Inspection on 09/12/08 for Flora Lodge

This inspection was carried out on 9th December 2008.

CSCI found this care home to be providing an Good service.

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

Flora Lodge 17/01/07

Flora Lodge 28/09/05

Flora Lodge 22/06/05

Flora Lodge 18/01/05

Flora Lodge 06/05/04

Flora Lodge 12/01/04

Similar services:

Hillside

Applegarth

Trevayler Residential Care Home

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Flora Lodge 21-23 Glenfield Road East Leicester Leicestershire LE3 5QW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rajshree Mistry     Date: 0 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 40 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 40 Information about the care home Name of care home: Address: Flora Lodge 21-23 Glenfield Road East Leicester Leicestershire LE3 5QW 01162530279 01162291298 flora-lodge@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Marika Halina Kozlowsky Type of registration: Number of places registered: Mrs Sudha Devi Rana,Mr Harbansh Rana care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Service User Numbers No person falling within categories MD/LD may be admitted to the home when 5 persons falling within categories MD/LD are already accommodated within the home. Service User Numbers No person falling within category LD may be admitted to the home unless that person also falls within category MD ie Dual disability. To be able to continue care for the named person of category MD(E) named in Variation V23781 application dated 5 August 2005 Date of last inspection Brief description of the care home Flora Lodge is a residential care home for up to fourteen people who have a mental health diagnosis and up to five people with a learning disability. Flora Lodge is situated close to the city centre, located on a main road with bus links into the city. There are Care Homes for Adults (18-65 years) Page 4 of 40 Over 65 0 0 5 14 Brief description of the care home shops, pubs and other amenities close by and within walking distance of the home. The accommodation is spread over four floors, which are accessed by stairs. There is no lift in the home to the upper floor. There are ten single bedrooms and two shared rooms, one of which is currently used as a single bedroom. There is a large lounge and dining room, close to the kitchen on the ground floor. There are designated areas where people can choose to smoke in. The Registered Manager provided us with the range of fees charged: £303.00 to £344.00, which includes the provision of personal toiletries. People are responsible for all other personal expenditure such as magazines and newspapers. People considering using Flora Lodge are encouraged to contact the home directly. The full details of the home and any specific requirements can be obtained from the home in the form of the Statement of Purpose and the Service User Guide. The latest inspection report from the Commission for Social Care Inspection is available at the home. Information about the service available is provided in the statement of purpose. Care Homes for Adults (18-65 years) Page 5 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We as it appears throughout this Inspection Report refers to The Commission for Social Care Inspection. This key inspection consisted of preparation by reviewing the last key Inspection Report dated 17th January 2007 and the review of the Annual Service Review dated 20th February 2008. We looked at the information we had about the management of Flora Lodge, the concerns, complaints and safeguarding investigation and the events that affected the wellbeing of people living at the home. The registered manager sent Care Homes for Adults (18-65 years) Page 6 of 40 to us the completed Annual Quality Assurance Assessment (AQAA) document, which reflected the homes own assessment of the standards within the home. We sent out twelve surveys to the people living at Flora Lodge, of which sixty percent were returned. The responses and comments received indicated people were happy with the lifestyle they experienced, the choice of meals, making decisions about their day, the staff support and how they can raise concerns. We sent out eleven surveys to staff, of which twenty percent were returned. The responses and comments received indicated there was a stable staff team that work well as a team and have good systems of communication. There are good management systems and staff have access to regular supervision, training and updates. We sent out four surveys to health and social care professionals such as the General Practitioner and the Community Psychiatric Nurse, of which none were returned. All the comments received in the surveys from the people living at Flora Lodge and the staff have been included in the relevant sections within this Inspection Report. We visited Flora Lodge on 9th December 2008, starting at 9:45hrs and finishing at 16:30hrs. The registered manager assisted us during the site visit along with the visiting responsible individual, who is the owner of the home. The main method of inspecting we used was case tracking. This means looking at the range of care and support needs people receive that ensure their rights, independence and choices are respected. This was done by selecting four people who have a range of care and support needs and included the newest person that had moved to the home. We spoke with the three people we case tracked and briefly spoke with other people living at the home. We read the care files of the four people containing information about peoples individual care needs, lifestyles and how their choices are respected whilst their safety is ensured. We made observations of people, the way staff treated and interacted with them and how they were able to continue living their choice of lifestyle. We spoke with staff including the newest member of staff about the recruitment, training and support they receive to support from the registered manager. We read the staff recruitment and training files that demonstrated that staff have the skill mix and qualities to support the people living at Flora Lodge. We looked at the home environment and the living area provided for people. These included some individual bedrooms, communal areas and included some of the areas that have been improved since the last key inspection. We read the information people received about Flora Lodge. The policies, procedures and specific records viewed demonstrated the day-to-day management of the home. The Commission for Social Care Inspection had a focus on Equality and Diversity and issues relating to these are included throughout the main body of this inspection report. What the care home does well: What has improved since the last inspection? Flora Lodge has addressed the areas of concerns identified at the last inspection of the service. Care Homes for Adults (18-65 years) Page 8 of 40 There have been some improvements made with the introduction of the health action plan, which looks at promoting individual peoples health and wellbeing from personal safety, better personal hygiene, health needs to being more independent. A book is now made available in the lounge where people can record any concerns that they may have but do not wish to directly tell the staff or the registered manager. This showed that people are being offered different ways of raising concerns. Staff have received information and training in safeguarding adults from abuse to ensure they are aware of their responsibilities should they witness or suspect someone is at risk from harm or abuse. Flora Lodge is registered with Skills for Care and now uses the induction workbook for all new staff employed. Flora Lodge has a newly refurbished kitchen, that people can use with the support of the staff. All the windows now have window restrictors to limit the opening and new security has been installed to all the exit doors recently to ensure peoples safety and security. The owner confirmed that there are plans to replace the carpets in the main corridor on the ground floor of the home. Flora Lodge has recently carried out an quality assurance survey to gain the views, opinions and experiences of people living at the home. The results of the survey are being gathered by the owner to identify areas that may need addressing to improve the quality of life people experience living at the home. What they could do better: This was a positive inspection of Flora Lodge. There was evidence of improvements made in response to the last inspection report. There were a number of good practice recommendations that were discussed with the registered manager and the owner, which were well received. A summary of the recommendations are detailed below. The information people receive about Flora Lodge should have more information that tells people about the process for moving into the home. Contracts of stay are in place but are not signed by individual people or the registered manager. The care plans used could be improved by using a person centred approach. This means looking at the holistic needs of people that promotes their health, well-being and choice of lifestyle. Whilst at present no-one living at the home takes any controlled medication, the home should seek advice from the Pharmacist to ensure the controlled drugs storage meets the new legislation under the Misuse of Drugs (Safe Custody) Regulation 1973. Flora Lodge could improve the knowledge and skills of staff by providing regular updates and information on the new ways of working and best practice to support the people living at the home. This relates to mental health awareness, challenging behaviour, moving and handling and awareness of providing quality end of life care and managing health risks with knowledge and the support from health staff. The development of some guidance, policy and procedure would help staff that may be Care Homes for Adults (18-65 years) Page 9 of 40 required to provide end of life care and support to people that have chosen to remain at home. Flora Lodge should consider measuring the results of the homes quality assurance survey against the homes statement of purpose. This would demonstrate if peoples experiences of Flora Lodge is different to the aims and objectives set out and help in the development of the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 40 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering using Flora Lodge have their care and support needs assessed before they move to the home to make sure these can be met. Evidence: We read the information people receive about Flora Lodge, which is known as the Statement of Purpose and the Service User Guide. Although we did not look at the easy read format with pictures, it is made available to people upon request. The content provides information about the aims and objectives of the home. It tells people what support with day-to-day needs, social, leisure and educational opportunities and the environment they can expect to receive. It sets out clearly how people can make a complaint and the process. The range of skills and experience of the registered manager and the staff team, shows people will receive the level of support that suits them. The policy and procedure for moving into the home is detailed and tells people about the assessment process, they have the opportunity to visit, can speak with people Care Homes for Adults (18-65 years) Page 12 of 40 Evidence: living at the home, the staff and have an overnight trail stay. However, the admission process written in the statement of purpose is unclear and does not give information that people need. We raised this with the registered manager and the owner who was present. Both accepted there was no information about the admission process in the information people received. We read the care files of four people we case tracked. All four people had different care and support needs and included the newest person that had moved to the home. Whilst most people needed reminding and prompting with their personal hygiene, others receive health care support from the District Nurse or the Community Psychiatric Nurse (CPN) and some needed support to make sure the risks are reduced without compromising their daily routines and lifestyle. The care files all contained a copy of the assessment of needs completed by the social worker and the homes assessments. The assessments were detailed looking at the care and support needs, significant history, medication and diverse needs from having specific health care support, attending a day centre, interests in wildlife, music, sports and family. We saw some files had a document known as the individual placement agreement, which forms part of the contractual agreement for social services funding people that live at Flora Lodge. We saw there were contracts with the terms and conditions of stay in the individual files, however, these were not completed or signed by the people living at the home or the registered manager. We spoke with two people that we case tracked in the privacy of their rooms. We saw in each bedroom, information about the homes complaints procedure and the contact details for social services, CSCI and a number of Advocacy services, should people wish to contact them for support. One person told us they visited the home before agreeing to move in, and this place is much better then where I use to be, Ive got a bigger room and they are good to me here. They both told us that they are supported if needed and able to do the things that they use to. This demonstrated the information gathered at the assessment, supported people to continue their interests. We saw people were very settled during the day, having their own routines that staff respected. This supported the