CARE HOME ADULTS 18-65
Narborough Lodge 504 Narborough Road Leicester Leicestershire LE3 2FU Lead Inspector
Chris Wroe Unannounced Inspection 5th September 2006 10:00 Narborough Lodge DS0000057109.V309543.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 Narborough Lodge DS0000057109.V309543.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. Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Narborough Lodge Address 504 Narborough Road Leicester Leicestershire LE3 2FU 0116 282 7337 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) Narborough Lodge Limited Alison Richardson Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (6) of places Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Registration condition Narborough Lodge Ltd is registered to only provide the service as outlined in their statement of Purpose/Service User Guide as agreed with the Commission for Social Care Inspection at the date of registration. 1st November 2005 Date of last inspection Brief Description of the Service: Narborough Lodge is a small care home for up to 6 adults who have learning disabilities and mental ill health. Everyone who lives in the home has their own bedroom. Bedrooms are on the first floor and ground floor of the house. All bedrooms are near bathrooms. The home is on Narborough Road, near to Fosse Park Shopping Centre. It takes about 30 minutes to go by bus to the city centre. There are some parking spaces in front of the home. The house has a big back garden. Basic fees for living in the home are from £380 to £480. Extra charges are made for hairdressing, chiropody, toiletries, and magazines and newspapers. Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection included a visit to the service. The inspector visited the home on 5th September 2006. The visit started at 4.00pm and lasted for three hours. All six residents were at home during the inspection. The inspector met with all residents, and spent more time talking with three residents. The main method of inspection used was ‘case tracking’. This means looking at the care given to residents in different ways. The ways this was done are: • talking to the residents • talking to staff • watching how residents are given support • looking at written records. Comment cards were sent out before the visit to the home, to people who live in the home, to ask them what they think about living there. Two comments cards were filled in by residents and sent back to the inspector. Comments cards were also sent to other people, like social workers and GPs. Two comment cards came back – one from a social worker and one from a clinical psychologist. Things the residents talked to the inspector about are included in the report. People who live in the home felt happy about the care they get. Some residents showed the inspector their bedrooms, and said they had everything they need. All the key standards were checked during this inspection. The information below is based only on those aspects checked in this inspection. Only six residents live in the home, so a lot of individual detail has been kept out of the report, to make sure it is kept confidential. What the service does well:
People who live in the home said they had a choice about whether they wanted to come and live there. Assessments are done, which give information about what someone needs before they come to live in the home. Staff have training to help them to make sure they can meet people’s needs when they move into the home. There are care plans in the home for each person who lives in the home. Care plans tell about what is important for each person. Staff know what each
Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 6 person who lives in the home needs, and about the things they like and don’t like. People who live in the home can choose things that they want to do. There are risk assessments in the home for each person. Risk assessments tell about how people who live in the home can be helped to do the things they want to do and be kept safe. People who live in the home can do different things. Some people go to college and some people go to day centres. Staff go shopping with people who live in the home. Everyone helps out with chores in the home, like washing up and keeping their bedroom tidy. People can have a key to their own bedroom. People who live in the home can see their family and friends when they want to. There are menus in the home, which show the different foods that are cooked. Everyone who lives in the home can choose what they would like to eat. Care staff cook meals for people who live in the home. Mealtimes are relaxed and friendly, and people who live in the home chat to each other. Staff help people who live in the home to look after themselves. Everyone has a GP nearby who they can see if they feel poorly. Staff are good at looking after people who live in the home, and making sure they ask the doctor for help if they need it. Medicines are kept safely in the home. Staff have had training to show them how to give out medicine. People who live in the home are mostly able to make choices about how they want to live their daily lives. Sometimes there are things that might need to be done to keep people safe, like being in at certain times of the day. Social workers or other people are involved in making agreements about this. There is information in the home, which tells people how they can make a complaint if they are not happy about something. Most people who live in the home feel able to talk to someone if they have a problem. People who live in the home have their own bank accounts. Staff make records about money that is spent to make sure everyone’s money is looked after. People living in the home have their own things in their bedrooms. The home is clean and comfortable. The staff in the home have worked there for a while and so they know people who live in the home well. Checks have been done to make sure staff are people who can be trusted. Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 7 Staff are given some training to show them how to do their job well. Staff feel that they are a good team. The manager has worked in the home for a long time so people who live in the home know her. There are different ways that people who live in the home can say what they think about the home. There are residents meetings in the home. Staff talk to people who live in the home about the things they like and don’t like. There are policies in the home, which tell staff about how to work safely. Staff do checks to make sure that equipment in the home is safe. What has improved since the last inspection? What they could do better:
It was not always clear in care plans whether they were changed if someone’s needs changed. It would be good if care plans are checked often and changes made if someone’s needs change. Some things that staff told the inspector, about risks for people who live in the home, were not written in the care plan or risk assessment. This means that there was not a proper plan about how to make sure residents are kept safe. It would be better if any problems were written about, so that everyone could be kept safe, and staff could be clear about how to deal with any problems. Staff said that one person needs to go to bed by nine o’clock because they need two members of staff to help them, and only one member of staff works in the home at night. It would be good if the manager could make sure that everyone who lives in the home is able to have a choice about when they want to go to bed, and that staff could meet their needs at whatever time they choose. One person said that they do not know who to complain to. It would be good if staff talk to everyone to make sure that they know who they can talk to if they are not happy about something. The home has to report anything serious that happens to the Commission for Social Care Inspection, but this has not always been done. It would be better if the manager makes sure that any serious incidents are reported. Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 8 There are some times when staff have to deal with difficult situations in the home. Staff have not been given proper training on how to handle difficult situations (sometimes called ‘challenging behaviour’) and how to make sure that they keep themselves and residents safe. The manager and owner should make sure that staff get proper training very soon. It would also be good if the owner and manager look at how to make sure staff and residents stay safe at night, when only one member of staff is on duty. Staff said they do not have keys to residents’ bedrooms, so if someone locks their door, they cannot get in. Staff need to be able to get into people’s bedrooms in case there is an emergency. The owner and manager should make sure staff can get into locked bedrooms if they need to. 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. Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 9 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 Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed and they are given choices about coming to live in the home. EVIDENCE: People who live in the home said they had a choice about whether they wanted to come and live there. One person said they were able to come and look at the home before they moved in. One person said they did not get enough information about what the home was like before they moved in. Assessments have been done, which give information about what someone needs before they come to live in the home. This helps the manager decide if the home is right for the person, and if staff can give the right support. Staff have training to help them to make sure they can meet people’s needs when they move into the home. Narborough Lodge DS0000057109.V309543.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual needs and choices are mainly met in the home. EVIDENCE: There are care plans in the home for each person who lives in the home. Care plans tell about what is important for each person. It was not always clear in care plans whether they were changed if someone’s needs changed. It would be good if care plans are checked often and changes made if someone’s needs change. People living in the home can see their care plans. Staff know what each person who lives in the home needs, and about the things they like and don’t like. Staff make sure other people, like social workers, keep in contact with people living in the home and know about what is happening. One psychologist who helps people living in the home said that staff listen to what they say about the best ways to support people. People who live in the home can choose things that they want to do. There are risk assessments in the home for each person. Risk assessments tell about how people who live in the home can be helped to do the things they want to do and be kept safe.
Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 12 Some things that staff told the inspector, about risks for people who live in the home, were not written in the care plan or risk assessment. This means that there was not a proper plan about how to make sure residents are kept safe. It would be better if any problems were written about, so that everyone could be kept safe, and staff could be clear about how to deal with any problems. People who live in the home said that they have choices about what they want to do each day. Narborough Lodge DS0000057109.V309543.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to have a good lifestyle. EVIDENCE: People who live in the home can do different things they want to do. Some people go to college and some people go to day centres. Staff go shopping with people who live in the home. Everyone helps out with chores in the home, like washing up and keeping their bedroom tidy. People can have a key to their own bedroom. People who live in the home can see their family and friends when they want to. One relative who was visiting the home during the inspection visit said that they like the home very much and could visit whenever the resident wanted them to. People who live in the home can also go and see their relatives and friends at their own homes. Staff said that one person needs to go to bed by nine o’clock because they need two members of staff to help them, and only one member of staff works
Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 14 in the home at night. It would be good if the manager could make sure that everyone who lives in the home is able to have a choice about when they want to go to bed, and that staff could meet their needs at whatever time they choose. There are menus in the home, which show the different foods that are cooked. Everyone who lives in the home can choose what they would like to eat. Care staff cook meals for people who live in the home. Mealtimes are relaxed and friendly, and people who live in the home chat to each other. Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 15 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, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents mostly have good personal and healthcare support in the home. EVIDENCE: Staff help people who live in the home to look after themselves. Everyone has a GP nearby who they can see if they feel poorly. Staff are good at looking after people who live in the home, and making sure they ask the doctor for help if they need it. Medicines are kept safely in the home. Staff have had training to show them how to give out medicine. Records are kept to show what medicines have been given to people. All records were well kept. People who live in the home are mostly able to make choices about how they want to live their daily lives. Sometimes there are things that might need to be done to keep people safe, like being in at certain times of the day. Social workers or other people are involved in making agreements about this. Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents mostly feel listened to in the home, and are mostly kept safe from harm. EVIDENCE: There is information in the home, which tells people how they can make a complaint if they are not happy about something. It has pictures to help people understand it, which is good. Most people who live in the home feel able to talk to someone if they have a problem. One person said that they do not know who to complain to. It would be good if staff talk to everyone to make sure that they know who they can talk to if they are not happy about something. Staff know they need to keep people who live in the home safe from harm. The home has to report anything serious that happens to the Commission for Social Care Inspection, but this has not always been done. It would be better if the manager makes sure that any serious incidents are reported. There are some times when staff have to deal with difficult situations in the home. Staff have not been given proper training on how to handle difficult situations (sometimes called ‘challenging behaviour’) and how to make sure that they keep themselves and residents safe. The manager and owner should make sure that staff get proper training very soon. It would also be good if the owner and manager look at how to make sure staff and residents stay safe at night, when only one member of staff is on duty. Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 17 People who live in the home have their own bank accounts. If staff support people and help them to buy things, receipts are kept. Staff make records about money that is spent to make sure everyone’s money is looked after. Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 18 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a good living environment. EVIDENCE: The inspector was shown around the home. People living in the home have their own things in their bedrooms. The home is clean and comfortable. People who live in the home think that the home is fresh and clean. One person said it smells nice. People who live in the home have keys to their own bedrooms. But staff said they do not have keys, so if someone locks their door, they cannot get in. Staff need to be able to get into people’s bedrooms in case there is an emergency. The owner and manager should make sure staff can get into locked bedrooms if they need to. Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from supportive staff. EVIDENCE: The staff in the home have worked there for a while and so they know people who live in the home well. Checks have been done to make sure staff are people who can be trusted. Staff are given some training to show them how to do their job well. Staff feel that they are a good team. There are two members of staff working in the home during the day, and one person working at night. Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 20 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, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from good management of the home. EVIDENCE: The manager has worked in the home for a long time so people who live in the home know her. There are different ways that people who live in the home can say what they think about the home. There are residents meetings in the home. Staff talk to people who live in the home about the things they like and don’t like. Staff have meetings to talk about working in the home and whether there are things that need to be done better. The manager meets with other managers so they can talk about good ways of caring for people, and share ideas. There are policies in the home, which tell staff about how to work safely. Staff do checks to make sure that equipment in the home is safe. Staff said that sinks in bedrooms are now safe, and there are checks done to make sure the
Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 21 water is not too hot. Staff have training to help them to work safely – like food hygiene training, so they know how to cook safely. Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 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. 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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. Refer to Standard YA6 YA9 Good Practice Recommendations It is recommended that care plans are reviewed regularly, and any changes in individual needs are recorded. It is recommended that risk assessments are prepared relating all aspects of risk identified regarding individuals living in the home. It is recommended that staffing arrangements allow for all residents to be able to choose when they wish to go to bed. It is recommended that all serious incidents affecting the wellbeing of residents are reported to the Commission for Social Care Inspection under Regulation 37, Care Homes Regulations 2001. It is strongly recommended that staff are provided with training about how to deal with ‘challenging behaviour’
DS0000057109.V309543.R01.S.doc Version 5.2 Page 24 3. YA16 4. YA23 5. YA23 Narborough Lodge including issues around restraint, in order that they are able to keep themselves and residents safe. 6. 7. YA23 YA24 It is recommended that the provider looks at ways in which to enable staff to feel safer at night in the home. It is strongly recommended that staff are enabled to have access to residents’ bedrooms in case of emergency. Narborough Lodge DS0000057109.V309543.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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