CARE HOME ADULTS 18-65
Mere Lodge 93 Mere Road Leicester LE5 5GQ Lead Inspector
Helen Abel Key Unannounced Inspection 30th July 2007 4:15 Mere Lodge DS0000064385.V341293.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 Mere Lodge DS0000064385.V341293.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. Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Mere Lodge Address 93 Mere Road Leicester LE5 5GQ 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) 0116 251 7441 Mere Lodge Healthcare Ltd Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th May 2006 Brief Description of the Service: Mere Lodge is a converted 2 storey, 4 bedded terraced property in the Highfields area of the city of Leicester. It is situated adjacent to Spinney Hill park and close to many shops and local amenities. The home consists of 2 lounges, a dining kitchen, and large bathroom with whirlpool bath to the ground floor; all 4 bedrooms, toilet with shower enclosure, and office are on the first floor; access to which is by the main staircase. A small outside paved area is available. Fees charged range from £1000 to £1700 per week. The last inspection report is held in the home and is available upon request. Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting two residents and tracking the care they received through looking at their records, discussion, where possible, with them and care staff and observation of care practices. This was an unannounced visit. The home’s acting manager was not on duty, so the senior carer in charge assisted with the inspection process. Planning for the visit included assessing notifications of significant events, and the service history, and the homes annual quality assurance assessment. The visit took place on a Monday afternoon between 4.15 and 8.30 pm and included a selected tour of the building, inspection of records and indirect observation of care practices. The Inspectors spoke with three residents and two staff. Findings from the inspection were feedback to the acting manager and the registered provider following on the inspection. What the service does well:
Comprehensive assessment procedures ensure that resident’s needs and aspirations are met. Residents are involved in day-to-day decisions, are well supported to take reasonable risks and good care plans accurately reflect their needs. Residents have opportunities to engage in vocational, leisure and community activities, are given support in maintaining links with family and friends and enjoy good, nutritious food. There is an emphasis on healthy eating with freshly cooked food and a reduction in snacks. Culturally appropriate food is provided. Residents receive appropriate personal support and their health and medication needs are well met. Good arrangements are in place for accessing additional support from the dietician and other professionals to meet the physical health needs that some residents have. Complaints systems ensure residents concerns are listened to and acted upon with residents being protected from abuse. The complaints procedure is regularly explained to residents and is available in easy read with pictures. Residents live in a homely environment. Bedrooms are kept in a generally clean and tidy condition. Residents are effectively supported and protected by well-trained staff. Staff were observed calm, caring and reassuring in all their interactions with residents. Resident’s benefit from a good management
Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 6 approach; with good systems in place to protect the health and safety of residents. What has improved since the last inspection? What they could do better:
The upstairs toilet to be repaired or replaced so that the ceramic surface is impermeable and prevents spread of infection to residents. To provide clean adequate floor coverings in both lounges for safe and comfortable shared space for residents to enjoy. The washing machine and tumble dryer and soiled laundry bin are based in the kitchen; and have the potential to spread infection as staff prepare and cook meals, and residents enter and meet here. Managers have agreed to seek guidance from environmental health to ensure safe outcomes for residents. Ways to improve the outside paved area to make it more attractive and enjoyable for residents to sit in should be considered. Repairs to resident’s key items that is used for maintaining their well-being should be undertaken in a timely manner. Residents should have access to their records and monies held by the home. This would ensure resident’s rights and best interests are safeguarded. Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 8 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 Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive assessment procedures ensure that resident’s needs and aspirations are met. EVIDENCE: The Service User Guide is available in different formats and has been made available to a new resident and their supporters. A comprehensive assessment process takes place before new residents move into the home. This includes the area manager visiting the person in their current setting, collecting assessments from all professionals’ involved and arranging times for the person to visit. As part of a phased programme of settling in slowly a new resident has been coming for two full days to visit over a few weeks. From this information a care plan will be produced. Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are involved in day-to-day decisions, are well supported to take reasonable risks and good care plans accurately reflect their needs. EVIDENCE: Two residents care plans were examined. These were detailed covering all aspects of support in relation to mental, physical and social needs. Comprehensive risks assessments form part of each plan and address risk to the resident as well as those around them. Staff actively contribute to care plans and routinely refer to them to gain information as how to respond to individually residents needs. Daily record keeping is good and reflects activities and events for residents. One resident’s family members are very involved in the planning of care with frequent visits from different family members.
Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 11 Residents are supported to make decisions about their lives in relation to such areas as décor, food, social and vocational activities. Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have opportunities to engage in vocational, leisure and community activities, are given support in maintaining links with family and friends and enjoy good, nutritious food. EVIDENCE: There are opportunities for residents to pursue appropriate vocational or educational activities such as work placements at local eateries, college classes and leisure pursuits. Residents meetings are held regularly to discuss life at the home. At a recent resident meeting residents had given staff lists of things they wanted to do over the summer. A resident confirmed some of the trips had been organised.
Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 13 “I have been on a train to Nottingham with my key worker. I am going on holiday to Skegness in August for three days in a hotel.” Regular visits and trips to family members are arranged and supported for two residents. Some residents were observed spending one to one time with staff in the kitchen and lounge. Another resident was seen reading a book propped up in bed. One resident said, “I like going to Half Turn Orange. I like to dance there.” Nutritional screening assessment is completed for all residents and concerns with regards to their eating and weight are monitored. There is a good variety of food is served including plenty of fruit and vegetables. Fresh fish and vegetables were served for an evening meal and one resident was supported to sit in a culturally appropriate way when eating cultural food. There is an emphasis on healthy eating with freshly cooked food and a reduction in snacks. A resident said, “Foods alright, proper cooking. I have coffee or tea in the evening and a biscuit”. Mere Lodge DS0000064385.V341293.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive appropriate personal support and their health and medication needs are well met. EVIDENCE: Residents personal support needs are clearly documented and they can choose whom they receive support from, in respect of the gender of staff. Staff help people who live in the home to look after themselves. Currently one resident case tracked has one staff member to work along side them at all times, this increases to two staff when outside the home. The Inspector observed supportive and encouraging interactions between staff and residents. All residents have access to primary care services such as GP, dentist and community nursing services. Good arrangements are in place for accessing additional support from the dietician and other professionals to meet the physical health needs that some residents have.
Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 15 Systems are in place for storing, recording and administering medication, only qualified staff members who have received appropriate training are involved in administration. Homely remedies for each resident have been signed for by their GP in the medication administration sheets. This ensures residents are protected. Mere Lodge DS0000064385.V341293.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints systems ensure residents concerns are listened to and acted upon with residents being protected from abuse. EVIDENCE: There is a policy, which tells people how they can make a complaint if they want to in pictures and is displayed on the notice board in the hallway. This is also available as written information and regularly explained to residents. The service has received several complaints since the last inspection and one on the morning of the inspection. Staff understand the procedure and know to respond promptly and record all the information. All staff receive training in adult protection, appropriate to the needs of the client group. At Induction all staff are made aware of all key policies relating to protection including whistle blowing. Good recruitment practices including obtaining Criminal Records Bureau checks before staff begin to work, also contribute to good outcomes for residents in terms of protection. Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a homely environment; however, there are some areas for improvement around maintenance and hygiene, which would benefit the residents. EVIDENCE: The home is in keeping with the style of property in the local community. All communal areas are spacious light and airy. Both lounges have marked and scuffed walls and radiator covers. Both lounge carpets were fraying and dirty around the doorway and presented poorly. The upstairs toilet was chipped and has the potential to spread infection. The registered provider confirmed after the inspection he had noticed the chipped toilet during his monthly monitoring visit to the home. The acting manager confirmed she was looking to redecorate the walls and laminate the hallway. The carpets were washed a month ago but
Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 18 accepted they still appeared dirty. Staff reported recording maintenance work but it took some time for work to be carried out. Some electrical items were regularly broken and had the potential to have an effect on one of the resident’s case tracked, if they were not repaired promptly. For example being able to listen to music in their room would calm and relax a resident There is a small paved courtyard outside that is well used by the residents. Two residents were observed, smoking and taking hot drinks, singing and chatting together. This area looks bare and drab and steps could be taken to make it more appealing to spend time in. The washing machine, tumble dryer and soiled covered clothes bin were sited in the kitchen area. The acting manager agreed to seek guidance from environmental health around the suitability of laundry facilities being sited in the kitchen where food is prepared and cooked. This arrangement has the potential to spread infection. Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are effectively supported and protected by well-trained staff. EVIDENCE: All staff receive a comprehensive induction. An ongoing training programme is in place, which includes training in areas relating to crisis prevention and intervention, learning disability, medication and first aid. A National Vocational Qualifications in care programme is being made available to unqualified staff. Staff said they received regular supervision with the area manager. One staff member said, “I receive good guidance and support.” Staff meetings are monthly and well attended. Staff said they could talk about any concerns or issue they would like to talk about. Staff said “I take residents swimming, shopping to the supermarket and to café’s. I play board games and do writing activities for one of the residents”. Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 20 A resident said, “The staff help you. xxxxxis my keyworker, if I need anything I just ask her. I am very happy here.” The acting manager confirmed after the inspection looking to recruit staff reflective of the resident group and their ethnic background. One staff member is able to speak in a community language to the resident case tracked and cook their cultural food. This provides an improved understanding and awareness of the resident’s cultural and religious needs. Staff recruitment records were not available to check in the absence of managers. Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a good management approach. Systems are in place to protect the health and safety of residents. EVIDENCE: Residents and staff thought the manager ran the home well and that she was approachable and thoughtful. The acting manager ensures practice issues were regularly discussed through staff meetings and informal / formal meetings with individual staff. All policies and procedures are updated regularly and are due a further update in August. The manager will shortly be submitting an application Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 22 to the Commission for Social Care inspection (CSCI) to become the registered manager. Residents meetings are regular and ensure resident rights are choices are considered. Regular staff meetings focus on how the home can improve and provide better care. There is a health and safety records with evidence of maintenance undertaken by the handyperson. Fire Precautions-staff members were asked the fire procedure and found to be aware of what steps to take place in the event of a fire. Water temperature testing takes place whenever residents are bathed with records held ensuring safe water temperatures. Resident’s monies were found to be properly kept with running balances and receipts held. The Inspector could not check Resident’s monies as they were held securely and staff were not able to access this area. This resulted in residents not being able to access to their money or bankbook. The manager and registered provider said this would be followed up. Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 23 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 2 28 2 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 x 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x 3 3 x Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 24 No 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 YA27 Regulation 16 Requirement The upstairs toilet to be repaired or replaced so that the ceramic surface is impermeable and prevents spread of infection to residents. To provide clean adequate floor coverings in both lounges for safe and comfortable shared space for residents to enjoy. The washing machine and tumble dryer and soiled laundry bin are based in the kitchen; and have the potential to spread infection as staff prepare and cook meals, and residents enter and meet here. Managers must seek guidance from environmental health to ensure safe outcomes for residents. Timescale for action 31/08/07 2 YA28 16 30/09/07 3 YA30 13(3) 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 25 No. 1 2 3 Refer to Standard YA24 YA29 YA41 Good Practice Recommendations To consider ways to improve the outside paved area to be attractive and enjoyable for residents to sit in. Look at ways to repair resident’s key items quickly that are used for maintaining their individual well being. Residents should have access to their records and monies held by the home. This would ensure resident’s rights and best interests are safeguarded. Mere Lodge DS0000064385.V341293.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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