information we received from the registered manager that stated people are provided with a warm and friendly atmosphere and meet individual needs and requests when possible. Staff we spoke with on duty said they get to meet the new person at the initial visits, having time to speak with them and other people living at the home. Staff said have information about peoples individual care and support needs, including medication and any known risks that affects their vulnerability, health and safety. This supported the Care Homes for Adults (18-65 years) Page 13 of 40 Evidence: information we received from the registered manager before the site visit. Care Homes for Adults (18-65 years) Page 14 of 40 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Flora Lodge have their individual needs met, make personal decisions and choices in how they are supported by the staff. Evidence: We read the care plans for the four people we case tracked, which were not person centred to show how the support provided improved outcomes for people. The care plans outlined the individual care and support needs with regards to their personal hygiene, health care and daily living such as attending day centres or treatment from the District Nurse or the Community Psychiatric Nurse. There was guidance for staff to follow with regards to diet, health, managing inappropriate behaviours such as sexual or verbal comments and how best to support people who are vulnerable or at risk such as road safety and managing their money. The staff we spoke with showed an awareness of risks posed to people living at the home, their vulnerability and described ways in which they help them. We saw care plans were reviewed on a monthly basis, which showed people received the level of care and support that they need. Care Homes for Adults (18-65 years) Page 15 of 40 Evidence: The registered manager told us that care plans are produced in alternative formats using easy read and supported by pictures and symbols for people with a learning disability. However, the care files we read did not have a care plan that was in a different format, so we were unable to see the way it helped people and guided the staff. We observed people were making their own decisions from the time they wake up to going out, attending hospital appointments to spending time at home in the privacy of their bedrooms. People that we spoke with in the privacy of their rooms chose the layout of their room, had put up pictures and posters of things that are of interest to them such as sports, pop stars, film stars and planes. These were further examples showing people were making their own decisions. The interaction between the staff and the people living in the home was good. People were relaxed and confident to talk to staff who responded to them in a similar respectful manner. We saw staff and the people living at the home, always knocking on the door before entering, which showed respect for each other. We spoke with staff on duty who said they key-work two or three people living at the home. As part of their role as key workers they complete the key workers diary that reflects the well-being of people, what they did, such as a social activity and includes significant events that affects their well-being such as not feeling well or using inappropriate language or behaviours and the help given by staff. Staff described the support they gave to a person that needed end of life care and had chosen to remain at Flora Lodge. One member of staff described how they used their experience, knowledge and with the expertise from the General Practitioner and the District Nurse made sure the person was comfortable until the end. This demonstrated the home was flexible in respecting the last wishes by making them comfortable at the home. We discussed this with the registered manager to find out what they had learnt from the experience and whether they had identified areas of improvement and development. Whilst the registered manager said staff responded well and felt everyone had learnt from the experience, accepted that they could develop procedures to help support other people in a similar situation. (See Personal and Healthcare Support) We looked at the staff training records that showed staff had completed the homes mandatory training including awareness of safeguarding adults from abuse procedures and some mental health awareness. Staff we spoke with demonstrated a good understanding around mental health, how it affects people in relation to how people behave and how the medication helps them. Care Homes for Adults (18-65 years) Page 16 of 40 Evidence: The registered manager told us some people are able and prefer to manage their own money. We looked at the records where peoples money is held in safekeeping for them, which showed a running balance and the signature of the person to whom the money belongs to and a member of staff. The two people we spoke with one was happy with the home looking after their money and the other preferred to manage their own money. The comments were received from the people living in the home included: I get my money when I need it and have to sign for it, its better and safe for me so I dont worry about it. I look after my own money. Care Homes for Adults (18-65 years) Page 17 of 40 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Flora Lodge are supported to enjoy and continue to experience their daily routines, lifestyle and are offered a good choice of meals. Evidence: The information we received from the registered manager before the site visit stated promotion of independence, outside activities, colleges, healthy eating and encouragement of personal needs. During the site visit we saw people had a range of things they did. One person was seen waiting for transport to take them to Age Concern, whilst other people were either returning from being out or were getting ready to go out. This supported the information we had received from the registered manager before the site visit. People we spoke with told us they do have their own daily routines. One person having Care Homes for Adults (18-65 years) Page 18 of 40 Evidence: had a lay-in, got showered and dressed in their own time, having had their a drink. They told us that the registered manager or the owner will take them out shopping for clothes or even go to the pub across the road. Another person told us they had just returned home with the owner, after attending a hospital appointment, which showed health care needs are supported. They told us they were very keen to learn to drive a motorcar and have a job. Whilst they were keen to do this recognised it may be difficult for them. People told us they do have contact with family. Some said they often visit them and have overnight stays, which is planned. This showed people are supported to maintain contact with their family and friends that makes people feel