge require very little if any assistance with regards to meeting their personal care needs, however staff do give verbal prompts as directed within written care and support plans to ensure they any issues or concerns are addressed in a sensitive manner. Health & social records seen show that as and when necessary residents are seen by their GP and that staff within the home do their utmost to gain advice and direction from other professional when the need arises. The community psychiatric nurse visits most of the residents at regular intervals. All of these visits and any interaction / administration of medication by the nurse is recorded upon the residents file. Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 13 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): Polices and procedures are in place to ensure residents views are listened to and acted upon and that they are protected from abuse, neglect and selfharm. EVIDENCE: Examination of the home’s complaints book indicated that the home is extremely proactive in recording and dealing with any concerns or complaints raised by residents. There was evidence to show that any such issues have been dealt with in a prompt and professional manner. The home also had a copy of “Protecting Vulnerable Adults in Wirral”. The manager confirmed that staff members have received relevant information and guidance regarding dealing with allegations of abuse etc. Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27 & 30 The home provides a clean and comfortable environment, there are sufficient toilets and bathrooms within the property and residents bedrooms appear to suit their needs. EVIDENCE: During the tour of the home all areas where found to be clean and tidy. Furnishings and fittings throughout the home were of a good standard and the décor was found to be bright and homely. A programme of redecoration and replacement of fittings is in use within the home. Residents spoken too confirmed that they are involved in the choosing of new items and colour schemes used within the home and that on occasions they have assisted with some of the decorating themselves. Bedrooms viewed reflected individual personalities and preferences. All bedrooms have suitable locks to ensure privacy for the residents. Staff members can override these locks in case of emergency. Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 &36 Recruitment and selection procedure are robust ensuring the safety of residents at all times. There is a strong emphasis on training and providing staff opportunities to develop their skills. EVIDENCE: An active staff training programme was seen in the home, which included a range of training sources, such as Halton College, the Social Services training centre, Wirral Metropolitan College, Health Call and Mill Lane Hospital in Wallasey. This ensures staff gain necessary skills and knowledge to perform their roles effectively. The home had a robust recruitment procedure. The inspector looked at two staffing files, these confirmed that a good standard of recruitment procedures is followed prior to staff being employed. Inspection of a sample of staff files evidenced that the supervision records were fully recorded, and that improvements have been made to the frequency that these sessions has increased. Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 16 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): 38,40 & 42 Elgin Lodge residents and staff benefit from a qualified and experienced manager, who ensures the health, safety and welfare of both residents and staff is promoted and safe guarded. EVIDENCE: During discussion with the manager it was clear that she was fully aware of her roles and responsibilities with regard to the running of Elgin Lodge for both the residents and her staff team. Throughout this inspection, she presented as a competent, effective and approachable manager. Observations indicated that the manager had a good rapport with the staff group. The health and safety of the residents and staff is promoted and maintained throughout the homes regularly reviewed polices and procedures. Records relating to routine maintenance of the building seen where found to be up to date. Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 17 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 4 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 X X 3 LIFESTYLES Standard No Score 11 3 12 X 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 X 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Elgin Lodge Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X 3 X 3 x 3 X DS0000018884.V271068.R01.S.doc Version 5.0 Page 18 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. Standard Regulation Requirement 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. Refer to Standard Good Practice Recommendations Elgin Lodge DS0000018884.V271068.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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. 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