Inspection on 14/07/08 for Hastings Lodge

This inspection was carried out on 14th July 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hastings Lodge 03/08/06

Hastings Lodge 23/01/06

Hastings Lodge 03/05/05

Hastings Lodge 25/10/04

Hastings Lodge 21/07/04

Hastings Lodge 27/01/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Hastings Lodge 20-22 Althorp Road St James Northampton NN5 5EF Lead Inspector Stephanie Vaughan Unannounced Inspection 15th July 2008 09:30 Hastings Lodge DS0000012797.V368410.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 Hastings Lodge DS0000012797.V368410.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. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hastings Lodge Address 20-22 Althorp Road St James Northampton NN5 5EF 01604 750329 01604 465911 hastings.lodge@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) Mr John Hastings Elliot Mrs Marie Marguerite Llandinaff-Elliot Mrs Marie Marguerite Llandinaff-Elliot Care Home 14 Category(ies) of Learning disability (14), Learning disability over registration, with number 65 years of age (2) of places Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To accommodate 11 services users at 20-22 Althorp Road, St James, Nothampton, NN5 5EF To accommodate 3 service users at 6 Althorp Road, St James, Northampton 3rd August 2006 Date of last inspection Brief Description of the Service: The home provides a service for 14 people with learning disabilities and is situated within a residential area of Northampton. The home is divided into three properties situated in the same street. Two of the properties are adjacent and have been tastefully converted into one property, which is home to 11 service users. A further 3 service users live in a smaller property a few doors away in the street. The properties blend in well with the surrounding houses in the area. Shops and other community facilities are close by. 12 service users are accommodated in single rooms and two in a double bedroom. The lounges, dining room and kitchen are freely accessible to all the residents. Fee levels differ according to needs of service users. The current fees range from 3 455:00 per week to £1249:00 with additional charges for holidays, some transport and personal items such as clothing and toiletries. The service provides information to the people who use the service such as the Commission for Social Care Inspection reports and these are displayed in the home. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Prior to this statutory inspection, a period of five hours was spent in preparation. This comprised reviewing the Annual Quality Assurance Assessment, a document sent to us by the provider, the previous inspection reports and associated requirements, the service history and other documentation. We received competed surveys from three people who use the service these indicate a good level of satisfaction with the service provided at Hastings Lodge. We received three completed surveys from staff these indicated that in general they feel that the service proves a good standard of care to the people who use the service. The Commission have received two concerns about this service one relating to the fact that the previous survey forms appeared to have been completed by the same person, possibly a staff member, however further enquiry indicated that the same staff member had supported individual residents to complete the surveys. A second concern was received that indicated that staff from overseas communicate in their own language whilst working in the home and this is further addressed in th main body of the report. There have been no complaints or Safeguarding Adults Allegations about this service. The Commission have a focus on Equality and Diversity and issues relating to this are also included in the main body of the report. This site visit to the home was conducted over a period of eight hours during which the inspectors made observations and spoke to residents and staff. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of four residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. The service specialised in the care of people who have learning disability, some have limited communication abilities and as such were unable to recollect or to fully express their views about this service. In these circumstances observations are used to inform the inspection activity. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 6 The Registered Manager was present during most of this inspection. What the service does well: Many of the people who use the service have lived at Hastings Lodge for a long time and they tell us that they are happy living there. The staff know them well and make sure that they are looked after in the way that they need and wish to be cared for. Residents say that they like the staff and that they feel well cared for. They are well presented and are able to express their personality and gender through the way that they dress. People who use the service say that they are able to make decisions and that they are supported to develop and maintain their interests. One resident has recently been to the British Grand Prix and said that it had been ‘fantastic to be there when Lewis Hamilton had won’. Another said that she had had ‘ a good time at church and that it had been packed’. Residents are supported to maintain interested and active lives, some are able to access the local community independently and other are supported to access local facilities such as clubs and day centres. People who use the service said that they were involved in making decisions about their routines activities and the menus. Residents were able to confirm that they liked the food, there was enough of it and that they were involved in the preparation of their breakfasts and packed lunches. People who use the service the service are able access the right health care services and are also able to have health checks and health promotion services such as the flu vaccination. People who use the service are able to receive their prescribed medication safely. The staff are trained in the right topics to make sure that they are able to care for the people who use the service safely. They also know how to protect people form abuse. The environment is homely and comfortable’ no hazards were identified. People who use the service were proud of their own rooms and said that they liked them and that they were able to make decisions about the décor and to have keys to their rooms. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 7 The Registered Manager is experienced and qualified to run the home and safe working practices were seen to be in place. What has improved since the last inspection? What they could do better: The service needs to make sure that they have all the right information for the people who use the service, including the Service Users Guide which tells people about how the home is run and what it is like to live there. This should also be made available in other formats such as easy read and audio tapes so that it is easy for people to use. The service needs to make sure that all the people who live there have up to date contracts in place and that these contain the right information such as the fees that are charged and what is included in the price. The service needs to review the way that they manage information and ensure that individual plans of care are ‘person centred’ and are in formats so that the residents or their representatives are able to be involved in the care planning and review process. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 8 A key worker system needs to be introduced so that people who live there can have the support from an identified member of staff of the same gender and culture. The service needs to take advice from a dietician to help staff balance the resident’s choices with their need to have special diets and to achieve a healthy diet. The service needs to make sure that there are detailed risk assessments in place regarding the purchase of over the counter medication by residents, to reduce and manage the associated risks. The arrangements for residents to access the kitchen need to be further reviewed to ensure that they are able to participate in supervised cooking activities, including the evening meal. The service needs to review the content of the formal complaints procedure to make sure that it has all the right contact information and that it is up to date. At least one person lives at Hastings Lodge has a visual impairment, the service would benefit from specific guidance from an Occupation Therapists and the Royal National Institute for the Blind regarding the environment, including the provision of appropriate aids and adaptations. The environment is adequate for the needs of the existing residents however there is limited outdoor space and access is also limited for residents who may require the use of wheelchairs. Recruitment practices need to be reviewed to make sure that staff have all of the right checks before they start working in the home. The service also needs to make sure that people are able to access carers of the same gender. The service also needs to make sure that staff from overseas use the English language at all times whilst they are on duty. Staff supervision needs to be conducted at least six times a year to make sure that staff are fulfilling their roles and responsibilities. Quality assurance systems needs to be further developed to make sure that the service knows what the people who use the service think and that this information is used to make improvements to the service. The standard of record keeping in the home needs to be improved. The records that have become out of date need to be archived so that staff and residents have access to concise and up to date information. The service also needs to make sure that all their records comply with current legislation such as the Data Protection Act and Freedom of Information Act. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 9 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. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 10 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 Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service do not have access to all of the right information, to help them make informed decisions. EVIDENCE: The service does not have a Service Users Guide and although they have no vacancies for new residents at the home this needs to be developed as specified in Standard 1 of the National Minimum Standards and ensure that it is made available in suitable formats for the people who use the service so that they have accessible and up to date information about the service and are able to make informed decisions. The service has a copy of the previous Commission for Social Care Inspection report and this is displayed in the hallway of the home. There have been no recent admissions and most of the people who live at Hastings Lodge have lived there for many years. The service ensures that people have regular assessments conducted by the Registered Manager and Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 12 also by the funding authorities, these are used to form the basis for the individual plans of care. Residents have individual contracts held on file these are out of date and do not contain all of the right information such as the cost of the fees. These need to be reviewed and reissued so that people have up to date information about the service and what it provides. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 13 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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have plans of care, which show that they are treated as individuals and are supported to maintain their independence. EVIDENCE: Each resident has an individual plan of care, which sets out how the resident is to be cared for. The service has amassed a considerable amount of information about the personal, health and social care needs of the people who live at Hastings Lodge over the years. The resident’s needs and preferences are well known to staff. However the organisation of the information needs to be reviewed to make sure that it is person centred rather than task orientated and that the relevant information is easily accessible to both the staff and to the residents. Care plans should be developed so that the residents, their Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 14 representatives and staff can be better involved in the care planning process and review. Arrangements should also be made to enable people who use the service to have a specified key worker who takes a special interest in that particular resident regarding their care and life in the home. People who use the service say that they can be involved in making decisions about their lives and the running of the home. Residents said that they had been able to follow their interests such a going to the British Grand Prix, which they said had been ‘fantastic’. The service also ensures that there are regular residents meetings where they are able to make decisions about the running of the home such as the menu planning and planning group activities such seasonal celebrations and birthday parties. The service uses a variety of visual aids to help residents make decisions. Residents were also able to conform that they were consulted about the décor of their rooms, their views about the new staff applicants during the selection process and whether they think that they would be able to live with potential new residents. The service has arrangements in place to ensure that people who use the service are able to access advocacy services. There was clear evidence that people are encouraged to maximise their independence, people are supported to manage their own money; a spot check was conducted and this showed that the service does this well and makes sure that the right records are kept. People who use the service are able to take risks within their daily lives, three people live in a separate house called the Cottage where they are able to take more responsibility for their lives and achieve greater independence, such as accessing the local community independently and by being more involved in the running of the home such as general house hold tasks. A Requirement was made at the last inspection regarding a resident who might return unexpectedly to the Cottage when there were no staff on duty there. The individual plan of care demonstrated that the provider had taken the required action and an appropriate risk assessment is now in place. The management of risk is generally good, risk assessments are in place according to the resident’s individual needs, such as choking, epilepsy and falls and there are the right controls in place to ensure that the risks are managed and reduced. These are reviewed on a regular basis; any restrictions placed on people who use the service are seen to be in their best interests and to be supported by the appropriate risk assessments. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents social, religious and recreational interests are promoted in accordance with their known lifestyles and given capacities, however these are not constantly documented. EVIDENCE: People who use the service told us that they had busy and fulfilling lifestyles, which reflected their individual interests and chosen activities. They are able to attend local day care services, craft centres and leisure facilities such as local bingo. They were also able to confirm that they participated in the local community through accessing local facilities such as shops, clubs and restaurants. Residents are also able to supported to maintain their faith should they wish to do so. One resident commented ‘ I went to church yesterday, it was lovely and really packed’. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 16 Individual plans of care showed that people who use the service are supported to exercise their political rights through participation in local and national elections. People who use the service are also supported to maintain contact with family and friends, either by receiving visitors at Hastings Lodge or by visiting families in their homes for over night stays. People who use the service also confirmed that routines are flexible in the home, within the constraints of their planned activities. People are able to choose to spend their time in either their own room or the communal areas. Individual plans of care showed that resident’s preferences are known to staff and that they are respected. People who use the service are assessed for their ability and wishes to hold keys to both the front door and their own bedroom doors and arrangements are in place to enable them to do this. Staff were seen to be respectful of the residents privacy and to use their preferred forms of address. People who use the service told us that they were involved in planning the menus, that they liked to food that was provided and that this was of adequate proportion. One resident commented that he would like a cooked breakfast and the menus did not indicate that this was available. However on further enquiry it was established that this is made available on request. A sample of menus were reviewed and showed that some of the people who use the service have limited intake of a varied diet, including access to the recommended portions of five fresh fruit and vegetables per day. However there was evidence that healthy eating alternatives are available and that the service caters for special diets and supports residents in a sensitive and caring manner. There is evidence that residents are able to access the kitchen and are supported to prepare their own breakfast and their packed lunch. Some of the more able residents expressed an interest in becoming more involved in the preparation of the cooked meals but said that they were not allowed in the kitchen due to health and safety arrangements. This should be reviewed to enable individuals to fulfil their ambitions, whist continuing to maintain safe working practices. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal and health care is managed well and meets the individual needs of the of the people who use the service although the documentation does not consistently reflect this. EVIDENCE: Each person who uses the service has an individual plan of care. These set out the basic need of the resident’s personal and health care needs. However these are not person centred and information about the residents is stored in alternative task based files which means that there is no one source of access to information about the residents needs either for the staff or the resident. Never the less there was evidence that the personal and health care needs and preferences of residents are known in detail by the staff. People who use the service said that they were supported well by the staff and they appeared to be well cared for and well presented. Residents are supported to make choices Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 18 about their appearance, such as choice of clothing, hairstyle, and jewellery and make up. The service has recently installed a new wet room on the ground floor; this means that people with a disability have improved access to convenient facilities. Appropriate aids and adaptations are available to ensure the safe use of the staircase. Individual plans of care showed that people who use the service have access to appropriate health care specialists such as General Practitioners, Hospital Consultants, Community Learning Disability Teams, Specialist Nurses such as the Continence Nursing Service, and other specialists such as physiotherapists, dentist, opticians, podiatrists. In addition the service employs their own Consultant Psychiatrist who provides monthly input to the people who use the service. The service also involves the ‘ best Interests’ team regarding decisions about capacity to consent or refuse treatment. People who use the service are supported to manage their health care needs; the service monitors their well being on a regular basis and also ensures that people have access to health screening and health promotion activities such as the flu vaccination. The management of epilepsy is good and there are appropriate arrangements in place to monitor the needs of the individual and to liaise with health professional and day care services. The service uses a Monitored Dose System supplied by a local pharmacist. Accurate records are maintained for medication that is received by the service and the Medication Administration Records indicate that the medication is given as it is prescribed. Several checks were conducted which showed that medication is managed well. However the service needs to review the storage of medication to ensure that this complies with recent guidance issued by the Royal British Pharmaceutical Society Guidelines. There is evidence that residents are assessed for their ability and wish to self medicate, however none of the existing residents are able to do this, in these circumstances their consent for the staff to do this on their behalf is obtained. In addition the individual plans of care showed that one of the more independent residents had a tendency to purchase pharmaceutical products from local shops and not to tell the staff that she had done this or whether she had taken any of that purchased. However the service has developed an adequate risk assessment relating to this practice, which shows how this is to be managed. This needs to be further developed with advice sought form the Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 19 local pharmacist and the inclusion of more specific detail to further reduce ad manage the associated risks. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are protected by the robust policies and practices used by care staff. EVIDENCE: People who use the service told us that they knew how to raise their concerns if they were unhappy about something and that they were confident that their concerns would be addressed. Through observation it was established that the staff were skilled in interpreting the residents non-verbal communications and that staff were responsive to these. The service has received no complaints since the last inspection, however two concerns have been raised with the Commission regarding staff from overseas suing their own language to communicate between themselves, in front of other residents and staff. There was evidence that the management had been aware of this incident and had addressed this with individuals and supported the staff concerned through training in the spoken English language. However although there was no evidence of this during the inspection one of the recently returned staff surveys indicated that this is a continuing problem, this Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 21 needs to be addressed with individuals at staff supervision and if necessary through the services own disciplinary procedure. The other concerns was with regard to the residents Comment Cards being returned indicating that they had been completed by staff members, further enquiry indicated that some of the residents had required the support of staff to completed the Comment Cards. The service has a complaints policy, which is displayed, within the home; there are also user-friendly versions to which residents have access. However the complaints policy needs to be further reviewed to ensure that it contains all of the right contact information. People who use the service were able to say that they felt safe living at Hastings Lodge and that the staff were nice to them. The staff were able to demonstrate a good understanding of their responsibilities in the Safeguarding of Adults, access to a Whistle Blowing policy and appropriate training in the Safeguarding of Adults. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment is good providing people who use the service with a comfortable and safe place to live. EVIDENCE: The premises comprise two converted terraced house to provide one larger establishment. In addition there is also a small terraced house at the end of the road that provides more independent living accommodation to the people who live there. This means that the premises are not ideally suited to the needs of the physically disabilities as there is no wheel chair access and the corridors and doorways are narrow. In addition there is at least one person Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 23 living at the home who has a visual disability and the service would benefit from seeking guidance from professionals such as Occupation Therapists and organisations designed to promote better access to the environment for those with visual impairment. Both homes offer single bedrooms, comfortable communal areas and a pleasant and comfortable