CARE HOME ADULTS 18-65
Elstow Lodge Wilstead Road Elstow Bedfordshire MK42 9YD Lead Inspector
Carol Mitchell Unannounced Inspection 12th October 2005 09:15 Elstow Lodge DS0000014899.V257547.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 Elstow Lodge DS0000014899.V257547.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. Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Elstow Lodge Address Wilstead Road Elstow Bedfordshire MK42 9YD 01234 405021 01234 214664 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 R M Sabey Mrs J Stokes Care Home 11 Category(ies) of Learning disability (11), Physical disability (1) registration, with number of places Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18/08/04 Brief Description of the Service: Elstow Lodge is a large detached house standing in well-maintained gardens. It is situated in the village of Elstow where there is a post office, church, and two public houses. There is a bus route to Bedford from Elstow. Some shops are located nearby, and there is ample parking at the home. The family run home is registered to provide residential accommodation for 11 adults with learning disabilities, and for 1 adult with physical disabilities. There is one bedroom on the ground floor, along with two lounges, the dining room, kitchen, and small laundry area. The remaining bedrooms, two of which are shared, are situated on the first floor. Residents are able to use the large garden, patio, and barbeque facilities provided. Most of the residents attend activities outside the home on most, or all weekdays. Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 3.5 hours on 12th October 2005. At the time of inspection, nine people were living at the home, and three were present during the inspection. (People living at the home spend a lot of the week outside the home at different day care facilities.) The inspector spent time with the three residents who were available, looked at their records, and looked around some parts of the building. The inspector also spoke to the manager, and a member of staff. A sample of staff files was also checked. The inspector is very grateful to staff and people living at the home for their help with this inspection. What the service does well:
The manager is good at making sure people living at the home receive the right care. The manager and the staff care about, and know the people living at the home well. A resident said, “The staff are all nice”. Residents have care plans where the staff can read about how they should support people at the home, and help them make choices. Residents are encouraged and helped to be as independent as possible. One resident told the inspector, “I walk to work, and bus back if it is raining.” Residents and families are listened to. A resident said, “I get listened to by Julie and the others. I’m happy with my room, I’ve got everything I need”. People living at the home are kept very busy with visits to college, day centres, and other activities. Trips out are arranged. One resident said, “We have a great time”. Staff are well trained, supported, and happy in their work. One staff member said, “It’s a home from home, the staff are very good and sympathetic, we do our best. The manager is very hot on training, and we have staff meetings.” The manager makes sure that proper checks are made on people before they can work at the home, and new staff do not work alone. Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
The manager is aware that the content of the residents’ contracts needs checking, and this was being done at the time of inspection. The pharmacist had visited the home during the week of inspection, and the manager had already acted on their advice about a better way of writing down information to do with medicines. The manager said that she would check that care plan reviews are all signed and dated. When staff write about residents every day, they are going to put down the time of writing as well as the date. Staff will also make sure that they write information which links to the resident’s care plan. The manager is improving how she records training for new staff, and will check that copies of staff contracts are kept in the staff files. Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 7 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. Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 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 Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 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): 2, 5 The manager of the home makes sure that people at the home can all live happily together by carefully assessing their needs. Therefore, residents can be sure that they will get the support they need. EVIDENCE: Careful assessment is done before admission to make sure that needs would be well met. Individual health and social care assessments had been completed, and these included details of interests, and different cultural needs. Residents have contracts, and the manager was reviewing the content of these at the time of inspection. Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 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, 8, 9. People living at the home can expect to be well supported because their care is thought about in detail, and written down. Caring staff know the residents well, and want them to be as independent as possible. EVIDENCE: Each resident has a care plan with useful and individual information. The care plans were being reviewed at the time of inspection. A resident was able to talk about his needs, and the care plan matched and complemented the detail of what was said. Care plans give meaningful information to help staff support decision-making, and understand residents’ ways of expressing their opinions and choices. Residents are supported to take risks in order to live as independently as possible. For example, one resident was doing her ironing at the time of inspection, and explained that she makes her own way to and from her place of work. Staff at the home have done training in the assessment and management of risk. The manager and staff member questioned were familiar with the needs of residents, and were able to detail the specific support required in individual
Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 11 cases. Residents speak to the manager every day, and residents said that what they say is important and listened to. Meetings are held for the residents who enjoy these. Family members and day centre staff are in close contact with the home, and questionnaires have been sent to families. Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 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, 16, 17. People living at the home can be sure that they will be able to develop personally, because they are encouraged to be independent, they are given choice, and suitable opportunities are made available to them. EVIDENCE: Two of the three residents at home at the beginning of the inspection were enthusiastically waiting for the bus to take them to day care. Residents were able to list lots of activities, which take place every week at different centres and at home. These include educational opportunities such as “sums and other work”, activities offered by college and day centres, social gatherings, discos, cinema nights, weekend trips out, shopping, pub meals, and church services. A resident said that staff would take him swimming if he wanted to go. Day trips and trips to shows are organised, and there is usually an annual holiday. One resident has a job in the local community, where she has a “great time”. Family and friends are welcome at any time, although residents are very busy with various activities outside the home during the week. Residents frequently stay with their families for weekend leave.
Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 13 Staff are aware of any support needed to help residents with personal relationships and any important information is written in the care plan. Residents are encouraged to take responsibility in their daily lives as far as possible. For example, a resident explained that he does his washing on Saturdays, and vacuums his own bedroom. The resident has a key to his room, and felt that his room is private to him. The manager and staff are aware of any particular dietary needs, and these are written in the care plans. A resident said that he likes the food, and described the wholesome meal served for dinner the evening before the day of inspection. Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 People living at the home can be sure they will be looked after in the right way, because the staff care about them and they receive training. EVIDENCE: Two residents were able to tell the inspector about how they are supported in ways, which are right for them. Residents at the home have different needs, and these were written about in care plans, and the manager and staff member talked in detail about the particular demands of individual residents. Care plans give advice to staff looking after residents who are unable to say clearly what they would like. The advice helps staff to offer choice regarding the personal support given to all residents. Individual health and other needs are met. For example, chiropody, audiology, and optician appointments are attended. Detailed information is available for staff about health conditions that residents have, and the manager described the health care needed for individual residents. Training about health needs is arranged for staff when necessary. Residents all have a family doctor, and health needs and appointments are recorded. Staff have been trained in the management of medicines, and a resident said that he is very happy with the way in which his medicines are organised. The home’s pharmacist had visited and checked the medicines two days prior to
Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 15 the inspection. The manager had already addressed the advice to improve the method of recording medicines coming into the home, and the way recording is done if a resident is away from the home. The wishes of residents or families regarding what should happen in the event of death have been explored, and details are recorded in the care plans. Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. People living at the home are able to say or express their views, and they know they will be taken seriously. The manager and staff have the right information and have received training, so residents can be sure that they will be protected from abuse. EVIDENCE: A resident was able to name the person in charge at the home, and said that he and others living there are able to see and talk to her every day. He said that he and the others are listened to and they feel comfortable talking about anything that is worrying them. The resident also said that he has an advocate to help him, and parents, all of whom are able to offer support. No recent complaints have been received. There is frequent contact with family members, social workers and others. Complaint forms are available, and questionnaires requesting feedback have been sent to families. Staff have received training about abuse, and about the protection of adults from abuse. The home has a policy about abuse in care homes, and the staff member questioned described the right action to take if she sees something in the home with which she is not comfortable. Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 17 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, 28, 30. The manager makes sure that the home is kept clean and safe, and residents have enough space and privacy. Therefore people living at the home feel comfortable and safe. EVIDENCE: The home is kept clean. For example, toilets are cleaned three times a day. Communal rooms are spacious and comfortable. Some residents also spend time in their bedrooms. Two residents said that they are very happy with their rooms, which they keep as they wish. Residents clean their own rooms if they can. Residents have keys to their rooms. The staff member questioned said that residents who currently share bedrooms, and their families, are very happy with the long-standing arrangement. The residents concerned like the company, and feel well supported by each other. A resident said that everyone can get into the garden, and that in summer it is used a lot. Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 18 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, 36. The manager makes sure that staff are checked, well trained, supported, and prepared for supporting residents, so people living at the home can be sure that their needs will be met. EVIDENCE: Residents said that they like the staff, and the way they are dealt with by staff. The manager makes sure that the proper checks are done before anyone is employed at the home. New staff shadow established staff until the manager is satisfied that the person is able to work unsupervised, and induction training is in place. The manager said that she will be recording the induction training being undertaken by a new staff member at the time of inspection. Contracts with job descriptions are issued. Training is given high priority at the home. Staff have done, or are undertaking National Vocational Qualification training, and other training also takes place. For example, staff have received training in supervision, abuse, fire, manual handling, health and safety, first aid, dementia, food handling, and medicines management. The manager keeps a close check on which staff member needs particular training. Staff meetings are held, staff receive supervision sessions, and feel well supported. The manager has undertaken a course about supervision.
Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 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 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, 42. The manager cares about the residents and has high standards, so that residents can be sure that they will benefit from living at a well run home. EVIDENCE: The manager is experienced, having been at the home for eleven years, and has completed management, and other training. Residents and staff see, and are able to speak with the manager frequently. Both staff and residents find the manager easy to approach, and open to suggestions. The manager organises training for staff in health and safety, and related matters such as risk assessment. Fire and other equipment are checked. Standards in the home are monitored by the manager, who was in the process of formalising a quality assurance programme at the time of inspection. Residents hold some money when this is possible, and proper records are kept about all residents’ money. One record and the money held were checked and found to be in good order.
Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 20 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 x 3 x x 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x x 3 x 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Elstow Lodge Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 3 x DS0000014899.V257547.R01.S.doc Version 5.0 Page 21 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 Elstow Lodge DS0000014899.V257547.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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