Inspection on 05/10/06 for Magnolia Lodge

This inspection was carried out on 5th October 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 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Magnolia Lodge 09/12/09

Magnolia Lodge 25/02/09

Magnolia Lodge 28/04/08

Magnolia Lodge 25/04/07

Magnolia Lodge 30/11/05

Magnolia Lodge 15/12/04

Magnolia Lodge 16/06/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Magnolia Lodge Herbert Road Chelston Torquay Devon TQ2 6RP Lead Inspector Sam Sly Unannounced Inspection 5th October 2006 13:30p Magnolia Lodge DS0000018392.V306801.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 Magnolia Lodge DS0000018392.V306801.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. Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Magnolia Lodge Address Herbert Road Chelston Torquay Devon TQ2 6RP 01803 605348 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) Rotel Ltd Vacant Care Home 11 Category(ies) of Learning disability (11), Learning disability over registration, with number 65 years of age (11) of places Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2005 Brief Description of the Service: Magnolia Lodge is a care home for adults with Learning Disabilities. The large detached house is situated in a residential area of Torquay. There is a car park to the front and gardens laid out mainly to lawn at the back. Entrance to the Home is level access into a sun lounge that is used by the smokers in the Home. The ground floor has 6 single en-suite bedrooms, 1 of which is used by staff on sleep-in duty, a lounge and dining room, office, kitchen and a laundry. Stairs lead to the lower ground floor, which is a self contained flat for one resident. It has a bedroom, bathroom, and lounge. Stairs lead to the first floor; a staff sleep-in room is situated halfway up the stairs. The first floor has a further 6 single en-suite bedrooms, and a bathroom. Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit took place during a weekday afternoon and early evening in October. Jeff Osborne who is known as an Expert By Experience accompanied the Inspector. He and his supporter Kieran Bright spoke to residents. The staff on duty, a visiting relative and two of the Owners of Magnolia Lodge were also spoken with. The Inspector visited Magnolia Lodge for a second morning to finish the Inspection and meet with the acting manager Louise Thompson and the Responsible Individual Allison Whitehead, who were not there on the first day. All types of written records were looked and a tour of all the shared rooms and some of the bedrooms was carried out. To write this report all the records of contact the Commission has had with Magnolia since the last inspection were looked at. The acting manager provided information too. Three of the residents, two staff, five relatives, and seven care managers returned comment cards to the Commission. The weekly fee at Magnolia Lodge ranges from £551 - £1000, with some residents receiving one-to-one staff support each day. All the standards that the Commission thinks are most important were looked at during the inspection process. What the service does well: What has improved since the last inspection? Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 6 There have been significant issues at Magnolia Lodge since the last inspection, which have been handled competently by the Owners. The Service is starting to improve once again. 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. Magnolia Lodge DS0000018392.V306801.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 Magnolia Lodge DS0000018392.V306801.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 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 adequate. This judgement has been made using available evidence including a visit to this service. There is enough information to choose whether to live at Magnolia, but not all residents will understand it. Resident’s needs are not fully assessed. EVIDENCE: Residents that returned comment cards to the Commission all said they chose to move to Magnolia Lodge and were given information about the Home before moving in. One resident said ‘I’m happy here and like living here.’ Another said ‘I like the residents at Magnolia Lodge.’ The information about Magnolia Lodge that is given to residents (the Service User Guide) is up-to-date and in easy to read language however, some residents do not read, and one resident told the Expert By Experience that: ‘If I had pictures to look at it would help me understand.’ There was also up-todate information to give to other people (the Statement of Purpose). Three resident’s care plans, including assessments of their needs were examined in detail and a fourth was looked at on the second visit. One resident had a thorough assessment, another was being completed, and two were not up-to-date and not thorough, although there was lots of information available from the Care Managers and other professionals. Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 9 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 adequate. This judgement has been made using available evidence including a visit to this service. Although residents are supported to make decisions about their lives, care plans do not reflect resident’s goals and aspirations. EVIDENCE: Four resident’s care plans and risk assessments were looked at in detail and the Expert By Experience spoke with residents. One resident said they helped to complete their care plan, another said they understood what was in it. Two residents were not so sure what a care plan was. The care plans looked at varied in quality and were not up-to-date. There was also not enough information of resident’s communication needs and support for challenging behaviour. The way care plans were written was not understandable to all residents as some could not read. Throughout the inspection it was found that information like menus, daily planners and meeting records were not in formats that all the residents could understand. The acting manager said that she was arranging reviews with professionals, but some resident’s plans had not been reviewed for many years. Two Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 10 residents told the Expert By Experience that they would like to move and have their own homes. Some residents were paying for one-to-one staff support, but no one spoken with was clear how much. Care plans did not detail this support. The staff member who was on the rota to be providing this one-to-one support had not turned up for work, and had not been replaced. All residents that were spoken with by the Expert By Experience, or sent comment cards to the Commission said they make their own decisions about what they want to do every day. Residents said: ‘I get my money on a Saturday and I go out and spend it.’ ‘I go out with Denise.’ Resident meeting records showed views were listened to and acted on. Records of meetings were not in a format understood by all residents. Discussion took place about meals, activities and anything else anyone wanted to talk about. Each resident had a key worker who held regular meetings with their allocated residents too. One of the Owners is the Department of Work & Pensions appointee for many of the residents and staff manage most resident’s finances, although everyone handles their own cash. One resident said: ‘I want to draw my own money from the bank’. The acting manager accepted that this was not happening at present. Another resident told the Expert By Experience that their money is kept in a tin in the office, and they normally have to wait until Saturday to be given it. Detailed records are kept of receipts, bank balances and the acting manager does an audit regularly. There are no clear records in each residents care plan to show them what benefits they were receiving. Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 11 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. Although resident’s lifestyles are fairly active and interesting more effort should be put into ensuring residents are given choices about where to go, what to eat and what to do with their lives. EVIDENCE: The Expert By Experience spoke with four residents during the visit, and the Inspector spoke with some of the others. One resident told the Expert By Experience that she likes to go shopping and had spent some of her money on a backpack that day. She also likes to have parties and had a great birthday party at Magnolia Lodge. Another resident told the Expert By Experience that he enjoyed going on trips that he had chosen, like to Grease the musical. The Expert By Experience learned that lots of residents had gone on a holiday to Butlins recently that they had enjoyed. Many of the residents, including three of those who spoke with the Expert By Experience attend a day service called Focus 2000, which is run by the Owners of Magnolia Lodge. They did not say whether they chose to go there or not. Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 12 One young resident told the Expert By Experience that he sleeps a lot after his day service. The acting manager and Responsible Individual were asked why this was, and said he liked to play play station games in his room, but it may also be because he is bored and does not have many friends at Magnolia Lodge. Another resident when asked by the Expert By Experience about what they liked to do at Magnolia Lodge said: ‘Watch TV. The resident did not do anything else. One resident told the Expert By Experience that she has a daughter, who she does not get to see much. Later the resident told the Inspector that a trip to see her daughter was arranged for the following week. This resident also told the Expert By Experience that she would like to go to the pub and would like newspapers and magazines to read as she did not attend Focus 2000, and was at home during the day. This resident had also returned a comment card to the Commission saying she would like to go out more and draw her own money from the bank. When resident’s comments to the Inspector and to the Expert By Experience were discussed with the Responsible Individual and acting manager it was clear they were not aware of some of these wishes. Five relatives returned comment cards to the Commission. One said, about their resident: ‘He is happy and loved by all the staff.’ All the relatives were satisfied with the overall care provided at Magnolia Lodge. One relative was visiting his son, from the north of England, and had been offered a room to stay the night and a meal. His son was very pleased to see him. The relative said he was able to kept in touch via telephone throughout the year and that he thought the care provided to his son was excellent. He did not know anything about his son’s care plan or about what he did during the day. Another relative who returned a comment card to the Commission said they had been disappointed with the general care their resident had received particularly day care, evening and weekend activities and medical support. The Responsible Individual and acting manager were aware of these issues, and said they were working to resolve them. One resident who returned a comment card to the Commission said: ‘I’m happy here and like living here. I like to see my mum sometimes.’ One resident who returned a comment card said: ‘I do my own cleaning and my floor when I want.’ Unfortunately when the Expert By Experience visited this resident’s accommodation it was very dirty with a dinner plate full of ash, which indicated that the resident was not getting the support from staff required to keep it clean. Residents spoken with by the Expert By Experience did not know what they were having for dinner that night even though it was only an hour away. The menu telling residents what was for dinner was written, and this meant many of them could not read it. The Expert By Experience were concerned when talking with one resident that there was no choice at meal times, as the supporting staff member said the meal was baked potatoes ‘again’ and added Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 13 ‘as usual’. The menus sent to the Commission, and on display at Magnolia Lodge did offer a choice of two meals, however because of the inaccessibility of the information to many of the residents, choice might be difficult. There were resident’s meetings records that showed that residents were asked what food they liked to eat. Magnolia Lodge DS0000018392.V306801.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 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are given personal and health care support, but to ensure it is given consistently and in ways residents prefer, care plans need to be detailed. Record keeping of medication administered by staff does not protect residents. EVIDENCE: Seven professionals returned comment cards to the Commission. Six of the seven were satisfied with the overall care provided, but there were several comments about the lack of stability and consistency at Magnolia Lodge and about the turnover of staff. One professional said: ‘There have been a lot of foreign staff whose poor command of English language has made communication with residents difficult.’ Another said: ‘I feel the home would benefit from a period of stability and consistency, hopefully this would return Magnolia back to the good care standards we were used to.’ And another said: ‘I was concerned that a member of staff, who was helping me with the carer part of a dementia assessment was moved to another home within the same Company on return from holiday before we had completed the assessment. I feel that there needs to be an investment in staff training and supervision.’ All professionals said that staff worked in partnership with them and that there was always a senior staff member available to talk to. There were mixed views Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 15 about whether staff demonstrated a clear understanding of resident’s needs. Care plans recorded how some health and care needs were to be supported by staff, however the care plans looked at were not detailed or up-to-date. Several residents required medical help that involved ‘invasive procedures’. One resident carried information on them about what should happen if the situation arose. There was no clear information on which staff had received training on carrying out the procedure for the other resident. All residents are registered with local GP’s and receive regular health checks including dentist, hearing and sight examinations. None of the resident’s self-administered medication. Most residents spoken with said they preferred staff looking after their medication, although one wanted to be more involved. Medication procedures for staff administration of drugs were observed. Medication was kept in a secure metal cupboard, with controlled drugs stored in appropriately. Records were kept of medication administered, and administered controlled drugs were recorded in a special register, which was not filled in correctly. The receipt and disposal of medication was carried out properly and a pharmacist regularly monitors the procedures at Magnolia Lodge. Magnolia Lodge DS0000018392.V306801.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 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. There are systems in place to listen to residents concerns, however the systems in place to protect residents are not robust. EVIDENCE: All the residents that commented to the Commission knew who to go to if they were unhappy knew how to make a complaint and named specific staff they would go to. There was an easy read complaints procedure with symbols, however it required additional information like the timescale in which residents could expect a complaint to be investigated in, and the contact details of the Commission. Staff held regular resident meetings and one-to-one meetings to listen to any concerns residents have. All relatives that returned comment cards to the Commission said they were aware of the complaints procedure. Neither the Commission nor the Home has received any formal complaints since the last inspection although the Commission had received a concern from a relative, which was investigated as part of the inspection. . There had been an adult protection investigation at Magnolia House since the last Inspection that had been dealt with swiftly and appropriately by the Owners and resulted in the dismissal of the previous registered manager. The lack of an overall staff training plan, made it difficult to find out which staff had attended adult protection training. However, the acting manager said that adult protection training for staff had been