Inspection on 22/04/05 for Mount Lodge

This inspection was carried out on 22nd April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Mount Lodge 19/02/08

Mount Lodge 16/03/07

Mount Lodge 06/09/05

Mount Lodge 26/08/04

Mount Lodge 17/05/04

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

CARE HOME ADULTS 18-65 Mount Lodge 5 Upper Avenue Eastbourne East Sussex BN21 3UY Lead Inspector Nigel Thompson Unannounced 22 April 2005 09:30 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. Mount Lodge Version 1.10 Page 3 SERVICE INFORMATION Name of service Mount Lodge Address 5 Upper Avenue Eastbourne East Sussex BN21 3UY 01323 411312 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) Community Housing and Therapy Vacant Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (MD) of places 16 Mount Lodge Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is sxteen (16). 2. That service users are aged between eighteen (18) and sixty five (65) years on admission. 3. That only service users with a mental disorder, excluding learning disability or dementia, to be admitted. Date of last inspection 26 August 2004 Brief Description of the Service: Mount Lodge, first registered in 1993, is a therapeutic community run by Community Housing and Therapy, (CHT), for 16 adults, between the ages of 18 and 65, who are experiencing mental health and emotional difficulties, excluding learning disability or dementia. Many service users (clients) have ‘dual diagnosis’ and in addition to their psychiatric condition may also have problems with substance misuse. The premises comprise of a large, three storey detached house, with an extensive garden to the rear and parking space at the front of the building. Service user accomodation comprises of single rooms, each fitted with a wash basin Communal areas include two large lounges, a separate dining room, an additional quiet lounge and a kitchen and laundry room. Sufficient toilets and bathrooms are provided throughout. The home is situated in a residential area of Eastbourne, a short walk from the town centre amenities, including shops and the main line railway station. A local bus service passes near by. Service user involvement is a significant aspect of the organisation’s approach to community care. Regular group discussion meetings form the basis for much of the structured work within the community. Independence and self awareness is promoted within the community and service users are encouraged to contribute to the day to day running of the home, including cleaning and planning and preparing meals. Mount Lodge Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours in April 2005. It found that eighteen of the National Minimum Standards that were assessed had been met or partially met and the overall quality of care provided was good. Service users spoken to during the inspection expressed satisfaction with the home, the staff and the service provided. A tour of the premises took place and documentation, including service user and staff files were inspected. All the staff on duty and seven of the thirteen service users were spoken to. What the service does well: Prospective service users benefit from the comprehensive statement of purpose and the informative ‘Mount Lodge Users’ Guide’. Both documents have been compiled in an accessible format, setting out in detail both what the therapeutic community is and what it provides, enabling prospective clients to make an informed choice about the suitability of the service. Service users are only admitted to the home (project), following clinical, mental health and social care assessment, to establish the individual’s suitability to become part of and benefit from the community. A major consideration is the need for compatibility with existing service users. Staff support is clearly a high priority within the home and this is reflected in the frequency of formal supervision, which the acting manager provides on a two weekly basis. All staff undertake a three year diploma course, with university accreditation. This will enable them to acquire the skills and knowledge to support the service users and meet their complex needs. There is an open and inclusive atmosphere within the community and service users spoken to during the inspection felt generally involved and ‘listened to’ and said that they benefited from the regular group meetings and having the opportunity to raise and discuss issues and concerns. Mount Lodge Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Service users’ individual care plans, including progress notes, should be regularly updated to minimise the risk of significant events or changes being missed and the potential for vital information not being recorded. More involvement, encouragement and support from staff may help to address the issue of apathy and poor participation in several of the groups, particularly cleaning and gardening. There are some concerns regarding the storage, administration and recording of medication. Medicines are being stored in a disorganised and overcrowded manner. The Medication Administration Records are also unsatisfactory and poorly maintained. In certain areas including several service users’ rooms and the upper floor staircases and landings, levels of cleanliness and hygiene were found to be less than satisfactory. An effective quality assurance system needs to be developed, seeking feedback from service users and relatives, to measure the effectiveness of the home in meeting its aims, objectives and stated purpose. Mount Lodge Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Mount Lodge Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Mount Lodge Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 2 The Statement of Purpose and Service Users’ Guide are excellent and provide prospective clients with details of the services provided, enabling