valued. The comments we received from people directly included: I much prefer living here, they leave you alone and you know they are around if you need them They do pop in and check if your ok I go out with Sudha for a drink, just a drive out or shopping and she takes me for hospital appointments I know the staff take people out swimming, shopping, pubs and to see their family Trips are planned and we talk about them at the residents & staff meetings. Whilst Flora Lodge is a no-smoking home, there are designated areas, where people can smoke cigarettes safely. We saw people only smoking in these areas, which showed the house rules were respected. The residents meeting minutes that we read reflected the topics discussed in relation to personal safety, security, smoking, personal hygiene bullying, trips and food and showed people are informed and involved in making decisions. Staff told us they do spend time with people talking with them, which we saw during out visit. Staff recognised the main challenges for people in addition to their safety, was encouraging people to maintain better personal hygiene, for which the home provides people with personal toiletries. Staff gave examples of how they try to encourage people to do more for themselves such as household tasks like cleaning their bedrooms, which people see as the work for staff on duty. Staff shared some good examples of how they have supported people to make sure they are safe and not vulnerable when they are out in the community by talking about the situations that Care Homes for Adults (18-65 years) Page 19 of 40 Evidence: could put them at risk and how this could be avoided. This showed staff helped people to ensure their safety by educating people through discussions. The daily records that we read showed peoples wellbeing and what they did each day. This ranged from participating in social events, visiting family, going out, attending the day centre, spending time at home with staff or in the privacy of their rooms, listening to music or watching television. This supported the interests recorded in peoples care plans and confirmed peoples were able to continue their daily routines and lifestyles. The care files we read stated peoples preferences of meals and special dietary needs such as low fat and low sugar meals. Meals are prepared by staff in the newly refurbished kitchen. Staff told us that although they try to encourage people to help, they often refuse, as they see this being the responsibility of staff. Staff showed awareness of peoples diets, tried to manage the sugar levels for one person and alerting the District Nurse if they had any concerns. The information we received from the registered manager before the site visit and staff training records viewed showed staff have received training in the safe handling of food or food and hygiene, which is part of the homes mandatory training. People were generally happy with the choice of meals provided. On the day of the site visit there was a choice of pork chops or steak pie with seasonal vegetables. One person said I do enjoy the meals and I like my fruit and try to have a healthy diet with my 5 portions a day. This showed some people were aware of having a healthy and well-balanced diet. Care Homes for Adults (18-65 years) Page 20 of 40 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Flora Lodge have their personal and health care needs met by trained staff who promote their independence and well-being. Evidence: The people we spoke with said they managed their own personal care; were supported to attend hospital appointments and could see the General Practitioner (GP) if needed. One person we spoke with said they like having the en-suite shower so that they can shower when they want to. Other people we spoke with; some had either a shower, a bath or a toilet in their bedrooms and used the communal bathroom. The care files we read for the people we case tracked contained details of their personal and health care needs, which mainly indicated that staff should encourage people with their personal hygiene. The key worker for one person we case tracked said they supported the person to get in and out of the bath and the care plan reflected the level of support needed and that promoted the persons independence. The key worker diaries report sheets read confirmed people were encouraged by staff with their personal hygiene and diet. We saw care plans were reviewed monthly and Care Homes for Adults (18-65 years) Page 21 of 40 Evidence: social workers completed annual reviews of people to make sure their needs were being met by the home. This supported the comments we received from talking with staff and the people we case tracked. Two people we spoke both said the registered manager or the owner takes them to attend hospital appointments. One person had only just returned from a hospital appointed showing us the plaster put on their arm after having a blood test. They told us they go to the Fosse Road Surgery to see their GP. The care records and daily key worker diaries people had their health care needs met by health care professionals. These ranged from the District Nurse administering insulin; annual health checks with the local GP and Community Psychiatric Nurse (CPN). This supported the information we received from the registered manager demonstrating peoples personal and health care needs being met. Staff we spoke with described the specialist care they provided to a person living at the home who became very poorly, (terminally ill) and needed end of life care, using their experiences from working in a nursing home. The person had requested to remain living at the home and the staff provided the 24-hour care, having acquired specialist equipment to avoid pressure sores developing with regular turning and supported by a team of specialist nurses. This showed the staff at the home respected the persons wish and were able to provide end of life care with the support from health care staff. We spoke with the registered manager about the learning gained and if the experience had resulted in changes in practice. The registered manager and owner having said the experience was good had not considered developing some guidance in the form of a policy and procedure to follow incase they have to provide a similar care arrangement in the future. We discussed the value of having a staff informed about end of life care, looking at pressure area management and updating moving and handling training for all the staff. Two people we case tracked said the staff give them their medication. Both were aware of why they were taking particular medication and what would happen if they chose not to take the medication, which showed they have an understanding of their mental health. Care files showed people were supported with annual health checks such as the Optician and Dentist and specialist health support from