Inspection on 14/03/08 for Lodge (The)

This inspection was carried out on 14th March 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lodge (The) 05/03/09

Lodge (The) 17/08/06

Lodge (The) 28/12/05

Lodge (The) 13/10/05

Lodge (The) 26/07/04

Lodge (The) 13/04/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Lodge (The) Lodge (The) Roman Way Farnham Surrey GU9 9RE Lead Inspector Pat Collins Unannounced Inspection 14th March 2008 08:15 Lodge (The) DS0000013584.V359519.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 Lodge (The) DS0000013584.V359519.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. Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lodge (The) Address Lodge (The) Roman Way Farnham Surrey GU9 9RE 01252 717021 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) sandrap@ability-housing.co.uk Ability Housing Association Ms Sandra Alexandra Passingham Care Home 5 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (2) of places Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. In addition to the primary condition Learning Disability up to 3 (three) service users below the age of 65 years may be within the category PD - Physical Disability and 2 (two) within the category SI - Sensory Impairment. In addition to the primary condition Learning Disability up to 2 (two) service users above the age of 65 years may be within the category PD (E) Physical disability and 1 (one) within the category SI (E) Sensory impairment. 17th August 2006 2. Date of last inspection Brief Description of the Service: The Lodge is a care home providing personal care for up to five adults with learning disabilities. People using the home’s services may have physical disabilities or sensory impairments as secondary conditions. The home is situated in a residential area on the outskirts of Farnham town and within walking distance of shops and public transport. The accommodation is arranged on ground floor level and is domestic in scale and character. It comprises of all single occupancy bedrooms, a lounge and separate dining room. The kitchen is suitable in design for the use of wheelchair and non-wheelchair users. Other facilities include a utility room, office, wheelchair accessible shower and toilet, assisted bathroom and mobility aids and equipment. There is an enclosed garden with furnished patio. The garden is shared with the tenants of a ‘supported living’ service next door. Parking facilities are available and service provision includes a wheelchair accessible vehicle. Ability Housing Association is registered to manage the home. This is a registered charity specialising in housing, care and support for people with disabilities. A registered manager is responsible for the home’s day-to day management. At the time of this inspection weekly fee charges were £780:00. Additional charges are for hairdressing, some social activities, toiletries, clothing, holidays and use of the home’s vehicle. Lodge (The) DS0000013584.V359519.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 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection visit formed part of the key inspection process using the ‘Inspecting for Better Lives’ (IBL) methodology. One inspector carried out the visit, spending six hours in the home. The report will say what ‘we’ found as it is written on behalf of the Commission for Social Care Inspection (CSCI). We have been informed that all of the people using the home’s service prefer to be referred to as ‘residents’ and for this reason this term is used hereafter in this report. We toured the building, looking at all communal rooms and some bedrooms, also the garden. This took place to be sure residents have a safe, wellmaintained and comfortable environment. Judgements about the wellbeing of residents have been based on their direct feedback, also their appearance and demeanour, information contained in their records and from discussions with staff. We observed care practice at breakfast and lunchtime and looked at various records. These included some care plans and the home’s statement of purpose, which is a book that tells people who the service is for. We also looked at the service users guide, the book that tells people how the home works, the complaint procedure and other records including some staff files. Judgements regarding how well the home is meeting the national minimum standards for adults and about the standard of care and support residents receive have been formed on the basis of these observations; also the cumulative assessment, knowledge and experience of the home since its last key inspection. This includes the content of the home’s self – assessment, called the annual quality assurance assessment, which we received from the registered manager before the inspection visit. Also information supplied by the service manager, registered manager and ‘acting’ manager, after the visit. We wish to thank all who contributed information to the inspection process. This includes all residents using the home’s services and staff on duty during the visit, for their time, hospitality and assistance. What the service does well: Prospective residents receive a comprehensive needs assessment before admission, carried out with sensitivity and skill to ensure their needs and aspirations can be met. Prospective residents are supported and encouraged to be involved in this process. They benefit from the time and effort spent on planning admissions, ensuring this is personal and well managed. Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 6 The home’s atmosphere is friendly and welcoming. A key service principle is for residents to be in control of their lives, as far as possible, to direct the service they receive and to have a strong influence over how their home is run. Residents are empowered to make informed decisions and have the right to take risks in their daily lives. This makes them happy and fulfilled. The home’s day-to-day operation focuses on enabling residents to achieve their full potential, giving them the confidence and life-skills that enable independence. The care planning approach starts with the individual, not services, taking account of residents’ wishes, needs and aspirations. Innovative ideas support residents’ individual learning. Pictorial information is used to aid communication and residents’ understanding, enabling decision-making. Residents make good use of community facilities and resources and have age appropriate programmes of activities based on their individual needs and choices. They are supported in leading full social lives and in maintaining relationships with friends, family members and other people important to them. 