Inspection on 04/09/07 for Hart Lodge

This inspection was carried out on 4th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hart Lodge 01/08/06

Hart Lodge 23/01/06

Hart Lodge 30/06/05

Hart Lodge 19/11/04

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

CARE HOME ADULTS 18-65 Hart Lodge 10 Whalebone Grove Chadwell Heath Romford Essex RM6 6BU Lead Inspector Mrs Sandra Parnell-Hopkinson Key Unannounced Inspection 4 September 2007 08:15 th DS0000059918.V341275.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 DS0000059918.V341275.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. DS0000059918.V341275.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hart Lodge Address 10 Whalebone Grove Chadwell Heath Romford Essex RM6 6BU 020 8590 7077 020 8500 9339 s.hart93@ntlworld.com 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) R Hart Care Ltd Kathleen Jackson Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places DS0000059918.V341275.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 2006 Brief Description of the Service: Hart Lodge is a registered care home for nine people of either sex who have mental health needs. The care home is situated in a residential area of Chadwell Heath, within the London Borough of Barking & Dagenham, and can be reached by road via the A12 and A13 or by bus routes, and is within easy reach of central Romford shopping amenities. The building has been converted from a family house to a nine-bedroom care home. The home provides a high standard of accommodation with all bedrooms being single with en suite, and some with shower en suite. There is a lounge/dining room with a rear garden which has been decked and has seating for residents. Residents are encouraged to be independent and to be part of the local community. Hart Lodge is owned by Hart Care Ltd which owns and operates another care home for people with mental health needs in the Southend area. At the time of this inspection the minimum fee is £980 per week up to an unspecified maximum fee level which is dependent upon the assessed needs of the individual. The statement of purpose and the inspection report were available in the lounge area of the home, and a copy of each can be obtained from the home upon request. DS0000059918.V341275.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection which took place from 08.15 hours on the 4th September, 2007. The information for this inspection has been gathered from a visit to the service, a pre-inspection questionnaire, some regulation 26 visit reports and discussions with service users, staff members and health professionals. Service user files were viewed together with maintenance records and other documents relating to the service. At the time of the inspection there were no visitors to the home. In discussions with the manager, staff and service users it was evident that matters of equality and diversity are addressed appropriately within this service. As part of the inspection, people using the service were asked how they wished to be referred to in this report, and they told the inspector that they would prefer to be called ‘service users’. What the service does well: The manager and staff are very aware of the need to ensure that issues around equality and diversity are given a high profile within this service, and this was evidenced from discussions with service users, healthcare professionals and from viewing documentation. It was evident from talking to service users and staff, and from observation, that service users are encouraged to be a part of the local community and to participate in community activities such as attending local colleges, cinemas, leisure centres and shops. Emphasis is placed on the rehabilitation of the service users, some of whom have been discharged from hospital under various sections of the Mental Health Act 1983. Service users are encouraged to be self-sufficient with regard to medication, personal hygiene, maintaining a clean home, cooking, shopping, clothes laundering and budgeting. One service user told the inspector “the manager is really nice and she cooks a lovely shepherds pie.” Staff training continues to be given a high profile with many of the staff having achieved either NVQ level 2 or 3. All staff receive regular supervision, and a member of staff told the inspector “this is like a family, we all get on well together, but if there is a problem we can talk to the manager who always listens and sorts things out.” All prospective service users have planned admissions and undertake several overnight visits to ensure that the service is the right one for them. DS0000059918.V341275.R01.S.doc Version 5.2 Page 6 In discussions with the manager it is evident that the proprietors continue to be supportive and have a good understanding of the needs of people with mental health problems, and the need to offer a flexible service. The home continues to be maintained to a good standard with regular redecoration and refurbishment being undertaken. 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. DS0000059918.V341275.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 DS0000059918.V341275.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): 2, 4 and 5 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. Prospective service users can be assured that their individual aspirations and needs will be assessed and that they will have the opportunity to visit and stay overnight at the home prior to making a definite decision to move in. Each service user has an individual written contract containing the terms and conditions of residency at Hart Lodge. EVIDENCE: The files of 5 service users were viewed and case tracked, and it was evident that prior to admission to the home all had had a full assessment undertaken of needs, and that all had been able to make several visits including some overnight stays, to the home prior to moving in permanently. All of the files viewed contained a copy of the licence agreement for residency at the home, and these had been signed by the individual service user. Also all of the files contained a copy of the summary of the single Care Management assessment integrated with the Care Programme Approach. The Care Homes Regulations 2001 have been amended with effect from the 1st September 2006 for new service users, and for existing service users with effect from 1st October 2006, so that more comprehensive information is to be DS0000059918.V341275.R01.S.doc Version 5.2 Page 9 included in the service user guide. Details of information to be included are contained within the amended regulations. Therefore, the service user guide must be reviewed and amended by the stated timescales. The manager was also provided with a copy of the Commission’s ‘Policy and Guidance on Provision of Fees Information by Care Homes’. DS0000059918.V341275.