Inspection on 29/08/07 for Lomack Lodge

This inspection was carried out on 29th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Pemdale

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

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

CARE HOME ADULTS 18-65 Lomack Lodge 10 St Georges Street Bedford Bedfordshire MK40 2LS Lead Inspector Ansuya Chudasama Unannounced Inspection 29th August 2007 10:57 Lomack Lodge DS0000067214.V349518.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 Lomack Lodge DS0000067214.V349518.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. Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lomack Lodge Address 10 St Georges Street Bedford Bedfordshire MK40 2LS 01234 844031 01234 840094 cbrennan@lomackhealth.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) Lomack Health Co Ltd Mr Stewart Wayne Simpson Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th November 2006 Brief Description of the Service: Lomack Lodge is a small home for seven users with learning disabilities. The building is a detached house with seven single bedrooms with en suite WC and shower and one room has a bath instead of a shower. The ground floor has two bedrooms and there are four bedrooms on the first floor, and one on the second floor. The home has a pleasantly decorated lounge, dining room and a kitchen. There is a communal laundry room on the first floor with a good size washing machine and dryer. There is a tarmac drive leading from the front to the rear of the house. The home has a garden with a table and chairs which the service users use in the summer time. The home is not suitable for people who are wheel chair users. The charges for care range from £1300 a week. It was also stated that the fees were negotiable and depended on the assessed needs of each service user that was admitted to the home. Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector visited the home without telling any one that she was going to visit on Wednesday the 29th of August 07 The inspector spoke to the manager and staff who were on duty. She talked to the people using the service, and asked staff about those people’s needs. She also looked at the medical records and daily notes for one of the people living in the home. This is called case tracking. She watched the staff and the people living in the home do things together. One of the people living in the home gave the inspector a tour of the home. At the time of the inspection there were two people living in the home. The home had vacancies for five people at the time of the visit. The information from the service users questionnaire’s and the completed Annual quality assurance Assessment (AQAA) form sent to the CSCI have been used in this report. The inspector would like to thank the manager, staff, and the people living in the home for their time in helping with this inspection. This is the first inspection undertaken since the people living in the home were admitted. The manager needs to display the report where staff, people living in the home and visitors can have easy access to this document. This inspection report should be read alongside the National Minimum Standards for Younger Adults (18-65). What the service does well: The home is clean and pleasantly decorated. The people in the home like living at the home. They feel well cared for by staff and say staff treat them well. They say their privacy is respected. They have house meetings and talk about things that they would like to do in the home and where they would like to go on holiday. They like the food and activities they do with help from staff. They also know who to tell if they are unhappy. The manager and staff help the two people living in the home to learn skills to help them become more independent. They enjoy working at the home. Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 6 The staff and people living in the home were interacting well and enjoying each other’s company, and staff were talking to the people living in the home in a positive and caring manner. 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. Lomack Lodge DS0000067214.V349518.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 Lomack Lodge DS0000067214.V349518.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): 1,2,3,4,5. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Good quality information is gathered prior to anyone moving to the home so that the person moving in can be confident the service can meet his or her needs. EVIDENCE: Since the last inspection, two new service users had moved into the home. The manager discussed the admission process for the people that were admitted to the home. This process was also discussed by one of the people living in the home who stated that they had visited the home with their family and their social worker and “liked it”. Evidence of this assessment process was seen in the file of the person that was being case tracked. The home had a statement of purpose but did not have a service user guide. The manager stated that a user friendly guide was being produced. Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 9 The home had individual placement agreements with the funding authority. However the people using the service did not have an individual written contract or terms and conditions with the home. Lomack Lodge DS0000067214.V349518.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): 6,7,9,10 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home did not have care plans or risk assessments to adequately provide staff with the information they need to satisfactorily meet the needs of the people who use the service. EVIDENCE: The people using the service did not have a care plan which set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the person are met. So therefore the home would not be able to judge whether appropriate care is delivered to the individual person in accordance with the persons individual assessed needs. The manager and staff used the information from the assessment Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 11 process to meet the needs of the people living in the home. The staff spoken to had build up good working relationships with the people living in the home. They had good understanding about their behaviours and likes and dislikes as well as knowing what the people were able to do for themselves. The home used the organisations agency staff and this meant that they would not have the information needed to know how to meet the care needs of the people living in the home. The home needs to undertake risk assessments for people living in the home in discussion with them to protect them from identified risks and hazards. The home encourages the people living in the home to make decisions about their lives with assistance from staff. For example the home has meetings with the people living in the home and those seen showed that meals, outings, fire testing, complaints policy and what is happening in the home was being discussed. The information about the people living in the home was kept secured in the office Lomack Lodge DS0000067214.V349518.