booked with Torbay Council but there was a waiting list. One newly appointed staff member interviewed had not attended training, and was not clear about what was in the adult protection policy or where it was. However, they were able to say what they would do if Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 17 abuse was reported. The induction training they received did not cover adult protection. There was lots of information including the local authority Alerter’s Guidance and department of health guidance ‘No secrets’ Guidance for staff. The Owners had introduced information on positive behavioural management into other Homes, including good practice advice from the British Institute for Learning Disabilities (BILD) however this was not yet available at Magnolia Lodge. Residents did not have behavioural plans. Magnolia Lodge DS0000018392.V306801.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment at Magnolia Lodge is homely, but not always clean, safe or comfortable for residents and the system in place to maintain it is not working. EVIDENCE: Both the Expert By Experience and the Inspector found aspects of the environment at Magnolia House poor. The Expert By Experience found some parts of the Home very dirty, with dirty carpets, broken furniture and the dining room very bare; with the tables residents were going to eat off in bad condition. The Inspector also found the following issues: Carpeting throughout the home, including the stairs was worn, frayed and dirty despite cleaning suggesting it requires replacing. Curtains in the lounge were faded, the windows were dirty, all the furniture in the lounge was broken making it difficult to get out off, water pipes made disturbing noises, there were leads trailing out of the TV that could be a trip hazard. There was a big coffee table in the lounge that the acting manager said was not used by residents. It took up a lot of space that residents could make more use of. Some fire doors did not fit flush in their frames when shut, and others were hard to open. Some residents were keeping their bedroom Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 19 fire doors open with belongings. An environmental health department report dated 30/08/06 indicated issues with the cleanliness, decoration and furnishings in the kitchen and many of these had not been dealt with. The walls in the kitchen, halls and communal rooms were dirty and tired looking. The tumble dryer was not working and the bath on the first floor needed resealing. The downstairs flat was filthy, in need of redecoration and refurbishment, smelt of damp and fire doors were wedged open. Resident’s bedrooms, that were viewed, were decorated to reflect the personalities and interests of the inhabitant and were bright and cheerful. Residents are encouraged to clean their own bedrooms and do laundry, however one resident requiring support was not getting it, as their rooms were very dirty and unhygienic. There is a cleaner employed five mornings a week and a maintenance system in place. The maintenance person was spoken with on the second day. He had a list of things to do that required immediate attention. He did not work full-time however, and said he did: ‘what he could when he could’ as there were three Homes to maintain. The maintenance system, which involved the acting manager filling out a monthly report which was sent to the Owners was not working effectively as the monthly reports showed that issues identified were not being dealt with by the Owners and were just repeated again the next month. Also as the reports did not include dates it was unclear at what point the six month and twelve month timescales were up. Many of the issues picked up by the Expert By Experience and the Inspector had been picked up by the acting manager and included in her reports. The communication between the Owners and the acting manager with regard to maintaining the environment was poor. The maintenance report picked up some environmental risks like trip hazards, but there was no regular risk assessment carried out of the Home to make sure everything was safe. The laundry was reasonably clean and some of the staff have done infection control training, however the environment generally was not clean or hygienic. Magnolia Lodge DS0000018392.V306801.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Residents are not protected by a safe staff recruitment process, and are not supported by an effective staff team. EVIDENCE: Each staff member had a recruitment and training file. Three files were examined in detail and some of the staff on duty were interviewed. There have been a lot of staff changes at Magnolia Lodge over the past year, including two changes of manager. Comments returned to the Commission from professionals highlighted that staff changes have not always benefited the residents. One professional said: ‘There have been a lot of foreign staff whose poor command of English language has made communication with residents difficult.’ Another said: ‘I feel the home would benefit from a period of stability and consistency, hopefully this would return Magnolia back to the good care standards we were used to.’ And another said: ‘I was concerned that a member of staff, who was helping me with the carer part of a dementia assessment was moved to another home within the same Company on return from holiday before we had completed the assessment. I feel that there needs to be an investment in staff training and supervision.’ Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 21 The acting manager gave examples of staff being moved from Magnolia Lodge to other Homes within the Company by the Owners, and staff being appointed by the Owners to work at Magnolia Lodge without her full involvement. The recruitment records examined showed the process was unsafe and that two staff had started before a POVA First check had been received, and CRB checks were still not back. Also a written interview record was not always kept, and there were no records that some staff fitness issues had been picked up. It was not clear what one-to-one staff support some residents were paying for, and therefore not clear if they were getting the right amount of support or there were the right numbers of staff on duty. The member of staff supposed to be providing this support had not turned up to work and had not been replaced on both days of inspections. It had also not been made clear by the Owners to the acting manager who was supervising this staff member. The acting manager had not yet started staff supervisions, or held a staff team meeting, but she was in the process of setting this up. The information given to the Commission before the inspection showed that only one staff member had NVQ 2, two staff members hold first aid certificates and three staff are trained to administer medication. Most staff helped with food preparation and not all of them had food hygiene certificates. Other training was provided, but it was unclear who had done what. The induction training new staff did was not thorough enough, and did not cover adult protection. The Responsible Individual said the Owners had recently bought a new Induction format. A new staff member interviewed was not clear what was in the Home’s policies and procedures. Staff were not receiving an equality and diversity training. The acting manager said that a thorough audit of training needs was being carried out, as when she took over the manager role she found it was unclear what training staff had and certificates were missing. There was no overall staff team training plan. The acting manager was not clear about the disciplinary process, and was advised to learn it. Staff were seen to be accessible and approachable and all the residents that returned comment cards said they would go to the acting manager, or named staff if they were unhappy and that staff treat them well. One resident said: ‘I like the staff here.’ One resident was upset and told the Expert By Experience that they did not like any of the staff at Magnolia Lodge, but they were later observed to be more calm, hugging staff and working alongside them. The visiting relative said the staff were good and that he was particularly pleased that one staff member had returned to work at Magnolia Lodge after a career break. Staff spoken with felt supported by the acting manager and able to make suggestions to improve the service. Magnolia Lodge DS0000018392.V306801.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 at least once during a 12 month period. 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. Magnolia Lodge is not yet a well run home. EVIDENCE: The Commission is still processing the acting manager’s application to be registered. The acting manager had in the past, but was not presently receiving regular supervision from any of the Owners, so her practice was not being monitored. There were regular manager meetings where managers from the three Homes owned by Rotel met. The acting manager said she felt supported by the Responsible Individual, who she could contact if necessary. She was doing NVQ 4 and the Registered Manager Award, but did not have dedicated time to complete this training and was falling behind. The Owners Quality Assurance system format was seen at Magnolia Lodge, but had not yet been started. The Responsible Individual said that the acting manager had had lots of more important issues to sort out, as the previous registered manager had not carried out a lot of the procedures correctly at Magnolia Lodge. Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 23 Professional’s comments to the Commission showed that the acting manager worked in partnership with them, and three of the four professionals were satisfied with the overall care provided. One professional said: ‘The manager worked jointly with me to improve the communication environment for my client and seems keen to improve communication within the home between staff and clients.’ All of the three relatives that returned comment cards said they were satisfied with the overall care provided. The acting manager had informed the Commission of some incidents affecting resident’s wellbeing but not others. Fire requirements made by Devon Fire Rescue service on 07/09/06 were being acted on. Still outstanding was a revision of the fire risk assessment. During the Inspection it was found that some fire doors were being held open by residents with belongings, some fire doors did not fit flush into their frames when shut and wedges were being used in the fire doors in the flat. The lounge fire door was also hard to open. Records showed regular fire alarm tests and training was provided and the information the acting manager sent the Commission before the inspection stated that gas, wiring and electrical appliances are regularly tested. There was a file for all the toxic cleaning products used and these were safely stored in a locked cupboard. A carving knife was found on the top of the cupboards in the kitchen. There were policies and procedures, but not all staff had read them, or knew where important policies were kept. Magnolia Lodge DS0000018392.V306801.