Inspection on 22/02/06 for Nickleby Lodge (Welcome House)

This inspection was carried out on 22nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nickleby Lodge (Welcome House) 28/06/07

Nickleby Lodge (Welcome House) 22/06/06

Nickleby Lodge (Welcome House) 29/11/05

Nickleby Lodge (Welcome House) 16/06/04

Nickleby Lodge (Welcome House) 23/02/04

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

CARE HOME ADULTS 18-65 Nickleby Lodge (Welcome House) 32 The Close Rochester Kent ME1 1SD Lead Inspector Sarah Montgomery Unannounced Inspection 22nd February 2006 16:00 Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 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 Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 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. Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Nickleby Lodge (Welcome House) Address 32 The Close Rochester Kent ME1 1SD 01634 843372 01634 827481 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) Dr Toqeer Aslam Tina May-Boughton Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2005 Brief Description of the Service: Nickleby Lodge is a registered care home for ten adults with mental health difficulties. The premises are a three-storey property which has been modernised and adapted for its present use. There is provision for six of the service users to have their own bedroom. The remaining four people are accommodated in two shared occupancy bedrooms. All of the bedrooms have a private wash hand basin. The property is located in a quiet residential street and it is within normal walking distance of various shops. Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by Sarah Montgomery (regulation inspector) and John Walker (Regulation Manager). The manager was present throughout the inspection. Evidence was gathered by talking with staff, service users, and reading of documents. What the service does well: What has improved since the last inspection? What they could do better: The home needs to implement improvements in collating pre assessment documentation, and in the writing of care plans and risk assessments. Staffing at the home is very low, and service users assessed needs are not being met. Staffing shortfalls have an impact on service delivery, and this shortfall must be addressed as a matter of urgency. Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 6 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. Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 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 Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 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 and 3. Service user care may be compromised due to insufficient recording of individual’s aspirations and needs during assessment. EVIDENCE: A pre assessment of a recently admitted service user was inspected. Information in the assessment documents was minimal, and most of it was blank. Shortly after moving to the home, the service user was admitted to hospital for a period of ten weeks due to a relapse with his mental health. On being discharged from the hospital, the home could not evidence any subsequent assessment, nor have any care plans or risk assessments been generated to date. The inspectors noted that prior to moving to the home, the service user did have a professional review and notes from this indicated support was needed regarding depression and anxiety. Aside from not having an assessment, this service user did not have any care plans or risk assessments. The inspection also evidenced that staff meetings are infrequent, with the home only holding one meeting in 2005, and to date have had one meeting this year. Staffing levels at the home are low. From 9am until 5pm (Monday to Friday) two members of staff are on duty. From 5pm until 9am the following morning, one member of staff is on duty. One member of staff is on duty at the weekends. Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 9 Given all the above information – lack of assessment, absence of care planning, absence of risk assessments, low levels of staffing, and no regular forum for staff to meet and discuss practice, inspectors conclude that the home cannot demonstrate that they have ensured that service users are cared for appropriately, with staff being knowledgeable about their assessed needs, or that they are working with the service user in a planned way, in conjunction with care plans and risk assessments. The home are not meeting national minimum standards or complying with Regulation with regard to assessment of service users. Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 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 and 9. Service users cannot be confident that their assessed and changing needs and personal goals are reflected in their individual plans, nor can they be confident that they will be supported to take risks as part of an independent lifestyle. EVIDENCE: Care plans inspected were considered to be too general, and did not sufficiently address ways in which service users were to be supported to achieve goals and aspirations. An example of this is a care plan which stated; ‘encourage (service user) to be as active as possible, encourage to obtain living skills, encourage to lead as normal life in all areas as possible’. The care plan is not supported by an assessment, which demonstrates the service users strengths in the areas identified for support. Staff are not given clear guidance as to what areas in (for example) living skills the service user has already gained. There are no explanations of what support is required, or how the service user prefers to be supported. Of the care plans sampled for inspection, inspectors also read the service users care notes. Inspection of these documents evidenced that care notes do not reflect the goals identified in care plans or risk assessments. All entries were general comments and many said ‘(service user) was very helpful this Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 11 evening’. Care notes should contain indicators of the service users assessed needs, and be able to demonstrate clearly that care plans and risk assessments for each service user is a natural part of their every day lives, and that their support needs are being addressed daily by staff working at the home. Risk assessments inspected were also considered ineffective. Inspectors were unsure (due to lack of information available in assessments) whether the home was fully aware of individual service users risks. Risks that were recorded were similar to care plans, in that, no description of support needs regarding managing the risk was noted. One risk assessment stated the risk as ‘aggressive behaviour due to alcohol abuse’. However, no guidelines or method of support needs regarding either the alcohol abuse or aggressive behaviour were noted. Inspectors noted that the service user for whom the above risk assessment was written, has been assessed by Welcome House as needing two hours care per day. Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 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): THESE STANDARDS WERE NOT INSPECTED. EVIDENCE: Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 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): THESE STANDARDS WERE NOT INSPECTED. EVIDENCE: Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 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): THESE STANDARDS WERE NOT INSPECTED. EVIDENCE: Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 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): 26 and 28. Service users benefit from living in a homely, comfortable and safe environment. EVIDENCE: While inspecting communal areas and some bedrooms, inspectors spoke with several service users. All service users spoken with were happy with the environment, and felt comfortable and ‘at home’. They spoke warmly of staff and inspectors observed good relationships between staff and service users. Inspectors found all areas to be comfortable and homely. Bedrooms were clearly decorated according to individual’s wishes and tastes. The home was clean, and service users were proud of where they live. Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 16 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): 33 and 34. Service users are not supported by an effective staff team. Service users cannot be confident they are protected by the home’s recruitment policy and practices. EVIDENCE: The current staffing hours allocated to Nickleby Lodge are 22 hours per day Monday to Friday, and 14 hours per day Saturday and Sunday. A total of 138 hours per week. The home is registered for 10 service users. Figures from the Residential Forum for this number of service users in a registered care home providing support to service users with mental health issues are 216 per week. The home is running a deficit of 78 hours per week. This deficit is equivalent to two full time staff members. Evidence gathered during the inspection indicate that service users needs are not being met. Service users are not being adequately assessed, care plans and risk assessments are vague, and the home cannot demonstrate that individual service users are being supported to achieve goals and aspirations. Two staff files were inspected. One file met requirements. The other file gave inspectors cause for concern, as references were incomplete; one reference was on file. This was a verbal reference. No other references were available. The home is required to ensure they are in receipt of written references prior to employees being offered employment. Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 17 Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 18 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): 38. Service users benefit from having a manager who is committed to the home and to providing care and support, but cannot be sure that this is achieved because of overall shortfalls in management of the service. EVIDENCE: The manager was present throughout the inspection. She demonstrated a commitment to providing care and support to service users at the home. She is knowledgeable about their needs, and is competent in working within recognised systems and guidelines. Evidenced gathered during the inspection indicated that service delivery is compromised because of insufficient staffing. Service users are not receiving adequate care or support to lead valued and fulfilling lives. Staff evidently work hard, but do not receive adequate support to enable them to fulfil requirements in Regulation or to fulfil the terms of the Welcome House business plan. Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 19 Shortfalls in staff numbers must be rectified. Without an adequate staff team who are suitably trained, the home will not be in a position to properly support individual service users in line with National Minimum Standards and Care Home Regulations. The Commission requires the registered provider to undertake a review of the home, and to prepare a formal report for the Commission. Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 20 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 1 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 3 27 X 28 3 29 X 30 x STAFFING Standard No Score 31 X 32 X 33 1 34 1 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 X X 1 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X X x X X X X X Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 21 No. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14(1)(a) 14(1)(b) Requirement The registered person shall not provided accommodation to a service user at the care home unless, so far as it shall have been practicable to do so – (a) needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; The registered person shall not provided accommodation to a service user at the care home unless, so far as it shall have been practicable to do so – (c) there has been appropriate consultation regarding the assessment with the service user or a representative of the service user; The registered person shall ensure that the assessment of the service user’s needs is – (a) kept under review; and (b) revised at any time when it is necessary to do so having regard to DS0000028989.V285912.R01.S.doc Timescale for action 30/04/06 2 YA3 14(1)(c) 30/04/06 3 YA3 14(2)(a) 14(2)(b) 30/04/06 Nickleby Lodge (Welcome House) Version 5.1 Page 22 4 YA3 14(1)(d) any change of circumstances. The registered person shall not provided accommodation to a service user at the care home unless, so far as it shall have been practicable to do so – (d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall – (a) make the service user’s plan available to the service user; (b) keep the service user’s plan under review; The registered person shall – (c) where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; and (d) notify the service user of any such revision. The registered person shall ensure that the care home is conducted so as – (a) to promote and make DS0000028989.V285912.R01.S.doc 30/04/06 5 YA6 15(1) 30/04/06 6 YA6 15(2)(a) 15(2)(b) 30/04/06 7 YA6 15(2)(c) 15(2)(d) 30/04/06 8 YA6 12(1)(a) 12(1)(b) 30/04/06 Nickleby Lodge (Welcome House) Version 5.1 Page 23 9 YA9 13(4)(b) 13(4)(c) 10 YA33 18(1)(a) 11 YA34 19(1)(b) proper provision for the health and welfare of service users; (b) to make proper provision for the care, and where appropriate, treatment, education and supervision of service users. The registered person shall 30/04/06 ensure that – (b)any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c)unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. 30/04/06 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users – (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person shall not 23/02/06 employ a person to work at the care home unless – (b)subject to paragraph (6), he has obtained in respect of that person the information and documents specified in – (i) paragraphs 1 to 7 of Schedule 2. Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Nickleby Lodge (Welcome House) DS0000028989.V285912.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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