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): 12,13,14,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people living in the home are provided with a variety of activities on a one to one basis with staff to develop their personal and social and skills. EVIDENCE: Discussion with the people living in the home showed, that they are offered opportunities to participate in the running of the home. The information in the communication book also showed that this was taking place. It was stated that they helped with the laundry, meal preparation, washing up after meal times, going to the shops to buy the food shopping, and their own personal shopping. One of the people living in the home stated that they prepared their own breakfast and made a cheesecake and they were very proud of this. Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 13 The inspector was informed by staff that one of the people living in the home was going to attend day care four times a week and one day was going to be spent at the home. This was to work on their daily living skills. At present this person was having a one to one with staff. It was said that they went out in the community and staff encouraged them to make their bed, do the laundry and help make lunch and tea. This was observed on the day of the inspection. Another person living in the home was being supported to settle in the home on a one to one basis. This person had refused to attend day care services previously. It was stated that the person’s behaviour had calmed down and they felt more settled living at the home. The manager stated that he was setting up day care once a week to a day care placement that the person would enjoy. It was also stated that a staff member would accompany the person in the beginning to support them. The day care would also increase when the person became more settled. A copy of the timetable of activities being undertaken for the week was recorded. A timetable was also displayed in picture form and the person that was being case tracked was able to discuss what they did by using the timetable. Some of the activities included going swimming, bowling, and visiting family. The two people living in the home had shown an interest in joining the gym and the manager was sorting this out. One of the people living in the home stated that they had a barbeque for their birthday and they enjoyed this. It was stated that the person was going on holiday in September 07 with staff to the seaside. One of the people using the service said this was “a happy place” and they liked living at the home. The staff were described as being very “helpful” and “nice”. The two people living in the home were observed getting on well together. Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. 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. The staff and the manager ensure that the health care needs of the people are met by involving the appropriate professionals to meet their needs. EVIDENCE: The staff on duty were able to give clear details in how the two people living in the home had their personal and health care needs met. This information was confirmed by one of the people using the service. This person also stated that they brought their own clothes and used the community hairdressers. Staff stated that only female staff gave personal care to female service users. The records case tracked for one of the people using the service had information on their medical diagnosis, medication profile and, how the person took their medication. A ‘service user agreement’ form for medication was Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 15 seen in a user friendly language. A family member signed this. The communication book read showed that families were being kept informed of the ‘service users conditions’. The medication records seen were being completed satisfactory. There was information on the weight chart and this was being completed properly. There were guidelines seen for supporting the person living in the home with their autism, and behaviours. This needed expanding as discussed at the inspection. A risk assessment was seen for epilepsy. The ABC record sheet for recording challenging behaviour was seen, and staff were completing this form. The manager stated that the information from this was discussed with the psychologist. The last incident recorded in the form was dated April 2007. It was stated that the person’s behaviours had stopped as they were settled at the home. A medical summary sheet with appointments with the medical professionals was maintained. A referral was also made by the home to the Arts psychotherapy department at Twinwoods health centre for one of the people using the service. Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 16 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. The people living in the home are able to express their concerns and feel safe and well supported by the staff. EVIDENCE: The home had a complaints policy and this was completed in widget user friendly language. The home had no complaints recorded. The service users questionnaires stated that they knew who to speak to if they were unhappy. This was also discussed in their house meetings. The inspector spoke to one of the people living in the home and it was stated that they would tell staff or their family if they were not happy. However it was stated that they were ‘happy at present’. The staff on duty spoken to stated that they had not completed the training on protecting vulnerable adults. However they knew what to do if they suspected any kind of abuse. It was said that they would inform the manager. The staff spoken to were able to give examples of how they knew when one of the person living in the home was unhappy. This was by understanding their behaviours and it was stated that the person was able to communicate verbally. It was stated that one of the other service user was not able to Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 17 communicate verbally well. But staff understood their behaviours and stated they knew when the person was unhappy. Training on safeguarding adults was discussed with the manager. It was stated that he was going to discuss these procedures with staff in the next staff meeting. He was also going to enquire about staff attending training courses on protecting vulnerable adults with social services. The money checked was correct for the two people living in the home. It was stated that the person that was being case tracked had their own account and they signed the chequebook to withdraw money from the bank. The information on how the home manages the two peoples money needs to be recorded in their care plan. The manager stated that he was going to do this. Lomack Lodge DS0000067214.V349518.