an informed decision to be made regarding admission to the home. EVIDENCE: A full and comprehensive statement of purpose is in place. The recently developed ‘Mount Lodge Users’ Guide’ is both informative and comprehensive. It has been compiled in a thoughtful and accessible format, setting out in detail both what the therapeutic community is and what it provides. A comprehensive admission policy and procedure is in place. All prospective service users are formally assessed by the acting manager or deputy manager, to establish their suitability for the community. In all cases a Care Programme Approach, (CPA), review is completed. However it was noted that in the case of one client, who had recently moved into Mount Lodge, there was no record of an ‘Assessment Interview’ and no evidence of a pre-admission assessment having been carried out. A social work report, including a social and psychiatric history was in place. Mount Lodge Version 1.10 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 &7 The systems for service user consultation are good and clients’ views are both sought and acted upon. EVIDENCE: An individual care plan, ‘Therapeutic Curriculum’ has been developed for each service user at Mount Lodge. The care plans that were inspected were found to be comprehensive and generally well maintained. Each plan contains the client’s personal details, social and professional contacts, details of any current issues and needs as well as regular evaluation and current prescribed medication. ‘Future Aims and Goals’ are broken down into short and long-term aims, each with an agreed plan of action. It was noted in the case of one service user, currently in hospital, the progress notes had not been updated and details of the circumstances leading to his hospitalisation were not recorded in either the care plan or the ‘Day book’. Service users attend a daily Community Meeting, Monday to Friday. This group is generally well attended and clients spoken to during the inspection said that they benefitted from the group and having the opportunity to raise and discuss Mount Lodge Version 1.10 Page 11 issues and concerns. ‘ There’s always someone to talk to – and some even listen’. Other groups currently running include a cleaning, a gardening and a finance group. The service is developing an employment group, and there is a leisure group on a Saturday. Each service user has a weekly one-to-one key worker session, and all are involved in meal preparation and shopping at least once a week. Clients are expected to attend their specific groups on a regular basis but interest in this appeared to be variable, with the gardening and cleaning groups notably suffering from a degree of apathy. Typical comments from service users included: ‘I didn’t feel like it today’. ‘I didn’t make the group today - I’ve been lying on my bed all morning’. Since the previous inspection, the policy regarding the consumption of alcohol on the premises at weekends has been reviewed and amended, as required. Mount Lodge Version 1.10 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16 & 17 Independence is promoted within the Home. Service users are able to come and go as they choose and have become part of the local community. Service users receive a wholesome and more balanced diet at times convenient to them. EVIDENCE: Service users are enabled and supported to participate as they wish in the local community, in accordance with their assessed needs. The deputy manager confirmed that individual community participation is variable and includes voluntary work in charity shops and attending local churches and colleges. Family links are supported as appropriate to the wishes of the individual. Mount Lodge Version 1.10 Page 13 Leisure interests and social care needs are recorded in service users’ care plans as part of the initial assessment process. Supported individual and group activities are arranged, including the cinema, concerts, barbeques and badminton. From discussions with staff and clients, it is evident that menu planning is now taken more seriously and meals are now generally far more varied, balanced and nutritious. ‘We have far more fresh vegetables now and the food is much better’. The weekly catering group discuss menu planning, reflecting the likes and dislikes of clients. The deputy manager confirmed that staff continue to monitor and reinforce healthy eating options. Mount Lodge Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) r19 & 20 The health needs of service users are well met with support, as necessary, from other health care professionals. The systems for the storage and administration of medication is poor and potentially place service users at risk EVIDENCE: Health care professionals from the community psychiatric services maintain regular links with the home. Following risk assessments, there are currently no service users who have responsibility for handling their own medication. As discussed with the deputy manager, a referral is to be made to the Pharmacist Inspector following concerns regarding the storage, administration and recording of medication. The current medicine cupboard, situated in the office is small and cluttered. Medicines are being stored in a disorganised and overcrowded manner, with a clear potential risk evident, particularly in such a busy and unpredictable environment. Mount Lodge Version 1.10 Page 15 The Medication Administration Records are also unsatisfactory. The forms currently being used are poor quality photocopies and it was noted that there were also several gaps, where staff had failed to sign that a service user had received –or not received – the appropriate medication. Mount Lodge Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 The current complaints procedure is satisfactory and service users feel that their views and concerns are listened to and acted