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. Service users and staff benefit from having a detailed care plan which is regularly reviewed. Monthly service user meetings are held to ensure that all service users are consulted on, and can participate in all aspects of life in the home. All service users are supported to take risks within a risk management framework as part of an independent lifestyle. EVIDENCE: Individual files were available for each service user and the care plans and related documentation of 5 service users’ were case tracked. Care plans are very comprehensive and are being used as working tools. They are sufficiently detailed as to be understood by all staff and to others who may not be as familiar with the individual service user. Each service user has a key worker who is able to provide one to one support and ensures that care plans are being kept up to date through regular evaluation and review. All service users’ DS0000059918.V341275.R01.S.doc Version 5.2 Page 11 plans of care are in line with the Care Programme Approach (CPA) and are reviewed in accordance with CPA procedures by the service users’ Consultant Psychiatrist. The manager ensures that the home works in partnership with all agencies so that there is effective and well co-ordinated mental health care for people living in the home. Service users are actively encouraged and supported to be involved in the development of their care plan. Engaging and motivating individuals is sometimes a challenge for staff due to the enduring and severe mental health problems experienced by people living in the home. However, staff have the training, experience and skills to engage the individual at varying levels to enable them to have a degree of meaningful involvement. Comprehensive risk assessments were in place for each service user and were subject to regular review and updated accordingly. They identified elements of risk for individuals and detailed strategies and actions to keep any such identified risks to a minimum. This included risks associated with physical/ verbal aggression and for individuals where the risk of relapse in their mental health was considered to be quite high. Service users are supported to take risks as part of promoting their independence and where there are limitations in place, such decisions are made involving the individual and were recorded. One service user enjoys regular visits by and to family, and is now also able to drive. There is a policy in place in the event of a person going missing from the home, which all staff were aware of. All service users have access to independent advocacy services as necessary. There is a strong focus on maintaining and promoting independence. Staff understand the importance of supporting residents to have control of their lives and make their own decisions. Individual staff were observed providing service users with information, assistance and support, and were respectful of their right to make decisions. The routines of daily living and activities were flexible and varied to suit the differing needs of service users in the home. The home maximises independence wherever possible and staff provide service users with information, assistance and support to make decisions about their own lives. The attitude and practice of the service and that of the staff team, promote opportunities for residents to remain independent, exercise choice and express their wishes and needs. Some of the service users who wish to reduce their smoking needs, are actively being supported by staff and other health care professionals. In discussions with some of the service users it was evident that regular meetings are being held with them, and that they are actively engaged in the running and direction of the home. One service user told the inspector “I am very happy here and the staff are very kind and always ask me what I want to eat, or do.” The inspector was also able to speak to two healthcare professionals who have involvement in the home, and they confirmed that service users are DS0000059918.V341275.R01.S.doc Version 5.2 Page 12 encouraged to be independent, with support where necessary, and that they are able to make and exercise choice. From viewing documentation and discussions with the staff it was evident that they were aware of the need to respect information given by residents in confidence, and to handle information about residents in accordance with the home’s written policies and procedures, the Date Protection Act 1998, Freedom of Information Act and in the best interests of the service users. DS0000059918.V341275.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 15, 16 and 17 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. Service users are actively encouraged and supported to be involved in social and leisure activities appropriate to the individual, and are able to maintain and develop personal relationships of their choosing. They are supported to exercise their rights, which are respected and promoted by staff and they are enabled to participate in the community in which they live. The nutritional needs of the residents are well considered so that food and mealtimes are seen as being important and enjoyable for all residents. Service users are provided with meals that are reflective of their choice, cultural and dietary needs, and those that are self-catering are supported to choose and enjoy and balanced diet. DS0000059918.V341275.R01.S.doc Version 5.2 Page 14 EVIDENCE: People living in the home are individually and collectively