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): 24,30. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The people using the service live in a very well maintained, attractive home, which is accessible to community facilities and services. EVIDENCE: A tour of the home was given by one of the people living in the home. The home was very clean and pleasantly decorated. All the bedrooms had en suite facilities. The bedroom of the person giving the tour was seen. The room was individualised to meet their needs. The person also stated that they liked their room. The lounge and dinning room were well planned to meet the needs of the people intended for. A quiet room was also available for the people living in Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 19 the home to sit quietly, and or meet with their friends. The kitchen and laundry were domestic in character and designed to enable and promote the involvement of the people living in the home. Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 20 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): 31,32,33,34,35,36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The manager is aware that that there are gaps in the training programme and has an action plan to deal with this to meet the needs of the people living in the home. EVIDENCE: It was stated that two permanent staff and the company’s agency care staff managed the home. The ratio of care staff to service users was very good. To maintain continuity, the manager tried to use the same staff all the time. One staff spoken to stated that they worked for the organisation’s agency. They had been working at the home since a female service user had been admitted to the home. It was stated that female staff only attended to female service users. The staff had received induction training when they started work at the home. This Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 21 needs to be recorded and a copy needs to be kept in their file. The staff enjoyed working at the home and with the people living at the home. The staff had her first supervision with the manager this month. A copy needs to be kept in their file. The staff recruitment records were not held at the home, these were kept at the head office of the agency. These records were inspected at the agency the next day. There was evidence that the recruitment procedures were being implemented by the agency. However the staff files needed to be better organised. These records need to be kept at the home. The training records inspected showed that not all the staff had training on protection of vulnerable adults, challenging behaviour, autism, and control and restraint undertaken by all the staff working at the home. A training and development plan for all staff was required. The manager also needs to ensure that up to date information of the training undertaken by staff is available with dates carried out. Some of this information was available for some staff but not for others. The manager needs to undertake supervision with all staff as stated in the standard. Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although procedures are in place, inadequate care planning and risk assessments place users at risk. EVIDENCE: The home was opened in February 2007. The rotas showed that the manager worked shifts with the agency’s care staff when the first person using the service was admitted to the home on the 14th of February. The manager therefore did not have time to undertake his administrative duties. The people living in the home did not have care plans or risk assessments, and contracts. Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 23 Since the second person was admitted to the home in July 2007 the manager was able to have one day to do his administration. The inspector spoke to the proprietor regarding the manager having more time to undertake the duties of the registered manager. The proprietor was very supportive and agreed for the manager to have the time needed to do his job. The proprietor was not aware that the manager did not have enough time to undertake his duties. The manager has the skills and experience to manage the home well. However he has not attended any training since he started work with the organisation. The manager enjoyed working at the home and with the people living at the home. The inspection showed that the home is run very much with the service users interests at heart. The staff spoken to stated that the manager needed more time to undertake his administration duties. It was also stated that care plans and risk assessments were required so when new staff worked at the home, they would know how to meet the needs of the people living in the home. Risk assessments for using the gas oven, and staff working alone were seen but others needed developing in the areas of safe working practices and activities. The fire alarm testing, emergency lighting, fire hazards, infection control was being carried out satisfactory. The manager states that they speak to the people using the service to find out their views about food, activities, holiday’s in their meetings. The manager stated in the AQAA that they needed to develop and produce feedback surveys for service users and stakeholders. Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 24 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 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 x 2 X X 2 X Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 25 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 2 Standard YA42 YA5 Regulation 13 5A Requirement Develop risk assessments for the environment and safe working practices. Provide service users a statement specifying the terms and conditions with the home Provide Care plans for all the people living in the home. Develop risk assessments for all service users to protect them from harm or abuse. All staff must receive training in order to meet the needs of the service users. This includes, challenging behaviour, autism, epilepsy, protection of vulnerable adults, Develop a staff training and development plan (for all staff) to incorporate induction, mandatory, specialist and NVQ training. Arrangements must be made for all staff to receive regular supervision. DS0000067214.V349518.R01.S.doc Timescale for action 30/10/07 30/10/07 3 YA6 15 30/10/07 4 5 YA9 YA32 13 18 30/10/07 30/10/07 6 YA35 18 30/10/07 7 YA36 18 30/10/07 Lomack Lodge Version 5.2 Page 26 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 Lomack Lodge DS0000067214.V349518.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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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