Inspection on 22/01/08 for Middleton Lodge

This inspection was carried out on 22nd January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Middleton Lodge 19/11/08

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

CARE HOME ADULTS 18-65 Middleton Lodge Mount Pleasant Station Road Middleton St George Darlington, County D DL2 1JA Lead Inspector Mrs Jean Pegg Key Unannounced Inspection 22nd January 2008 09:45 Middleton Lodge DS0000069965.V356877.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 Middleton Lodge DS0000069965.V356877.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. Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Middleton Lodge Address Mount Pleasant Station Road Middleton St George Darlington, County D DL2 1JA 079810 800805 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) Potensial Limited Jacqueline Hodgson Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: 2. Learning disability - Code LD, maximum number of places: 10 The maximum number of service users who can be accommodated is: 10 New Service Date of last inspection Brief Description of the Service: Middleton Lodge is a single storey building that has been refurbished to provide a modern living environment for ten people with a learning disability. The home is set in it’s own grounds and provides single room en-suite accommodation. Inside the building there are two dining rooms, two lounge areas, an activities room, kitchen and laundry. Outside there are garden areas and parking areas for visitors and staff. The home is in the village of Middleton St George and can be reached by both public and private transport. Local shops are nearby. Fees for this home were not made known to us during our visit. We know that the fees do not cover all items and that personal items such as clothing, hairdressing etc has to paid for in addition to the fees. Please check current fee levels with the manager. Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection visits to this home took place on 22 January and 7 February 2008. We got the information that is used in this report by asking the manager of the home to complete the Annual Quality Assurance Assessment document (AQAA). This document has to be completed each year and returned to the Commission for Social Care Inspection. A range of other documents were looked at when we visited the home. We also sent out surveys to people who live and work at the home and who have relatives at the home. None of these surveys were returned to us. We did speak to some relatives and spent time observing the routines of the home and talking to staff. We were helped to carry out this inspection by an expert by experience. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. For this visit we asked the expert to look at the environment and what it would be like to live in this home. The experts finding will be included in this report. The registered manager helped us during our first visit. The Head of Care helped us during our second visit as the registered manager had resigned and left the employment of the home. What the service does well: Detailed assessments to find out peoples’ needs are completed before they are admitted to the home. These assessments provide information that is used to write care plans that identify how individual needs will be met. People are invited to visit the home to help them decide if they would like to live there. Generally the care plans and risk assessments provide information about how care needs will be met. The people living at the home do have access to some activities in the home. They are able to go out in the local community when there is sufficient staff on duty. Food and snacks are available throughout the day. Generally people are offered support in a way that that has been agreed in their care plan. Individual health needs are met through contact with other health care professionals. We were told “the care plans tell you what needs doing.” Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 6 The home has a complaints procedure and an adult protection procedure in place for people to follow. Generally the home provides a good standard of modern accommodation for the people who live there. Generally, the home has enough staff on duty to provide a reasonable level of support and care to the people who live there. We were told that “Staffing has improved.” The home is aiming to recruit more staff to work at the home; this will mean that there will be more people available to help the people who live there. A lot of the staff working at the home have a National Vocational Qualification in Care, which means that they have been trained to do the job. The registered provider of the home has put temporary management cover in pace while they recruit a new permanent manager for the home. This means that the home has people identified to look after it and the people who live and work there. What has improved since the last inspection? What they could do better: The information about the home should be made available in a format that people living at the home can understand. People living at the home should have a contract that they or someone that represents them have signed. This contract should include all the details that they need to know about how much they pay and what they are paying for, which room they will be sleeping in and what the rules of living at the home are. The care plans and risk assessments should be written in a way that shows how individual choices have been considered and taken into account when agreeing how care needs are to be met. The quality of life for people living at the home could be improved by increasing the resources available in the home for leisure activities and by increasing the number of staff on duty who are available to take people out. They should also have more access to a vehicle to go out in when they want to. We were told that “residents go out shopping or for meals if the mini bus is available.” People could be helped to make choices at meal times by using menus that are in a format they can understand. The light in the dining room could be brighter. Generally medication is managed quite well but some improvements could be made to limit the possibility of medication errors occurring. For example up to Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 7 date photographs of people to be kept with the medicine administration records. The complaints procedure should be written in a format that can be easily understood by the people living at the home. Training in the protection of vulnerable adults is needed to make sure that staff are confident and knowledgeable about how to respond to suspicions of abuse. Staff should receive regular training and supervision to make sure that they know what they are expected to do and how they should be doing it. Systems for monitoring the quality of care that the home provides need to be put into place. The home also needs to improve the way it manages maintenance and repair problems in the home by making sure that things that can not be repaired by the handyman are seen to without delay. 