involved in determining the type of activities they wish to participate in, when and with whom they choose. Service users’ meetings are held once a month and minutes are available to service users and staff. From viewing minutes of these regular meetings it was apparent that activities and other house matters are discussed in this forum. Several of the service users have lived at the home since it opened, but some have moved onto independent living. This means that there is a turnover of service users, which is to the success of this rehabilitation service. There is a wide range of leisure activities for service users to engage in both in the home and the community. This included attendance at local colleges, drop in centres, and other specialist mental health centres. Trips to the cinema, theatre, shops, local cafes and pubs are also enjoyed by some of the service users. One service user told the inspector, “I like going to the shops to buy things, and am quite good at this now.” Another service user has attended a local college and has successfully attained a qualification in painting and decorating, and is planning to move onto independent living in the near future. It was clear that the type and variety of activities were reflective of their individual choice, ability, age and culture. On the day of the visit staff were observed to be supporting individuals to pursue their individual interests and hobbies. Other service users are well orientated and integrated in the community and make use of public transport. One service user has a car which he makes regular use of. Where there are family links and friendships, service users are encouraged and supported by staff to maintain these links. One service user visits family and they, in turn, visit the home. One service user is doing voluntary work, and is also attending a weekly gardening course. Service users are also encouraged to exercise their civil rights around voting at local and general elections. The routines of daily living and activities were flexible and varied to suit the differing needs of service users in the home. All staff are very aware that Hart Lodge is the home of the service users, they respect this and try to make this as pleasant as is possible. Some service users are self-catering and are given money to purchase their own food requirements but they have to provide necessary receipts and their diets are monitored by the key worker to ensure that the meals are nutritional and balanced. Such service users have their own store cupboard and a separate small refrigerator. The care plans viewed indicated that dietary intake and weights were being monitored where appropriate. Some meals are arranged for all of the service users so that they, and staff, can enjoy a meal together. Such menus are discussed with service users and in line with DS0000059918.V341275.R01.S.doc Version 5.2 Page 15 promoting equality and diversity, menus were reflective of the diverse needs and preferences of individuals. One service user told the inspector “the food is good, and she (referring to the manager) makes a mean shepherds pie and lasagne.” Service users are involved in ensuring that the communal areas and their own bedrooms are kept clean, and they are responsible for doing their own laundry with supervision where necessary. It was apparent during the inspection that the service users and the staff interact very well with each other, and one service user told the inspector “we are a family, and get on well together.” DS0000059918.V341275.R01.S.doc Version 5.2 Page 16 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 and 20 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. Service users’ personal and healthcare needs are closely monitored by a skilled, trained and knowledgeable staff team. This ensures that their needs are recognised, understood and met. Personal support is provided in a manner, which suits their individual needs and preferences. There are clear medication policies and procedures for staff to follow and this ensures that service users are safeguarded with regard to the administration of medication and their health care matters are efficiently managed. Service users who are self-medicating do so within a risk management framework and the home’s policy. EVIDENCE: 3 of the service users spoken to confirmed that they were happy with the support they receive around their personal care needs. Service users have a choice in relation to same gender care preferences when receiving assistance DS0000059918.V341275.R01.S.doc Version 5.2 Page 17 with personal care, and their care plans set out how their personal support is to be provided. Some service users require a higher level of staff support in meeting their personal care needs than others, but staff are aware of the need to balance service users’ independence and choice with flexible and responsive personal support. All of the care plans examined clearly recorded referrals to specialist health care professionals and that appointments were being kept. There were welldetailed care plans relating to specific health care needs and weight management. Records indicated that service users attend routine health appointments including GP; dietician, dentist, optician, chiropodist and routine cervical and breast screening. As far as possible service users are given the opportunity and support to independently attend their own appointments, and are seen as individuals taking responsibility for their own health care. Staff are very observant and alert to changes in individuals behaviour and mood and fully understand how they should respond and the action required. Care plans detail specific behavioural interventions. The service employs a clinical advisor who also undertakes professional supervision of the manager, and another health professional undertakes regular cognitive therapy group work with the service users. There are policies and procedures for the handling and recording of medication. An audit was undertaken of the management of medicines in the home, and a random sample of Medication Administration Record (MAR) charts were examined. Medication storage was satisfactory and medication records were being fully completed. Regular checks are undertaken to ensure that staff comply with the organisation’s policy and procedure. 