the CPN and the District Nurse, with their insulin. The registered manager said having good relationships with the CPNs benefits the people to ensure their well-being. We saw the medication is stored in individual cassette prepared by the Pharmacist and is stored securely in a locked medication cabinet. We saw record of a pharmacy inspection visit made on the same that showed the home receives regular Pharmacist visits to ensure medication, storage and management systems are good. Trained staff Care Homes for Adults (18-65 years) Page 22 of 40 Evidence: are able to give people their medication and staff training records viewed confirmed staff had received training in the safe administration of medicines. The registered manager said that all staff are due to update their safe handling of medication although no dates of the training were known at this time. We looked at the medication cassettes and records for the four people we case tracked, all were signed and showed records accurately reflected the medication taken. The policies and procedures of managing and administration medication were in place, staff were aware and they followed these procedures. This showed people received their medication on time, which supported the comments received from the people we spoke with and the information we received from the registered manager before the site visit. Flora Lodge at present does not have people taking strong medication, known as controlled medication. We advised the registered manager to seek advice from the Pharmacist to ensure the controlled medication storage complies with the new legislation under the Misuse of Drugs (Safe Custody) Regulation 1973. The information we received from the registered manager before the site visit identified areas from improvements. The registered manager has already started to develop the health action plans, for all the people living at the home to be involved in to have a healthier lifestyle. The registered manager hopes this will be in place by the next key inspection of the service. Care Homes for Adults (18-65 years) Page 23 of 40 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Flora Lodge have their individual rights protected, confident concerns are addressed and are protected from harm and abuse by trained staff. Evidence: The complaints procedures is displayed in the home, included in the information people receive about the home and on the back of door in each bedroom. The complaints procedure sets out the process of how the concern or complaint will be investigated and includes the details of four Advocacy Services that people can contact. The registered manager told us the complaints procedure is available in an easy read format with pictures and symbols to help people understand, although one was not made available for us to view. The information we received from the registered manager before the site visit identified improvements planned for the next 12 months. Flora Lodge hopes to introduce an independent advocate to visit and speak with the people living at the home on a regularly basis. This showed the home is making it easier for people to access independent support with promotes peoples independence. We observed there is an open culture that allows people who live at Flora Lodge to express their views and concerns in a safe and understanding environment. Staff were seen responding to peoples questions and concerns respectfully. People we spoke with Care Homes for Adults (18-65 years) Page 24 of 40 Evidence: were confident to complain and we received comments like; I would tell Marika or Sudha. This supported the responses we received in the surveys from the people living at Flora Lodge. All the responses indicated that they know who to speak with if they are unhappy and know how to make a complaint. We wanted to find out how staff deal with concerns or complaints from the people living at the home. They told us people are very confident to complain and would let you know immediately if there was a problem. Staff showed they were aware peoples daily routines and would talk with the person, if they showed lack of interest and motivation. Flora Lodge has received 4 complaints since the last inspection of the home. The complaints record book we read, showed the recorded complaints along with the actions taken by the registered manager showing the investigation process and how it was resolved. This showed that the complaints procedure was followed. The Commission for Social Care Inspection has not received any expressions of concerns or complaints about the home or the care and support people receive. The information we received from the registered manager before the site visit stated that they now leave a book in the lounge for people living at the home to write down any concerns or complaints they may have. It also stated that people are reminded of their rights to live without abuse, neglect, intimidation individually and at the residents meetings. The residents meeting minutes read confirmed this, supported by the staff surveys, which all indicated they know how to respond to concerns or complaints that people may raise with them. This demonstrated the home and staff actively promote peoples personal safety and well-being. Staff we spoke with demonstrated a good understanding of safeguarding issues, which means promoting the well-being of people using the service from harm, risk or abuse. Staff were aware of individual peoples vulnerability and the support they provide to ensure people are safe and any known risks are managed through discussions and agreed arrangements. The staff survey responses indicated staff know what to do if people had concerns or complaints. This demonstrated the home and staff actively promote peoples personal safety and well-being. The comments received included: Report it to the manager I would report any concerns to the manager or the owners and if need be, the inspector Care Homes for Adults (18-65 years) Page 25 of 40 Evidence: The service always puts the service user first and their needs or concerns The manager is always available for support or to listen to any concerns Staff were confident to report concerns, poor or unsafe practice witness, using the homes whistle-blowing procedure. Staff know their responsibility to report suspicions and allegations of abuse, which showed staff were aware of the homes procedures. Staff training records showed staff had received training in safeguarding adults from abuse procedures, induction workbook for new staff and the national vocational qualifications in care. Flora Lodge has reported to the relevant authorities, an incident under the safeguarding procedures. Whilst the investigation is on-going and the registered manager and the owner have installed security systems to all the exits and window restrictors to ensure peoples safety. The registered manager has worked closely with