CARE HOME ADULTS 18-65
May Lodge Barrow Hill Sellindge Ashford Kent TN25 6JG Lead Inspector
Kim Rogers Unannounced Inspection 31 January 2006 12:30
st May Lodge DS0000065349.V277502.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 May Lodge DS0000065349.V277502.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. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service May Lodge Address Barrow Hill Sellindge Ashford Kent TN25 6JG 01303 813926 01303 814974 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 Services (No.2) Ltd Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st October 2005 Brief Description of the Service: May Lodge is registered to provide care to six people who have a learning disability aged between 18 & 65. The aim of the Home is to provide a service to younger adults, within the age range 18 - 25 who have a diagnosis of autistic spectrum disorder or Asperger’s syndrome. The home is a detached bungalow, surrounded by its own gardens, and comprises of 6 single bedrooms; three with full en-suite facilities, three with toilet and wash hand basin. Two communal bathrooms with WC are positioned in easy reach for all. For communal use are a lounge, with TV and video facilities and a dining room, with a music system. The home has a large kitchen and a separate laundry. A large garden, to the rear of the property has a picnic table, a variety of recreational items and some developing plant boarders. The home is in easy walking distance of the village of Sellindge that has a shop, pub, and community centre and is on a direct bus route to the towns of Ashford and Hythe. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out on a Tuesday afternoon. The acting manager, Erica White was at the home with staff and some service users. Two service users were out visiting relatives and friends. One service user left the home to go bowling during the inspection. Other service users were either in their rooms, the hallway or in the lounge. The Inspector spoke to the manager, service users and staff, had a look around the home and looked at some records. Staff were preparing a party for a service users with a ‘Pirates of the Caribbean’ theme. Some staff had come in on their day off to prepare for the party. Most of the National Minimum Standards were assessed at the last inspection so the Inspector concentrated on the previous requirements. Most remain not met although the manager has sought some advice and talked of her ideas to improve the service and meet these requirements. Although the manager has some information, ideas and resources none have yet been implemented. What the service does well: What has improved since the last inspection?
Individual wall cupboards have been fitted to the wall in the staff toilet for staff belongings. The manager said that locks would be fitted to these cupboards. The duty office has been reorganised leading to a more effective use of the space. The manager has made a referral to the local community team for support and advice in respect of 3 service users.
May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 6 All bedrooms now have mirrors and some have bathroom cabinets. 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. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 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 May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 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): 2 Service users aspirations are assessed although strategies in place are not monitored or reviewed to ensure success. EVIDENCE: The Inspector looked at one service user in detail. Some aspirations were recorded in respect of this service user. One action plan was dated February 2005 and the other September 2005. There were some actions recorded that staff should take although no one was named and no time scale attached. The ‘date achieved column’ was blank on both action plans. There was no evidence that the plan had been reviewed. The aspirations noted for 2006 were ‘to have a holiday’ and ‘to socialise more’ The action by staff recorded was ‘collect holiday info’ and ‘look into more variety of activities’ Again, no one was named so it was unclear who was going to do what and there was no timescale. There was little evidence of service user involvement and the format used is not accessible to service users. The Inspector required that the manager look into more person centred approaches to assessing and care planning and discussed more suitable ways of action planning for service users. Service users hopes and dreams must be established then interventions planned by staff on how they intend to support those hopes and dreams.
