Inspection on 18/02/08 for Leigham Lodge

This inspection was carried out on 18th February 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Leigham Lodge 02/06/06

Leigham Lodge 20/12/05

Leigham Lodge 16/05/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Leigham Lodge 64 Leigham Court Road Streatham London SW16 2EL Lead Inspector Rehema Russell Key Unannounced Inspection 18th February 2008 09:00 Leigham Lodge DS0000044234.V342204.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 Leigham Lodge DS0000044234.V342204.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. Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leigham Lodge Address 64 Leigham Court Road Streatham London SW16 2EL 0208 664 6640 0208 664 6640 leigham@beaconcaregroup.co.uk 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) Leigham Lodge Ltd Ms. Yombo Olukotun Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 2006 Brief Description of the Service: Leigham Lodge was registered on 31st December 2004 to provide care and accommodation to six people with learning disabilities with challenging behaviour/autism. It is owned by Beacon Care, a private company, which has other local and national homes. The home is a two storey semi-detached building entered via an electronically operated gate with entry phone. There is limited room for parking on the forecourt inside the front gate and there is a medium sized garden at the rear. On-street parking is available in nearby roads. The home is located on a bus route and within 5-10 minutes walk from a large shopping centre with full community facilities and bus and rail routes into central London and out to the coast. The home also has its own car for individual transport. The ground floor has two lounges, a kitchen, a dining room, a bathroom with toilet and two bedrooms, each with en-suite. There is access to the garden via a door in the dining room and also via a French door in one of the bedrooms. Upstairs there are four bedrooms, three of which are en-suite, a bathroom with toilet, a double cupboard which houses the laundry facilities and a very small office. Prospective service users would be given a Statement of Purpose and Service User Guide. A copy of the most recent CSCI inspection report would be available for perusal at the home. The Statement of Purpose states that the current fee is £1,228 per week with ‘variation around the typical costing listed… due to individual and additional service user requirements’. There are no additional charges. Leigham Lodge DS0000044234.V342204.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 star. This means the people who use this service experience good quality outcomes. This inspection was carried out by one inspector on Monday 18th February 2008. The inspection was carried out without the aide of an AQAA, which had not been received by the home and therefore not completed and returned. During the course of the inspection the manager, four members of support staff and one service user were spoken with, all service users were seen and observed, the building was toured briefly and documentation and records were looked at. All service users have severe learning disabilities and/or autism traits and all but one cannot communicate verbally. The service user who can communicate verbally does so in single words or very short phrases and it is only possible to ask him very simple questions about his experience of living at the home. However, all service users appeared happy and relaxed at the home on the day of the inspection. What the service does well: • • • • • • • • • • The registered manager makes sure that there is a good atmosphere at the home, that service users are happy and well cared for and that staff are supported in their work Staff work hard to make sure that service users are healthy and happy, are able to make as many choices as possible about their daily lives, and are cared for with respect and dignity. Good information is provided so that people know what to expect from living at the home A lot of information is gathered about people before they come to the home so that staff are sure the home will be suitable People are able to visit the home before they choose to live there There are detailed plans for meeting service users’ choices and needs once they come to live at the home. Service users can do lots of activities Staff make sure service users receive good healthcare Staff keep detailed records so that service users’ health and safety is protected There are enough staff to care for service users, and they are qualified Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Leigham Lodge DS0000044234.V342204.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 Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is full information available in a suitable format for service users and their advocates to make an informed choice about the home. The home undertakes a thorough assessment of the needs and aspirations of potential service users so that they can ensure these are met. Prospective service users have an opportunity to visit the home before choosing to live there. EVIDENCE: There is a Statement of Purpose and Service User Guide. The Statement of Purpose has been recently updated to reflect recent staff changes, such as the names of the new deputy and support workers. The Service User Guide is in a format that is suitable to service users with learning disabilities. Prospective service users and their relatives and advocates therefore have access to the information they need to make an informed choice about the home. Assessment files have consents to have received the Statement of Purpose and Service User Guide signed by the service user/relative/advocate, which is good practice. There has been a change in legislation since the key inspection of 2nd June 2006 which came into force in September 2006. It requires the Service Users Guide and individual contracts to stipulate the terms and conditions (including fee levels) that apply to key services (both personal care and food) and the payment arrangements (resident contribution/local authority contribution). The Guide must also state whether the terms and conditions Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 9 (including fees) would be different in circumstances where a person’s care is funded, in whole or in part, by someone other than the resident. Although the home’s contracts outline the breakdown of fees charged, the new information required needs to be added to the home’s Service User Guide. See Requirement 1. The assessment files for the two service users who had been admitted to the home since the previous inspection 20th December 2006 were looked at. They