CARE HOME ADULTS 18-65
Fir Lodge 91 Bloomfield Avenue Bath Bath & N E Somerset BA2 3AE Lead Inspector
Sam Fox Unannounced Inspection 8th October 2005 10:00 Fir Lodge DS0000008180.V256612.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 Fir Lodge DS0000008180.V256612.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. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Fir Lodge Address 91 Bloomfield Avenue Bath Bath & N E Somerset BA2 3AE 01225 421241 01225 421241 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) New Era Housing Association Limited Mrs Elizabeth Black Care Home 5 Category(ies) of Learning disability (3), Physical disability (2) registration, with number of places Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 5 bed home currently registered for 5 people with learning and / or physical disabilities. 24th January 2005 Date of last inspection Brief Description of the Service: Fir Lodge is a care home operated by New Era, an independent voluntary organisation. Four of the five beds offered by Fir Lodge are block contracted by Bath & North East Somerset Local Authority. Fir Lodge is a spacious Victorian house situated in a quiet location, and provides easy access to local shops on Bear Flat and Moorland Road. The city centre is also no more than a mile away. Accommodation is provided on three floors. There are six single bedrooms in total, one on the ground floor, which has ensuite facilities, and four on the first floor, one with ensuite facilities and another with a through floor lift, which was installed specifically for the person who accommodates this bedroom. Staff members provide sleep-in cover and use the sixth bedroom, which is on the second floor. There is also an office and a kitchen on the second floor. A communal lounge area, a dining room, kitchen and laundry area are located on the ground floor. There are two bathrooms with toilets, one on the first floor and one on the second floor. There is also an additional communal toilet on the ground floor. The home is set in its own grounds and there is a garden with a patio area, which can be accessed by wheelchair down a path, which runs along the side of the house. The home has its own minibus, which is leased and service users contribute a proportion of their mobility allowance towards transport provision. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s second annual unannounced inspection – the main purpose of which was to check on progress made towards previous requirements and to ensure that they were continuing to provide good standards of care. Primarily evidence was gathered from discussion with staff, three of whom were interviewed, and examination of records. During this visit two residents went out, one was on holiday and the remaining two did not wish to speak with the inspector – hence the inspection does not specifically include their views. Not all standards were inspected and this report should be read in conjunction with other reports so a fuller picture of the home can be gained. What the service does well: What has improved since the last inspection?
As a result of recent mistakes improvements have been made to the medication system– this has made the system safer for residents. In addition to this the introduction of medication profiles has increased staff awareness of what is prescribed and the consequences of a missed dose. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 6 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. Fir Lodge DS0000008180.V256612.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 Fir Lodge DS0000008180.V256612.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): NONE EVIDENCE: None of these standards were assessed during this visit. At the last inspection, however, it was noted that the home had a completed Statement of Purpose and service user guide. These set out the aims and objectives of the home and the facilities and services to be offered. This meets with requirements of the legislation. Fir Lodge DS0000008180.V256612.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 Care plans and guidelines are well written which means that residents can expect to receive a consistent and individualised service. Risks are well managed so residents can continue to lead active lifestyles safely. They can also be re-assured that personal information will be kept confidential. EVIDENCE: Two personal files were seen. These contain detailed guidelines about the support residents need to go about their daily living. These included preferred morning and daily routines, communication issues and assistance needed with personal hygiene. The files also contained plans of care to support individuals with their aspirations and emotional needs. Generally the care plans were recorded to good detail, written in a sensitive and respectful manner, and are reviewed and updated regularly. Fir Lodge operates a keyworking system through which each resident is allocated a named member of staff who plays more of a central role in coordinating the service they receive. Staff displayed a good understanding of their roles and responsibilities in this respect and it was apparent that this system works well within the home.
Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 10 There were up to date risk assessments in place for individual residents which included accessing communal facilities, money management and the use of kitchen equipment. These provided evidence that the home takes action to reduce identified risks whist also encouraging residents to retain their independence. Staff also confirmed that they had received risk assessment training. Staff displayed a good awareness of issues involved about confidentiality and this subject is covered during the home’s induction. All files are stored in appropriately. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14,15,17 Staff provide good levels of motivation and support so residents have opportunities to lead active and interesting lifestyles. They are encouraged to maintain links that are important to them and benefit from eating well. EVIDENCE: Fir Lodge has a van which is used by residents to access local community facilities. On the day of the inspection two residents who were going for an afternoon walk. The home’s diary and other records indicated that this is not an unusual event and that all are encouraged to be active within the local community. There were up to date risk assessments available about the use of the van and detailed guidelines for one resident who needs additional support to become motivated to go out. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 12 One member of staff said that the home has good relations with their neighbours and that local shopkeepers knew residents. They said they felt part of the local community. Members of staff explained what residents liked to do during the week – formal activities vary according to individual needs and preferences. It was apparent that they lead interesting and active lifestyles. A weekly planner also evidenced that they are encouraged to spend one day during the week at home when they are supported to do household chores. During the time of this visit one resident was away on holiday in Spain. Other residents have had holidays throughout the year. It was apparent that residents are encouraged to make their own choices in this respect and it is good practice that separate holidays are organised according to individual preferences. It was apparent through records and discussion with staff that residents have varying contact with family and friends and that staff try to encourage residents to maintain these links. Menus provided evidence that residents are offered a wide variety of nutritious meals and that they are given choices according to their preferences. It was observed that residents could eat their lunch where they wished, one chose to have it in their bedroom and another ate theirs in the lounge. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 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 the following standard(s): 18,19,20 The staff team are well trained, respectful and friendly, therefore residents can expect to receive full support with their personal and health care needs in a manner that respects their privacy. The medication system is safe. EVIDENCE: There were detailed guidelines in personal files about what support residents need for their personal care. These were written to good detail and indicated that the home takes into account individual preferences. Staff were observed discreetly supporting residents during the time of this visit. Staff record all visits to health care professionals and there was plenty of evidence that residents continue to be supported to see the relevant health professionals. Personal files also included Health Action Plans. These, however, contained limited information and it was not clear as to their intended purpose. It is recommended that these be the subject of further development and discussion – they could, for example, be used to evidence how the home seeks to promote preventative health care. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 14 Records also provided evidence that residents go for annual checkups, including to the dentists and opticians. Fir Lodge operates a monitored dosage system for the administration of medication that is delivered at regular intervals by the local pharmacist. Records held in relation to these were found to be well maintained and met with the requirements of the legislation. There have been some errors with the medication system recently that have been bought to the attention of the CSCI. The home has now implemented a new system of checking these to try and reduce the risk of errors. Staff on duty said that they think this has improved the situation. In addition to the above staff have also written medication profiles – these describe what tablets are for, their potential side effect and what to do in the event of a missed dose. This is a positive development. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 15 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 Staff are proactive in developing different communication skills so residents with non-verbal communication can be assured that their views will be listened to. Staff are trained to protect residents from abuse. EVIDENCE: New Era has a complaints procedure which details actions to be taken in the event of a concern being raised, with timescales. This meets with requirements of the legislation. A number of residents have complex communication needs and cannot directly verbally indicate their wishes. Personal files detailed issues in relation to communication and detailed behaviours which may be indicative that a resident is upset or concerned. Staff spoken with displayed a good understanding of individuals’ needs in this respect. This is good practice and important if the home is to encourage an atmosphere in which residents can air their views. As an additional mark of good practice one member of staff has recently completed her Makaton training and there are plans in place to cascade this to all members of staff. This will enable the home to continue to improve methods of communication. New Era has a protection of vulnerable adults policy and it was confirmed at the last inspection that staff have received training about this. All staff spoken with said they would report bad practice and knew how to do so. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 16 Fir Lodge accommodates residents who have complex and sometimes, challenging behaviour. There were guidelines about this and distraction techniques on personal files. Two members of staff said that they had recently been on courses about challenging behaviour. The home notifies the CSCI promptly of any incidents affecting the wellbeing of residents and these are well recorded within the home. As an additional mark of good practice records indicated that an external manager appointed by New Era to oversee the home monitors these incidents. Members of staff were advised to ensure that all savings books should kept in the safe and that the code to the safe should be kept secure. There is a monitoring device used for one resident. This is used because of a medical condition and not as a means to restrict his freedom. Fir Lodge DS0000008180.V256612.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, 26, 27, 28, 29, 30 Residents benefit from living in a comfortable and clean environment. They are provided with specialist equipment to maximise their independence. EVIDENCE: Fir Lodge is residential in style and blends in well with the local community. There have been a number of aids and adaptations made to the premises, specifically for the requirements of one resident. The home has been in contact with the relevant specialists to seek the appropriate advice about this. All communal areas of the home were comfortably furnished and homely in appearance. The home benefits from a large dining area and separate lounge on the ground floor which gives plenty of space for the five residents currently accommodated. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 18 It was understood that the kitchen has recently been refurbished which has considerably improved this area. It was noted, however, that the cooker is old and staff said that the oven was not working effectively. It is recommended that this be replaced. There are bathrooms and toilets on the ground and second floor. These were clean – they were, however, bare and institutional in appearance; staff need to take action to make these areas more homely. Four bedrooms were viewed. They were personalised and reflected individual tastes – indicating that choice and independence are promoted. One bedroom had an unpleasant odour, staff should take further action to try and reduce this, and the room may require re-decoration. All areas of the home were cleaned to a good standard and staff confirmed that they have had training about the use of chemicals used for cleaning. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 19 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, 35, 36 Staff are well trained and highly motivated so residents can be assured that they will have the skills and enthusiasm to meet their needs. They are aware of their roles, work well as a team and residents benefit from a well supported team. EVIDENCE: Staff rotas indicated that there are always two staff on duty with a period throughout the day when there is an extra member of staff on. For example during this inspection an additional member of staff came on duty at 1.00pm so there were three staff available until 4.00pm. At night one staff sleeps in. These are sufficient levels to meet the needs of those residents currently accommodated. Staff described their roles and responsibilities within the home and they displayed a clear sense of what was expected of them. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 20 All staff spoken with confirmed that they received formal supervision every six weeks and this was confirmed through diary appointments. They said that they discussed issues about residents, concerns and training. It was apparent that they viewed these sessions as productive and useful. In addition to the above all three staff interviewed spoke positively about the training opportunities they were offered by New Era. Two of them said that they were given a good induction which included formal sessions away from the home when they were introduced to the aims of the organisation and given statutory training. They confirmed that the induction was linked with LDAF (Learning disability award framework) training. In addition to this they had either achieved or were continuing with National Vocational Qualifications. From discussion with them it was clear that they were skilled and had a good understanding of issues relating to the resident group. Staff confirmed that they had regular meetings. It was apparent that they felt they worked well as a team. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 21 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, 41, 42 Residents benefit from living in a well run home and can be reassured that there are good systems in place to maintain their health and safety. EVIDENCE: All three staff spoken with at the time of this visit spoke highly of the manager and the way that the home was run. They said they felt that she was approachable and that they felt listened to. They also said that she led by example and always worked alongside them. In addition to this they described issues that may have been a source of conflict between staff which have been resolved sensitively and positively by the manager. Two staff spoken with had recently attended training courses and were pleased that they were going to take the lead on promoting what they had learnt within the home. It was apparent through this that extra responsibilities are delegated to staff and that they are enthusiastic about taking on additional tasks.
Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 22 Staff confirmed that they had received their statutory training of first aid, manual handling, health and safety and basic food hygiene. Records evidence that fire tests and checks take place at the appropriate intervals. It was noted that the fire procedure included the use of an emergency chair that could be used to evacuate one resident down the stairs on the first floor who uses a wheelchair. Staff were unclear about where this was stored and it was not clear how much practice they had had in using this. They must be confident and safe to do this and a requirement is made that the manager review its use. Fir Lodge has a system in place for weekly health and safety checks which include visual checks and hot water temperature checks. Records held were up to date and well maintained. In addition to the above there were a number of health and safety risk assessments which had recently been reviewed and for which staff had signed their awareness of. These included doing the household shopping, house security and lifting wheelchairs. The lift had been serviced in May and all portable electrical appliances have been tested. There were records to evidence that the home’s van is checked regularly and copies of letters to confirm that staff were competent to drive it. All records seen at the time of this visits were written in plain English and regularly reviewed. The inspection process was aided by a well-organised office. Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 23 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 x x x x 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 2 2 3 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score 3 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Fir Lodge Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x 3 2 x DS0000008180.V256612.R01.S.doc Version 5.0 Page 24 YES 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 YA34 Regulation 17(2) Requirement CRB clearance outcomes to be available for inspection on the premises. (This requirement is carried forward as it was not looked at during this inspection) Implement a system which ensures that staff members application forms and references are available in the home before they commence employment in the home. (This requirement is carried forward as it was not looked at during this inspection) Make bathrooms more homely Reduce odour in identified bedroom Review use of evacuation chair Keep all savings books in the safe and make sure the code is secure Timescale for action 31/12/05 2. YA34 17(2)Sch 4.6 31/12/05 3. 4. 5. 6. YA27 YA26 YA41 YA23 23(1)(a) 16(2)(k) 13(4)(c) 12 30/11/05 30/10/05 30/10/05 15/10/05 Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA24 YA24 YA34 Good Practice Recommendations Renew the stair carpet up to the second floor landing, on the landing and in the homes office. Redecorate the homes office. Introduce and maintain a CRB record log on the premises, which identifies whether staff members CRB clearances were satisfactory or whether a risk assessment was necessary. Replace cooker Update and review Health Action plans 4. 5 YA28 YA19 Fir Lodge DS0000008180.V256612.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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