Inspection on 06/10/05 for Gladwyn Lodge

This inspection was carried out on 6th October 2005.

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 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gladwyn Lodge 23/03/06

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 Final Unannounced Inspection 6th October 11:30 Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 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 Mr Sonnil Geereedharey Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 8 persons) 11th March 2005 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.V257375.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home remains as a domicile and comfortable environment. The presentation of the home environment has improved, with some decoration to the first floor, although the registered person will need to keep on top of this as the house is clearly ‘lived in’ by eight active adults. The tidiness and general organisation was improved. The structure of the care management was also improved, with an enhanced format incorporating more detail. The system is more ‘evidenced based’ than previous and the acting manager intends to further develop this, particularly regarding the daily recording process. Risk assessment has improved, although there were examples of good practice remaining outside of the documentation of the care plan. Staffing is the weak area. Whilst staff remain committed and supportive of service users with very low turnover, a sound recruitment practice and a developing supervisory structure, training remains an area for improvement. Service users spoken with were confidant and ‘at home’ with their surroundings. Access to the community and their involvement with social and leisure pursuits remain positive. Sampled policies, procedures and records were being maintained in a satisfactory way. The acting manager was confident of progressive improvement toward meeting National Minimum Standards and had made some improvements since the previous inspection. At the previous inspection eleven National Minimum Standards were rated below level 3. At this inspection, having inspected all of the previous short falls, the National Minimum Standards remaining in need of improvement had reduced to six. What the service does well: • • • Supports service users in a domicile and supportive environment. Care ethos is user focussed and reflects ordinary life principles. Premises are maintained as a family type home. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 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. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 • Service users benefit from information, a pre-admission assessment approach, the knowledge that known needs can be met by the service and a three month trial period. Service users benefit from having written terms and conditions. • EVIDENCE: The service has a Statement of Purpose that meets Regulatory requirements. This document has been recently reviewed. Each service user has a ‘Service Users Guide’ incorporating all of the necessary requirements. The manager is looking at options of producing the information in alternative formats, including video and audio. Current service users are relatively able and most can either read the documents or able to understand the main points. The service user group currently accommodated have been living at the home for some years. No new admissions have been made for a number of years. On this basis the admissions procedure has not been used, however, should a referral be made the arrangements in place would be appropriate to manage the process in a way that is flexible and designed to offer a gradual and planned admission. Existing service users have had their needs re-assessed via local authority reviews and internal specific assessment. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 9 Contractual arrangements are revised on an ongoing basis as a result of regular reviews of service users by the placing local authority. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10 • • • • • Service users benefit from a revised and improved care planning approach. Service users are enabled to make decisions about their lives with assistance. Service users are informally consulted about life in the home. For the most part service users are supported to take reasonable risks. Service users benefit from the home’s policy and procedure on confidentiality and data protection. EVIDENCE: The care planning arrangements have been gradually developed over the preceding year. The sample seen indicated that the main components were present, including assessment, decision making, monitoring and review. The monitoring methodology continues to be developed to maximise the way in which service users contribute to the process. Various recording formats have Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 11 been tried and this continues to be the subject of development. Further developments were being planned and these were discussed between the inspector and the acting manager. Advice was provided where appropriate. The majority of service users were not at home during the inspection, although the inspector was able to speak with a small number of service users. The service positively encourages service users to make the most of the local community, with or without support, as appropriate. Service users spoken with were confident and expressed satisfaction with the support they receive. Individual consultation between carers and service users was evident. Service users were seen to confidently use the kitchen without reference to carers and this supports the home’s intended outcome of ordinary life principles. Service user meetings are undertaken, although the carers are keen to ensure that this process does not become too formal. Opportunities were evident to discuss preferences and dislikes at various parts of the day, particularly mealtimes. The care planning documentation contained some risk assessment data. The degree of personal knowledge of needs, wants and goals between carers and service users is high. This was evident in view of the very low staff turnover and length of time service users have been living at the home. The way in which risk assessment is recorded has improved, although it is recommended that those risks that are assessed by staff for ‘everyday’ movements are adequately recorded. The service has a policy and procedure regarding confidentiality and data protection. One small room on the first floor is used as an office, in which documentation is held to appropriate levels of security using locked cabinets. Service users spoken with stated they were aware that information was held about them but none spoken with expressed a desire to access the information on a regular basis. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13 & 17 • • • • Service users benefit from being supported to develop personal skills. Service users have opportunities to participate in ‘ordinary life’ activities. Service users benefit from encouragement to use the local community. Service users benefit from a varied diet and flexible mealtimes. EVIDENCE: Service users are positively encouraged to participate in the day to day operation of the home as opportunities exist to undertake various self help tasks. Tasks include the cleaning and tidying of service users’ own rooms and participating, with assistance as required, in preparing their own meals. Service users do not presently contribute to the main meal of the day, as the registered person holds the view that only those persons who have passed the necessary standards of food hygiene competence should contribute to the food preparation for others. Further discussion around this was undertaken between the inspector and the manager to identify a positive way forward. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 13 Service users do contribute to the day to day tasks related to their own self help strategy. This typically includes tasks associated with personal laundry, however, not all of these tasks were included within the personal care plan in adequate detail. Resulting from discussion with carers, service users and via observation it was evident that examples of sound practice were being followed that were not always recorded. The recently recruited manager is advised to ensure that, when reviewing the methodology of care planning, this aspect is revised to ensure the home is able to evidence all the positive aspects of the service. See recommendations. All service users access the local community on a regular basis, either to the town centre facilities, drop in centres and other social and leisure outlets such as social clubs. The food provision is comprehensive with good stocks of both fresh and frozen produce. Fresh fruit was available. Adequate records were being maintained. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 20 • • Service users benefit from a continuity of care from workers who know their needs and preferences. Service users who require medicines on a regular basis benefit from a secure and well administered system. EVIDENCE: The care outcomes have a quality aspect that comes from established relationships. Care workers were able to demonstrate a clear understanding of both current, presenting needs and also from a chronological understanding of previous developmental goals having been achieved. This is possible in view of the long standing of care workers and the length of time service users have lived at the home. A small number of service users take regular medicines. These were secure and well administered. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 • Service users are protected by the home’s arrangements regarding Protection of Vulnerable Adults procedures. EVIDENCE: The home’s approach to the policy and procedure regarding protection issues has been enhanced since the previous inspection. The home has now fully adopted the Essex County Council ‘POVA’ procedures. The staff group, however, would benefit from general training about adult protection issues. See recommendations. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 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): 24, 25, 28, 29, 30 • • • Service users benefit from living within a homely, domicile environment where their individual bedrooms reflect personal identity. Communal areas are maintained in a satisfactory way and compliment the individual space. All service users accommodated are ambulant and do not require any specialist mobility equipment. One service user has a sensory difficulty and the arrangements to meet this persons needs were satisfactory. The home environment was clean and hygienic. EVIDENCE: Whilst not all of the bedrooms were visited on this occasion, those visited were homely, individual and reflected the personality and interests of the person. Various improvements to the environment were noted since the previous inspection. Some of the first floor rooms have been redecorated and there was a general sense of the home being more tidy and organised. The manager stated that this was a result of enabling and supporting service users to look Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 17 after their personal space in a more organised way. The communal areas were clean and comfortable. The environment has a busy and ‘lived in’ feel, with eight active adults using all parts of the home. The registered person is recommended to ensure that a regular maintenance programme is continued, particularly high risk areas such as toilets and bathrooms. See recommendations. One service user requires support resulting from a hearing loss. Arrangements for this were satisfactory regarding the environment. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 • • • • Service users do not fully benefit from qualified care workers. Service users benefit from an effective staff team that has been recruited in accordance with regulatory requirements. Service users do not benefit from care workers who are trained to the minimum requirement. Service users do not fully benefit from a staff group that is supervised to the required standard. EVIDENCE: One of the enduring difficulties the service has sustained is regarding ongoing training. The care worker group is experienced and has attained a variety of qualifications, however, less than 50 of care workers are qualified to National Vocational Qualification (NVQ) level 2. There are an insufficient proportion of care workers who are ‘signed up’ to receive this training. Care worker ratios, in relation to service users, are calculated by the use of the Residential Forum method recommended by the Department of Health. The staff roster indicated that levels were being maintained. The assessment categories appeared to reflect the support requirements of service users. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 19 Whilst the proportion of care worker training is below that required, the overall team is evidently effective by virtue of the individual knowledge of each service user and the highly intuitive way in which the care team operate. Staff meetings do take place, although the supervisory approach remains below that required by National Minimum Standards. The position regarding supervision has improved with a revised format recently introduced and at the time of the next inspection this system will be reviewed again. As previously stated within this report the care worker turnover remains low. Since the previous inspection no care workers have left the home, nor any new workers commenced. The recruitment information was inspected and was reflective of regulatory requirements. The recently recruited manager has yet to devise a training and development plan for staff, although a draft plan was discussed at the inspection. Staff training and development will need to be a high priority if National Minimum Standard 35 is to be achieved. The Inspector gave advice in this regard. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41 & 42 • • • • Service users do not fully benefit from a manager who is qualified. Service users do not fully benefit from a quality assured service. Service users benefit from the home’s records policies and procedures. Service users benefit from promoted and protected health safety and welfare. EVIDENCE: At the time of inspection the acting manager was in attendance with one care worker. The acting manager has not yet attained an NVQ level 4 in care and management, but is seeking a placement as soon as possible. See recommendations. Continued progress had been made regarding the consultative process associated with quality assurance and quality monitoring. The system has yet to have a reliable analysis of collected data. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 21 Policies and procedures were sampled, along with records. Of those seen, all were being adequately maintained. There were no obvious health and safety hazards noted at the time of inspection. The acting manager was maintaining a Care of Substances Hazardous to Health (COSHH) register. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 3 Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X X 3 3 3 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 3 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Gladwyn Lodge Score 3 X 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 3 3 3 X DS0000017828.V257375.R01.S.doc Version 5.0 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA32 Regulation 18 Requirement The Registered Person must ensure that service users are supported by competent and qualified staff. The Registered Person must ensure that service users are supported by an effective staff team. The Registered Person must ensure that staff are appropriately supervised. The Registered Person must ensure that a quality assurance and quality monitoring system is in place. Timescale for action 31/01/06 2 YA35 18 31/01/06 3 4 YA36 YA39 18(2) 24 30/11/05 31/01/06 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 Refer to Standard YA9 YA11 Good Practice Recommendations The Registered Person is recommended to include all risk assessment practice undertaken by carers in written form within the plan of care. The Registered Person is recommended to include all of DS0000017828.V257375.R01.S.doc Version 5.0 Page 24 Gladwyn Lodge 3 4 5 YA23 YA30 YA37 the self-help tasks undertaken by service users within the plan of care. 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 2005. Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 25 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. Extracts may not be used or reproduced without the express permission of CSCI Gladwyn Lodge DS0000017828.V257375.R01.S.doc Version 5.0 Page 26 - 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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