were very thorough and included a full assessment from the service user’s social worker/care manager, a full, thorough and clearly written assessment of need by the registered manager and information and guidelines from the service user’s previous placement and from relevant specialists. There was evidence of full consultation with relatives/advocates, including a record of any limitations and restrictions to be used that is agreed with and signed by a relative/social worker/advocate. In this way the service user and their relative/advocate know that their needs and aspirations have been fully assessed, that the home has made provision to meet them, and that a relative/advocate has been involved throughout the process. The two new service users had both been given several opportunities to make trial visits to the home before admission. This had included half day visits, whole day visits and overnight stays. Contracts were present on care files and give details of the charges for key services. Leigham Lodge DS0000044234.V342204.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, 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users’ assessed and changing needs and personal goals are reflected in their individual care plans and regularly reviewed and updated. Service users make decisions and choices about their lives with support and assistance from staff, and from relatives and advocates wherever possible. There are full and detailed risk assessments so that service users are supported to be as independent as possible whilst being protected from undue risk. EVIDENCE: Three care plans were looked at: one belonging to one of the most recently admitted service users, and two belonging to service users who have lived at the home for several years. All three care plans include a photograph of the service user, a list of personal and professional contacts, a person centred plan, care plans written from the point of view of the service user and covering the full range of needs and aspirations, a Path Way written from the point of view of the service user and a matrix of goal plans that covered immediate, medium term and long term goals. All documents are clearly written, signed Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 11 and dated and regularly reviewed. These documents give staff a full and thorough picture of the service user’s needs, likes, dislikes and aspirations and clear and detailed information of how these are to be met. Each care file also has guidelines for managing the particular difficult behaviour of the service user and a list of staff signatures that certifies they have read and understood the documents, which is good practice. There was evidence from observation and speaking with staff that service users’ are all encouraged to make as many decisions about their daily lives and care given as they are able. As all service users have limited cognitive and verbal abilities, staff assist them to make choices/decisions by interpreting their behaviours, sounds and moods, and by using tools such as objects of reference and photographs. In these ways service users are able to choose the décor and furnishings for their bedrooms, and on a daily basis, when to go to sleep and when to get up, whether to undertake activities and which ones they wish to do at any time, what food to eat and which clothes to wear. If any of these choices are inappropriate for any reason, such as choosing flimsy clothes when they are going out and it is very cold, staff explained how they gently persuade the service user to make a more sensible and safe choice. As previously mentioned, there is evidence that interested relatives and advocates are involved in all relevant aspect of service users’ care, and there is a list of any restrictions to service users’ rights/choices that is agreed through the assessment process and signed by their relative/advocate when possible. All care files have a risk assessment section. This consists of risk assessments for all areas relevant to the individual service user, for example manual handling, accessing the community, wheelchair use, outdoor areas, financial abuse, electrical equipment, and accessing the kitchen, toilet and bathroom. Each risk assessment is well laid out, detailed and clearly written. Each care file has a risk assessment review record which evidences that each risk assessment is reviewed every six months, and therefore kept up to date in regard to service user’s changing behaviours. There are also guidelines appropriate to individual service user’s behaviours, such as absconsion or obsessive behaviours. The home’s missing persons procedure was seen. It was found to be thorough and clearly written, with a copy displayed on the notice board in the staff office for easy reference in times of emergency. Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are supported to undertake a range of daily activities, which assist their personal development, ensure they are part of the local community, help them access a range of leisure facilities and are age, peer and culturally appropriate. Personal and family relationships are encouraged and supported, service users’ rights are respected and they are given a healthy and nutritious diet. This results in service users having a suitable and enjoyable lifestyle. EVIDENCE: There are activity charts for each service user on the walls in the staff room, and also in each individual’s bedroom. These charts have a photograph of the service user and list the times of each activity scheduled each day. These, and evidence from keyworker minutes, speaking with staff and observation indicated that service users undertake a full range of activities that are tailored to their individual preferences, needs and behaviours. Two service users Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 13 attend college, with a third service user, one of the new admissions, just starting. One service user attends a day centre three times per week and another goes to a luncheon club which is specialist for her religion/culture. Another service user has cultural dance sessions, and because he enjoys bouncing, a large trampoline has been acquired for the garden, which has a net surrounding it to protect him should he bounce off. Another service user, who does not like to attend day centres or colleges, is taken out every day undertake the type of activities he does enjoy – van rides, day trips, shopping centres and café lunches. Supported activities are also undertaken in the home, such as assisting with laundry, choosing foods for cookery sessions, sensory sessions and aromatherapy. Last year, all service users had individual holidays. There are