the relevant authorities and kept us informed of the investigation. The registered manager told us some people like to look after their own money and have set up their own bank accounts. Two people we spoke with said they prefer to have the home look after their money, which they can have at any time. One person said I know they give us all the toiletries but I like to buy my own deodorant and shaving gels, to suit my skin. The registered manager described arrangement and showed us the records for two people whose money is held in safekeeping. The records showed a clear record of peoples money and transactions, which were signed by a member of staff and the individual. This showed peoples money was kept safe. Staff surveys responses indicated staff were recruited upon receipt of checks such as criminal records bureau (CRB) disclosures and references. The newest member of staff said even though they had a new CRB check carried out by their last employer, Flora Lodge completed their own CRB check before they were allowed to start work. The staff recruitment files for three staff seen, all contained evidence to show that preemployment checks were carried out and staff completed a programme of induction to ensure they had the training to care and support the people living at Flora Lodge. Care Homes for Adults (18-65 years) Page 26 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is clean, maintained and suitably comfortable for them. Evidence: Flora Lodge is situated on a busy main road near a bus stop, with local amenities, shops and pubs. It is close to the city centre if people prefer to walk to the town centre. Flora Lodge offers people living accommodation over four floors accessible by the stairs. All the bedrooms are individual; ten single and two shared bedrooms, some have an ensuite, shower or bath or a toilet. Although Flora Lodge is a non-smoking home, there are two areas identified where people can choose to smoke in. There is a newly refurbished kitchen and dining area and a large lounge with a fish tank that creates a homely feel. We saw people coming and going throughout the day. Some people were in the smoking room or were smoking in the courtyard at the rear of the home, whilst other people spent time in their bedrooms listening to music, watching television or relaxing. We spoke with two people in their rooms, one person preferring to have a key to their bedroom. The bedrooms were individually decorated reflecting individual interests and hobbies such as sports, music, film stars, fighter planes and furnished with bedroom Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: furniture to suit. One person said they I saw the bedroom when I first visited and like it and were asked about decorating it but felt they didnt think it needed decorating. They told us they like spending time in their room, which is spacious, has a shower and they entertain themselves by watching the television or listening to the sports on the radio. This showed people were able to continue their individual interests and enjoyed their privacy. The home is clean and well maintained, which supported the survey responses we received from people living at Flora Lodge. We saw a member of staff cleaning peoples bedrooms, toilets and bathrooms wearing protective clothing. The member of staff had left some cleaning products in the bedroom and quickly returned to collect them when the person was seen going into their bedroom. Staff told us they do try to encourage people to be involved in household task but people generally see this as staffs responsibility. Since the last inspection of the service, all the windows now have window restrictors in place and has had the kitchen refurbished. All the exits now have better security following an incident to ensure peoples health, safety and well being. The owner said people chose to have a brown carpet in the hallway, which is now dirty as people often spill their drinks and now needs replacing. The information we received from the registered manager identified how the service intends to improve, by encouraging people to be more involved in decisions about re-decoration of communal areas, private rooms and furnishings. This showed that the service wants people to continue being involved in what happens in the home. The registered manager showed awareness of making sure people were safe and risks were reduced as far as practicable in relation to diversity, gender and cultural needs. She gave us the example of how staff now are able to offer better support a person who has now moved to the ground floor bedroom with regards to their gender and vulnerability. The information we received from the registered manager before the site visit stated people are involved making decisions about the home and they receive feedback from the residents meetings, daily records and through the homes quality assurance survey. The laundry room is located away from the kitchen and staff do peoples laundry. Staff training records showed staff had received training in health and safety, food hygiene and infection control. Staff demonstrated awareness of the current best practice and ensuring people were encouraged to improve their personal hygiene. Staff were seen reminding people to wash their hands after using the bathroom or when they go into Care Homes for Adults (18-65 years) Page 28 of 40 Evidence: the kitchen. Other examples given by staff included suggesting to people that they have a shower and change their clothes to help them relax. This supported one comment made by a person that we spoke with who said staff always tell me to wash my hands, when they see me go into the kitchen. Staff survey responses indicated staff have received training for their role, understand and meet the needs of people and are kept up to date with new ways of working. Care Homes for Adults (18-65 years) Page 29 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Flora Lodge are supported by staff who have undergone good recruitment process and training to support and meet peoples individual needs. Evidence: People living at Flora Lodge appeared to enjoy a positive relationship with the staff, the registered manager and the owner present at the time of the site visit. People were seen approaching the staff, who responded to them by listening to what they had to say. Comments received from the people we spoke with included: they leave you alone, but they will check to see if you are ok and Marika, Sudha and the staff are very good to me. This supported the responses we received from the surveys received from the people living at Flora Lodge, indicating staff treat them well; listen and act on what they say. People told us that there were always a couple of staff on duty each day. The registered manager told us although there is a stable staff team, the home recently appointed two new care staff to compliment the staffing