Inspection on 02/08/05 for Meadow Lodge

This inspection was carried out on 2nd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Meadow Lodge 19/03/09

Meadow Lodge 04/02/08

Meadow Lodge 14/08/06

Meadow Lodge 13/12/05

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 2 August 2005 nd 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 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 Stationary 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 D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 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 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 LD Learning Disability (4) registration, with number LD(E) Learning Disability - over 65 (4) of places Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 4 service users with learning disabilities, over the age of 65, at any one time. Date of last inspection 1st December 2004 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 manager and staff team also run 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 D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one morning on 2nd August 2005. Three service users were using the respite unit, although only one was at home during the inspection. Staff showed the inspector round the premises, and a number of records were inspected, including service user care plans, health and safety records and staff training records. The management arrangements have recently changed in the home, and the acting manager was present for part of the time. The care staff on duty were welcoming and co-operative, and are to be congratulated for their positive approach to inspection. What the service does well: What has improved since the last inspection? What they could do better: The storage and maintenance of records could be improved. It was very concerning to find confidential records about service users on a computer which was open to everyone, and the home has been asked to investigate this and to ensure that it does not happen again. Staff training files were not up to date, and the service user questionnaire could not be found. There was also no up to date file of the monthly management visits. Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 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 D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 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 standard(s) 1 and 2 Prospective service users and families are given information leaflets so that they can choose whether or not they wish to use the home for respite care, although a detailed Statement of Purpose would give them more information to aid their choice. Prospective service users have their needs, hopes and goals assessed and recorded before they move in to the home so that staff know how best to support them. 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. There is a well established process for the assessment of prospective residents. Referrals are usually initiated by other professionals, and a community care assessment is given to the home. Records showed that a detailed range of information is obtained, and clearly set out what needs a person has, and what support the home will provide. Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 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 standard(s) 6, 9 and 10 Care plans reflected the needs and personal goals of residents, which means that staff are able to support them in the way they wish. Residents are supported to take risks where appropriate, and encouraged to be as independent as possible, although risk assessments need to be separated out. Confidential information relating to service users was not being handled appropriately. EVIDENCE: Each service user has a separate care plan, which contained information about mobility, communication, activities, sleep patterns, personal care needs, and likes and dislikes. These are reviewed on a regular basis. Care plans detail how each person preferred to be supported during personal care, and diary sheets are completed by staff about what each service user has done during the day. It has been previously recommended that care plans should be made available in a format that is more easily understood by service users, and this should still be a goal of the organisation. One staff member spoken to said she was trying to “help people feel good about themselves” when she was carrying out her work. Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 Page 10 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. Currently the risk assessment format means that all risks are rated together, making it unclear what control measures are in place for each identified risk. The acting manager has been asked to ensure that each risk identified has a separate risk assessment on file. Records examined were stored in a lockable office and in locked filing cabinets. However, one resident was keen to show his computer work, and when doing so, it was clear that several other service user files were available to anyone on the computer desktop. The staff member on duty was clear that this was the residents’ computer, and that no confidential material should be on it. From the information recorded in the computer files, the staff member was able to see who had written it, and that the information related to a resident of another home. The files were deleted, and the acting manager has been asked to investigate this serious breach of confidentiality. Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 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 standard(s) 12, 13 and 15 Social and leisure activities are varied and tailored to individual need, with residents choosing what they wish to do. Residents can have as much or as little contact with family and friends as they wish, and are encouraged and supported by staff. EVIDENCE: Two service users were out that day, and staff ensure that those who enjoy regular daytime activities can continue to do so whilst staying at Meadow Lodge. Activities include attending clubs, college and day centres, swimming, computer games, basic cookery and socialising with friends. Others enjoyed listening to music, going out for a meal, shopping and watching TV and videos. One service user who was at home had helped to dry the breakfast dishes, and was sitting at the dining table doing a jigsaw. He spoke about how he also helps others at the local college. He was planning to go into town with a staff member that day, and said “staff help me to do things”. Most of the respite service users live at home with families, and staff encourage and support these links whilst at Meadow Lodge, although the frequency of contact varies depending on individual circumstances. Visitors can Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 Page 12 be entertained either in the privacy of residents’ own bedrooms or in the communal areas available. Friendships both inside and outside the home are encouraged. Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 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 standard(s) 18 Healthcare needs of residents are written in care plans so that they can receive support in the way they need and prefer. EVIDENCE: All respite service users have support plans for any personal care required. The information contained in them is gathered from the initial community care assessment, the home’s own assessment and staff knowledge of the service users. People have guidelines in place which say how they like to be helped to get washed and dressed, assisted with food and describe their bedtime routine. Some people who stay at Meadow Lodge are fairly independent and can manage their own personal care. Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 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 standard(s) 23 The policies and procedures the home has in place try to ensure that residents are safeguarded from abuse and harm. EVIDENCE: The home has copies of the “No Secrets” document, as well as the organisational policy and procedure on responding to allegations of abuse. All staff members have received Vulnerable Adults training, and all are encouraged to report any incidences of poor practice. A “Whistle Blowing” procedure is also available for all staff, and risk assessments are in place for all service users. All staff have Criminal Records Bureau (CRB) checks and are checked against the Protection of Vulnerable Adults (POVA) register. Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 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 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 staff member spoken to said she tried to make sure that Meadow Lodge was “a home from home” for service users. Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 35 Service users’ are supported and protected by the recruitment procedures used by Wiltshire County Council. Residents’ individual and joint needs are met by staff who have had induction and some specialist training, and are undertaking NVQ. EVIDENCE: The staff team at Meadow Lodge also work at Derriads, another Chippenham respite service, and reported continued staff shortages. Agency staff are drafted in to support the permanent staff, and the home has ensured that all agencies used have Criminal Records Bureau (CRB) checks in place for their staff. The home also strives to have the same agency staff as often as possible, ensuring continuity for service users and staff. Wiltshire County Council’s own employment checks include CRB checks, two written references and a medical declaration. Staff training included medication administration, environmental hygiene, food handling, emergency first aid, manual handling, basic health and safety, and fire training. Staff 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. Further staff training included Epilepsy Awareness, Deaf Awareness and Vulnerable Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 Page 17 Adults Procedures, and risk assessment training is done by all senior members of staff. Several staff have completed NVQ and several more hope to complete theirs within a short time. However, the training file did not contain all the evidence needed to show that all these courses had been attended, with several certificates found to be missing. The file also contained training details of past staff members. Staff on duty and the acting manager were able to give details of training done, and explained that staff certificates were probably on file in the other “sister” home, Derriads. The acting manager has therefore been asked to ensure that Meadow Lodge staff training records contain up to date information. Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 41 and 42 Service users benefit from a well run home. Poor record keeping meant that there was no evidence that service users views were taken into account, and that they underpin all self monitoring and development in the home. The home’s health and safety policies and procedures, and the checks carried out, mean that residents’ safety and welfare are protected. EVIDENCE: Two acting managers are running the two respite services jointly, as the registered manager has moved to another post within Wiltshire County Council. An application to register a manager has yet to be submitted to the CSCI, although this is due to happen soon. It was reported by the acting manager that an annual questionnaire is sent out to service users and families, although this could not be found on the premises and must be made available for inspection. Staff also reported that they Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 Page 19 receive regular visits by senior managers of Wiltshire County Council, although there were no monthly reports available and these have not been sent to the CSCI on a monthly basis. The registered provider must ensure regular monthly visits to the home and must provide a copy of the report of these visits to the CSCI. All staff have had food hygiene training and food temperatures are recorded on a daily basis. Fire drills are done on a monthly basis, with fire instructions given to service users, and initials recorded of all those who take part. Fire alarms are tested weekly, emergency lighting is tested on a monthly basis, and there is a fire risk assessment in place for the building. Staff have contacted the Health Protection Agency and have received a copy of the new infection control procedures. A health and safety audit is conducted on an annual basis. Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 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 3 x x x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 2 1 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x x Standard No 31 32 33 34 35 36 Score x x x 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Meadow Lodge Score 3 x x x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x 2 3 x D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 Page 21 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 1 Regulation 4 Schedule 1 13 (4) (b) 17 (1) (b) 18 (1) (c) (i) 26 Requirement The home must have an up to date statement of purpose and service user guide, specific to the home. There must be a separate risk assessment in place for each assessed risk. All service user records must be kept stored in a way that ensures confidentiality. All staff training records must be kept up to date. 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. The registered person must ensure that the quality assurance questionnaire is made available for inspection. Timescale for action 02/10/05 2. 3. 4. 5. 9 10 35 39 02/10/05 02/08/05 02/10/05 02/10/05 6. 41 24 (2) 02/10/05 7. 8. 9. Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 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 6 Good Practice Recommendations Care plans should be prepared in a format which is more easily understood by service users. Meadow Lodge D51_D01_S32434_MeadowLodge_V191585_020805_Stage4.doc Version 1.40 Page 23 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, 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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