Inspection on 23/03/06 for Gladwyn Lodge

This inspection was carried out on 23rd March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gladwyn Lodge 06/10/05

Gladwyn Lodge 11/03/05

Gladwyn Lodge 26/10/04

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

CARE HOME ADULTS 18-65 Gladwyn Lodge 65-67 Harwich Road Colchester Essex CO4 3BU Lead Inspector Tim Thornton-Jones Unannounced Inspection 23rd March 2006 10:05 Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 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 Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 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. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Gladwyn Lodge Address 65-67 Harwich Road Colchester Essex CO4 3BU 01206 793207 N/A Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Daramdeo Ramchurn Miss Anusha Ramchurn Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 8 persons) The registered manager must complete NVQ4 in care and management within 18 months from the date of this certificate Date of last inspection Brief Description of the Service: Gladwyn Lodge is a residential service for adults with a learning disability. The service aims to provide supportive living, within a realistic domestic setting, for those persons who do not require complex care management. The home does not purport to accommodate those, for example, with challenging behaviour or who have associated complex physical care requirements such as acute continence management. The advised purpose of the service is to provide a homely environment, with care and support, to those who are unable or no longer wish to live with relatives, as part of a group home approach, with a view to enabling those accommodated to live as independent a life as possible. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this inspection was to complete the assessment of the remaining National Minimum Standards for this service during the period 1st April 2005 to 31st March 2006 and to reassess the standards not achieved at the previous inspection. A total of 17 National Minimum Standards were reviewed. Of these, 5 were assessed as not meeting minimum requirements. Four of these were carried forward short falls and therefore remain in need of improvement. Whilst some improvement was noted in the move toward compliance of these standards, it is disappointing that a small proportion of these have remained for an extended period. The Registered Person must ensure that an action plan is in place to ensure progress. Some aspects of staff related standards have improved, including staff supervision and a commitment by staff to attend training. The Manager has developed care planning and these now reflect more comprehensively the self-help objective of some service users. There does need to be improved evidence of service users’ involvement in the formulation of the plan and decision making. Overall, there is an improvement on the previous inspection outcome, although carried forward shortfalls must be resolved. What the service does well: What has improved since the last inspection? • • • Some decoration has taken place. Supervisory practice. Care planning. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 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 Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None. EVIDENCE: The National Minimum Standards within this group were examined at the previous inspection and found to comply with requirements. In discussion with the Manager, it was confirmed the documentation associated with these standards remain unchanged. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 • Service users benefit from the home’s approach to ordinary life principles. EVIDENCE: Care management arrangements have been revised regarding risk assessment activity and these are now better recorded. Service users living at the home are relatively able and use a variety of community activities and resources from both an unsupervised and supported standpoint. The balance between making judgements regarding individual risk and the promotion of individual rights, underpinning the ‘dignity of risk’, can be challenging. The existing group of service users have lived at the home for a number of years and, with very low staff turnover, a considerable amount of knowledge, understanding and trust has been built between those who live and work at Gladwyn Lodge. Issues regarding risk should continue to be updated and re-assessed as appropriate. The Manager will need to ensure that all potential risks are considered, particularly those associated with service users using the community unaccompanied, whilst not encumbering the ordinary life principles the home continues to achieve. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 10 There needs to be improved evidence of service user involvement in care planning and risk assessment to ensure that service users’ consent, to the intended outcomes, has been obtained or, alternatively, that the risk assessment is able to justify why the decision and subsequent action is being taken. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 14, 15 & 16 • • Service users benefit from opportunities to develop social skills and access to social and leisure activities and opportunities. Service users do not benefit from comprehensive reviews of personal and sexual relationships. EVIDENCE: Whilst the care plans for individuals were not fully examined, the aspects of the home’s support regarding practices covered by this group of National Minimum Standards were considered. The Manager has developed strategies to assist service users to adopt more control over their lives with an emphasis of self-help within the home. This varies for each service user in accordance with individual motivation. Service users have access to various social and leisure opportunities within the locality. Typically these include the use of public houses, day activity centres and clubs, to the involvement in routine tasks of shopping and daily life tasks. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 12 The home assists service users to maintain links with friends and family, although the review and planning process of the sampled records did not take account of sexual relationships. This is often a challenging area for care staff to support service users with, however, the review process should take account of service users wishes and thoughts in this regard. The service is tuned in to service users’ individual rights regarding their private rooms and possessions. Staff are developing a greater sense of service users’ ‘ownership’ of their surroundings. One service user spoken with expressed their satisfaction of the freedom they enjoy and the encouragement to be as independent as possible. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 21 • • Service users benefit from the home’s support with physical and healthcare needs. Service users do not fully benefit from the home’s support with illness and end of life issues. EVIDENCE: The principle of ‘an ordinary life’ is demonstrated via the support with healthcare services. Appointments for primary healthcare services are made via community appointments and are adequately recorded. One service user has been referred to a specialist and the home is working in partnership with the service user and their GP. The service user spoken with at the time of inspection has a hearing loss. The arrangements for this were inspected and found to be satisfactory, with routine appointments having been made for audiologist specialist support. Aspects of the care management continue to steadily develop, however, an area for further work is the sensitive area of illness and end of life issues. The Manager stated that informal discussions with service users have taken place Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 14 and that the service user group, being relatively young, do not recognise the relevance. However, this is a matter that will need to be introduced, where appropriate, as part of the review process. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 • Service users benefit from the home’s complaints approach. EVIDENCE: The service has a complaints procedure, which has been reviewed and updated to enable service users to access the information more readily. This is one of the improvements the recently appointed Manager has made. The Manager confirmed that the home had not received any complaints during the period since the previous inspection. CSCI has not received any complaints during the same period. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 & 27 • Service users benefit from individualised rooms and access to toilet and bathroom facilities. EVIDENCE: Gladwyn Lodge registration was transferred to the CSCI as an existing service. Under these circumstances the facilities that existed in the home at the time of transfer must be maintained. This inspection concluded that the facilities were being adequately maintained internally, although in parts were becoming ‘tired’ and in need of some attention. Some of the pictures had been replaced in the lounge. Not all rooms were visited on this occasion, as most service users were out, however, those visited were individual and reflected the personality of the occupant. Some rooms had been redecorated. The communal toilet and bathroom facilities were functional, although would benefit from further routine decoration. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35 & 36 • Service users benefit from an established staff group who are experienced, although are in need of various training updates. Staff are now supervised more frequently. EVIDENCE: The staff turnover in this service has been extremely low over the last few years, which augers well for a staff group to understand and develop relationships with service users. This distinct advantage has, to some extent, worked against the home on the basis that a very high degree of intuitive care and support is evident, based upon a genuine positive knowledge and understanding of each service user. It is nevertheless important that carers receive ongoing training and development and the Manager has begun to make progress in this regard through encouraging some of the staff to make a commitment to undertaking NVQ training. This will be reviewed at future inspection since a lack of training has been a weakness in the service. In addition to ’mainstream’ training, staff will need to ensure that skills and knowledge associated with the needs of service users are updated. Training associated with Protection of Vulnerable Adults (POVA), care planning and assessment, epilepsy, for example, should be assessed by the Manager. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 18 The training profiles are developing and the Manager demonstrated a good understanding of the requirements to meet National Minimum Standards. The supervisory approach has been reviewed and a revised format has been introduced. Each staff member now has a supervision agreement and the sessions are pre-planned and recorded in a suitable format. The Manager is on line to meet the frequency requirements and this will continue to be monitored at future visits. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 39 & 43 • • • Service users benefit from an improved approach that reflects an open approach. Service users do not yet fully benefit from a comprehensive quality assurance and monitoring approach. The accounting procedures were not available for inspection. EVIDENCE: This inspection was unable to obtain a comprehensive view about the service from service users due to the low number available. This will be an area for CSCI to review for the forthcoming inspection process. However, in discussion with the Manager, she was able to describe the ways in which she has reviewed the home’s approach to the service delivery, which was reflective of improved practice and service user involvement and empowerment. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 20 The quality assurance system continues to develop, although was not yet complete. Some semi-formal consultation has taken place with service users since the previous questionnaires were circulated and completed. The current Manager has some experience of quality monitoring and is considering the most appropriate way forward for the service. At present the arrangements do not meet with National Minimum Standards. The Manager does not have direct budgetary responsibility, although does have a ‘float’ arrangement for purchases on a day-to-day basis. The Registered Person has undertaken visits under Regulation 26, although these have not been frequent enough to meet the regulatory requirement. Copies of reports must be sent to CSCI on a monthly basis. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 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 X 2 X 3 X 4 X 5 X X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 3 27 3 28 X 29 X 30 X STAFFING Standard No Score 31 3 32 2 33 X 34 X 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 3 X LIFESTYLES Standard No Score 11 3 12 X 13 X 14 3 15 2 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X 2 X 3 2 X X X 2 Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA23 Regulation 18, 13(6) Timescale for action The Registered Person must 30/06/06 ensure that all staff working with vulnerable adults are adequately trained to understand current good practice concerning the Protection of Vulnerable Adults. The Registered Person must 30/06/06 ensure that service users are supported by competent and qualified staff. This is a repeat requirement. The Registered Person must 30/06/06 ensure that service users are supported by an effective staff team. This is a repeat requirement. The Registered Person must 30/06/06 ensure that a quality assurance and quality monitoring system is in place. This is a repeat requirement. The Registered Person must 30/06/06 ensure that the overall management of the service ensures the effectiveness, financial viability and accountability of the home. Requirement 2. YA32 18 3. YA35 18 4. YA39 24 5. YA43 25 Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard YA9 YA11 YA15 YA21 YA23 YA30 YA37 Good Practice Recommendations The Registered Person is recommended to review risk assessment practice undertaken by carers in written form within the plan of care. The Registered Person is recommended to include all of the self-help tasks undertaken by service users within the plan of care. The Registered Person is recommended to ensure that the care plan process has regard for the relationship and sexual needs of service users, as appropriate. The Registered Person is recommended to develop the review process to include illness and end of life issues, as appropriate. The Registered Person is recommended to engage with the Essex Vulnerable Adults Committee training facility regarding POVA training. The Registered Person is recommended to ensure that maintenance and cleaning of high risk areas is maintained on a systematic basis. The Registered Person is recommended to ensure that the manager is qualified to NVQ level 4 in care and management by December 2006. Gladwyn Lodge DS0000017828.V286297.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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