Inspection on 20/06/06 for Magnolia Lodge

This inspection was carried out on 20th June 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Magnolia Lodge 13/08/07

Magnolia Lodge 25/01/06

Magnolia Lodge 04/10/05

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Magnolia Lodge 42 Hollow Lane Shinfield Reading Berks RG2 9BT Lead Inspector Stephen Webb Unannounced Inspection 20th June 2006 10:15 Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 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 Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 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. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Magnolia Lodge Address 42 Hollow Lane Shinfield Reading Berks RG2 9BT 01707 652053 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) Caretech Community Service Limited Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th January 2006 Brief Description of the Service: Magnolia Lodge is a care home providing personal care to up to six adults who have learning, physical and emotional/mental health difficulties. There are currently five male service users in residence, four of whom have physical disabilities and use wheelchairs. Magnolia Lodge is a large detached house set back on a main road a few miles from both Reading and Wokingham town centres. It is a two-storied building with the first floor accessible via an internal passenger lift. There are five single bedrooms on the first floor and one on the ground floor. None of the bedrooms have en-suite facilities. There are local community facilities nearby and the home has its own transport as well as being on a public transport route to the local town centres. The current fees are between £770 and £1334 per week. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 10.15am until 5.00pm on 20th of June 2006. The inspection also included reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversations with service users, management and staff at the unit, and from three returned service user questionnaires. The inspector also toured most of the premises and had lunch with two of the service users. There was a sense of the service having been in limbo, pending approval for the planned building developments, which will address the majority of the physical shortfalls. However, until recently this has been compounded by the lack of consistent, effective management and of a consistent staff team. Environmental works, which should have been addressed irrespective of the planning delays, have not been completed, and aspects such as training and team development have fallen behind, to the detriment of the environment and the sense of cohesion of the unit. The new manager has begun to introduce changes in a number of areas, which are starting to impact positively on the service. What the service does well: The service has an appropriate written procedure for admissions and assessment, including risk assessments, consultation, visits and an individually planned transition. The practice of involving service users in staff recruitment procedures is a positive one. Service users have access to some activities and stimulation, within and outside the unit. (see below) Conversation with service users confirmed they were happy living at Magnolia Lodge and had opportunities to make choices in their daily lives. They were happy with the support from staff. The unit has a positive and supportive relationship with external healthcare professionals. There is an appropriate medication management and recording system in place. Training has been provided to all staff regarding one specialist medication need. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 6 The service has an effective complaints procedure in place, which is explained to service users. The service users spoken to, confirmed their understanding of this, and one already attends self-advocacy sessions. What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User guides would benefit from updating to reflect changes. There is a need to produce written risk assessments and fire evacuation plans for the wheelchair users accommodated on the first floor. Case records were not consistently maintained between the three case files in all cases and some records were not filed in order, making the tracking of changes more difficult. There is a need to develop the ability of staff to support and enable service users to develop their own skills further, and training is under way to develop Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 7 these areas as well as keyworking skills. This should include increasing the involvement of service users in their own care, shopping for and preparation of meals and in household tasks. The current premises do not meet the needs of wheelchair users effectively, and limit accessibility in certain areas, such as the laundry. The plans for development of the unit must address these needs sufficiently. There is a need to broaden the range of stimulation and activities available to service users as well as increasing their involvement in their own day-to-day care and in the local community. Although each service user now has a weekly activity planner, these currently show limited planned activity, mainly day centre or employment attendance, and should be developed further to include a better range of opportunities. Some impromptu activities do take place, but these are not systematically recorded. This should be improved. The current staffing levels of two care staff during the day could well be a limiting factor to activities within the community, and consideration should be given to increasing the staffing. The ready availability of fruit and other healthy items should be increased generally and within the menus to try to encourage a healthier diet. The healthcare recording system needs to be rationalised to ensure that it is comprehensive without repetition. Staff need to be reminded to follow the medication procedure. It is of concern that medication issues have also emerged in the last two inspection reports. The manager should consider providing training on handling complaints, to all staff as part of their induction. It was also of concern that five staff had yet to receive POVA (Protection Of Vulnerable Adults) training. This should be provided as part of foundation training to all staff, and should be provided as a priority to the staff who have no evidence of having received this recently. Shortfalls were identified in the recruitment system. The physical environment of the home remains very poor, despite some redecoration since the previous inspection. There are items of damaged and worn furniture, stained and worn carpets and missing window dressings. The layout is poorly adapted for wheelchair users, with various level changes within the unit and on routes to outside, and the laundry is inaccessible. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 8 Of particular concern are the outstanding works required in the fire authority deficiency notice, which expired in May, which must be addressed, whatever long term plans are proposed, to maintain the safety of the current unit. The organisation’s plans for addressing the major shortfalls of the premises both in the short and long-term, must be provided to the CSCI. There is a need to address the shortfalls identified in core staff training in accordance with the latest guidance, in order to establish a comprehensive and effective training programme. The organisation must put forward a manager for registration as a priority. 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. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 9 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 Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some updating of the statement of purpose and further development of the service user guide would be beneficial. The current assessment system could only be examined on paper, as there had been no recent admissions to the unit, but it would be satisfactory if followed. EVIDENCE: The unit had a service user guide, and though some attempts had been made to render this accessible to service users, further development might be of benefit in terms of its accessibility, perhaps through the use of more symbols, images of photos as appropriate. An appropriate Statement of purpose was in place though it too, would benefit from some updating to reflect changes since it was written. There have been no recent admissions to the unit so it was not possible to examine the current assessment process in action. However, the written system was examined and was satisfactory. There was an appropriate written admissions policy procedure in place, which included a series of planned visits, completion of assessment documents, Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 11 consultation with service user and relatives, (where appropriate), and the establishment of an individualised transition programme based on the needs of the prospective service user. The process includes a risk assessment system, which was seen to be in place for existing service users, and the development of a service user plan. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Though there is evidence of some exemplary practice, such as the developing inclusion of service users in staff recruitment, and the identification of individual’s gender preferences in respect of staff support with personal care; there remain shortfalls in the key area of fire evacuation risk assessments, and there is room for further development in other areas such as recording. EVIDENCE: Following a recent complete review, detailed care plans were in place, which included a communication profile, details of likes, dislikes and choices, and individual support requirements. There was also information regarding any gender preference where personal care support is given, which is good practice. The manager and service manager were also undertaking a cycle of external reviews for each service user, to ensure that all relevant current information was available from relevant professionals. These were all being carried out in the week of inspection and the following week, as some were overdue. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 13 The service manager stated that once the statutory reviews were completed, a round of internal reviews would take place to look in more detail at how the needs of individual service users would be met and establish the roles and expectations for staff within the new system. The files and daily records provided evidence that service users are enabled and supported to make choices in their daily lives, and the communication profiles were further evidence of attempts to enable this. The daily records were fairly detailed but not always filed in order, which made tracking information more difficult. All records should be filed in order and periodically monitored by management. (Recommendation made under Standard 41). It was reported that the need remained, to ensure that all staff fully understand the principles of the service, as part of moves towards greater individualisation of care and increased delegation of responsibility to keyworkers. To this end the team were in the midst of a series of training days on care planning, personal care support and keyworking, one of which took place on the day of inspection. Conversation with some service users was possible and they confirmed that they were able to make day-to-day choices about activities, getting up, clothing, meals, who they spend time with, etc. There was evidence of management of his own funds, on the part of one service user, with a written confirmation on his file. The manager confirmed that all of the current service users could make their wishes know to staff. It was also stated that one service user had taken part in the last round of staff recruitment and there were plans to further extend their involvement in future staff recruitment. This is good practice. The home operates a system called talk-time, which provides for specific oneto-one time with the keyworker for each individual, to enable them to talk about any concerns, which operates instead of service user meetings. The existence of three separate files for each service user presents some potential for confusion and the cut-off point defining whether a document was appropriate for filing in the historical file or the current file, was not clear. If the system of three files per service user is to be maintained, clear guidance regarding the appropriate split between these documents, should be provided to all staff, in terms of document type and date. (Recommendation made under Standard 41). Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 14 Individual risk assessments for each service user were in place and held on their individual current file, and generic collective risk assessments were filed together elsewhere. However, a recent fire officer visit had highlighted the need for a risk assessment and evacuation plan for the wheelchair users occupying first floor bedrooms, and this document had yet to be produced. In the longer term, this issue will be addressed by the accommodation of the four wheelchair users in new ground floor bedrooms, which are to be provided as part of a new extension. The manager had received training on risk assessment the week prior to the inspection and must provide the required risk assessment as a matter of urgency to cover the interim period until these ground floor facilities are provided. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The more independent service users have more options, but there is room for improvement in the level of community involvement, the availability of activities and leisure, support for service users in doing more for themselves and developing their skills, and in the provision of meals and the contribution of service users in this area. EVIDENCE: One service user attends paid employment at a day centre, two days per week but opts to also attend voluntarily on a further three days. Another attends adult education. Individual weekly activity plans were present on case tracked files, but these contained limited scheduled activity, mainly regular day centre attendance. In one case, this was said to be the preference of the individual. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 16 The life and leisure experiences plans contained only limited entries. One social diary indicated some additional impromptu activities such as trips to the bank or the garage shop, and to a pub, but the unit was not a hive of activity on the day of inspection. None of the service users has a known desire to attend worship in any form, though the manager was clear that this would be facilitated if desired. The development of the keyworking role and increased involvement of staff should be used to improve the range and frequency of activities, both within the unit and the local community. All offered activities should be recorded, as should any refusals, in order to evidence that a satisfactory range is made available. Funding for one-to-one staffing has recently been agreed for one service user, which will be used to increase their access to activities and community involvement. The limited feedback obtained directly from service users suggested they were happy with the level of activity, though one or two did appear to be bored and wanting staff input at times during the inspection. Within the unit there are a few games available including darts, and connect four. The current staffing levels of two support staff on duty at a time during the day, Monday to Friday, may well be a limiting factor in the provision of activities at times, though as indicated above, one-to-one funding had been agreed for one service user from July, which should free up some additional staff time to improve this. The manager is aiming to provide three staff during the day at weekends as well. Two service users have regular family contact, one has very infrequent visits and one has no known family. The manager indicated he was exploring the possible involvement of a local independent advocacy service to work with service users. One service user is already attending “Speaking Out” a local self-advocacy support group. This is an example of good practice, as is the involvement of a service user in the last round of staff recruitment. The routines of the unit allow for individuals to have a say in how they spend their day, and there is a move to further develop the involvement of staff in facilitating this through their keyworking and support of service users. Observed interactions between staff and service users were limited though as already noted, most were engaged in an on-site staff training day. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 17 Although it was said that service users have some involvement in housekeeping, meal preparation etc, and are developing in areas such as making their own drinks, (observed to be supported by the manager), there was little evidence of this on the day or within the activity plans examined, and the manager acknowledged that this too, is an area which would benefit from improvement through better enabling by staff. The menus provided indicate a mixture of processed and fresh foods, and the manager indicated that he monitored the level of processed ingredients. The lunches observed included a mix of fresh and processed items but lacked the inclusion of sufficient fresh fruit and vegetables to balance the diet. There was a fruit bowl containing fresh fruit in the kitchen, but it was on top of the tall fridge, where it would be inaccessible to several service users and not readily available to encourage individuals to eat the fruit. The manager agreed to relocate the bowl to a more prominent location. The manager indicated that the menus were planned with some consultation with service users, and some also got involved in the food shopping for the unit. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is evidence of developing good practice in some areas, and the plans for the redevelopment of the unit will hopefully dramatically improve the provision, especially for the wheelchair users. However, the ongoing medication errors, lack of proper provision, or risk assessment for wheelchair using service users, and lack of a single coherent healthcare recording system, mean that overall the section cannot be scored as adequate at this time. EVIDENCE: The unit does not satisfactorily meet the needs of the four service users who use wheelchairs. Adaptation is currently poor, with short ramps having been provided to make the best of a poor layout with various level changes within the unit and on routes to outside. Wheelchair users are also accommodated on the first floor, which is not an ideal situation. The lift cannot be used in an evacuation situation, and there was no risk assessment or fire evacuation plan in place for these service users. (Requirement made under Standard 9). Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 19 These issues must be addressed by the planned building redevelopment, which includes the provision of four ground floor, en-suite bedrooms to accommodate these service users, and must include the levelling of the floor throughout the unit, and the provision of wheelchair ramps which meet building regulations at all exits used by service users. (Requirement made under Standard 29). The manager acknowledged that the staff team were still getting to grips with their role as enablers of the service users, rather than doing too much for them, without first supporting them to do whatever they can or wish to undertake for themselves. This was seen as an area for ongoing improvement, and was being addressed via a series of training workshops for the team on key working, care planning and support. There is a flexible daily routine which service users can influence individually around times of getting up, eating, opting to attend activities etc, and as already noted, one service user attends regular self-advocacy sessions. The manager is also exploring the possibility of developing links with a local independent advocacy scheme to further the options of the others. The unit has regular and supportive contact with external medical practitioners including CPN, GP, district nurse and others as required. One of the service users experiences seizures and is on appropriate medication to try to control these. He described how he is aware when his seizures are coming on, and explained that he had fallen and banged his eye during a recent seizure. All of the staff have received the appropriate specialist administration training for his medication. Certificates for this training were seen on a sample of the staff records. New Health Action Plans are being introduced, which include recording formats for medical appointments, however, there did not appear to be a record for dental visits in this system. This should be rectified. Also found within each service user’s file were elements of another health appointment record system, which was potentially confusing. This system did include a record format for dental appointments. However, in the case of one service user, where the GP had identified the need for an urgent dental appointment, no record of this visit having taken place, could be located within the health appointment records systems. The manager was able to confirm personally that the visit took place but agreed that the absence of a record of this was not satisfactory. The manager must ensure that a single coherent recording system is in place within all individual files, where any medical information on service users, and Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 20 details of their medical appointments is recorded. Superfluous record formats should be removed from the system to avoid potential confusion. The home has an appropriate medication procedure in place, and there is a staff signature sheet to confirm they have read the procedure. Each service user has a detailed medication profile in place, including details of possible side effects of the medication. This is good practice. The medication administration record (MAR) sheets include recording of, and initialling for the quantities of medication received, which provides the start of the medication audit trail. The pharmacist had visited in March 2006 to inspect the medication systems and found them broadly satisfactory. Although the manager reportedly checks the MAR sheets weekly, one or two gaps in recording were still evident, which is not satisfactory. The majority of the staff have received medication training, with a few due to receive this early in August. Despite this, the gaps in recording indicate the need for further input from management regarding the importance of accurate medication records, especially given that medication issues have been raised at the previous two inspections. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has an effective complaints procedure in place, which is explained to service users. It is good practice that one service user already attends selfadvocacy sessions and that advocacy services are being considered for others. It would be good practice for all staff to receive training input on the handling of complaints as part of their induction. The protection of service users from harm is potentially compromised buy the outstanding need for POVA training for some of the staff, and the identified example of poor recruitment practice. These issues must be addressed. (Requirements made under Standards 34 and 35). EVIDENCE: The complaints records indicated no complaints since the manager started in the unit in April 2006. There was only one recoded complaint since the previous inspection in January 2006. This related to a service user’s bedroom, and was appropriately addressed. All of the service users were considered to be able to make their feelings known to staff if they had any concern. The complaints procedure was available in a service user-friendly format, and had been gone through verbally with four of the service users. The manager considered that the fifth service user would be unable to understand the concept of the procedure, but would be able to express any dissatisfaction to staff. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 22 Individual copies of the procedure were available on service user files. Service users confirmed verbally that they would be happy to take any concerns to the manager. Staff do not receive specific in house training on the management and recording of complaints, but the subject is addressed within NVQ for those who undertake this. It would be good practice for all staff to receive some training input on the recognition and handling of complaints as part of their induction. As noted already, one service user attends self-advocacy sessions. The manager had requested further Protection Of Vulnerable Adults, (POVA) training, because, according to available records, five staff have yet to receive this. It was reported that the planned October POVA course was fully booked and no further staff from this unit were allocated places. This is unsatisfactory and all staff who have not received POVA training recently, must be provided with this training by a competent person, as a matter of urgency. This training should be provided to staff as part of induction/foundation training. (Requirement made under Standard 35). A record of the signature of one service user to confirm they would manage their own finances, was see on one of the sampled files. Examination of a sample of recruitment records indicated that the previous manager had written the employer reference for one of the employed staff, whilst in post at the unit. This is poor practice, especially where a previous employer was recorded on the application form, and could potentially compromise the protection of service users. (Requirement made under Standard 34). Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The physical environment remains very poor and is unlikely to maximise the emotional well-being of service users. Although some attempts have been made to repaint communal areas, the overall impression remains unsatisfactory, due to the presence of shabby and broken furniture and stained carpets, missing window dressings and areas of water damage. The premises currently do not meet the needs of the four wheelchair users, in terms of safety precautions, physical accessibility and ease of circulation. There are a number of outstanding remedial works required from the fire authority deficiency notice, which must be addressed. Whilst the planning delays are regrettable, more work should have been and should still be done to improve the environment pending their completion. EVIDENCE: The premises currently fall significantly beneath an acceptable standard in terms of décor, furnishings, layout, level of maintenance, and suitability to Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 24 meet the needs of the service users. The current environment is unlikely to enhance the emotional wellbeing of service users, or the motivation of staff. Although there are plans for major improvements to the physical environment, these have been delayed due to planning objections and have only recently been agreed. Although attempts have been made to address some aspects of the décor in the interim, there remain areas with staining due to water penetration, stained and worn carpets in various areas, and various broken and shabby furniture in use. In some areas these issues could and should have been addressed in the interim, to maintain a more satisfactory standard. For example, there were broken and damaged items of furniture, which could have been replaced immediately, without waiting for the completion of building work. Any broken items should at least have been repaired or removed from use in the interim. The dining room and lounge furniture is shabby and in need of replacement, and there was a need for curtains or other window-dressings at some windows and patio doors. The final plans should be provided to the CSCI, together with a proposed schedule and phasing of the works; and the work should now be expedited, with due regard for the well-being of the service users. A significant number of areas from the Fire Officer’s deficiency notice, (expiry 10th of May 2006), remained outstanding. In particular, there were no risk assessments or evacuation plans in place for the four wheelchair using service users accommodated in first floor bedrooms, staff fire training records were not fully up to date, a staircase enclosure cupboard was still not locked shut, emergency lighting still did not meet requirements, a required additional smoke detector had not been fitted, and additional signage had not been provided. These outstanding works must be addressed as a priority. The previous requirement to replace the stained carpets in ground floor communal areas had also not been addressed owing to the planning delays. Given the potential for detrimental effects on the emotional health of some service users owing to the poor standard of the current environment, consideration should be given to the interim replacement of this flooring if the building works are likely to take in excess of six months from the date of this inspection. The current arrangements for smokers are not really appropriate, being just outside the games room under a wooden lean-to garage structure, but the Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 25 service users were clearly used to this location and felt at ease there, with or without staff supervision. Attempts have been made to minimise the risk by providing a metal tin for dog-ends, though this was not universally used. The front garden area was large, consisting mostly of a mixture of tarmac parking area and lawn. This area is not used as it is open to the road. The rear garden was large and fairly well tended, and consisted mainly of lawn. As already noted, wheelchair users are currently accommodated on the first floor, which is not an ideal situation. The proposed plans for developing the building include the provision of four ground floor en suite bedrooms to accommodate these service users. These works must also include the levelling of the floor throughout the unit, wherever possible, and the provision of wheelchair ramps, in accordance with building regulations, at all exits used by service users. There was an unpleasant odour in some areas of the building, which may reflect the condition of carpets in these areas. The current laundry provision remains inadequate. There is a one machine located within the existing inadequate and inaccessible laundry, and another sited in the “games room” outside the manager’s office. The manager stated that a washing machine with a sluice cycle was not required at present, but agreed to keep this under review. A suitably located wheelchair accessible laundry facility must be established as a priority within the planned works. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This is a newly constituted team, which is still being developed in terms of individuals skills in keyworking, enabling and supporting the development of service users and care planning and recording. The establishment of the permanent management team is a positive step in the development of the unit. The level of NVQ meets the standard but will be improved upon as further staff undertake their NVQ. There were some shortfalls in recruitment systems, which should be addressed to maximise the protection of service users. However, the inclusion of service users in the recruitment process is a positive step. The training programme is developing but the level of training achieved remained insufficient at the time of inspection. EVIDENCE: The staff team are undertaking a series of training sessions on keyworking, enabling and care planning to enhance their skills in these areas. The manager had recently confirmed two permanent senior appointments and an individual was due to be offered the deputy post. This will enable the Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 27 management team to begin to develop and take the unit forward via a consistent approach. The unit still uses some agency hours each week and it is hoped to continue to reduce these. Fifty percent of care staff had obtained their NVQ level 2. A sample of staff recruitment records were examined and found to be in order for the most part, though there was no copy or written confirmation of an enhanced CRB on file in one case. This should be addressed. It was also noted that the previous manager had written the “previous employer” reference for one staff member whilst in post in this unit, which is poor practice, especially where the application form indicated a previous employer who could have been approached for a reference. The involvement of one of the service users in the last round of recruitment was a positive development, which the manager was hoping to build upon. This is good practice. At present the manager has only individualised training records available, but is planning to devise a collective training matrix to monitor training needs across the team. Feedback from staff indicated that a range of training courses had been made available recently, to add to those which staff may have obtained with previous employers. Examination of the available training records indicated some gaps in core training, which the organisation will need to address, including five staff needing POVA training, as noted earlier, and three needing fire safety, and some requiring food hygiene. A small number also required medication training before they could administer, but this was booked in August, as were some other courses. The organisation does have a training programme in place but the next planned POVA training in October, is reportedly full and not offering any places to staff on this team. This is unsatisfactory and arrangements must be made for outstanding staff to receive POVA training from a competent trainer, as a priority. The provision of training to all staff on working with mental health issues was a requirement of the last inspection, which had not been met, though the manager had requested this. This training should be provided as a priority. The manager reported that the LDAF induction records for all staff were to be completed and signed off in the week of the inspection. The manager needs to establish what core/foundation training remains outstanding and make appropriate arrangements for these shortfalls to be addressed promptly. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 28 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The unit has suffered from a lack of consistent, effective management, and the organisation must now propose a manager for registration. There is evidence that the new manager of the unit is taking significant steps, with the support of his line manager, to improve the management and quality of this service. However, at the time of inspection the service still fell short of the required standards in a number of areas. The developments towards a quality assurance system are positive, though some further development is necessary, and the manager is establishing a management team to take the unit forward, as well as more effective systems of staff support and guidance. Training is improving but significant shortfalls in core training remain to be addressed, and there were a number of outstanding health and safety related concerns. Some clarity and guidance to staff, was required with regard to the completion and management of service user records. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 29 EVIDENCE: The manager is suitably experienced and discussed his plans and those of the organisation, for developing the quality of the service. However, he has yet to be put forward for registration, and this should be instigated as a priority. He continues to attend some training to develop and update his skills. The organisation has a system of one-to-one sessions between keyworker and service user, (instead of residents meetings), which are an opportunity for service users to be consulted about their views on the service, and the care received. There is also a series of questionnaires, which include symbols and pictures, in an attempt to enable those who are unable to communicate verbally to express their views. The organisation also carries out an internal quality audit on a six monthly cycle, via an external consultant. A copy of this was provided to the inspector, and confirmed some of the shortfalls identified in this report, as well as identifying positive developments in various areas. However, the manager was not aware of questionnaires yet having been utilised for relatives or relevant external professionals, which would be an expected part of a comprehensive quality assurance system. There is a system of relatives meetings on a six monthly basis, but these tend only to be attended by the next of kin of two of the service users. Also, the minutes of these meetings were not available in the unit, being retained at head office. As part of the manager’s quality assurance process it would be helpful for these minutes to be available in the unit, and for quality assurance feedback to be sought from external professionals and relatives. There was an annual development plan in place for the unit, which is a positive step towards future progress. The majority of Regulation 26 monthly monitoring visits had taken place, though there was no available report for March, (unclear whether visit took place), and the report for another month was held by the line manager due to issues around some of the content. These visits must take place on a monthly basis and the reports must be available in the unit. Each service user’s records were contained in a number of separate files, most of which were held in the office, though with the building in some disarray owing to the impending building works, some were stored elsewhere. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 30 As noted earlier, some elements of service user records would benefit from being placed in chronological order and there should be clear guidelines about the separation between the various service user files to ensure consistency of practice around filing. In terms of safe working practices, there were a number of shortfalls in basic staff training in safety-related areas, including moving and handling and health and safety, though both of these were planned for July, food hygiene and POVA training. As noted earlier there were significant areas of the Fire Officer’s deficiency notice, (expiry 10th of May 2006), which remain outstanding. (Requirement made under Standard 24). Accident forms are filed on individual case record files. The manager completes an accident monitoring form, which is sent to head office on a monthly basis. If these forms were retained collectively they would meet the need for a collective record of accidents, for monitoring purposes. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 1 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X 2 1 x Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 32 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 23(4)(c) Requirement The manager must ensure that an appropriate risk assessment, and procedure is put in place with regard to the evacuation of wheelchair-using service users from the first floor bedrooms in the event of fire. The manager must ensure that effective consultation takes place with service users in order to develop and broaden their social interests and community involvement. The manager must ensure that effective consultation takes place with service users in order to broaden the range of activities available to them. The manager must ensure that the staff enable service users to develop their own self-caring skills and decision making about the care they receive, as part of promoting their independence. The manager must ensure that service users receive a suitable, wholesome and nutritious diet. The manager must ensure that appropriate healthcare records are maintained. DS0000065611.V292206.R01.S.doc Timescale for action 20/07/06 2 YA13 16(2)(m) 20/09/06 3 YA14 16(2)(n) 20/09/06 4 YA16 12(2) 20/09/06 5 6 YA17 YA19 16(2)(i) 17(1)(a) 20/09/06 20/08/06 Magnolia Lodge Version 5.1 Page 33 7 8 9 10 YA20 YA24 YA24 YA24 13(2) & 17(1)(a) 23(2) 23(4) 23(2) 11 YA24 16(2)(c) The manager must ensure that proper medication records are maintained at all times. The manager must arrange for the prompt replacement of broken, and damaged furniture. The manager must ensure that the outstanding fire safety remedial works are addressed. The manager must ensure that appropriate window dressings are provided where absent, in order to enable the privacy of service users to be maximised. The carpets in the communal areas on the ground floor must be replaced at the completion of the building works. 20/08/06 20/08/06 20/08/06 20/08/06 20/12/06 12 YA29 23(2)(n) 13 YA30 13(1)(3) This requirement remains outstanding from the last inspection, but was not undertaken owing to planning delays. The manager must ensure that 20/09/06 the planned building works fully address the needs of wheelchairusing service users. The manager must provide 20/09/06 evidence that suitable, wheelchair-accessible laundry facilities will be provided at the home. 14 15 YA34 YA35 This requirement remains outstanding from the last inspection, though it is recognised that it cannot be addressed until the unit’s building works are addressed 19(1) The manager must ensure that appropriate recruitment practice is followed in all cases. 13(6) & The manager must ensure that 18(1)(c)(i) the staff who have yet to receive POVA training, receive this as a priority. DS0000065611.V292206.R01.S.doc 20/07/06 20/08/06 Magnolia Lodge Version 5.1 Page 34 16 YA35 18(1)(c)(i) The manager must ensure that all staff receive training on working with mental health needs. This requirement remains outstanding from the last inspection and must be addressed as a priority. The registered provider must put forward a suitable manager for registration. The registered provider must further develop the quality assurance system in line with Standard 39. The manager must establish a training plan to ensure that all staff receive training as defined by current guidance, in all areas relating to health and safety. 20/08/06 17 18 YA37 YA39 8 24 20/08/06 20/09/06 19 YA42 18 20/08/06 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 YA1 Good Practice Recommendations The manager should consider what updating to the statement of purpose is necessary now and establish a system for its annual review. Further development of the service user guide should also be considered. The manager should ensure that the staff develop their skills at enabling and encouraging the appropriate involvement of service users in planning, shopping for, and preparing the meals. The manager should consider the provision of staff training on complaints, as part of induction in order to ensure that staff are proactively enabled to “listen to and act upon the views of service users and others”. Consideration should be given by the manager to replacing the stained carpets in ground floor communal areas, in the interim, if the building works will not be completed within six months of this inspection. DS0000065611.V292206.R01.S.doc Version 5.1 Page 35 2 YA17 3 YA22 4 YA24 Magnolia Lodge 5 YA24 6 YA41 The manager should provide copies of the final plans for the building works together with details of the proposed phasing of the works, to enable the CSCI to ensure that the premises will be suitable for the stated purpose, and the works will be carried out so as to minimise the disruption to service users. The manager should consider the provision of clear guidance to staff regarding the correct filing protocol and the maintenance of case records in good order. Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 36 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 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 Magnolia Lodge DS0000065611.V292206.R01.S.doc Version 5.1 Page 37 - 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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