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. Middleton Lodge DS0000069965.V356877.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 Middleton Lodge DS0000069965.V356877.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): 1,2,4 & 5 People who use the service experience adequate quality outcomes in this area. Some information about the home is available but this needs to be in a format that the people living at the home can understand. Detailed assessments to find out peoples’ needs are completed before they are admitted to the home. Trial visits are offered to see if people like the home. There is no evidence that people living at the home are provided with individual contracts that detail their terms and conditions of residence. We have made this judgment using a range of evidence, including a visit to this service EVIDENCE: There was a Statement of Purpose and a Service Users’ Guide available but we were told that no one had been given a copy of the Service Users’ Guide, as it was not in a format that could be understood by them. We discussed this issue with the Head of Care and suggested that information should be available in a format that could be understood by the people that live there for example easy read and pictures. We looked at the pre admission assessments that were completed for the people living at the home. The assessments were completed in detail and Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 10 provided a good range of information that would help to decide if the home could meet the individual’s needs. We noticed that letters had been provided that confirmed that the home could meet the person’s needs and provided details of how those needs would be met. Care plans had then been written based on the information provided by the assessment. From looking at daily reports we found evidence of people being offered trial visits to the home. A relative that we spoke to also confirmed that trial visits had happened. We asked to see copies of individual contracts provided for the people who live at the home. We were told that these contracts were dealt with by head office. At the time of writing this report we have not received any evidence of those contracts. Every person living at the home should be provided with a contract in a format appropriate to his or her needs. This contract should specify which room they will occupy, the terms and conditions of occupancy, the support and facilities that will be provided to them, any rules that may restrict freedom, fees charged and what they cover, when they are to be paid and by whom, the rights and responsibilities of both parties, a copy of the service user plan and the arrangements for reviewing that plan. Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 11 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 People who use the service experience adequate quality outcomes in this area. Generally the care plans and risk assessments detail information about how care should be provided. These plans and assessments should be improved to show how individual choices have been considered and taken into account. We have made this judgment using a range of evidence, including a visit to this service EVIDENCE: We looked at the individual service user plans for people living at the home. The individual plans covered a variety of different areas including personal social and health issues. We did notice that some areas concerning dignity and choice could be more explicit within the care plans and this was discussed with the Head of Care during our second visit. Staff are required to sign to say that they have read and understood the care plan. The relative we spoke to confirmed that reviews are held and that a very detailed report had been Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 12 prepared by the home for a previous review meeting. The relative also indicated that the care provided had been variable and did not always agree with the care plan. The relative has raised these concerns with the home. The care plans indicated that they should be evaluated every month but this had not happened. The Head of Care said that all care plans would be reviewed to ensure that they were accurate and up to date. The care plans were quite detailed however; they did not always reflect issues to do with choice. We also noticed that people could have been provided with more opportunities to make simple choices throughout the day. This was discussed with the Head of Care who acknowledged our comments and explained that staff meetings had been arranged to discuss some of these issues. Not everyone living at the home manages his or her own finances. We looked at the system used to account for the money held on behalf of people and found them to be satisfactory. Risk assessments had been completed and were in place in individual plans of care. There was some discussion around the relevance and accuracy of some of these assessments for example the use of restraint straps and level of support individuals’ required for outings. The Head of Care said that these would be reviewed to ensure that they remained accurate and relevant. Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 13 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): 12,13,14,15,16 & 17 People who use the service experience adequate quality outcomes in this area. The people living at the home experience a lifestyle that is sometimes limited by the resources available. This has been recognized and there are plans in place to make improvements. We have made this judgment using a range of evidence, including a visit to this service EVIDENCE: The ‘expert by experience’ told us “The staff member told me that none of the residents go to college, work or do voluntary work within the community.” We were also told that the home does provide day services between 10am – 12noon and 2pm – 4pm each day. The activities provided are limited and dependant upon the availability of staff. Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 14 During our first visit we were told that involvement in community activities was restricted by the number of staff on duty and access to a vehicle. We know that from speaking to people and from what we saw in written records that an undertaking to provide transport to facilitate family visits could not always be honoured. The ‘expert by experience’ told us that the people who live at the home do not go out independently but they are able to go out with staff support. They said “The staff told me that residents go out shopping or for meals if the mini bus is available.” They recommended “The home should have its own mini bus or use public transport so residents can go out and do more outdoor activities in the community.” During our second visit the Head of Care told us that arrangements could be made to hire a vehicle if it was needed to make sure people got out in the community. During our second visit we spoke to staff about accessing the community and were told “Things have improved, not going out as much but more staff in, three on a shift. There are more people to look after them (the people who live at the home) you can do one to one activities, visit families or go to the park.” The ‘expert by experience’ also told us “I found out the residents can take part in the following activities: Drawing; Painting; Board games; Shopping; Pub meals and Beauty treatments. The staff told me that on the evenings and weekends residents have ‘chill time’ where they can Watch TV and DVD’s.” During our visit we saw one person having their nails painted and another playing with a game of ‘Connect Four.’ There is a dedicated activities room in the home. The ‘expert by experience made some suggestions as to how activities could be improved. They said “I think that residents should do more activities especially on an evening and weekends. They could go bowling, to the pub, pictures or for walks, or they could do activities at home such as themed night like Burns night, or Italian night, or a home cinema night. There should be more board games, a computer, a snooker table and gardening activities.” These suggestions were passed onto the Head of Care for consideration. When we spoke to staff we were told that they had been asked to “Make a list of stuff we want.” (To improve the range of activities). The individual care plans that we saw had a list of people who were part of that person support network. As stated earlier access to transport had caused some problems in maintaining visits to family members for some people living at the home. And as stated earlier the Head of Care said that transport could be hired if needed. Whilst we were visiting the home we noticed that the people living at the home were able to walk freely around the home from room to room. We knew from looking at the risk assessments that access outside of the home was restricted due to safety reasons and the need to have assistance from staff to help with mobility problems. We commented that the availability of staff would also have an impact on opportunities to go outside. This issue had been recognised by the Head of Care. We were told on our first visit that “day services” were scheduled 10 – 12 and 2-4. and that there was a house meeting on a Friday. Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 15 We noticed that one person living at the home liked to help with the washing up. We were told that staff were mainly responsible for ensuring that cooking and cleaning tasks were completed. We observed some parts of the lunchtime and tea time routine during our visit. For lunch we saw that a light meal of soup juice and tea had been offered and at teatime a cooked meal of burgers and chips was presented to the people living at the home. At lunchtime we noticed that one person did not eat their soup, we did not see an alternative being offered. A four weekly menu had been devised but there were no alternatives identified on the menu. The menu was presented in a standard format. Pictures or photographs of meals or food could be used to help people living at the home to make choices about what they wanted to eat. The lighting in the dining room at teatime was very dim. This did not help to create a good atmosphere for people to dine in. Plastic aprons were used to protect the clothing of some people but we did not see people being asked if they wanted to use the aprons. We did notice that meals were cut up for people to help them eat more independently. The staff we observed were supportive but we did notice some lack of awareness in how issues relating to dignity and choice were handled. The ‘expert by experience’ told us that they had been told that the residents can go food shopping with staff but this does not happen on a regular basis; the staff cook the meals although the residents are encouraged to help with the cakes and desserts; there is a four week menu that residents can choose from with a healthy choice; meals are set usually around the same time but if residents are not ready they can eat at different times. The expert also found out that the kitchen is locked for safety because of the hot water, so staff give snacks and drinks to residents throughout the day. Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 16 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. People who use the service experience good quality outcomes in this area. Generally people are offered support in a way that that has been agreed. Health needs are met through contact with other health care professionals. Generally medication is managed quite well but some improvements could be made to further limit the possibility of medication errors occurring. We have made this judgment using a range of evidence, including a visit to this service EVIDENCE: From the care plans we looked at we saw that the plans had been agreed with representatives of the people living at the home. One relative told us that they had been generally quite happy with the care provided by the home but that they had noticed a deterioration since Christmas time and had made their concerns known to the Head of Care. The staff we spoke to told us “the care plans tell you what needs doing.” And “ Everyone is showered or bathed every day – they are encouraged to help them selves.” And “Time is not an issue they all get up at different times.” Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 17 The records we looked at showed that other health care professionals visited the home to support the health needs of the people living at the home. Weights are monitored to make sure that people do not gain or loose too much weight. We observed medicines being given out at lunchtime. Only staff that have been trained in administering medication give it out. A monitored dosage system prepared by the pharmacist is used in the home. The way that medication changes are recorded in care plans could be improved and medicine administration sheets need to have photographs of the people who take medicines to reduce the possibility of medication errors occurring. Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 18 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 People who use the service experience adequate quality outcomes in this area. The complaints procedure is not written in a format that can be easily understood by the people living at the home. Training in the protection of vulnerable adults is needed to ensure that staff are confident and knowledgeable about how to respond to suspicions of abuse. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: During our fist visit we were shown the complaints policy. This was written in a standard format that was not very user friendly. We saw the complaints book but noticed that there had been no complaints identified. During our second visit we were told that a pictorial complaints procedure that had been used successfully in another home would be introduced to people living at this home. The home has a procedure in place for staff to follow should they suspect that someone is being abused. This procedure had the correct contact details identified. We were told that some staff had received training in the Protection of Vulnerable Adults. The arrangements for looking after money held on behalf of people living at the home were satisfactory. Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 19 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 & 30 People who use the service experience good quality outcomes in this area. Generally the home provides a good standard of modern accommodation. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: We looked around the home during our first visit. The home is a single storey building that has been refurbished to quite a high standard. There were some building issues that still needed to be resolved for example screws missing from doors, a socket missing from the dining room wall, locks missing from bedside cabinets. There were also some issues to do with privacy in that plain glass doors allowed easy viewing into the home. The home had modern furniture in place and was minimalist in style. We noticed that the internal doors were heavy and that there was a tendency to prop the lounge door that was next to the dining room open. The lounge next to the dining room is also Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 20 an internal room, which means that the only natural light comes through an overhead skylight. The television reception in this room was not very good. The Head of Care said that they were making arrangements to get the television reception sorted out. We discussed the use of door guards with the Head of Care. The grounds were tidy. There were shrubs at the front of the home but the back garden was mainly lawn. The internal patio area was very plain with no planters or furniture. There were no external lights, which meant that it was very dark when walking outside when the natural light had gone. This could cause Health and Safety problems at night. These are some of the comments that the ‘expert by experience’ made. “When looking around the bedrooms I liked the fact they were all very spacious and had their own ensuites. I liked the fact residents are able to choose how to have their rooms decorated.” There was a fully equipped laundry in the home and we were told that all the equipment worked. The home has infection control procedures in place however, we did notice that in the communal hand washing areas that we used that liquid soap and paper towels were not readily available. This means that people would not be able to wash their hands properly. There were generally no unpleasant odours in the home during our visits. Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 21 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): 32,33,34,35 &36 People who use the service experience adequate quality outcomes in this area. Although satisfactory, the current level of staffing provision in the home will benefit from the planned recruitment and training programme. We have made this judgment using a range of evidence, including a visit to this service EVIDENCE: 60 of staff working at the home on our second visit had a National Vocational Qualification in Care at level 2 or above. The home has experienced a turnover of staff during recent months. During our second visit to the home we were told that staff were being recruited and that some staff from other homes in the group were covering shifts to ensure adequate staff cover. Agency staff were also being used. We were told that staff have to carry out caring, cooking and cleaning duties in the home. We noticed that during our first visit to the home that the requirement to complete these duties detracted from the time available to spend with the people who live at the home. This was acknowledged by the Head of Care who said that Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 22 they were aiming to have four or five staff on duty each shift including the manager. A member of staff told us “Staffing has improved.” And “Every time I’ve worked there have been three or four of us on duty. They are ‘taking people on’ at the minute.” We were also shown a list of dates for staff meetings planned to take place in the home and a copy of the agenda for the next meeting. We checked some staff recruitment files and found that all necessary checks had been carried out before people had been allowed to work in the home. There was no evidence to show that the people living at the home had been involved in the selection of new staff. The staff training records showed that there was only one trained first aider on the team and this persons training was soon to expire. The remaining records showed that many people were without up to date training and that some induction programmes had not been properly completed. Competency assessments for people who administer medications had not been signed off. The Head of Care said arrangements had been put into place to train all staff in first aid and that a systematic approach to training would be adopted. The standard for staff receiving supervision in the home is once a month. The records we saw showed that this had not been happening. On our second visit we were told that the supervision process had now been put into place. Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 23 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 & 42 People who use the service experience adequate quality outcomes in this area. Satisfactory interim management arrangements are in place pending the appointment of a permanent registered manager. Effective quality assurance systems need to be developed and improvements need to be made for the management of outstanding maintenance issues in the home. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: During out first visit to the home the manager told us that, the previous day, she had submitted her resignation as registered manager of the home. The manager had left the home by the time we made our second visit. The Head of Care helped us with the second part of the inspection process and updated us Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 24 as to the interim management arrangements that had been put into place. We were told that two experienced managers form other homes within the group would be providing management cover until a permanent appointment could be made. The Head of Care said that he would also be spending time at the home to offer support. The staff we spoke to told us “We are getting a new manager in. There is someone in who is acting manager. The Head of Care is here most days.” And “ X is doing really well. I think it feels like she is in control of the place. She has back up if she needs it.” We agreed with the Head of Care that it was important that a permanent appointment should be made as soon as possible. To date there was no written annual development plan in place for the home. As the home is only new there has not been time to complete stakeholder surveys. The Head of Care showed us a copy of the monthly report that they had completed on the home in December 2007. There was very little evidence of any quality assurance processes being in place to ensure that the objectives of the home were being achieved. We were shown completed Health and safety audits that showed that a lot of outstanding work needed to be carried out on the building for example the socket cover which was missing from the dining room, screws missing from door handles, the SAS care staff emergency call system not identifying areas correctly. We were told that these reports had been submitted every week since the home had opened but that work has still not been completed. The Environmental Health Officer visited on 20 August 2007 and the Fire Officer had visited 30 May 2007. The home had been awarded Five stars for the Tees Valley Food Hygiene Standards Award. When we looked at maintenance records we noticed that the emergency lighting systems checks were out of date and that the last fire drill had been held 8 November 2007. A member of staff told us that they had not been given any fire instruction when they had started working at the home. The Head of Care told us that training was being put into place and that outstanding maintenance items would be seen to. Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 X 3 3 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 2 X Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA37 YA37 Regulation 8 (1) (a) 8 (2) (a) (b) Requirement Timescale for action 31/05/08 The registered provider must appoint an individual to manage the care home. The registered person must 31/05/08 notify The Commission for Social Care Inspection of the name of the person so appointed; and the date on which the appointment is to take effect. 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 4 Refer to Standard YA1 YA1 YA5 Good Practice Recommendations Information about the home should be available in formats suitable for the people for whom the home is intended. Information about fees and charges should be readily available in the home. Each person living at the home should have a copy of their individual contract, which has been signed by them or their representative and the registered manager. People living in the home should be offered more opportunities to make choices and decisions. DS0000069965.V356877.R01.S.doc Version 5.2 Page 27 YA7 Middleton Lodge 5 6 YA9 YA13 7 8 9 10 11 12 YA14 YA15 YA17 YA17 YA17 YA20 13 14 15 16 17 18 YA22 YA23 YA24 YA24 YA30 YA33 19 YA35 20 21 YA36 YA37 Care plans and risk assessments should show how individual choices and decisions have been taken into account. People living at the home should continue to be helped to take part in the local community in which they live through having access to suitable levels of support including transport and people. The registered person should continue to improve the range of activities available in the home. Opportunities to maintain family links and friendships outside of the home should continue to be developed. The registered person should ensure that people are offered choices at mealtimes and that menus show the alternatives that are available. Menus could be presented in alternative formats that everyone living in the home could understand. For example the use of pictures or photos of meals. The lighting in the dining room could be improved to create a nicer place for people to eat in. Photographs of the people taking medication should be placed in the medicines administration record sheets This would help to reduce the possibility of medication administration errors occurring. People living at the home should receive a copy of the complaints procedure in a format that they can understand. The registered person should ensure that all staff receives training in the protection of vulnerable adults. Outdoor lighting should be considered to ensure the health and safety of people living and working at the home when it is dark. All outstanding building works should be completed as soon as possible. Liquid soap and paper towels should be made available in communal hand washing areas. The registered person should continually monitor staffing levels to ensure that there are sufficient staff on duty at all times to meet the personal social and emotional needs of the people living at the home. Staff training should be completed as soon as possible to ensure that the staff working at the home have the skills and knowledge to meet the assessed needs of the people living at the home. Staff should receive regular supervision sessions to help them carry out their job roles effectively. A manager should be appointed to the home as soon as possible. DS0000069965.V356877.R01.S.doc Version 5.2 Page 28 Middleton Lodge 22 YA39 23 24 YA42 YA42 Effective quality assurance systems that include the views of the people living at the home and their representatives should be put into place so that the aims and objectives of the home can be constantly monitored and improvements made. Staff should receive regular training updates in health and safety related topics. Proper recording and audit systems should be in place to ensure that regular maintenance checks are completed and faults repaired as soon as possible. Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB 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 © 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 Middleton Lodge DS0000069965.V356877.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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