May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 9 Any intervention by staff must be implemented and regularly reviewed to make sure it is working. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Service user plans would benefit from more person centred approaches and more frequent review. Individual communication guidelines need to be improved and implemented. EVIDENCE: Each service user has an individual service user plan developed from the initial assessment. This is the agreement between the home and the service user about how the home intends to meet the person’s needs. The Inspector sampled service user plans. There was nothing to demonstrate that service users were involved in developing the plans. Some interventions had been written without consultation with behaviour specialists. As found at the last inspection, risk assessments are in place and all restraints are documented but are not being clearly reviewed and analysed to ensure their effectiveness. Generic risk assessments are used. On some incident forms there was no action recorded to prevent further occurrences. Plans in general showed limited monitoring and review and the Inspector discussed the need for more frequent review with the manager. There was some out of date information in one plan. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 11 A requirement was made at the last inspection that every individual that has a communication need, have an assessment and the outcome of such an assessment form the basis of individual communication guidelines and staff training. Work has been started although there has been no implementation of individual communication guidelines since the last inspection. The manager has made a referral to the local community team on respect of 3 service users. During the visit most staff were in the dining room behind a closed door preparing for a party. On at least 2 occasions the manager left the office and went to the dining room to ask staff to come and support service users. The shift planner in use is planned around the staff. The Inspector spoke to the manager about the need to plan shifts around the needs of the service users so service users participate, are engaged and get the support they need. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Service users could be more engaged when at home. EVIDENCE: As mentioned the shift planner in use is based around the staff and should be planned around service users. During this visit most of the staff were in the dining room preparing for a party. During a look around the Inspector observed two service users were in the lounge with one staff. The television was on although neither service user was engaged in watching the television. One service user was in her room. One service user came into the office on occasions to interact with the manager. There must be opportunities for service users to be fully engaged and participate in appropriate activities when at home. The kitchen is kept locked. As found at the last inspection the manager should review these restrictive practices. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 13 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 Service users know that their preferences about personal care support will be recorded. Service users would benefit from having an individual health action plan. EVIDENCE: Personal care needs are clearly detailed in service user plans. This ensures that service users are supported in the way they prefer. As mentioned service user plans would benefit from more regular review. Health needs are assessed although no action plans have been developed with service users to ensure that health needs are supported and monitored. The inspector recommended that the home develop an individual health action plan with each service user. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 14 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): EVIDENCE: These standards were assessed at the last inspection. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 15 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 This home is comfortable and safe with a homely environment. This home is clean and hygienic. EVIDENCE: All bedrooms are for single occupancy and are highly personalised. Some rooms have en suite facilities. All bedrooms have at least a WC and wash hand basin. There are two other bathrooms. There is a large lounge and dining room with TV and music systems. There is a garden to the front and rear of the property and plenty of parking spaces. Lockers have been fitted to the wall in the staff WC to house staff belongings. There is a duty office which has been reorganised since the last inspection, although was hot on the day of the visit. This should be monitored, as medication is stored here. The home was clean and orderly. Hand washing facilities are sited appropriately. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 16 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): 33,34 Engagement and participation will increase if staff use more person centred active support approaches and plan shifts around service users. Service users must be protected by robust recruitment checks. EVIDENCE: The Inspector observed missed opportunities to engage service users in some activities. Service users appeared to be either in their rooms, in the lounge or coming into the office to see the manager. The development and implementation of communication systems for individuals should increase engagement and participation. The home has a manager, deputy, 2 senior staff and team of support workers. The manager said that there are currently 2 support worker vacancies. Interviews are due to take place. Existing staff and some agency staff are currently used to cover any shortfalls. The Inspector sampled information held in respect of each staff member. Schedule 2 of the Care Homes Regulations specifies what information should be at the home in respect of each member of staff. Some of the required information was not present. A requirement was made to address this. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 17 The manager said she would like staff to have training related directly to service users needs and is researching a training provider. This was a requirement of the last inspection. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 18 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 The manager has a good understanding of service users needs. Implementing her ideas for improving the home will benefit service users. EVIDENCE: The manager has had over 4 years experience and spoke with knowledge and understanding of current service users needs. The manager was observed interacting with service users in a positive respectful manner. The manager should consolidate this experience and knowledge with the completion of the required managers qualification. The manager said she is working towards this. The manager spoke about her ideas to improve the service although nothing has been implemented since the last inspection. The manager said she has completed her application to register with the Commission as manager but has not sent this to the Commission as required at the last inspection. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 19 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 X 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 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 2 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 2 X X X X X X May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 20 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. Standard YA6 Regulation 14,15 Requirement Every individual, who demonstrates communication difficulties, have a communication assessment (by a speech and language therapist, where needed) and the outcome of such assessment is followed up with staff training, guidelines and support. NOT MET Individual plans be reviewed and have a person centred focus drawing out what is important to the individual and how to positively support them in all situations. NOT MET Reactive management strategies be written in a situational context and all restraints used be reviewed by manager with aim to reduce wherever possible. NOT MET Ensure medication storage temperature in the duty office is kept below that stated on guidance. Review environmental restrictions. Staff have suitable training to be skilled and competent in their
DS0000065349.V277502.R01.S.doc Timescale for action 01/03/06 2. YA6 14,15,24 20/04/06 3. YA6 13,14,15 31/03/06 4. YA20 13(2) 31/03/06 5. 6. YA9 YA32 17 18 31/03/06 31/03/06 May Lodge Version 5.1 Page 21 7. 8. YA37 YA34 9 12 roles with this service user group, to enable service user development. Manager apply for registration through CSCI.NOT MET Staff files must contain the documents required under Schedule 2 28/02/06 31/03/06 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. 2. 3. Refer to Standard YA16 YA28 YA19 Good Practice Recommendations Daily chores are shared with staff and service users and incorporated in the daily shift planner. (Previously unmet requirement) Address shortfall in service user communal space. Health action plans should be developed for each service user. May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 May Lodge DS0000065349.V277502.R01.S.doc Version 5.1 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