upon. EVIDENCE: The service’s complaints policy and procedure has been reviewed and a copy of the procedure is now displayed on the notice board. However it was noted that, despite a previous requirement, there is still no adequate log currently maintained of complaints received, details of any action taken and the eventual outcome. Policies and procedures, including ‘Whistle blowing’, have been developed in relation to recognising and reporting incidents of actual or potential abuse. However the deputy manager was unable to provide updated policies relating to the Protection of Vulnerable Adults, (POVA), which he claimed were being reviewed and updated at Head Office. It was also evident that, despite being discussed with the acting manager at the last inspection, a copy of the East Sussex Social Services ‘Multi agency guidelines for the protection of vulnerable adults’ has still not been obtained. Mount Lodge Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The standard of the décor within Mount Lodge is variable and does not generally provide service users with an attractive, homely and comfortable place to live. EVIDENCE: Mount Lodge Version 1.10 Page 18 The significant improvement in the physical environment at Mount Lodge has unfortunately not been sustained, since the previous inspection. In certain areas including several service users’ rooms and the upper floor staircases and landings, levels of cleanliness and hygiene were found to be less than satisfactory. It was noted that furniture in the main lounge, including several worn settees, has been replaced since the previous inspection. The deputy manager stated that new carpets were due to be fitted throughout the building, within the next few days. Comments from service users were generally favourable and positive while still acknowledging there have been some problems. ‘It’s always been a good house, even when it was a bad house – because it’s my house’. ‘It’s a pity that it took you coming round here and kicking arse, before anything was done’. ‘It’s a happy house’. Mount Lodge Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 35 The staff generally have a sound understanding of the service users’ support needs. This is clear from the positive relationships which have developed between clients and staff. EVIDENCE: The deputy manager confirmed that there is always the acting manager or deputy manager and two other staff members on duty during the day. At night there is currently one sleep in member of staff on duty in addition to a manager, who is always on call. The policy regarding staffing levels during the night reflects the unpredictable nature of the client group and the complex mental health needs of the service users. The deputy manager described an incident that occurred during the night, when a service user needed hospital treatment, which resulted in the acting manager, who was on call, coming on duty to cover while the sleep in member of staff escorted the client in the ambulance. All staff receive appropriate, comprehensive and detailed training in fire safety, safe handling of medicines and food hygiene. Staff also are expected to complete the Diploma in Dialogical Group Therapy for therapeutic community practitioners. This is a 3-year course accredited by Mount Lodge Version 1.10 Page 20 Middlesex University. The training covers aspects of mental health, substance misuse and therapeutic approaches to treatment and is paid for by the organisation. Mount Lodge Version 1.10 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 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) 39 & 42 The home’s quality monitoring system is limited in its effectiveness, as it does not currently seek feedback from service users’ family, friends, advocates and stakeholders in the community. EVIDENCE: The deputy manager was unaware of any quality assurance system in place but confirmed that satisfaction questionnaires for service users and relatives is currently being developed. The deputy manger confirmed that the health, safety and welfare of service uses and staff remains a priority and training provided includes first aid, food hygiene and fire safety. Training was appropriately recorded in staff files. Mount Lodge Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 2 x x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 Mount Lodge x 3 3 x 3 Standard No 31 32 33 34 35 36 Score x x 3 x x x Version 1.10 Page 23 16 17 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x Mount Lodge Version 1.10 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 14 (a) (b) & (c) 15 (2) (b) Requirement It is required that new service users are only admitted to the home on the basis of a full and comprehensive assessment. It is required that the service users care plan is kept under review and updated to reflect changing needs and circumstances. It is required that effective arrangements are in place to ensure the recording, safe storage and safe administration of medicines. It is required that a record is maintained of all complaints received, including details of any investigation, action taken and the outcome. (Timescale of 30.11.2004 not met). It is required that the premises are kept clean, hygienic and free from offensive odours throughout. It is required that an effective quality assurance and monitoring system be implemented, based on seeking the views of service users. Timescale for action 30.04.2005 2. 6 31.05.2005 3. 20 13 (2) 30.04.2005 4. 22 22 (8) 31.05.2005 5. 30 23 (2) (d) 31.05.2005 6. 39 24 (1) (a,b) (3) 30.06.2005 Mount Lodge Version 1.10 Page 25 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 Good Practice Recommendations Mount Lodge Version 1.10 Page 26 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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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