levels: two staff and the manager are on duty during the day and two work nights. This demonstrated staffing levels respond to needs of the people living at Flora Lodge. Care Homes for Adults (18-65 years) Page 30 of 40 Evidence: We wanted to know whether staff recruitment promotes the health and well-being of people living at Flora Lodge. The staff survey responses received indicated the employer carried out the employment checks before starting work. We spoke with the newest member of staff employed at the home who was on duty. They described the recruitment process that they completed and confirmed they were allowed to start work upon receipt of two satisfactory references and a criminal records bureau (CRB) disclosure. We looked at the records of three staff, which included the newest member of staff and found they had undergone a good recruitment process, which included an interview, receipt of two satisfactory references and a check as to a persons suitability to work with vulnerable people, which includes finding out if they have a criminal record. This means all staff have had a criminal records bureau (CRB) disclosure. This supported the staff survey responses received. The information we received from the registered manager before the site visit stated 72 of staff had attained the national vocational qualification (NVQ) level 2 and above in care. The registered manager confirmed that the new staff now complete the induction workbook through Skills for Care, which is recognised and provides the staff with the knowledge and skills to care and support the people living at Flora Lodge. This was consistent with what the newest member of staff told us as they were working through this induction workbook and comment received in the staff survey: I had worked here previously so I know my job role but I was still given a thorough induction. The staff confirmed they regularly have staff meetings and individual supervision and appraisal meetings with the registered manager where discussion take place with regards to work issues, training and development needs. This was consistent with the responses received in the staff survey, the records in the staff files, which supported the information we received from the registered manager before the site visit. We wanted to find out if people were supported by staff who are knowledgeable about mental health problems and learning disabilities, skilled and trained in the current best practice. Staff demonstrated how mental health problems or a learning disability affect peoples life. We looked at the staff training records and certificates that showed staff had received training in a range of topics relating to induction training, NVQ and health and safety. There were training certificates to show staff were trained in food hygiene, first aid and safeguarding adults from abuse training. The registered manager told us that she is waiting for confirmation for training updates for staff in safe handling of medicines, safeguarding adults from abuse training and mental health. This supported the responses and comments received in the staff surveys regarding training, which Care Homes for Adults (18-65 years) Page 31 of 40 Evidence: included: The support is always there and we have been given NVQ training so we have the knowledge and experience ... everything runs well at Flora Lodge and all staff are good workers and are always given good training We discussed with the registered manager and the owner the impact of having to care for a person at home, who was terminally ill and the awareness that staff needed. It was suggested to the registered manager that staff would benefit from having information and guidance on providing end of life care, having looked after a person at the home recently. The registered manager recognised the need to raise staff awareness in relation to pressure area management; updating the moving and handling training; challenging behaviour and learning disability to help support the people that live at the home. The registered manager acknowledged how this would promote continuity of care and peoples well-being. The registered manager said she would look to identify training courses and information for the staff team. Observations made during the site visit and discussions with the staff on duty demonstrated they have a good awareness of peoples needs. Staff recognised peoples vulnerability, how best to support them through through the knowledge gained from training. Staff were confident to support people living at the home, not phased by peoples behaviours, comments and challenged positively to help them understand if their behaviour was inappropriate. Care Homes for Adults (18-65 years) Page 32 of 40 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using Flora Lodge benefit from a well run home, involved in making decisions about the home and have internal monitoring systems that measure the quality of the service. Evidence: The registered manager of Flora Lodge, Marika Kozlowsky, has been managing the home for many years, having experience of working with people with mental health and a learning disability. She has gained a national vocational qualification (NVQ) at level 4, the Registered Managers Award and has attended the Mental Capacity training, to update her knowledge on the new legislation. The registered manager confirmed she is looking to find mental health training for staff to keep them up to date with new ways of working and new information to help them in their work. From our discussion with the registered manager and the owner it was evident that the home continues to provide people living at Flora Lodge with a stable environment, where the management and staff are as approachable and supportive. Care Homes for Adults (18-65 years) Page 33 of 40 Evidence: This supported the comments we received from the people living at the home. The owner is actively involved with Flora Lodge. She visits several times a week when she will assess the home, speaks with the people living at the home and the staff and has regular discussions with the registered manager. The comments we received from the people we spoke with and the surveys included: The staff leave us alone but do check to see if we are ok If there was anything wrong I would quite happily speak with Marika or Sudha There was evidence of good working relationships with the social and health care professionals to maintain and provide the right support, from the records viewed and discussions with the people living at the home. The registered manager identified the areas of improvements in the information provided before the site visit, which included more staff meetings and 1:1 sessions including staff and service users with decision making; improve policies, training budgets and funding. This showed the service recognises how it needs to improve and wants to involve the staff and the people