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 Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 8 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 Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 9 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): People in this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 1 & 2 Prospective residents and their representatives have the information they need to make an informed choice about the home’s suitability. The home’s admissions assessments process ensures needs are assessed before admissions, to be sure people receive the right type of care. EVIDENCE: The home’s statement of purpose, which is a book that tells people who the home is for, was updated shortly after the inspection visit. We were informed that a personal copy would be given to each resident. The service users guide, that is the book telling people how the service works, was available in the office. This was produced in a format using symbols and pictures and written in easy read language to make this information meaningful and interesting for residents. The service users guide was being updated at the time of this inspection. All of the residents said they were unable to recollect being offered a personal copy of this book and stated they would like one. They had received a copy of the organisations charter of rights. Following the inspection visit the service manager confirmed that it was the intention to issue a personal copy of the service users guide, when available, to each resident. There were four male residents living at the home at the time of the inspection visit aged between 47 to 76 years. There have been no admissions since the last inspection and currently there is one vacancy following the discharge of a Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 10 former resident, last year. It was understood that assessments were taking place for a prospective resident though these records not available for inspection. Records relating to previous admissions show that prospective residents can be confident of the home’s suitability to meet their individual needs. This is because a full assessment takes place before admission, with skill and sensitivity. Prospective residents and people close to them are involved in this process. The assessment tells the staff all about them, what they hope for and want to achieve, and about the care and support they need. The assessment record viewed was focused on achieving positive outcomes for that individual; it ensured the home’s facilities, services and staffing was suitable to meet individual needs, including diversity needs. Time had been spent on planning an individualized approach to admissions, ensuring this was personal and coordinated. Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 11 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): People in this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 6, 7, 8, 9 Residents are consulted in planning the care and support they receive. They are supported in making informed decisions and have the right to take risks in their daily lives. There is a strong ethos of their involvement in decisions affecting the day-to-day running of their home. EVIDENCE: Residents are asked about and involved in all aspects of life in the home. This is because the management of the home ensures they are offered opportunities to participate in the day to day running of the home, to the extent they wish to be, and can influence decisions affecting them. This was evidenced through discussions with residents also by care records and records of residents’ meetings viewed. The needs and goals of residents are set out in plans of care and residents’ involved in this process. The care plan we looked at was up to date, reflecting current needs. Care records include risk assessments, seizure and behaviour management guidelines and a range of information important to that person, showing how he made choices in his daily life. His care plans addressed Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 12 diversity, communication, personal, health care and social needs and his aspirations. They focused on what is important to this person as an individual and his strengths, skills, abilities and goals. The registered manager told us in the annual assessment that there are plans to introduce care plans written more from the point of view of residents. These are called person centred plans. Daily records are maintained for each resident and these records are summarised monthly. Through discussions with residents and staff and examination of records it was evident that residents are supported in having control of their lives, including their finances, as far as they can be. This is because staff ensure their rights and choices are promoted. Residents are supported in taking risks, enabling and promoting independence within individual capabilities. This is because the staff have appropriate information on which to base decisions. Residents are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures ensuring confidential storage of care records and other personal information. Residents are asked for their agreement to visitors from within the organisation looking at their records when organising these visits. Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People in this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 11, 12, 13, 15, 16, 17. Residents have opportunity to make choices about their lifestyle and are supported in developing and practicing life skills. Social, educational cultural and recreational activities appear to meet their expectations and needs. EVIDENCE: Life skills training opportunities are provided for residents’ by staff in the dayto-day running of the home. Residents receive sustained encouragement, instruction and stimulation as continuing elements in their daily lives. They are supported with budgeting and managing their personal finances. There is a policy statement promoting equality and diversity, and evidence seen of this being put into practice. Spiritual beliefs are respected and accommodated. Two residents were noted to attend a religious service on alternate weeks. A resident said that one of his brothers had died since the last inspection and it was his belief that this brother was with his mother in heaven. Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 14 Each resident is treated as an individual. Daily routines and practice demonstrate staff awareness and commitment to overcoming environmental and attitudinal barriers to people with disabilities leading fulfilling lives. A key worker was noted to have highlighted the need for a motor to be fitted to a residents’ wheelchair. It had become increasing difficult for one support worker to safely manoeuvre the wheelchair outside of the home and this was beginning to restrict community activities for this individual. He said he is looking forward to having a motorised wheelchair to enable him to go out more often. It was noted he had expressed the wish to have opportunity to use leisure centre facilities at his last review meeting. This was drawn to the attention of the ‘acting’ manager during the inspection visit. Residents take part in activities appropriate to their age and culture and are part of their local community. Each resident has a weekly activities programme covering a wide range of social, therapeutic, educational and vocational activities they choose to engage in, inside and outside of the home. It was suggested that consideration be given to producing the activity programmes in an accessible format, using pictorial and symbol images, and for residents to have a personal copy. Examples of activities include swimming at a hydrotherapy pool, music therapy sessions in the home, engaging in a wide range of activities at various day care centres and shopping with staff. One resident has regular one to one time with a designated Mencap worker who takes him out each week. He said they go out for meals, shopping and to garden centres. It was evident from the feedback from all of the residents that they are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected. Residents described how they decide on menus as a group each week, using pictures of food to aid recall and decision-making. They stated they enjoyed their meals and the record of food indicated the meals are varied and wholesome. A pictorial menu was displayed. They have increased control over portion sizes since introducing the use of serving dishes. Residents said they keep in touch with family and friends. One resident said plans had been made to support him in a visit to the new home of a former resident. Another said he visits to his mother who has moved into a care home, with staff support. A group discussion took place with three residents. They all said they were happy with their lives and life in general at the home. A resident said he enjoyed regular visits from his brother and they go out together for meals and to the pub. Another said he sometimes spoke with his brother on the telephone. Residents have opportunity to go away for holidays that they are involved in choosing and planning. Two residents were looking forward to a holiday in Cornwall with staff later this year. Another said he had not yet decided where to go on holiday but was considering a trip to Florida. A resident spoken with separately said, “Everything is alright here”. He stated he still enjoyed his favourite activity, which is wheelchair ice-skating. Lodge (The) DS0000013584.V359519.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): People in this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 18, 19, 20 The health and personal care received by residents is based on their individual needs and the management of medication is safe. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Residents are registered with a general practitioner and access primary and specialist health services in accordance with their assessed needs. Discussions at the time of the inspection visit included staff training and support in the management of stoma care and epilepsy. Health and personal care needs are clearly set out in care plans. Observations of practice and feedback from residents indicated that principles of respect, dignity and privacy are put into practice in the delivery of personal care. This is evidently person led, flexible and consistent, meeting the changing needs and increasing dependency of residents. Staff on duty, which included an agency worker who regularly works at the home, demonstrated knowledge about residents’ care needs and preferences. They were alert to changes in mood, behaviour and general wellbeing. Systems are in place to ensure medical appointments are not missed. The registered manager has told us in the Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 16 annual quality assurance assessment that it is the future intention to implement health action planning. Aids and equipment are available in the home to encourage maximum independence. These are regularly reviewed to accommodate changing needs. We have corresponded with the registered manager on a number of occasions since late last year after receiving information from an anonymous source. We were told that staff at times experienced difficulty in managing the increasing needs of residents, associated with the ageing process and health related conditions. At the time of this inspection it was evident that risk assessments relating to the use of the hoist needed to be reviewed. These were not sufficiently detailed to