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 2 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 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X X 2 X Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 25 Yes 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 YA2 YA6 YA18 YA19 Regulation 14 15 Requirement Each resident must have a comprehensive needs assessment. Each resident must have a clear care plan that gives clear instruction about meeting identified needs. This plan must be reviewed regularly and updated. Care plans must include clear guidance to staff on residents communication needs. Residents with behavioural needs must have clear behavioural plans in place. Each resident must have a 25/01/07 comprehensive risk assessment that clearly identifies how risks will be minimised. Resident’s social, educational 25/01/07 and work needs must be fully assessed and appropriate services provided at Magnolia Lodge and in the community. Clear records must be kept of 25/12/06 staff who have been trained to give invasive medical interventions DS0000018392.V306801.R01.S.doc Version 5.2 Page 26 Timescale for action 25/01/07 25/01/07 3. YA9 13 (4) 4. YA12 YA13 16 (m) (n) 5. YA19 12 Magnolia Lodge 6. 7. 8. YA20 YA22 YA24 13(2) 13(6) 23 9. YA24 13 (4) 10. YA33 YA6 18 Controlled drugs records must be kept appropriately. All staff must be able to identify abuse and know the procedure for reporting abuse. The maintenance programme must be effective and ensure that long-term and short-term issues are dealt with within suitable timescales. An environmental risk assessment must be regularly carried out and must include risks associated with hot surfaces and hot water (Previous timescale 28/02/06 – not met). Appropriate staffing levels must be provided to include the 1:1 support funded. 25/11/06 25/11/06 25/12/06 25/12/06 25/12/06 11. YA34 19 12. YA34 19 Each resident’s 1:1 staff support must be recorded in his or her care plan and on the rota. A record should be kept of 25/12/06 decision-making with regard to issues of staff fitness identified in application forms. Staff must not start work until 25/11/06 appropriate POVA First and CRB checks have been carried out. The recruitment policy must reflect this. The acting manager must receive the support and supervision, from the Owners, required to undertake her managerial duties. This includes time to complete NVQ 4 and the Registered Manager Award. The registered provider must ensure that monthly visits are made to Magnolia Lodge. The Home’s Quality Assurance system must be implemented. Fire doors must all fit flush into the frames when closed. DS0000018392.V306801.R01.S.doc 13. YA37 18 (c) 25/11/06 14. 15. 16. YA39 YA39 YA42 26 24 23 (4) 25/11/06 25/12/06 25/11/06 Magnolia Lodge Version 5.2 Page 27 Fire doors must not be held open with belongings or wedges. The Fire risk assessment must be completed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA6 Good Practice Recommendations The Service User Guide should be in a format understood by residents and include the complaints procedure and the contact details of the Commission. The 1:1 support residents are getting should be recorded in care plans and indicated on staff rotas. Goals for moving into their own homes should be in the care plans of those residents that indicated this desire to the Expert By Experience. Staff should make much more use of alternative forms of communication: photos, symbols, and makaton, due to the communication needs of residents. Residents should be given the support they require to keep their accommodation hygienic. This support should be documented in their care plan. The menu should be understood by residents to enable choices to be made at each meal. A self-medication risk framework should be used as part of the assessment process for all residents to promote selfmedication. Staff should be aware of the complaints procedure. The easy read complaint procedure should have the 28 day investigation timescale and the contact details of the Commission. The maintenance issues identified in this report should be acted on swiftly. A written interview format should be used during staff recruitment to record decision-making. The acting manager should be directly involved in all staff appointments and moves from Magnolia Lodge. There should be an overall staff team training plan so that DS0000018392.V306801.R01.S.doc Version 5.2 Page 28 3. 4. 5. 6. 7. YA7 YA16 YA17 YA20 YA22 8. 9. YA24 YA34 10. YA35 Magnolia Lodge the acting manager is aware what training has been completed and is still required. At least 50 of the staff team should have NVQ 2. All staff preparing food should have Food Hygiene Certificates. All new staff should have appropriate induction and foundation training, which includes adult protection. The registered provider should inform the Commission of any incident that affects the wellbeing of a resident. All new staff should do an induction course that complies with Skills for Care specifications. Staff should be aware of the equality and diversity issues affecting residents, and be clearly breaking down barriers. Staff should have regular supervision and staff meetings. The acting manager should understand, and implement where necessary the disciplinary process. 11. 12. YA42 YA35 13. 14. YA36 YA37 Magnolia Lodge DS0000018392.V306801.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 DS0000018392.V306801.R01.S.doc Version 5.2 Page 30 - 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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