Inspection on 13/12/05 for Meadow Lodge

This inspection was carried out on 13th December 2005.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadow Lodge 19/03/09

Meadow Lodge 04/02/08

Meadow Lodge 14/08/06

Meadow Lodge 02/08/05

Meadow Lodge 01/12/04

Meadow Lodge 26/07/04

Meadow Lodge 30/03/04

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 Meadow Lodge Sadlers Mead Monkton Park Chippenham Wiltshire SN15 3PE Lead Inspector Alyson Fairweather Unannounced Inspection 13th December 2005 2:00 Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 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 Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 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. Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Meadow Lodge Address Sadlers Mead Monkton Park Chippenham Wiltshire SN15 3PE 01249 656136 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) Wiltshire County Council Vacant Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4) of places Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 4 service users with learning disabilities, or learning disabilities, over the age of 65, at any one time. 2nd August 2005 Date of last inspection Brief Description of the Service: Meadow Lodge is situated in a quiet residential area on the outskirts of Chippenham. The home provides respite care for up to four service users who have learning disabilities, and service users continue to take part in activities and training sessions which they would when they are at home. The home is owned and managed by Wiltshire County Council. The staff team also provide care for service users in Derriads, which is part of the Chippenham Respite Service. There is 24 hour staff cover to provide support for service users. Meadow Lodge is an attractive home, with a lounge, dining room and a domestic style kitchen. It is light and airy, with comfortable furnishings. There are four single bedrooms, one with ensuite facilities. To the rear of the house is a large, secluded garden which is accessible to the service users, with attractive features and a paved patio area. There is ample parking to the front of the building. Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one afternoon and evening on 13th December 2005. There were three people using the respite unit, all of whom were at home in the evening. The deputy manager and one member staff were on duty. Written comments have been received from two service users and four families. The inspector walked round the premises and examined several records, including medication, risk assessments and staff training files. What the service does well: What has improved since the last inspection? What they could do better: At the last inspection, Wiltshire County Council was asked to make sure that the reports of their monthly visits were sent to the Commission for Social Care (CSCI). They were also asked to make sure that the home’s Service User Guide and Statement of Purpose were up date. They have failed to do so, and have been asked to do so for the second time. Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 6 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. Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 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 Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 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 Prospective service users and families do not have enough current information leaflets to help them choose whether or not they wish to use the home for respite care. EVIDENCE: The home had a Service User Guide in place which gave service users information about the two Chippenham respite services. There was no Statement of Purpose, although the acting manager said that the organisation was going to write one which covered all Wiltshire County Council’s services. In discussion, it was agreed that each individual service was unique, and that, for example, Meadow Lodge could not cater for wheelchair users, as the home was not large enough. Therefore, the Statement of Purpose should reflect the current state of each home rather than be a generic one. The home was asked to ensure that this was done at the last inspection, and still has not done so, although the deputy manager said that it was to be done in the near future. Once again the home has been asked to have an up to date statement of purpose and service user guide, specific to the home. Discussion was held with the deputy manager about the seriousness of failing to meet this requirement for a second time. Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 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): 7 and 9 Service users are assisted where necessary to make decisions about their own lives, and are supported to risks as part of an independent lifestyle. EVIDENCE: Service users are supported to make decisions about their own lives with guidance from the staff. The interaction observed between staff and service users showed clearly that staff were aware of service users’ wishes. People are encouraged to manage their own finances wherever possible. Where restrictions are in place, for example to limit self harm or harm to others, this is clearly recorded and guidelines are drawn up for staff to follow. No formal advocacy is in place, but families have formed a “Friends of Meadow Lodge & Derriads” and help staff look at how they can improve the service. Risk assessments had been done for each service user and these included things such as mobility and travelling, and ways of minimising risks were identified. These risk assessments are reviewed annually, unless there is a need to do otherwise. Staff place great emphasis on encouraging service users to be as independent as possible, while trying to minimise any risk to their safety. It was noted that there were several different styles of risk Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 10 assessments in use, and it has been recommended that one standard format is introduced. It would also be helpful to have a format which was more suitable for service users with disabilities. Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 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): 16 and 17 Service users’ rights are respected and responsibilities recognised in their daily lives. Mealtimes are an enjoyable time, and service users are offered a healthy diet. EVIDENCE: Service users can choose when to be alone or in company, and when not to join in an activity. Staff enter service users’ bedrooms only with the individual’s permission, and were seen to knock on the bedroom door before entering. Daily routines are flexible, with people choosing what they want to do when they return from day services. Service users have unrestricted access to the home and grounds, and can come and go as they please. One service user commented that he would like to go swimming, and the deputy manager was going to see if this could be made possible. The food provided in the home was of a good quality, and residents can help with preparing meals, if they wish. There is ready access to the kitchen, and people can help themselves to smacks if they want to. A good supply of fruit and vegetables was available and healthy eating options were on offer. Once all service users had returned from their day services, they all decided what Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 12 they wanted to eat. The dining room is adjacent to the kitchen, and is a large, bright room. Tea time was a very happy meal, with the service users, staff and the inspector all eating together. Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 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): 19 and 20 Physical and emotional needs of service users are written in care plans so that they can receive support in the way they need and prefer. The home’s medication policies try to ensure that service users are safe when their medication needs are being met, and anyone wishing to self medicate is supported to do so. EVIDENCE: All service users have support plans, with information contained in them gathered from the initial community care assessment and from the various professionals involved with the individual. If the families live locally, the person’s own GP is used, and their local GPs used for those who live further afield. Medical professionals are seen as and when required. This varies according to the needs of individuals and the situations arising while having respite care. The home has good links with the local learning disability teams, which enables an effective response to any crisis periods that may arise. All service users attend reviews on a regular basis, and the care plan may be amended at this time. One service user was seen to be unwell during the inspection, and staff made sure she was well cared for, whilst still attending to the needs of the other people staying in Meadow Lodge that night. Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 14 Some people who stay at Meadow Lodge are able to look after some medication that they can buy over the counter, for example some creams. For other service users, responsibility for medication is taken by staff, and all staff have medication training when they first start work. The home’s medication policy states that two staff will sign when medication is administered, and this was seen to be adhered to. Staff also keep a running total of all medication in the home, and a check on the medication stock showed that all was in order. Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 15 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 Service users’ views are listened to and acted on. EVIDENCE: There is a complaints procedure which outlines the steps to take if there are any complaints, and all service users get a copy of this. It also gives details of how service users and families can contact the Commission for Social Care Inspection (CSCI). A complaints book is kept in the office, and any complaint would be recorded there. Three concerns identified by families had been addressed appropriately. Some relatives had commented to the inspector that they weren’t aware of the home’s complaints procedure, and discussion was held with the deputy manager as to how this could be addressed. No complaints have been received by the Commission for Social Care (Commission for Social Care) Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 16 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 and 30 The care which residents and staff take to maintain the home means that residents live in a homely, comfortable safe environment, which is clean and hygienic. EVIDENCE: Meadow Lodge is an attractive home, with a lounge, dining room and a domestic style kitchen. It is light and airy, with comfortable furnishings. There are four single bedrooms, one with ensuite facilities. Residents’ bedrooms were homely and each contained individual personal items. To the rear of the house is a large, secluded garden which is accessible to the service users, with attractive features and a paved patio area. It was clean and hygienic, with policies and procedures in place for the maintenance of the building. One service user commented that Meadow Lodge is like being at home. Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 17 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 and 35 Service users are supported by competent and qualified staff. Their individual and joint needs are met by trained staff, although this training should be regularly updated. EVIDENCE: All new staff receive induction training, and have also started using the Learning Disability Award Framework (LDAF) to assist their training, which means that the needs of service users with learning disabilities will be more fully understood. There are currently five staff undertaking NVQ Level 3 and five who have completed it. One has also completed the Work Place Assessor award. The staff training file showed that staff had done training in positive response, peg feeding and adult and child protection. However, it was noted that not all staff had completed their annual update for manual handling, and the registered person has been asked to ensure that this is done. Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 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 and 39 Service users benefit from a well run home, although the appointment of a permanent manager would improve this. Poor evidence of Wiltshire County Council visits and reports means that it is difficult to establish that service users’ views underpin all self monitoring and development in the home. EVIDENCE: Two acting managers are running the two respite services jointly, as the registered manager has moved to another post within Wiltshire County Council. However, one of these is due to leave soon. An application to register a manager has yet to be submitted to the CSCI, although at the last inspection this was said to be happening soon. The appointment of a permanent manager would allow the service users and the staff team to benefit from secure and stable leadership. Wiltshire County Council have an obligation to visit all their registered homes on a monthly basis and report on these visits to the Commission for Social Care. Staff reported that they receive regular visits by senior managers of Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 19 Wiltshire County Council, and although one report had recently been sent, these have not been sent to the CSCI on a monthly basis. Once again the registered provider has been asked to ensure regular monthly visits to the home and to provide a copy of the report of these visits to the CSCI. The deputy manager had already been informed about the seriousness of failing to meet requirements for a second time. Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X X 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Meadow Lodge Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X X X DS0000032434.V266774.R01.S.doc Version 5.0 Page 21 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 YA1 Regulation 4 Schedule 1 Requirement The registered person must have an up to date statement of purpose and service user guide, specific to the home. Comment: This is the second time this requirement has been made. The registered person must ensure that staff training updates take place, and that records are kept of this. The registered person must ensure regular monthly visits to the home and must provide a copy of the report of these visits to the CSCI. Comment: This is the second time this requirement has been made. Timescale for action 13/02/06 2. YA35 18 (1) (c) (i) 26 13/02/06 3. YA39 13/02/06 Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 22 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 YA9 Good Practice Recommendations One format for risk assessments should be used instead of several various ones. Meadow Lodge DS0000032434.V266774.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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. 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