show whether one or two staff is necessary to the safe use of this equipment. There can be times during the day when staff may be alone on the premises with residents and every night when there is one waking night staff. Noting a number of recent incidents necessitating use of the hoist, it is important to ensure guidelines are appropriate to support safe practice for lone workers. It is important to ensure appropriate use of emergency services as currently the guidance is for staff not trained in use of the hoist or who do not feel competent in the use of this equipment to call upon emergency services for assistance with moving and handling. The ‘acting’ manager and service manager have taken these comments on board and agreed to review the risk assessments and adequacy of staffing levels. All of the residents accommodated have epilepsy and some have a history of prolonged and multiple seizures for which they are prescribed emergency medication. Since the last inspection individual seizure management plans have been developed with clear guidance for staff. Protocols are in place describing in what circumstances emergency medication should be administered. Staff had received training in the administration of an emergency drug for oral administration. Not all staff have received training for administering an emergency drug by another route. Guidelines are in place for this to be administered by paramedics. Records set out clear expectations relating to staff monitoring for seizures throughout the 24-hour day. A monitoring device is used in the bedroom of one resident for night support workers to be alerted to seizure activity. Other residents prefer to sleep with their bedroom doors held open by magnetic holders that automatically release in the event of the fire alarm being activated. Medication was securely stored. The medication records sampled for two residents confirmed medication received, administered and disposed of had been recorded. A monitored dosage medication system is supplied by a local pharmacy. The pharmacist is contracted to review the medication management and practice at the home twice a year. Four support workers are designated responsibility for administering medication and have received relevant training. Lodge (The) DS0000013584.V359519.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): People in this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 22 & 23 The complaint procedure is accessible to residents and their representatives. Complaint policies and practices are robust for responding to complaints and allegations or suspicions of abuse. Residents are protected by staff recruitment practices but not fully by the staff training policy, where there are some shortfalls in safeguarding adults training. EVIDENCE: The home’s ethos welcomes complaints and suggestions, which are used positively for continuous service development. The complaint procedure is displayed in a user-friendly format on the notice board in the dining room. Though this notice board was not at a height to ensure accessible to wheelchair users, discussions with residents confirmed they were fully aware of how to make a complaint. This is a regular agenda item at their meetings with staff. We have not received any complaints about the home since the last inspection. The home has investigated three complaints using its own procedures, in the last twelve months. On examining the complaint records for two of these complaints we found that these complaints had been taken seriously and were fully investigated. A written outcome had been sent to the complainants and the issues resolved. Records relating to the third complaint were not available for inspection. It was established after the visit that this complaint had been investigated by a manager external to the home and the records not yet returned to the home. We were informed the complaint concerned the practice and conduct of a staff Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 18 member and lessons had been learned from this investigation for this staff member and the whole team. The establishment had a copy of the local multi-agency safeguarding vulnerable adult procedures. There had been no investigations or referrals under these procedures since the last inspection. Staff recruitment procedures protect residents by ensuring checks made against the national list of people unsuitable to work with vulnerable adults (Pova). A new development was the policy for new staff not to take up post in advance of receiving an enhanced Criminal Records Bureau disclosure for them. Discussions with staff on duty confirmed they were clear of what action to take in the event of any allegations or suspicions of abuse. Whilst most staff had received safeguarding adults training, two staff had not undertaken this training, according to the staff training records seen after the inspection visit. All staff have access to the organisation’s whistle blowing procedure. Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 19 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): People in this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 24, 25, 26, 27, 28, 29, 30 This family-scale home provides a comfortable, good standard of accommodation suitable to the needs and lifestyles of those accommodated. The home was clean and hygienic and mostly designed to maximise independence. Management addressed health and safety shortfalls found in the environment during this inspection. EVIDENCE: The home is conveniently situated within walking distance of Farnham town centre. Ramped access is available to the front entrance and to the garden. The front door is fitted with an automated opening and closing device. The enclosed rear garden was tidy for the time of year and included provision of a furnished patio. Residents stated that they each had potted and grown their own plants last year. The standard of décor throughout the home was satisfactory and all areas clean and comfortable. Residents stated they valued having their own bedrooms and staff respected their privacy. The kitchen had