television, video and DVD facilities in the home and each service user has either a television or radio or music system in their rooms. All except one of the service users are in regular contact with family members. Three service users have relations who visit them at the home and two service users are escorted regularly to visit their families at home. Staff also support service users to contact their families by telephone, even for the non-verbal service user – his relative only visits occasionally so staff ensure weekly “contact” to maintain the relationship. Staff have framed photographs of service users with their families where these are available and displayed them in service user’s bedrooms, which further helps to strengthen their family links. Daily routines are flexible according to individual service user’s choices and needs. For example, one service user chooses to get up at 4 am each morning, whilst another sleeps in till 9 am unless it is a day centre attendance day. Similarly, service users go to bed at any time from 9 to 11 pm, according to their individual choice. An exception is the service user whose autistic needs requires a fixed routine, and this is charted out and provided daily. There was also evidence that staff respect service user’s rights wherever possible – such as the one service user who is able to opening his own post – and only restrict these rights when it is in the interests of the individual and recorded in care plans. For example, one service user’s wardrobe is kept locked to limit his shedding behaviours but the key is kept in a particular drawer in his room where he is able to access it. Similarly, several bathroom and toilets in the home are kept locked to prevent individuals from blocking them with clothes/paper/other objects. The kitchen is kept locked if there is no member of staff supervise it because several service user’s would damage themselves or the equipment if given unsupervised access. One service user’s bedroom on the ground floor is kept locked to prevent other service users’ from entering it and violating her privacy. She is very able to indicate verbally when she wants to access her bedroom and staff always oblige. Menus were seen and evidenced that service users are given an imaginative, varied and nutritionally good range of food, which includes plenty of fresh fruit and vegetables, and a range of foods suited to the cultural backgrounds and preferences of service users. Once a week staff assist service users to choose Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 14 the next week’s menu using photographs and pictures of different meals, and service users can also indicate their choices when they accompany staff on weekly shopping trips. The kitchen fridge was clean, well ordered and tidy, with all opened food, such as milk and jam, date labelled, and a well kept list of temperature checks. Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 15 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, 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal support is given in a way that ensures service users’ privacy and dignity, and their physical and emotional health care needs are met. There are funeral plans on file in case of emergency. Medication storage and administration was in good order but there was one medication bottle that was not labelled. EVIDENCE: Staff were observed to treat service users with dignity and respect. Three support workers were spoken who demonstrated a good understanding of how to ensure service user’s privacy, how to manage challenging behaviours, and gave examples of how service users’ individual choices are promoted. The home’s policy is that personal physical care is given by same gender staff, and this is facilitated by a staff group that is mixed in terms of both gender and cultural background. All service users were observed to be well groomed and dressed with their appearance reflected their ages and personal choices. A wheelchair had been obtained for one service user to enable her to be taken out for “walks” in the community. Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 16 Documentary evidence demonstrated that a full range of professionals and specialists are used to meet the assessed and changing healthcare needs of service users. This includes general practitioner, dentist, community learning disability team, psychologist, optician, chiropodist and behavioural support service. Care files also have an “accident and emergency grab sheet” which has full details of any health needs that would need to be considered by medical staff in the event of an emergency, which is good practice. Best interest meetings are held with all interested parties, including advocates, where it is necessary to obtain consent for medical treatment. Care files also have thorough details of service user’s medication and also a “Consent to receive, store, administer and return medication” which is discussed with the service user, care manager and relative and signed and dated by one of them, which is good practice. Medication is stored in a locked cabinet attached to the wall in the staff room. Storage, administration and recording of medication was checked and found to be in good order. There was an anomaly on one medication. The pharmacist had supplied one bottle of medication which had the label containing information about the medication on the carton only, rather than on the medication bottle itself. Staff knew that the medication was of the correct quantity and dose but the carton had subsequently been discarded. This meant that staff were now administering medication from an unlabelled bottle, and therefore could not following the correct procedure of checking the details of this medication each time they administered it. See Requirement 2. Care files had written funeral arrangement plans, consisting of a form whereby the service user/relative indicated the type of funeral wanted and who would be responsible for arranging it. Those plans seen were signed and dated by both the family member and the registered manager. As all service users at the home are relatively young it is not expected that funeral arrangements would be necessary but it is good practice to have the information and permissions on file. Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 17 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. There is a policy for dealing with complaints, together with a user-friendly version that is suited to service users’ disabilities, but neither give details of how to contact the Commission. There is an updated abuse policy to protect service users from abuse, neglect and self-harm. EVIDENCE: The complaints file was seen and evidenced that there had been no formal complaints since the previous random inspection of 23rd November 2006. There is a complaints policy in the policy file in the staff room and a copy displayed on the notice board at the entrance of the home. The notice board also has a copy of the more user-friendly version of the complaints policy displayed, so that both versions are readily available to both service users and visitors. However, although this was present in previous versions, neither current version makes reference to the Commission, as is required under Regulation 22 (7). See Requirement 3. There have been no adult protection issues at the home. The inspection reports of 2nd June 2006 and 23rd November 2006 required that the abuse policy and procedure was updated to reflect current practice, including that related to local and placing authorities. This has been done and the current policy was found to be particularly thorough and well written. Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 18 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, 26, 27, 28, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users live in a homely, comfortable and safe environment. Their bedrooms are attractive, comfortable, well furnished and reflect their individual interests and choices. Toilets and bathrooms provide privacy and shared spaces meet service users’ individual and collective needs. The home is clean and hygienic throughout, and kept in good condition despite the heavy wear and tear received. There are some areas on the ground floor which need either repairs or to be made good. EVIDENCE: The inspector made a brief tour of the building. There is an entry phone system which controls an electronically operated gate to the front of the house, and a secure double lock on the back garden door, which support service users’ security. There is a step up to the front door, a stairwell to the upstairs, and stepped access to the back garden, so the home is not suitable to people with mobility problems. However, if the front step can be negotiated, visitors in wheelchairs could be accommodated as all of the communal areas, plus a Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 19 communal bathroom and toilet, are on the ground floor. At the base of the steps which lead from the dining room out to the garden there is an area of missing ground tiles. The home has been told that this area cannot be tiled because access is needed to pipework, however the areas needs to be covered in some way so that service users or staff do not trip and injure themselves. See Requirement 4. The home exceeds the National Minimum Standard in regard to communal areas. These consist of two lounges, one of which is very large, the dining room, the kitchen and the garden. The lounges and dining room have the basic furniture required but are sparsely furnished in terms of fixtures, fittings and ornamentation due to the challenging behaviours of the service users. Nevertheless, these rooms have been made a little homely by a wall mural in the dining room and framed pictures in the lounges. One lounge also has a notice board with photographs and the names of staff who are on each shift for the current day. Bedrooms have been made very attractive. Each is decorated, furnished and fitted according to the tastes, choices and behaviours of the individual service user. Furniture, fittings and décor are of high quality. In some rooms, framed pictures/posters have been fixed high on the walls so that they can be displayed whilst protected from the service user’s behaviours. In bedrooms where this is not necessary, the service user’s possessions and ornamentation are more traditionally displayed. One service user has made such good progress in her behaviours since the previous inspection of 23rd November 2006 that her possessions can now be displayed normally in her room, whereas previously everything except her soft toys had to be put out of her reach. This same service user’s room had been refurbished recently and she had chosen to have a double bed instead of a single, and has also selected her new duvet cover. Another service user had also chosen to have a double bed, and has a flag of his home country framed on the wall. Both of the ground floor bedrooms and two of the four upstairs bedrooms have en-suite facilities. There is a communal bathroom with toilet on both floors which service users with non en-suite bedrooms can use, and which means that toilet and bathroom facilities are always easily accessible to service users no matter where they are in the home. The home exceeds the National Minimum Standard in regard to toilet and bathroom facilities. There are a few areas on ground floor walls that need to be redecorated/made good after the removal of fixtures and fittings and the inspector was informed that this maintenance was due to be carried out very shortly. The home was clean and hygienic throughout. The kitchen was very clean and well organised. The fridge was particularly clean and well ordered, with any opened foods being labelled and dated. There were menus and lists of food temperature checks easily well filled in and easily available for checking. However, there are some tiles missing by the sink, a cupboard below the sink Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 20 that needs repair and paintwork near the bin which needs to be made good. As these areas have the potential to carry germs, they must be properly maintained to ensure safety. The temperature markings on the oven have been worn off and this should also be repaired. See Requirement 5. Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent, qualified and appropriately trained staff. Service users are protected by the home’s recruitment policy and procedures. EVIDENCE: The staff complement consists of a manager, deputy and 13 support workers. Seven support workers have already attained NVQ Level 2, several of whom are now studying for NVQ Level 3, and the remainder are in the process of obtaining it. This means that the home has exceeded the recommended target of 50 of support workers with NVQ Level 2. Four support workers were spoken with. They evidenced a good understanding of individual service user’s characteristics, preferences and needs, a good understanding of how to manage challenging behaviours, and a respect and commitment to service users’ rights, independence, choice and dignity. One described how she had gone out of her way to ensure that a service user understood and was happy with the decision of a change of keyworker, another described sensitive strategies that had been implemented and had resulted in the greatly improved behaviours of another service user. Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 22 A support worker who had been at the home for just over 6 months described the recruitment procedure that had been followed. This included an application form, interview, taking up of 3 previous employer references, Protection of Vulnerable Adults First and Criminal Records Bureau checks, declaration of health and the issuing of the General Social Care Council code of conduct & practice and employment contract. The support worker had been on a six months probationary period, during which she had received feedback on her performance. This evidenced a thorough recruitment procedure which ensures the safety and protection of service users. As the manager had to leave the home during the afternoon the inspector did not manage to check recruitment files but the manager has assured the inspector that all papers are in order and that CRB reference details for all employees of the home are retained there. The manager has prepared a training schedule for the first six months of the next finanancial year. This was seen and was found to cover all of the mandatory training courses, such as health & safety, food hygiene and fire awareness as well as other critical areas such as medication and adult protection. In addition, provision has been made for staff to attend other courses that are relevant to the client group and to keeping up to date with care issues, such as mental health awareness (the new Mental Health Act), equal opportunities and risk assessment. The schedule ensures that all new staff have mandatory training, that established staff have updates on mandatory training, and that all staff have access to current care practice courses relevant to the client group. Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 23 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): 12 The Registered Manager is competent, qualified and experienced to run the home and creates an open, positive and supportive atmosphere. The home consults with external professionals and service users’ advocates to obtain feedback on the quality of service being provided. Policies and procedures are up to date so that they safeguard service users’ rights and best interests. The health, safety and welfare of service users are promoted and protected. EVIDENCE: The registered manager is qualified, competent and experienced to run the home, having previously managed a home for people with learning disabilities and having the Registered Manager’s Award and NVQ Level 4. She has managed this home for over two years, during which she has steered staff and service users safely through a very difficult period when there was an inappropriate placement at the home that caused severe disruption. Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 24 The registered manager’s approach is open, positive and inclusive, whilst being firm about the high standard of practice and commitment that she expects from staff. Staff spoken with confirmed that the manager encouraged good teamwork at the home and that she is “very approachable” and she is “always there for you” “can talk to her, go to her”. The Registered Provider does not operate a professionally recognised quality assurance system but evidence of very thorough monthly Regulation 26 visits and reports by the company’s Regional Operational Manager were seen. In addition, in November 2007, quality assurance questionnaires had been sent to various external professionals engaged with the home, to relatives and advocates of all service users, and to 14 members of staff. The returned questionnaires from the community nurse, behavioural specialist and 3 social workers were seen and all were positive about the home. Responses from relatives were also positive, stating they were “very happy, everything is fine” and “in a short time (name) seems to be happy and settled”. The home intends to make a summary of these surveys available to service users, representatives and interested parties as recommended under Standard 39 of the National Minimum Standards. There had been an outstanding requirement since the inspection of 2nd June 2006 that the policies and procedures provided by the Registered Provider were made relevant to the home’s client group and updated to include current practice. At this inspection several policies and procedures were viewed, such as diversity, complaints, adult protection and abuse, admissions, drugs & medicines, infection control and nutrition. These had all been reviewed and updated so that they now provide staff with the correct policies and procedures to follow. A range of health and safety certificates were seen and evidenced that the home is operating safe working practices. Documentation seen included fire risk assessments on all areas (which were very thorough), fire drills, gas certificate, fire officer visit, food hygiene inspection, Legionella, employer’s liability, call points, extinguishers, Control of Substances Hazardous to Health, risk assessments, monthly health & safety checks, food temperatures, fridge temperatures and weekly water temperature checks. Reviews also been carried out, dated and signed, on necessary documentation such as risk assessments and COSHH data sheets. Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 25 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 3 5 3 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 4 27 4 28 4 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 4 3 3 X 3 x Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 26 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 Registered Person must add the information about fees and what they cover to the Service User Guide, in accordance with changes in legislation. The Registered Person must ensure that all medications administered at the home are correctly labelled. The Registered Person must ensure that the complaints policy includes the required information about how to contact the Commission. The Registered Person must ensure that the area of tiling at the bottom of the garden steps is made safe. The Registered Person must ensure that all areas of missing tiles etc. in the kitchen are made good and that the temperature markings on the oven are repaired/replaced. Timescale for action 01/07/08 2. YA20 13(2) 18/02/08 3. YA22 22(7) 01/07/08 4. YA24 23(2)(o) 01/07/08 5. YA30 16(2)(g) 01/06/08 Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 27 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 Leigham Lodge DS0000044234.V342204.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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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