Inspection on 09/05/07 for Forest Lodge

This inspection was carried out on 9th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Forest Lodge 28/09/06

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Forest Lodge Locksway Road Portsmouth Hampshire PO4 8LU Lead Inspector Wendy Mills Key Unannounced Inspection 9th May 2007 10:00 Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Lodge Address Locksway Road Portsmouth Hampshire PO4 8LU 023 92 733421 F/P 023 92 733421 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) Hampshire Partnership NHS Trust Dawn Beverley Louise Snell Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th September 2006 Brief Description of the Service: Forest Lodge is a residential home providing care, support and accommodation for up to five younger adults (aged 18 to 65 years) with complex learning disabilities. The home has been in existence for some years but was registered under the Hampshire Partnership NHS Trust early in 2006. The building is a detached two-storey property surrounded by gardens and trees. It is located in a residential area of Portsmouth. Nearby facilities include shops, a post office, public houses and bus services. The home has five single rooms, one with an en-suite facility. One bedroom is on the ground floor and stairs access the rooms on the first floor. The large lounge/dining room and kitchen are situated on the ground floor. There is a good-sized garden at the rear. This is a safe, enclosed space with seating and a trampoline for use by the residents. There is ample parking space at the back of the home. The fees for this home are individually calculated and are dependent on the level of need of each service user. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced and lasted four and half hours. During the course of the visit it was possible to speak to three members of the care staff, the team manager and the registered manager. The views of visiting health and social care professionals were sought by telephone. Three of the service users were at home on the day of this visit. Although it is difficult to find out what they think of the home due to their complex difficulties, it was possible to both directly and indirectly observe the way they interact with staff and enjoy the comfort of their home. A variety of documentation was examined, including care plans, staff files and health and safety records. The home has a welcoming, calm and relaxed atmosphere. The service users are well cared for and their complex needs are met. All comments received about the service were very positive. The service users, their supporters, the staff and the registered manager are thanked for the welcome they gave and their assistance throughout this visit. What the service does well: The home cares for the service users in a pleasant, relaxed and supportive environment. There is very good understanding of best care practice and very good support for people with complex needs. Staff are well trained and well motivated. There is very good communication at all levels. The service users have a variety of communication needs. Staff are able to communicate using Makaton and finger spelling. Their verbal prompts are given in a calm and easily understood way and their non-verbal communication is gentle and positive. There is an ongoing programme that aims to ensure all staff gain the National Vocational Qualification (NVQ) at level 3. This motivates staff and ensures that they are well qualified to carry out their demanding roles. The home values equality and diversity. It respects, and caters for, cultural and religious differences. Excellent contact and relationships are maintained with the families and supporters of the service users. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users, their relatives and supporters, are provided with the information they need about the home. Appropriate pre-admission assessments are made. This ensures that only those residents who are suited to the home, and whose needs can be met, are admitted to the home. EVIDENCE: There have been no new admissions to the home since the last inspection. There is a Statement of Purpose and a Service User Guide. The registered manager and her staff are skilled at using a variety of methods of communication. They ensure that, as far as possible, the service users understand their rights and responsibilities whilst living in the home. There is a robust pre-admission policy and procedure. Examination of care plans showed that comprehensive pre-admission assessments had been made before a place was offered. Currently there is one vacancy. The manager said that some prospective service users had been assessed but had none been offered a place as they were not suitable for the home. She showed a good understanding of the importance of a pre-admission assessment. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are supported to make choices and take appropriate risks. This helps them maximise their independence. EVIDENCE: Each resident has a personal plan, which reflects their individual needs, aspirations and goals. They also have a person-centred Personal Profile and Health Action Plan. The personal plans are of a high standard. They clearly set out identified needs and desired outcomes. The plans also contain specific guidelines for staff and provide specialist information, for example, guidelines about the management of epilepsy. Risk assessments are in place and records are made of the decision making process. Staff said that they are very much involved in updating care plans and advocate on behalf of the service users. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users take part in a variety of meaningful activities. This means that they are able to be active and lead fulfilling lives. EVIDENCE: The manager and staff work hard to find a variety of activities that are suitable for the service users. Their assessed needs mean part time work would not be suitable. The service users participate in a variety of pastimes. They enjoy a lot of physical activities such as trampolining, walking, swimming and going to the gym. They also go to the local pub, to the nearby beach and take drives out to visit places further a field. They also go on holiday supported by staff from the home. On the day of this visit one service user was at his day placement and the other three were relaxing at home. One was helping in the kitchen, with the support of staff, one was enjoying time in his room and the other was listening Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 11 to music. There is a shelving unit in the lounge that contains a good selection of CDs, videos and games. Activities are recorded in the personal plans and reviewed regularly. Good contact is maintained with all the service users’ families. Some go on holiday abroad with their families and, when necessary, staff support the service users to make visits home. Communication in the home is excellent. The manager and staff are good at using Makaton and finger spelling. They are also very good at managing challenging behaviour and significant improvement has been made recently. During the visit one resident was indirectly observed using a self-calming technique with a little support from a member of staff. This meant that his behaviour did not escalate into actions that would have impacted on the peace and comfort of the other service users. The manager said that this was a recent improvement. The service users, staff and manager are commended for the way the perseverance and consistency in working to manage challenging behaviour. Throughout this visit it was possible to observe the interaction between the staff and the service users. Their communication, using both verbal and nonverbal means, was calm and sensitive. Their interactions were good humoured and any signs of anxiety that might lead to a service user acting out with challenging behaviour, was quickly diffused by using calming techniques. The home has multi cultural residents and staff. There is a very good understanding of the diverse needs of the different cultural and religious beliefs. Special diets are catered for, religious festivals are celebrated within the home and there is good information about differing religious practices on the personal plans. On the day of this visit there was plenty of good quality, fresh produce in the home. Menus are prepared weekly and displayed in the kitchen. However, this is very flexible and can be altered to suit the choices and needs of the service users. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home promotes the health and well being of the service users. The service users are encouraged to keep physically active and to eat healthily. They are well supported emotionally and their personal care needs of the service users are met in a sensitive and respectful manner. EVIDENCE: At the time of this visit there were three residents in the home and one away at his day placement. The three at home all looked to be in robust good health. Staff confirmed that the service users generally enjoy good health and that their nutrition is good. They keep a check on weight and appetites. Routines in the house are very flexible and the service users are able to get up and go to bed in their own time. Their privacy and dignity is very well respected. Staff knock on doors and understand the needs of the service users to spend private time in their own rooms. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 13 The health care needs of the service users are regularly assessed. All are registered with local GPs. Good relationships are maintained with health and social care professionals. Records show that the service users all receive regular attention from a range of health and social care professionals such as the dentist, occupational therapist, speech and language therapist and chiropodist. Health care needs are recorded in the individual personal plans. Health care professionals, who were contacted by telephone, spoke very highly about the home. They said that the manager and staff co-operate well and put health care advice into practice. Medication is well managed in the home. The home maintains very good relationships with the local pharmacy and the pharmacist visits to check on medicines and give staff advice. Medicines are stored safely and there are good systems in place for ordering medicines and the return of unused medicines. Records are well maintained. Only staff trained in the administration of medicines give the service users their medication. There have been two medication errors since the last inspection. This resulted in two service users not receiving their medication at the correct time. These errors were quickly noted and the appropriate action taken. Neither service user suffered any ill effects. Staff were made aware of the errors and processes put into place to prevent further occurrences. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The views of the service users and their supporters are listened to and acted upon. There are robust policies and procedures for the protection of vulnerable adults. These support staff in protecting the service users from all forms of abuse. EVIDENCE: The home has a formal complaints policy and procedure. This is included in the Service User Guide. Although it was difficult to assess whether the service users are able to understand complaints and protection procedures, observation of the way they interact with staff showed that the service users are comfortable and confident when communicating with staff. Health care professionals supported this view and said that they felt sure that staff would report any concerns immediately. There have been no formal complaints since the last inspection. Staff said that they would have no hesitation in reporting any form of abuse. They said that they found it difficult to imagine that any form of abuse would take place in the home as there is such a supportive atmosphere. Staff have undertaken training in the protection of vulnerable adults. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is welcoming, comfortable and well maintained. This gives the service users a pleasant place in which they can maximise their independence and enjoy their relaxation time. EVIDENCE: A tour of the home was made in the company of one of the support workers. The home is spacious and well-maintained. All areas were noted to be clean, tidy and free from unpleasant odours on the day of this visit. Care support staff undertake the domestic tasks and try to encourage the service users to participate in suitable tasks. There is an ongoing maintenance programme. The décor is in good order and flooring in most areas is good and does not present a trip hazard. The stair carpet is scheduled to be replaced soon ad there is now some significant wear. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 16 The upstairs bathroom is also due to be upgraded soon. This is a large room and it would benefit from a storage cupboard in which bath aids could be stored when not in use. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels, staff training and staff skills are all very good. This means that a well-motivated and able staff team cares for the service users. EVIDENCE: There is a very stable staff team with only one new member having joined in the last three years. Seventeen support staff work in the home. Some are full time and some are part time. Any staff absence is covered by other members of the staff team. This means that the staff on duty are always familiar to the service users and understand their needs. Currently there is also a team manager who is a qualified learning disabilities nurse. Staff expressed concern that the team manager’s post is likely to go. They all said that they felt the manager needed the support of a deputy. This will leave a very flat staffing structure. Staff rosters show that staffing is flexible, and responsive to the needs of the residents. They also confirm that there is an adequate number of staff scheduled to be on duty in the home at all times. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 18 A sample of staff files was examined. This sample included the file of the most recently recruited member of staff. All files were in order. There was good evidence that all appropriate pre-employment checks had been made, that regular supervision takes place and that good levels of training are maintained. The staff spoken to all demonstrated a mature and committed approach to their work. They said that they “love working at Forest Lodge”. They said that there is very good team working. One said, “We all get on very well, of course there are times when we disagree about something, how to manage a situation, that sort of thing, but we always have a debate about it and come to an agreement”. They said that there is good communication within the home and that there are regular staff meetings and one-to-one supervision. They all said that they fell free to express their views and concerns and that these are taken seriously. Training at the home is good. The home has a training plan. All mandatory training is up-to-date and there is a good amount of specialist training, such as the management of epilepsy, challenging behaviour, communication, including Makaton and other specialisms. Staff also share their skills with each other, for example, one member of staff has over ten years,’ experience in using Makaton and is able to help others progress. There is an ongoing programme that supports the care staff to gain the National Vocational Qualification at level three. (NVQ 3). However, staff said that they believe the new Trust (Hampshire Partnership NHS Trust) is unlikely to continue to support this programme as they perceive that care staff only need to hold the NVQ at level 2. If this is the case it could prove to be a retrograde step. The staff are highly motivated to gain qualifications that will support them in their work. The Trust should ensure that it communicates its direction and reasons to the staff. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and current organisational structures provide for an adequate line management system. EVIDENCE: The manager has some twenty-two years experience of working with people with learning disabilities. She was appointed to the post at Forest Lodge in January 2006 and was registered with the Commission for Social Care Inspection early on in 2007. She already holds the NVQ 3 in Care and is due to complete the NVQ 4 a week after this visit. She has recently begun to work towards the Registered Manager’s Award (RMA). She has also attended mandatory and specialist training arranged by the home. She receives regular one-to-one supervision from her line manager. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 20 Staff were very complimentary about the manager. They said that she listens to their views and acts upon them if appropriate. They respect her skills and say that she understands best practice in care. Regular staff meetings and supervision take place. As noted under staffing, there is a real anxiety amongst the staff about the impending removal of the post of team manager/deputy. There are quality assurance systems in place. The registered person visits the home on a monthly basis to check the welfare of the service users, the state of environment and to talk to the staff and the manager. The views of relatives and supporters are sought and a key worker system enables staff to advocate on behalf of individual service users. The manager said that she is able to manage the home within the allocated budget but was unsure of how the fees relate to the total budget. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 X X X 3 3 Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA35 Good Practice Recommendations The registered providers should continue to support the staff to gain the NVQ at level 3. This will ensure that they have the skills they require to support service users with very complex needs. Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Forest Lodge DS0000067319.V337938.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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