been refurbished Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 20 in recent years to a good standard, providing some wheelchair accessible work surfaces and sink unit. The laundry however is not accessible to wheelchair users to enable and promote their involvement in personal laundry tasks. The home was sufficiently warm during the visit. The register manager told us in the annual quality assurance assessment that there are plans to replace the storage heaters this year. A support worker explained that these were not ideal as it was difficult to control the heating and sometimes in the evenings heating was less than adequate. Though the emergency call system was stated to have a history of malfunctioning, at the time of the visit this was working. A range of equipment and aids were available in the environment to promote independence, aid mobility and assist residents with visual impairments in safely navigating their way round the home. Aids include a shower chair, grip rails, raised toilet seats, walking aids and bath with integral bath hoist. The telephone used by residents in the dining room was at a suitable height for wheelchair users. Areas of discussion with the service manager after the inspection included the congested dining room. This was potentially hazardous for residents with mobility and visual impairments, owing to the storage of a hoist in this area. The service manager has since informed us that the hoist has been relocated to the spare bedroom, pending adapting a cupboard so that a freezer can be relocated and the hoist stored in the cupboard by the office. We were told that the residents’ notice board is to be lowered so this is accessible to wheelchair users. Most staff had received infection control training and an infection control policy and procedure was available. Supplies of disposable gloves and aprons were sufficient and yellow bag clinical waste disposal arrangements were in place. Antibacterial hand rubs were used and liquid soap and paper towels supplies were in toilets and bath and shower rooms. The number of toilet and bathing facilities were adequate and fitted with appropriate aids and adaptations. It was suggested that the call bell lead be accessible from the toilet in the shower room, thereby promoting residents’ independence and privacy, also safety. Lodge (The) DS0000013584.V359519.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): People in this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 31, 32, 34, 35 Some shortfalls in staff training have been identified also the need to review the adequacy of staffing levels. The recruitment policies and procedures safeguard residents. EVIDENCE: Support workers have a generic role, undertaking domestic tasks in addition to personal care and support duties. Staff were observed to have positive relationships with residents and to be caring in their approach. A resident expressed the view that all staff are “nice”. The home employs six support workers, including two dedicated night workers. One staff member had left in the last 12 months and the home’s management had been unable to fill the one senior support worker post, which had been vacant for almost two years. The gender balance of the staff team does not reflect the gender of the resident group. There is only one male support worker within the team who works part – time, on night duty. Two support workers had been recruited since the last inspection and two support worker vacancies remain unfilled. Regular bank and agency workers cover staffing shortfalls. Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 22 Recruitment records were not all evidenced for the two support workers whose files were viewed in the home. Following this visit, contact with the service manager established that the organisation’s head office centrally managed staff recruitment and vetting procedures. An electronic system existed that managers could access to evidence recruitment and vetting records. Unfortunately, the ‘acting’ manager had only recently been redeployed to the home and was not aware that she could contact head office for the password to be able to access the electronic files. Since the inspection visit the service manager and ‘acting’ manager advised they had produced an index checklist for staff recruitment records and matrix for recording Criminal Record Bureau (CRB) disclosure and Pova information in accordance with CRB policy. The service manager supplied the missing recruitment information shortly after the inspection visit, demonstrating that statutory recruitment information and documents had been obtained for the new staff employed and full vetting procedures followed. The usual staffing levels are two support workers throughout the waking day, excluding the ‘acting’ manager and one waking support worker at night. On – call arrangements are in place for staff to contact a manager for advice. Staff confirmed that a support worker must be on the premises at all times when residents are home. All staff had received moving and handling training and five had been trained in use of the hoist. Though management required staff to practice using the hoist once a month, not all staff had done so, according to the home’s records. Discussions with the ‘acting’ manager confirmed no system in place to establish whether bank and agency staff had received training in use the hoist. The ‘acting’ manager confirmed this would be followed up. Discussions with management after the visit included the need to review the risk management guidance for lone workers relating to use of the hoist. The service manager agreed this would be reviewed also the adequacy of staffing levels, in light of the changing needs and increasing dependency of residents. At the time of correspondence received from the registered manager in December 2007, it was noted she had looked at incidents in past 12 months, which showed no emergency treatment, or lifting required following seizures. It was evident that since then the hoist had been used on a number of occasions for this purpose, for falls and assistance