living at the home. We discussed with the registered manager and the owner the quality of the information they provided in the Annual Quality Assurance Assessment, (AQAA) that they sent to us before the site visit. Several areas of improvements were suggested in completing the AQAA in relation to evidencing and demonstrating the benefit for people living at the home. For example, consideration should be made on how people benefit from staff being training and the support provided by the health and social care professionals. This was well received by the registered manager. Staff told us they were confident to raise issues with the registered manager. They commented on the positive and inclusive management style she has, listens to view of staff relating to training needs, the home environment and the people living at the home. There are clear roles, responsibilities and the staff valued the support that they received from the registered manager and the owner This supported the responses received in the staff surveys regarding communication between staff and support from the registered manager. The staff told us they have regular team meetings, supervisions and appraisals meetings where they can raise issues and discuss their individual training and development needs. The staff files showed staff had individual meetings with the registered manager. This showed staff skills are kept up to date; support the people living at the home in a manner that suits them, which supported the comments we received in the staff surveys that included the following comments: Care Homes for Adults (18-65 years) Page 34 of 40 Evidence: I feel that everything is done that should be, due to good management and appropriate training The support is always there and we have been given NVQ training so we have the knowledge and experience. We wanted to know if the people living at Flora Lodge are involved in making some decisions about the home. People told us that they regularly have a residents meeting, where they are told about any planned changes or improvements being considered at the home and where they can raise issues. We read the minutes of the last residents meeting held on 7th October 2008, which covered topics such as health and safety, fire procedures, bullying, security, smoking, trips: Blackpool lights and Christmas shopping, hygiene and food. This showed people are involved and their personal safety and well-being is promoted. Flora Lodge recently sent out the annual quality assurance survey to the people living at the home. We saw some of the responses received, which asked people to indicate their experience and views on the home environment, individual support and personal care, choice and lifestyle and the management. The owner is in the process of collating the responses. We wanted to know how the results are measured and what, if any, changes come about. The registered manager said the results are not measured and improvements are considered if there are poor responses to questions, which is discussed initially at the residents meeting. We suggested that they should consider measuring the results from the quality assurance against the statement of purpose to see if people actually experience the service as intended, looking at the outcomes and benefits for the people living at Flora Lodge. This was acknowledged and accepted by the registered manager and assurance given that statement of purpose would be measured by the results of the quality assurance to ensure individual experiences meets their expectations of Flora Lodge. The information we received from the registered manager before the site visit confirmed all the policies and procedures are reviewed and updated annually. From the discussion with the registered manager about the end of life support provided to a person living at the home, it was suggested that some guidance should be developed to help staff support people in a similar situation. The registered manager gave assurance this would be developed and staff would have information and training to ensure skills are up to date. The information provided by the registered manager before the site visit details the regular maintenance of equipment and systems within the home, such as the heating Care Homes for Adults (18-65 years) Page 35 of 40 Evidence: and electrical systems, including the fire fighting equipment and systems. Two people we spoke with confirmed the fire alarms are tested. One person said they have regular fire alarm test and drills and occasionally the smoke alarms goes off because people burn toast or are smoking where they shouldnt be and you see staff sorting it out. Care Homes for Adults (18-65 years) Page 36 of 40 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 37 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The statement of purpose and the information people receive should contain more details to tell people about the admission process to the home. The contract of stay with the terms and conditions given to people living at the home, should be signed by the person and the registered manager. Care plans could be improved by making them person centred looking at the person holistically, showing how the support provided by staff and the other agencies, meet peoples care and support needs that results in positive outcomes that improve the quality of life people have. The registered person should ensure staff training is up to date and staff are aware of the current best practice in relation to moving and handling and the safe administration of medication, mental health awareness and challenging behaviour. The registered person should consider developing policies and procedures to guide staff and have provision to support people in the event of becoming terminally ill, be cared for with the help of other health care professionals. The registered person should seek advice from the Pharmacist to ensure the controlled drugs storage complies with the new legislation under the Misuse of drugs (Safe Page 38 of 40 2 5 3 6 4 19 5 19 6 20 Care Homes for Adults (18-65 years) Custody) Regulation 1973. 7 35 The registered person should ensure staff skills and knowledge about the current best practice is maintained so that they can support the people living at the home. Staff should have training or information to help staff understand mental health problems, learning disability and how it impacts peoples life including pressure area management, moving and handling and challenging behaviour. The homes quality assurance results should be measured against the statement of purpose to show if the expectations of the service are met, help identify areas of improvement and ensure the statement of purpose evolves as the service changes. 8 39 Care Homes for Adults (18-65 years) Page 39 of 40 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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