environment in keeping with the local community, close to local amenities. The home was seen to be clean and safe throughout. People who use the service said that they liked living there and that they were able to bring in their own personal possessions and to have their own room decorated according to their tastes and interests. Rooms are fitted with locks and residents are able to hold a key to both the premises and their own rooms if they wish and are able to do so. In general rooms are fitted with appropriate safety fixtures and fittings such as radiator guards and window restrictors. There are three communal areas including two sitting rooms and a dining room in the main building and also a lounge and separate dining areas in the Cottage. Following the last inspection a new wet room has been installed on the ground floor of the main home, which means that residents with physical disability are more able to access the facilities. However the radiator is at present exposed and the management are mindful of the need to ensure that this is addressed. In addition the hot water temperature in this room and also another one of the rooms on the ground floor was tepid to the touch. The cold water flow was also restricted in both of these areas. This was raised with the management who have arranged for a plumber to come to the home on the same day. Staff confirmed that all equipment was in good working order, separate laundry facilities and that they had access to training in Infection Control. There was evidence that the management were mindful of the need to maintain good infection control practices in the home. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 24 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, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff training is managed well however recruitment practices are not consistently robust and have the potential to put residents at risk. EVIDENCE: People who use the service said that they liked living at Hastings Lodge and that the staff were nice to them. Interactions between residents and staff were seen to be good. Staff have a good understanding of the residents needs and their non-verbal communications. Staffing levels are adequate in that there is one waking staff member on duty at each home throughout the night. There are at least two staff on duty throughout the day at the main site and this is increased by the presence of the Registered Manager and also additional staff at peak times. There is also one member of staff at the Cottage during times when the residents are at home and a risk assessment is now in place for occasions when a resident may return to the home unexpectedly. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 25 There is a stable staff team who work with considerable flexibility, including split shifts, to support staffing levels, to ensure the continuity of care and cover for absent colleagues. The management are mindful of the need to ensure that staff have sufficient time to recover between shifts and are currently recruiting additional staff to cover absences. The culture of the existing residents is predominantly white British and the service employs staff who are 80 British, however the majority of these are Asian British. The service has ensured that staff receive training in cultural awareness and training to promote their use of the English language. The management are mindful of the need to ensure that the staff group reflects the gender, age, race and culture of the existing residents. However the current staff group are also predominantly female however there is a male administrator and male cleaner. This means that male residents may not be able to choose to receive care from carers of the same gender. Staff were able to confirm good recruitment practices and appropriate clearances before they started working at the home. Two staff files for new staff were seen to contain evidence of Criminal Records Bureau Clearances and povafirst clearances. However both files of these files failed to evidence that appropriate references had been obtained either prior to or following the commencement of their employment. An immediate requirement was made to ensure that all new staff have all the appropriate pre employment checks before they commence employment in the home. The provider indicated that this had been an oversight on his behalf and that he would ensure that the appropriate documentation was obtained and placed on file. In addition one of the staff files contained some information from the Home Office, which granted them leave to obtain employment in this county for a specified number of hours whist attending college. However there was also evidence that the same staff member was working at another establishment, which indicates that the specified hours may have been exceeded. In addition another file failed to clearly identify the arrangements that had been agreed by the Home Office. There is evidence that the staff have access to appropriate training including National Vocational Qualification in Care level 2 & 3 and also are able to access training to develop their management skills. Staff spoken to were able to confirm access to appropriate mandatory training, including induction training, Basic Food Hygiene, Fire Safety, First aid, Infection control, Safe Administration of Medication and Health and Safety. In addition staff also have access to training specific to the needs of the individual Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 26 residents such as the management of epilepsy and dementia. Staff files also contained evidence that this training was provided in a timely way. There is evidence that staff have supervision, which includes monitoring the way that staff are performing their roles and responsibilities, however these were not being done with the necessary level of frequency. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 27 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, 41 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate leadership, guidance and direction means that the service is managed in the best interests of the people who use the service. EVIDENCE: The registered manager is highly experienced in the care of residents with learning disability and has been the Registered Manager for many years and has appropriate qualifications. Staff spoken to stated that they found her to be supportive, her interactions with staff reinforced this. Her close involvement with people who use the Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 28 service enabled her to demonstrate good practice in communicating with and supporting residents and to set a good example to staff. The service has implemented basic informal quality assurance processes, which involve liaison with other health professionals and obtaining the residents view about the service through regular meetings with them. These systems need to be further developed to ensure that the service uses a formal systematic way of obtaining feed back and identifying area for service development. However there is evidence that the Registered Manager does regularly review the accident records to identify high-risk areas or activities. There is also evidence that she checks the content of the daily records to make sure that the people who use the service are receiving the right care and support. The standard of record keeping in the home is variable; each resident has several files containing basic information, which have been accrued over a period of time. Other task-orientated files have been developed and show when people have been weighed or to keep records of the food that has been eaten. In addition there is a diary and communications book that contains entries on a daily basis pertaining to individual residents on the same page. No hazards were identified and the service employs an external agency to support them with Health and Safety checks. All checks were seen to be in order, such as fire records and Portable Appliance Testing, although the boiler check appeared to now be out of date. Staff have access to the right training and safe working practices were observed. The Commission have received no notifications of accidents or incidents affecting the well being of residents since the last inspection. This was discussed with the Registered Manager who has now obtained the new Regulation 37 form and is aware of the occasions when this should be sent. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 29 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 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 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 2 X 2 3 X Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 30 No 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 YA1 Regulation 5 Requirement The service must develop a Service Users Guide that meets the criteria specified in the National Minimum Standards and ensure that this is made available to residents in suitable formats. To ensure that people who use the service have access to up to date and appropriate information. The management must ensure that all of the required pre employment checks, including two written references are obtained prior to staff commence employment within the home. To ensure that residents are in safe hands at all times 3. YA34 19 Immediate Requirement The management must ensure that they obtain appropriate documentation form the Home Office regarding the appointment of overseas staff, and ensure that they comply with their specified restrictions. DS0000012797.V368410.R01.S.doc Timescale for action 01/09/08 2. YA34 19 14/07/08 01/09/08 Hastings Lodge Version 5.2 Page 31 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 YA5 YA6 Good Practice Recommendations Individual service contracts needs to be reviewed to ensure that they contain the right information and that they are up to date. The individual plans of care need to be reviewed to make sure that they are person centred and that the staff and residents have access to up to date information and that they are able to participate in the care planning process and review process. A key worker system should be introduced so that residents have access to a named member of staff who is able to support and represent their interests. The service should seek guidance form a dietician to help staff balance the resident’s choices with their need to have special diets and to achieve a healthy balanced diet. Arrangements for the residents to access the kitchen should be reviewed so that they are able to participate in the preparation of evening meals. The service should further develop the risk assessment regarding the purchase of over the counter medication by a resident, to reduce and manage the associated risks. The service should review the arrangements for the safe storage of medication to ensure that it complies with the new guidance issued by the Royal British Pharmaceutical Society Guidelines. The Complaints policy needs to be reviewed to ensure that it contains the appropriate contact information and that it is up to date. The service should seek guidance from the Occupational Therapists and Royal national Institute for the Blind regarding the layout of the environment and appropriate aids and adaptations for the visually impaired. The environment should be reviewed to ensure that it is accessible to wheel chair users. The recruitment practices should be reviewed to ensure that the staffing mix reflects the gender and culture of the DS0000012797.V368410.R01.S.doc Version 5.2 Page 32 3. 4. 5. 6. 7. YA6 YA17 YA17 YA20 YA20 8. 9. YA22 YA24 10 11 YA24 YA34 Hastings Lodge 12 13 14 YA36 YA36 YA39 15 YA41 people who use the service. Staff supervision should be conducted at least six times per year for each member of staff The management should continue to ensure that staff use the English language at all times when on duty. Formal quality assurance systems need to be introduced to ensure that the service seeks the views of the people who use the service and that their views are used to inform the service development. The standard of record keeping should be reviewed to ensure that staff have access to concise and wellorganised information that complies with current legislation such as the Data Protection Act and the Freedom of information Act. Hastings Lodge DS0000012797.V368410.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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