with transfers and the emergency services in attendance on occasions. The service manager has confirmed the organisation was looking into the possibility of reinstating a sleep-in support worker on the premises at night. It was the registered manager’s view when she wrote to us in December that a sleeping –in member of staff would give greater security and support to night support workers and relieve pressure on on-call managers. The training and development portfolios for two staff were examined during the inspection visit. It was not possible to demonstrate they had received induction and all statutory training. Following the visit it was again found this information was held electronically and produced by the registered manager. Though a programme of statutory training for staff was evident, which included Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 23 Learning Disability Award Framework accredited training; some shortfalls in staff training were noted. The induction training for a new support worker had not been signed off and gaps in training for some staff were noted. Specifically, first aid, safeguarding adults and epilepsy awareness. It was positive to observe the increase in staff that had qualifications in care at NVQ Level 2 or above since the last inspection, exceeding the national minimum standard. Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People in this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 37, 38, 39, 41, 42 Whilst there are management providing good outcomes for residents a number of areas for improvement in the home’s management and administration were highlighted by this inspection. EVIDENCE: The registered manager told us in the annual quality assurance assessment we received before the inspection visit that she has concluded her studies for a management qualification in care at NVQ Level 4. She has also attained the Registered Managers Award qualification. Circumstances outside the registered manager’s control had led to her redeployment within the organisation since January 2008. Interim management arrangements have been in place however these lacked continuity; also the ‘acting’ managers do not appear aware of all statutory requirements relating to registered care homes. Though both ‘acting’ managers Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 25 deployed to manage the home were experienced managers, it was found that a number of incidents had not been notified to us, in accordance with the regulations. At the outset of the inspection the ‘acting’ manager was not present. The support worker in charge of the home was noted to be unable to find the ‘acting’ manager’s mobile telephone number and was unable to contact her when she failed to arrive on duty at the time expected. The support worker wished to inform her that she would be leaving an agency worker in the home working alone with three residents whilst she escorted another resident to a hospital appointment. The agency worker regularly worked at the home and knew the residents well, The ‘acting’ manager phoned in before the support worker left, advising her that she would not be coming in until late afternoon due to a prior work related engagement. The ‘acting’ manager agreed to come in earlier at mid-day when informed that an inspection was in progress and support workers were unable to access the records necessary to the inspection. On her arrival the ‘acting’ manager was helpful, however it was established that she also did not have access to all the records necessary to the inspection. The service manager forwarded this information to us after the visit. The service manager had been promoted to this post in November 2007. Though records viewed in the home indicated that statutory provider visits were irregular, it was evidenced after the inspection these visit had been carried out since her appointment and the missing reports were stored electronically. Areas of discussion with the service manager included the need for improved senior management overview of the home’s management during this interim management period. Also for review of auditing systems to enable effective self-evaluation of risks further to the inspection highlighting potential hazards in the environment. Specifically, storage of combustible items saved for recycling under the cooker in the kitchen and storage of the hoist in the dining room. The latter made this area very congested posing a hazard to residents with mobility problems and sight impairments. The service manager took immediate remedial action in both matters. Also discussed and agreed was the need to review practice, risk assessments and adequacy of staffing levels in relation to the use of the hoist by lone workers. The need to ensure all complaints and assessment records are kept in the home was also raised. Records are held securely and staff are aware of the boundaries of confidentiality. Staff conferences take place annually at which staff are encouraged to express their views and make suggestions. We have been told that the organisation is currently updating its policies and procedures. Quality assurance systems are inclusive of residents and their representatives. Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 4 33 2 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 x LIFESTYLES Standard No Score 11 4 12 4 13 3 14 3 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 1 3 3 3 2 2 x Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 YA37 Regulation 37(1)(2) Requirement For notification to be made to the Commission for Social Care Inspection in accordance with statutory requirements, of all events adversely affecting the well-being or safety of residents. Timescale for action 15/03/08 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. Refer to Standard YA3 Good Practice Recommendations For a call bell to be installed beside the toilet in the shower room. Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Lodge (The) DS0000013584.V359519.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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