Inspection on 06/09/05 for Mount Lodge

This inspection was carried out on 6th September 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 22/04/05

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 Announced Inspection 6th September 2005 11:30 Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 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 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) Community Housing and Therapy Ms Rosanna Basso Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is sixteen (16). That service users are aged between eighteen (18) and sixty-five (65) years on admission. That only service users with a mental disorder, excluding learning disability or dementia, to be admitted. 28 April 2005 Date of last inspection 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 DS0000021169.V249174.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over six hours in September 2005. It found that 16 of the 22 National Minimum Standards that were assessed had been met and the overall quality of care provided was good. Service users spoken with 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 users’ care plans and staff files, was inspected. All the staff on duty and seven of the fourteen service users were spoken with. What the service does well: The manager, deputy manager and dedicated support staff work hard to develop and maintain a stimulating, open and inclusive atmosphere within the home. Service users are actively involved in many decision making processes within the home and are regularly consulted regarding all aspects of their day to day living. Comprehensive service user care plans – although needing to be regularly updated - ensure that an individual’s ongoing care and support needs are met in a structured and consistent manner. An effective key worker system is in place and there is clear evidence that staff work closely with service users and are aware of their specific care and support needs. A thorough staff recruitment procedure protects service users, by ensuring that all necessary checks are completed prior to a person starting work at Mount Lodge. Staff receive effective induction and foundation training, regular supervision and are clearly valued and supported by the management team. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 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. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 & 5 The thorough admission policy and procedure ensures that service users are admitted only on the basis of a full needs assessment, undertaken by people competent to do so. EVIDENCE: A comprehensive admission policy and procedure is in place. All prospective service users (clients) are formally assessed by the manager or deputy manager, by means of an initial interview, to establish their care and support needs and suitability for the community. In all cases a Care Programme Approach, (CPA), review is completed. Supporting documentation, examined during the inspection, provided by the prospective clients local health authority included a full psychiatric assessment, social history and risk assessments. Details from the previous ‘CPA’ care plan and most recent ‘Case Summary’ are also provided, including ‘Reasons for referral’ The manager confirmed that prospective service users are invited to visit the home to look around and meet with existing clients and staff. They also have the opportunity, where appropriate, to stay overnight. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 9 All referrals and applications to the home are discussed with staff and service users. The deputy manager stressed the importance of compatibility and confirmed that existing clients are aware of the referral and admission procedures and are directly involved in any decision making process. Service users are initially admitted on a six week trial period, during which time there is continuous assessment and monitoring of the placement to ensure that the individual ‘shares time and space’ with other members of the community and ‘actively engages’ with the various groups and programmes. The manager confirmed that ultimately it has to be decided whether the individual has the ‘potential to benefit from living in the community’. Service users who had recently been admitted to Mount Lodge confirmed that the service generally met their expectations and their needs. Once a decision has been made to admit a person to the home, they are provided with and sign a ‘Client’s agreement’ (Licence to occupy) Signed contracts which were examined contained details of terms and conditions of occupancy and clearly set out both the obligations of the service (CHT – Mount Lodge) and the obligations of the service user. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 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 the following standard(s): 6, 7, 8 & 9 Service users’ care plans are developed from a comprehensive assessment of an individual’s support needs and enable staff to meet such needs in a structured and consistent manner. Service users are encouraged and supported to make decisions about their day to day living and benefit from effective consultation systems. EVIDENCE: An individual care plan, ‘Therapeutic Curriculum’ has been developed for each service user at Mount Lodge. The comprehensive care plans that were inspected were found to be generally up to date and 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. However, through case tracking, it was noted that in one service user’s care plan that was examined there was no evidence that risk assessments had been Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 11 updated to reflect the individual’s changing needs and circumstances. As discussed, it is required that individual care plans be kept under review. The manager confirmed that service users are directly involved in their individual care planning and are consulted as to whether they wish their relatives to partake in their care planning and reviews. Service users spoken with during the inspection were able to confirm that this was the case, however it was evident that very few had taken the opportunity of involving family members. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: These standards were not assessed on this occasion. All key standards were assessed during the previous inspection carried out on 22 April 2005. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 19 Staff have developed positive relationships with service users and demonstrate a sound understanding of their care and support needs. EVIDENCE: The manager confirmed that independence and individuality continue to be promoted within the community. Mount Lodge operates an effective key worker system and, during the inspection, staff were observed working closely and consistently with service users to meet their identified personal care and support needs. Following consultation with service users, specific guidelines have been developed for all staff, ensuring that support is provided in a structured and consistent manner and in a way that the individual prefers. Through observation and discussion with staff and service users it was evident there is a clear focus within the community on doing things ‘with’ rather than ‘for’ people. Staff work alongside clients, providing physical and emotional support and tasks, including cleaning, shopping and meal preparation are often undertaken together. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The open and inclusive atmosphere within the home enables service users, staff and visitors to feel able to express any concerns, confident that they will be listened to. EVIDENCE: The home’s complaints recording format has been reviewed and improved, as required, since the previous inspection. It now includes details of: ‘The complaint’; ‘Follow up action’; ‘Conclusion / Outcome’ and ‘Feedback to the complainant’. However it was noted that the complaints policy and procedure were found to contain details relating to another service in the organisation. This was discussed with the manager, who is to ensure that all policies and procedures maintained at Mount Lodge are service specific. Service users and members of staff spoken with during the inspection confirmed that they would have no hesitation in speaking to the manager or deputy manager or in making a complaint if necessary. Each person was also confident that they would be listened to. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 30 Environmental standards within Mount Lodge have improved in many communal areas and now provide service users with a generally clean, comfortable and well-maintained place to live. However, there is a potential risk for service users as levels of cleanliness and hygiene are poor in certain individual rooms. EVIDENCE: Since the previous inspection, as required, improvements have been made to the physical environment. The manager confirmed that there has been a thorough review of the ‘cleaning group’. A daily programme for cleaning all communal areas within the home has been developed and implemented, covering such activities as hovering, dusting and emptying ashtrays. Service users spoke positively about the improved levels of cleanliness: ‘Something needed to be done ‘. ‘The place is looking much better now’. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 16 Unfortunately the improvements do not extend to service users’ rooms, many of which were showing signs of neglect. Certain carpets were found to be dirty and stained and overall levels of cleanliness and hygiene were poor and generally unacceptable. The manager confirmed that there are plans to redecorate and fit new carpet in service users’ rooms, where necessary. Communal areas including the dining room, landings and staircases have been repainted and a new stair carpet fitted, since the last inspection. The lounge, kitchen, bathrooms and therapy room are also to be redecorated in the near future. Work is currently in progress to repair and repaint the wooden window frames at the front of the building. Outside, there has clearly been a lot of time and effort gone into improving the large rear garden. It is recommended that the barbeque and garden furniture be upgraded and it is hoped that the improvements made will be maintained. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34 & 36 There are sufficient trained and competent staff on duty at all times to meet the assessed, complex and often high dependency needs of the service users. Thorough recruitment procedures help to ensure the safety and protection of service users. Effective supervision and training has resulted in high staff morale and an enthusiastic and motivated workforce with a sound understanding of the support needs of the service users. EVIDENCE: Individual job descriptions for all staff were in place and clearly defined. All staff receive appropriate, comprehensive induction and foundation training. Detailed training is also provided in fire safety, safe handling of medicines and food hygiene. All training is recorded. Staff at Mount Lodge, who are all psychology graduates, also undertake a Diploma in Dialogical Group Therapy for therapeutic community practitioners. This is a 3-year course accredited by 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 DS0000021169.V249174.R01.S.doc Version 5.0 Page 18 The manager confirmed that there is always either herself or the 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. To address the unpredictable and frequently stressful nature of working at Mount Lodge, the manager continues to provide all care support staff with formal supervision on a weekly basis. She also operates an ‘open door’ policy, with staff able to discuss any issues at anytime. Staff spoken to confirmed the support and training they receive and acknowledged the personal benefit of effective supervision: ‘The manager and deputy manager are both very approachable and supportive and will always make time to listen’. Staff files that were examined were found to be generally well maintained, containing all necessary information, including two written references, proof of identity and satisfactory Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Service users and staff benefit from the manager’s calm, open and approachable style of leadership and clear and positive sense of direction. Service users benefit from up to date policies and procedures relating to health and safety, which staff are aware of and adhere to. EVIDENCE: The manager confirmed that, despite the unsatisfactory state of some clients’ rooms, the health, safety and welfare of service users and staff is of paramount importance. As previously documented, staff training is provided in many aspects of safe working practices, including food hygiene, fire safety and first aid. All staff training is recorded. COSHH assessments and guidelines are in place. Temperature regulators are fitted to all hot water outlets, accessible to service users. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 20 All accidents, incidents and injuries are recorded and reported, as required. The manager, who has recently been registered with the CSCI, is this month due to commence studying for the NVQ level 4 in management and care. She has clearly worked hard to develop a relaxed, open and inclusive atmosphere within the home. Staff and service users, spoken with during the inspection confirmed how approachable and supportive the manager and the deputy manager are. Effective quality monitoring systems are in place, including a satisfaction questionnaire for service users, developed since the last inspection. Following discussion, the format for the questionnaire is to be reviewed and amended to provide opportunity for service users to add any comments or suggestions they may have regarding the standard of service provision. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 3 3 3 Standard No 22 23 Score 2 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X 3 X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 X X 3 X 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mount Lodge Score 3 3 X x Standard No 37 38 39 40 41 42 43 Score 3 3 2 X X 3 X DS0000021169.V249174.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 6 Regulation 15 (2) (b) Requirement Timescale for action 30/09/05 2 30 23 (2) (d) 3 39 24 (1) (3) It is required that the service users’ individual care plans, including risk assessments, be regularly reviewed and updated to reflect any change in needs or circumstances. It is required that all parts of the 31/10/05 home, including service users’ rooms are kept clean, hygienic and reasonably decorated. It is required that an effective 31/10/05 quality assurance and monitoring system be implemented, based on seeking the views of service users. (Previous timescale of 30.06.2005 not met.) 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 22 Good Practice Recommendations It is recommended that the complaints policy and procedure be reviewed and amended to provide service specific details, relating to Mount Lodge. DS0000021169.V249174.R01.S.doc Version 5.0 Page 23 Mount Lodge 2 3 24 39 It is recommended that service users be supported, where appropriate, to maintain their room to a satisfactory standard of cleanliness and hygiene. It is recommended that satisfaction questionnaires provide service users with the opportunity to comment or make suggestions regarding their service provision. Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection East Sussex Area Office 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. Extracts may not be used or reproduced without the express permission of CSCI Mount Lodge DS0000021169.V249174.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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