Inspection on 20/11/07 for Elizabeth Lodge

This inspection was carried out on 20th November 2007.

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

Elizabeth Lodge 12/11/08

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Elizabeth Lodge Cedar Grove Trowbridge Wiltshire BA14 0HS Lead Inspector Alison Duffy Unannounced Inspection 20 November 2007 09:30 th Elizabeth Lodge DS0000070384.V353450.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 Elizabeth Lodge DS0000070384.V353450.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. Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elizabeth Lodge Address Cedar Grove Trowbridge Wiltshire BA14 0HS 01225 761281 01225 761297 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.grooms-shaftesbury.org.uk Grooms-Shaftesbury Mr Philip Caple Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection This is classified as a new service due to the recent merger of the organisation. Brief Description of the Service: Elizabeth Lodge is a residential care home that is registered to care for eight younger adults with a learning and/or a physical disability. The Shaftesbury Society previously managed the home. In June 2007, The Shaftesbury Society merged with an organisation, John Grooms. Grooms-Shaftesbury was created. No material changes to the premises or the facilities were made, as a result of the change in provider. The registered manager is Mr Philip Caple. Mr Caple has approximately 17 years experience of working with older people and adults with a learning disability. Mr Caple was registered with the CSCI in May 2007. All residents have a single bedroom on the ground floor. Two of the bedrooms have en-suite shower rooms. Some rooms have overhead hoisting equipment. There is also a separate shower room, a further bathroom and a separate toilet. There is a very large lounge/dining room. Residents’ benefit from a sensory room, which is regularly decorated with a different theme. The grounds are accessible to wheelchair users. There is a sensory garden to the rear of the property and an enclosed garden to the side. The staffing rota provides a minimum of four support workers and a senior support worker on duty during the waking day. There are two waking night staff and a member of staff provides sleeping in provision. There is an on call management system, twenty-four hours a day. Fees for living at the home are based on individual need and currently range between £1153.00 and £2200.00 a week. Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place on 20th November 2007 between the hours of 9:30am and 6pm. Mr Phillip Caple, registered manager, was available throughout and received feedback at the end of the visit. We met with four service users and four members of staff on duty. Discussion took place with Mr Caple regarding current care provision and the developments made since the last inspection. A tour of the accommodation was made with a member of staff. Various forms of documentation were viewed. This included care plans and risk assessments, staff training and recruitment documentation. Due to complex disabilities, service users were unable to give feedback about the service received. Interactions between staff and service users were observed and all were noted to be positive, attentive and respectful. All service users were well groomed. As part of the inspection process, surveys were sent to the care home, to distribute, as required. Mr Caple confirmed these were sent to each primary relative and those health care professionals, who regularly visit the home. The feedback gained from surveys is detailed within the main text of this report. CSCI sent Mr Caple an Annual Quality Assurance Assessment (AQAA) to complete before the inspection. Mr Caple completed this thoroughly and in detail. Some of the document’s content is taken into account within the evidence sections of this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: Residents receive a high level of support with their care needs, which is undertaken with regular advice and intervention from specialised services. Staff are committed to providing good care and support to residents. Staff demonstrated a good understanding of residents’ needs. Positive relationships were evident. Staff promote residents’ rights and encourage involvement within the local community. Regular trips out are arranged. Family contact is promoted. Training is given priority and specialist areas, such as those associated within individual health care needs, are readily addressed. Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 6 A robust recruitment procedure is in place, which provides a clear system for safeguarding residents. Any incident, which occurs in the home, is reported to CSCI and the Safeguarding Adults Unit. All incidents are fully investigated, with control measures to minimise further occurrences. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 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 Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from an organised admission procedure, which ensures their needs, will be met within the home. EVIDENCE: Elizabeth Lodge continues to provide long-term care provision. There have been no new placements to the home, since the last inspection. The home currently has a vacancy yet there are no plans at present, for this to be filled. It was therefore not possible to assess the admission procedure, in practice. There are detailed admission policies and procedures in place. Mr Caple explained a full and robust assessment would take place before a placement was offered. From information highlighted within the AQAA, this practice was confirmed. Documentation stated that Mr Caple would meet the prospective resident in his/her own environment, to assess their needs. Mr Caple would complete a detailed assessment, which would form part of a care plan. An assessment from the placing authority would also be received. Family members and other interested parties, such as specialist health care personnel, would be invited to contribute to the assessment process. Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning is of a good standard and enables staff to have sufficient information to meet residents’ needs. Residents are encouraged to be involved in decision-making. Residents are safeguarded from potential hazards through clear, considered risk taking. EVIDENCE: Each resident has a detailed, comprehensive care plan. The plan covers aspects of personal and health care, as well as communication and daily activity. The content of the plans was generally very specific. This included aspects, such as sitting on a service user’s left side to assist them with eating. Preferred items of clothing and the best way to assist residents with dressing were clearly evident. Within the activities section however, detail of interests, were not particularly evident. For example within one plan, it was stated ‘I enjoy activities with interaction.’ Another stated ‘I need variety in my daily life.’ Mr Caple was advised to give clarity to these statements. The plans Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 10 contained detailed guidelines in terms of bathing, the use of the hoist and the use of body harnesses. In some instances, pictorial guidelines were in place. Mr Caple reported that discussions with staff have taken place regarding record keeping. This continues to be a learning curve for some, however Mr Caple believed, that records have improved. This was confirmed, as those records viewed contained factual accounts rather than previous, subjective language. Discussion took place with staff regarding the care of two residents. Staff were knowledgeable and clearly aware of individual needs. The information discussed, was identified within care plans. Residents are unable to communicate their needs through speech. Staff spoke of recognising distress and encouraging decision-making. They explained this was very much dependent on the resident. Such systems could involve concise communication or interpreting body language, vocalised sounds or eye contact. One member of staff believed the most important factor, was getting to know the resident. They explained ‘you just know when something is not quite right, then you need to establish the reason, which can be more difficult.’ In terms of choices with meal provision for example, staff reported that they get to know preferences. If a preference is prepared, but a refusal to eat is evident, another alternative is tried. The home works on the basis that taking risks is a natural part of gaining life experience. Residents are therefore not discouraged to undertake certain activities, solely on the grounds that there is an element of risk. This was particularly apparent, when staff explained the level of external activity that takes place. All residents have a range of detailed risk assessments as part of their care plan. These include travelling on the home’s transport and potential injury through the use of equipment. Some assessments detailed a number of residents’ names. Mr Caple was advised to remove these, to ensure individuality and confidentiality. Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assisted to undertake meaningful activity and maintain important relationships. Residents benefit from menus that are developed according to individual preference and healthy eating. EVIDENCE: Four residents were at home, during the inspection. Three were at their day service. Mr Caple said that day service attendance has been historical yet very much enjoyed. All placements however are due to cease. Mr Caple explained that although a challenge, the day service closure would be addressed in a positive manner, with new opportunities found for residents. All residents have a key worker and it was anticipated, that this role would assist with further identifying residents’ social interests. Staff explained that external activity is given high priority. They explained the importance of being part of the community and for residents not be Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 12 discriminated against because of their disability. It was reported that walks in the local vicinity, to the shop and local garden centre are regularly made. The home has its own transport to facilitate journeys, further a field. Staff gave examples of trips out to the coast, theme parks and fast food restaurants. Mr Caple said that one resident undertakes horse riding. Plans are in place for more residents to pursue this interest. Consideration is also being given to hydrotherapy facilities. Within a survey, one relative stated, as a means to improve the service ‘give more stimulation.’ They also stated ‘do not leave him/her in his/her wheelchair all of the time, take him/her out more.’ During the inspection, two residents were getting ready to go to the dentist. Just as they were leaving however, staff were informed that the appointments had been cancelled. In order not to give disappointment or a change to expectations, a trip to Shearwater, was undertaken. A member of staff confirmed that is was essential, for one resident in particular not to have their anticipated routine disrupted. There is a sensory room within the home. A member of staff said that it is very well used. A theme is devised on a 6-8 weekly basis, so that the surroundings are regularly changed. Mr Caple said that refurbishing the room is a project for the future. It is hoped that this will be professionally undertaken. There are a number of sensory items within the corridors. Mr Caple explained that further attention is to be given to this area. Some residents also have sensory equipment in their bedrooms. As stated earlier in this report, residents are encouraged to make decisions in relation to their ability. Known likes and dislikes are identified within care plans. One member of staff explained that residents are being encouraged to be involved with aspects such as cleaning and tidying their bedroom. Another said residents could if they wanted to, join staff in the kitchen during meal preparation. Staff explained, that while residents may not be able to physically assist, the social interaction is important. Hospitality was evident throughout the inspection. Staff confirmed that visitors are welcomed and are able to meet with their relative/friend in the communal areas or in the resident’s own room. As residents are unable to clearly express their wishes, family members are strong advocates. Regular communication is therefore maintained with family members. A parents meeting is also held. Staff reported that there is a general rolling menu, although this can be changed as required. They confirmed that there is an emphasis on fresh fruit and vegetables. The main meal of the day is generally taken in the evening. During the inspection, residents were assisted to eat their lunch of tuna and tomato sandwiches. They then had cake and an apple and kiwi fruit. One resident was encouraged to eat throughout the morning, as they had refused Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 13 breakfast. They were encouraged with known favourites. They later had some fruit and then had lunch. All residents require staff support to eat. This could be by either full assistance, hand-over-hand or general prompting. Such requirements, including special equipment are detailed within care plans. The assistance given to two residents was observed. All assistance was undertaken attentively, in a sensitive and respectful manner. Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ very complex health care needs are met through an experienced, well-trained staff team and access to regular health care personnel. Medication systems are well managed yet staff must follow procedures to ensure errors do not occur. EVIDENCE: Due to very complex needs, residents are unable to express how they wish their care to be given. Staff explained however, that through getting to know residents as individuals, specific preferences have become apparent. These are clearly identified within care plans. For example, one plan stated ‘I would like someone I know, to help me eat. I do not want a male member of staff to help me.’ Staff also explained that general observations are used to determine individual need. For example, there are no set times for getting up. If a resident appears settled and perhaps sleepy, they would receive their assistance to get up, at a later time. Residents receive a high level of support with their health care needs on a daily basis. During the inspection, two residents had a series of seizures. Staff were Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 15 noted to respond quickly and efficiently, in an attentive yet gentle manner. A number of residents have a detailed epilepsy profile on their file. One profile however, had not been recently updated. Mr Caple reported he would address this. Staff spoke in detail about the pattern of some seizures. Detailed records describing the type and length of each seizure were in place. Staff have received training in epilepsy. The training also involved the administration of treatments, such as rectal diazepam. Residents are reliant on staff to recognise any signs of ill health. The presentation of pain was discussed with staff. One member of staff gave clear indicators for one resident. These were identified within the resident’s care plan. Another plan however did not address pain management. The staff however, felt indication could be determined through body language. A record is maintained of all medical appointments and intervention. Residents visit services such as the GP and the dentist, as required. One relative however, within their survey said ‘Doctors requests not always carried out.’ Another relative stated ‘when a resident of the home goes into hospital for any reason there should be a support person with them all the time, this is not the case at the moment.’ Within a training record it was identified that a member of staff had been trained in a resident’s physiotherapy programme. There was no evidence of this on the resident’s care plan. Mr Caple said he would address this, as a programme should be in place. Mr Caple confirmed that with the closure of day services, staff would be expected to be more involved with such treatments. Additional training is being investigated. All residents have been assessed in relation to their risk of developing a pressure sore. A risk assessment detailing a number of detailed control measures are in place. However, information on the resident’s care plan is more limited. Mr Caple was advised to identify preventative measures, as stated within the risk assessment, on the residents care plan. Specific times when residents are assisted from their wheelchairs, to change their position should also be clearly stated. Other aspects, which may cause a pressure sore, such as footwear or creases in clothing, should be identified. Due to their health conditions, residents are unable to manage their own medication. Following training and competency checks, key staff undertake medication administration. The organisation has clear medication policies and procedures. A monitored dosage system is used. This is orderly stored in locked wall cabinets. Records regarding receipt and medication administration were satisfactorily maintained. A number of residents have their medication covertly within food. Records referred to an agreement from the GP to do this, yet the agreement could not be located. Mr Caple said the agreement would be renewed. As good practice, medication with a short shelf life was being dated when opened. Since the last inspection, there have been two incidents of a resident not being given a dose of their medication. Another incident involved Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 16 staff later identifying, that a resident had not swallowed their medication. Mr Caple reported that all incidents had been investigated and addressed in accordance with organisational policies. Elizabeth Lodge DS0000070384.V353450.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents rely strongly on others, to recognise any signs of discontentment. Systems are in place to minimise the risk of abuse to residents yet withdrawing staff’s involvement in some individual finances, would assure further protection. EVIDENCE: The organisation has a formalised system of managing complaints. A copy of the complaints procedure is given to all residents and their relatives on admission. However, due to their complex health care conditions, residents rely on others to recognise any form of discontentment. Mr Caple and staff reported that residents’ families are strong advocates. Regular contact is promoted. There is also a parents meeting, which is used as a forum to discuss issues, as they arise. A record of complaints was in place. Investigations appeared thorough with an aim to resolve issues effectively. However, within a survey one relative, felt this was not so. Since the last inspection, there has been one random inspection in relation to a complaint, reported to CSCI. There was no evidence to uphold the allegation that was made. Mr Caple reported that the Safeguarding Adults Unit are informed of any incidents, which may occur in the home. Referral forms demonstrated that the medication errors, for example had been reported. Mr Caple said staff, are responsible for reporting any allegation or suspicion of abuse to management. Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 18 Management would then instigate the relevant procedure. When asking staff a hypothetical question about abuse, this was confirmed. The majority of staff have undertaken adult abuse training. Further courses are currently being investigated, in order to address the shortfalls. Due to the residents’ complex health conditions, all require full assistance to manage their financial affairs. A number of family members undertake this responsibility for some residents. However, two designated senior staff have been authorised to withdraw money from two residents’ bank/building society accounts. Policies and procedures, which contain various control measures, are in place to address this. However, the protection of residents and the identified staff were discussed with Mr Caple. Mr Caple said the system was unsatisfactory yet historical. Mr Caple explained that consideration, in the past, had been given to removing the responsibility from staff. It had however been unsuccessful. It was agreed that this area, should be reconsidered. A number of residents have money in the safe, for safekeeping. This system was examined. All cash amounts corresponded to the balance sheets. It was advised that receipts, although numbered, should be attached to the relevant balance sheet. This would aid the audit trail. A number of receipts detailed a monthly transport cost. Mr Caple was informed of the need to evidence, the process used, to establish such amounts. Elizabeth Lodge DS0000070384.V353450.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a comfortable, clean, well-maintained environment that is conducive to their needs. EVIDENCE: All residents have a single room. Two rooms have an en-suite facility. Within a tour of the accommodation, it was noted that the majority of residents’ rooms were personalised. However, one room did not reflect the residents’ personality or interests. A large framework to the resident’s bed dominated the room. While acknowledging this is a required aspect of the resident’s care, it was suggested that the room could be made brighter. This could involve decoration to the ceiling or further sensory equipment, to create a more stimulating and relaxing environment. The en-suite facility appeared clinical through white tiling, the large enclosed storage area and certain equipment. A member of staff explained that due to the resident’s needs, the en-suite is not used. It therefore becomes more of a storage area. It was agreed that with some consideration, the room could be made more personalised. Mr Caple agreed Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 20 that the room does not reflect the age and gender of the resident. Mr Caple explained he would discuss possible improvements, with the resident’s family. Since the last key inspection, various projects have been undertaken to improve the environment and reduce potential noise disturbance. This has involved moving the area where residents eat, into the lounge. The dining room has been converted into a quiet room with a computer. New carpeting has replaced laminate flooring. Air conditioning units have been installed in communal areas. Windows to the rear of the property have been doubleglazed. Mr Caple reported that plans to create a safe, usable outdoor space to the front of the property, is currently in progress. Mr Caple also said that the refurbishment of the bathroom, with a specialised Jacuzzi style bath, has been identified within the budget for next year. A member of staff reported that there have been no changes to the laundry systems since the last inspection. They explained the facilities continue to meet the needs of the service. During the day, support workers are responsible, for the laundering of all residents clothing and bedding. The night staff complete the ironing. On the day of the inspection, the home was cleaned to a good standard and there were no unpleasant odours. Staff have access to protective clothing, as required. Elizabeth Lodge DS0000070384.V353450.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactorily maintained and enable one-to-one work with residents. Residents are protected through a clear, well-managed recruitment procedure. Residents benefit from a well trained staff team. EVIDENCE: Staffing levels are currently maintained at generally five staff on duty throughout the day. This includes a senior support worker who leads the shift. At night there are two waking night staff. A senior support worker also undertakes sleeping in provision. In addition, there is always an on call management system. One resident requires continual one-to-one staff support. This is included in the above staffing levels. In addition to care provision, staff are responsible for all housekeeping tasks. This includes cooking, cleaning and the laundry. One member of staff said, ‘additional staffing,’ as a means to improve the service. They explained that on paper, staffing levels appear good. However, due to residents’ complex needs and the high level of support required, the member of staff felt, the home is not overstaffed. A relative also confirmed this. They stated ‘always the answer to things not done, are met with ‘we don’t have enough staff to carry this out.’ Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 22 Mr Caple explained that due to staffing vacancies, covering the staffing roster has been a challenge. A high level of agency staff has been used. To ensure consistency, requests were made to the agency, for the same members of staff to work at the home. A member of staff confirmed this had worked well, as the agency staff, had built relationships with residents. Mr Caple reported that successful recruitment has recently taken place. The staff appointed, have not however, as yet commenced employment. They are waiting for references and their Criminal Records Bureau checks. The file of the most recent member of staff was viewed. This was ordered and contained the required information. Written notes of the applicant’s interview were also in place. One reference however, was addressed ‘to whom it may concern.’ Mr Caple was advised to verify such references. Mr Caple confirmed that personnel, within Head Office undertake the recruitment process. Mr Caple performs the formal interview. Mr Caple reported that the organisation has a training department. They are responsible for all arrangements. Mr Caple said that the training programme for next year is currently being developed. Staff confirmed that training is given high priority and training courses are always being undertaken. Training is also discussed as part of formal supervision. All staff have recently undertaken manual handling training. Mr Caple reported that this has created a base level. The home’s manual handling trainer is now expected to continue, with regular training sessions. All staff are currently registered for a distance learning course in food safety. Dates for refresher first aid training have been arranged. The majority of staff have completed adult protection training. All have undertaken epilepsy training, which includes treatments, such as the administration of rectal diazepam. All staff have a training file. However, some sessions staff said they had undertaken, were not evidenced with certificates. Mr Caple said that some certificates from recent training courses, had not been received. Mr Caple confirmed he would address this. Within the AQAA sent to CSCI before the inspection, Mr Caple confirmed that thirteen staff including two agency staff have NVQ level 2. Two are working towards the award. The home therefore meets the standard of over 50 of the staff team with NVQ level 2 or equivalent. Mr Caple is anticipating that any new staff will also commence NVQ training. Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a manager who is resident focused and promotes a good standard of service provision. The development of a formal quality assurance system would identify further improvements within the home. Residents’ welfare is safeguarded through well-managed health and safety systems. EVIDENCE: Mr Caple was registered with us in May 2007. He came to the home originally, to cover the post, on an agency basis. Mr Caple has worked in various care settings, for approximately 17 years. He has the Registered Managers Award and the City and Guilds Advanced Management for Care qualification. Through discussion it was evident that Mr Caple is committed to residents’ well being and the continual on going improvement of the home. Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 24 Mr Caple said that the organisation does not at present have an on going quality assurance system. Consideration however, is being given to this area. Mr Caple explained that shortly after commencing employment, he sent questionnaires to residents’ relatives. The number of returned questionnaires was minimal and therefore the feedback was limited. An established system of regular parents’ meetings is in place. Members of the organisation also visit regularly to assess the service. A record is maintained and sent to us. The organisation is currently in the process of reviewing all existing policies and procedures. This includes, a wide range of issues related to health and safety. Detailed and individual risk assessments are in place. Equipment, such as overhead and manual hoists, are regularly maintained and serviced as required. Documentation demonstrates this. A record of bath temperatures is maintained. Hot water outlets within residents’ bedrooms are thermostatically controlled. However, within the hand washbasin in the toilet, it was noted that the temperature of the hot water fluctuated. Mr Caple was advised to monitor this. Certificates to demonstrate gas safety are in place. Mr Caple confirmed that the portable electrical appliances are due to be tested. However the maintenance person, who was responsible for this, has recently left employment. Mr Caple explained that it is planned for a new member of staff to take on the role and be trained appropriately. All staff are up to date with their mandatory training, such as manual handling. Any accidents are fully investigated and referred to the Safeguarding Adults Unit. A copy of the incident report is also sent to the operations manager and to us. Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 25 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 X 2 3 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X 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 X 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 26 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. 1 Refer to Standard YA6 Good Practice Recommendations Guidelines regarding the level of support each resident requires in the garden should be clearly documented within care plans. This was identified at the random inspection of 26.7.07. The standard has been addressed but the information does not identify the specific timescales, in which residents should be left unattended. Daily records should demonstrate specific details to evidence the time residents spend in the garden and the support they receive, during this time. This was identified at the random inspection of 26.7.07. The daily reports did not evidence times spent in the garden although it was recognised, as being November. All documentation should be specifically related to individual residents and not contain names of other residents. Control measures to minimise the risk of a pressure sore, should be identified in the resident’s care place. Other DS0000070384.V353450.R01.S.doc Version 5.2 Page 27 2 YA6 3 4 YA9 YA19 Elizabeth Lodge 5 6 7 8 9 10 YA19 YA23 YA23 YA23 YA25 YA42 potential reasons, which may cause a pressure sore, should be identified. Treatment programmes such as physiotherapy, should be clearly detailed within the resident’s care plan. Consideration should be given to ways in which some residents can have access to their bank account, without the involvement of staff. Receipts should be attached to the relevant balance sheet to assist with the audit trail of expenditures. Ways in which transport costs are determined should be clearly explained on receipts and documentation such as the Statement of Purpose. Consideration should be given to ways in which the general environment, in the identified resident’s bedroom, could be enhanced. The hot water from the hand washbasin in the downstairs toilet should be regularly monitored due to unpredictable water temperature. Elizabeth Lodge DS0000070384.V353450.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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