2 service users are currently self-medicating, and this is done within a risk management framework and in line with home’s policy and procedure. These service users have regular reviews of their medication, which is closely monitored by staff. Service users receive good support with their medication, which for all is an important element of maintaining their mental health and well-being. As discussed with the manager during the inspection, all hand written entries on the MAR sheets should be signed by two members of staff to ensure accurate transcribing of information. The manager was given copies of the Commission’s recent guidances on the administration of medication. DS0000059918.V341275.R01.S.doc Version 5.2 Page 18 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 and 23 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. Service users feel that their views are listened to and acted upon and that they and their families will not be victimised for making a complaint. Staff working in the home have received training in safeguarding adults to ensure that there is a proper response to any suspicion or allegation of abuse. Service users are safeguarded from abuse and harm through the use of staff training, regular supervision and monitoring. EVIDENCE: Staff working in the home have received training in the safeguarding of adults, and this is included in induction training for any new staff. Those staff spoken to during the inspection were aware of the action to be taken if they had concerns about the safety and welfare of service users and were also vigilant to the potential for abuse between service user and service user(s). This knowledge is regularly reinforced and discussed through supervision and staff meetings. There are policies and procedures in the home which are accessible and understood by staff regarding safeguarding adults and staff are clear about local reporting protocols and referral to the local authority. Service users have access to external agencies and professionals through advocacy services and CPA reviews. There is a written complaints policy and procedure, which is clearly displayed and included in the Statement of Purpose and Service User Guide. No complaints had been recorded since the last inspection. In discussion with the DS0000059918.V341275.R01.S.doc Version 5.2 Page 19 manager and staff it was evident that they take residents’ concerns and views seriously and were clear on the service users’ right to complain and that they would encourage and support them to do so. Those service users spoken to felt able and confident to complain, should they feel the need to. One service user said: “I would tell them at the service users’ meeting” Other service users commented that they would speak to the manager; their named key worker or at their meetings. One service user told the inspector “the manager is really nice and I feel that I can speak to her.” There is a policy and procedure in place and known by staff for the management of physical or verbal aggression by a service user. DS0000059918.V341275.R01.S.doc Version 5.2 Page 20 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, 25 and 30 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. Service users live in a homely, comfortable and safe environment which is clean and hygienic, and they have bedrooms which suit their needs and lifestyles. EVIDENCE: A tour of the building was undertaken, and all of the bedrooms are single and en suite, some with either a shower or bath. The inspector visited the room of one service user by invitation and this was well furnished and decorated to suit that person’s needs and particular preferences. Service users are encouraged to personalise their bedrooms so that they are reflective of the occupant’s culture, religious, personal interests and lifestyle needs. There is a large lounge/dining room which is decorated and furnished to a good standard. There is a communal kitchen which was also clean as was the laundry area. COSHH materials were kept in a locked cupboard in the laundry room. DS0000059918.V341275.R01.S.doc Version 5.2 Page 21 There is a separate small lounge where service users can use the telephone in private. The rear garden area has been laid to decking, with ‘green’ matting in parts to prevent service users and staff slipping if the decking is wet. There were planted pots and tubs which added to the ambience of this area. There is a smoking room on the top floor which meets the requirements of the recent smoke free legislation, but this does need some attention with regard to redecoration. Whenever possible, service users are encouraged to smoke in the garden area, and for this purpose a gazebo has been erected on the decking area. To ensure the safety of staff who are caring from service users who smoke, the manager should develop a policy and her attention is directed to a document produced by the Royal College of Nursing which can be accessed through www.rcn.org.uk. DS0000059918.V341275.R01.S.doc Version 5.2 Page 22 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, 35 and 36 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Staffing levels are satisfactory and service users benefit from a committed and motivated staff team who have the skills, training and competence to meet the individual assessed needs of service users. The procedures for the recruitment of staff are robust and provide safeguards for the protection of people living in the home. EVIDENCE: The files of 3 new staff members were viewed and these were found to be in order and in accordance with the statutory requirements. All had application forms, references and enhanced criminal records bureau disclosures. In discussions with the manager, it was agreed that in future she will also retain on file the interview notes made during the recruitment process. The files viewed all had a copy of the contract of employment which had been issued and signed by the staff member. DS0000059918.V341275.R01.S.doc Version 5.2 Page 23 The organisation uses both internal and external trainers, and staff are doing the Common Induction Standards training. New staff undertake an initial induction and all new staff have to serve a probationary period of 6 months. At the end of this time the employment is reviewed and either confirmed or not. Staff have undertaken training in Mental Health and Mental Illness, administration of medication, schizophrenia, safeguarding adults, fire safety, health and safety, first aid, violence/aggression and rehabilitation and recovery. Many of the staff have achieved qualifications at NVQ level 2 or 3 and this training is ongoing for those staff who have not yet achieved this qualification. All staff receive regular supervision, and regular monthly staff meetings are held. Several staff who were spoken to confirmed that training is always available, and that any necessary training identified by them can be discussed with the manager so that arrangements can be made for them to undertake such training. Staff rotas were inspected and staffing levels and skill mix of staff was sufficient to meet the assessed care needs of service users. Generally there is a stable workforce at the home, and effective team working was observed and evidenced throughout the inspection. Staff interacted well, both with each other and the service users, and this was in line with each individual’s programme of care. There is little use of agency staff and any gaps in the rota are generally covered by permanent staff. This is clearly to the benefit of service users since it provides consistency of care, which is extremely important for people with mental health care needs. In discussion with the manager and staff it was apparent that staff morale is high, and they are enthusiastic and positive about wanting to improve the quality of life for service users. It was apparent at the time of the inspection that the ethnicity of the majority of the staff team was different to that of the people living in the home. However, all staff working in the home demonstrated a good understanding of equality and diversity issues. This was reflected in the documentation and care being given so that the spiritual, dietary, cultural, sexual and any other diverse needs of service users is understood by staff and appropriately met, wherever possible. Staff were able to demonstrate a thorough understanding of the particular needs of individual service users and could therefore deliver meaningful person centred care. DS0000059918.V341275.R01.S.doc Version 5.2 Page 24 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, 39, 42 and 43 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. The manager of the home is a well qualified and experienced person and service users benefit from this as the home is run in their best interests. Monitoring visits are undertaken regularly by the clinical advisor, acting on behalf of the responsible individual, to monitor and report on the quality of the service being provided in the home. Staff are appropriately supervised and the health, safety and welfare of service users and staff are promoted and protected. DS0000059918.V341275.R01.S.doc Version 5.2 Page 25 EVIDENCE: Since the last inspection the manager has now achieved registration with the Commission as required by the Care Standards Act 2000 and the Care Homes Regulations 2001. It was evident during the inspection that the home is being well managed and the manager is keen to work in collaboration with external agencies and the Commission. Through staff training, supervision and good management, staff are ensuring that residents receive a high standard of care and that the home is run in their best interests. All staff spoken to throughout the visit spoke very positively about how well supported they felt by the manager. Staff receive regular 1:1 supervision, direct observation of care practices and regular staff group meetings. The manager has an open and inclusive style of management and staff and service users feel valued. She is very service user focused and works continuously to improve the service and provide an increased quality of care for people living in the home with the support of a strong staff team and in partnership with other agencies and health care professionals. All staff appear to work as a team and value each other’s contributions. The organisation and the manager ensure that policies and procedures are reviewed on a regular basis and the manager keeps up to date with new and changing legislation. Audits, spot checks and quality monitoring systems provide evidence that practice reflects the homes policies and procedures. The inspector had a discussion with the manager around the introduction of the Mental Capacity Act 2005, which became effective from April 2007. The manager was aware of this new legislation and is scheduled to attend training around this. She will then be discussing this with staff and people living in the home. Regulation 26 visits are being undertaken and copies of these are retained in the home. A wide range of records were looked at including fire safety, health and safety checks, gas, electric and accident/ incident reports. These records were found to be detailed, up to date and accurate. Fire alarms are tested weekly from a different point in the home. A copy of the registration certificate and insurance certificate were displayed in the reception area of the home. Responses from service users, healthcare professionals and staff were very positive as to the management style and of the current service being delivered at Hart Lodge. DS0000059918.V341275.R01.S.doc Version 5.2 Page 26 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 3 3 X 4 3 5 3 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 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 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 3 12 3 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 X 3 X X 3 3 DS0000059918.V341275.R01.S.doc Version 5.2 Page 27 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. 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. Refer to Standard Good Practice Recommendations DS0000059918.V341275.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. 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