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

This inspection was carried out on 22nd June 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 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) 22/02/06

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 Mark Hemmings Unannounced Inspection 22nd June 2006 10:00 Nickleby Lodge (Welcome House) DS0000028989.V300833.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 Nickleby Lodge (Welcome House) DS0000028989.V300833.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. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 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) Welcome House Residential Care 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.V300833.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 2006 Brief Description of the Service: Nickleby Lodge (the Home) is registered to provide accommodation and personal care services for up to 10 adults (service users), who have difficulties with managing aspects of their mental health. 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. The Home is owned and operated by Welcome House. This is a private company which operates a number of similar residential care services in the general area. The Responsible Individual is Dr Aslam. The Registered Provider supplies information to prospective service users through a variety of routes. These include the provision of a Service Users’ Guide. This is a brochure which outlines the principal features of the facilities and services available in the Home. Also, the Registered Provider ensures that a copy of the most recent Inspection Report from the Commission is available for reference in the Home if requested. The Registered Provider has informed the Commission that the current fee it charges for residence in Nickleby Lodge is £540.00 per week. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Report has been based upon a number of sources of evidence. These included a review of the correspondence in relation to the Home received by the Commission since the last inspection visit. Another source of evidence involved any written information received from service users, from their relatives and from social workers (care managers). Also, the Lead Inspector and another Regulation Inspector (Mr J Harris) completed an unannounced site visit to the Home. This took about six hours to complete. During this time, the Inspectors spoke in some detail with six of the service users. Some of these discussions were in private. The Inspectors also joined a number of the service users for lunch. The Inspectors spoke with the Registered Manager, with the Deputy Manager and with two of the support workers. Also, they met with the Responsible Individual and with two members of the Registered Provider’s senior management team. The Inspectors examined various parts of the accommodation and they reviewed a selection of the key records and documents. The Inspectors conclude that the Registered Provider generally operates the Home so as to provide the service users in residence with access to the resources they need to enable them to lead normal everyday lives. However, there are several omissions which might impact adversely upon service users and so which need to be addressed. There are seven Required Developments and four Recommended Developments at the end of this Report. With respect to the former of these, the Registered Provider should submit to the Commission a written Action Plan. This should state what has been done and what will be done to ensure that the Registered Provider complies fully with the Required Developments specified in this Report. The Commission should receive this Action Plan by 1 August 2006. The Inspectors note that the Registered Provider accommodates in the Home four service users who are older people. It is understood that the Registered Provider is in the process of clarifying what steps now need to be taken in order to ensure that its registration reflects appropriately this category of its provision. What the service does well: Service users said that the Home provides them with a relaxed and generally comfortable setting within which to make their home. They observed that they receive all the assistance they need. Also, they said that the support workers are attentive and kind in their manner. The Inspectors think that the Home generally is administered so as to enable service users’ needs for support to be met. They were impressed with the confident informality which characterised Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 6 the interactions they observed between the support workers and the service users. It was noted that the service users are assisted to receive promptly any medical attention which might be needed. The service users are provided with adequate and varied meals. What has improved since the last inspection? What they could do better: The Inspectors noted there to be specific omissions in one service user’s individual plan of care. This was noted to be reflected in some uncertainty about what assistance was going to be provided and when. In these situations there is a greater chance that something important for the welfare of a service user, will get missed or will be completed incorrectly. Also noted, were omissions in the system used to administer a medicine for one of the service users. Again, this is important because the lack of a clear framework is one of the things which can lead to medicines being administered in the wrong way. The Inspectors noted that the Registered Provider does not provide support workers with formal professional supervision. This means that at the moment, they do not get the chance to take time out to reflect upon their work and to receive advice from someone senior. This is important given the complexity of some of the assistance they provide and the need to coordinate this provision carefully within the staff team. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 7 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.V300833.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. There are systems in place to ensure that prospective service users and their representatives have their needs assessed. EVIDENCE: The Inspectors noted that there had not been any new admissions to the Home since the last inspection visit. Therefore, it was not possible for them to assess the practical application of the various systems adopted by the Registered Provider to establish the suitability of the Home for prospective service users. However, they noted that the Registered Manager is aware of the need to give this matter careful consideration. This is so that a new service user’s needs for support, can be met reliably from the start of their period of residence. The Registered Manager was observed to be familiar with the principal subjects to be considered and it was noted that the Registered Provider has prepared a form which has been designed to guide and to record the process. The Registered Manager said that she informs support workers about the needs of new service users by asking them to read the information she has collected. Also, they are asked to review information received from the relevant care manager (social worker). In addition to this, she said that she briefs support workers orally so that they can clarify any points of detail as may be necessary. The support workers confirmed this account and they said Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 10 that they consider themselves to have been informed adequately about the needs of service users admitted in the past. The Inspectors asked some of the service users about the arrangements made when they moved into the Home. They considered that their needs for assistance had been met from the start and that this provision had been in line with their expectations. The Registered Manager said that she is confident that the current team of support workers based in the Home, has the range of skills and knowledge necessary for it to support the service users in residence. With the exceptions noted elsewhere in this Report, the Inspectors broadly noted evidence which was consistent with this account. The Registered Manager was noted to be aware of the various sources external to the Home from which specialist advice can be sought, should the need arise. The Inspectors reviewed evidence which showed that some of this advice had been accessed by the Registered Manager in a timely manner since the last inspection visit. The Commission has not received since the last inspection visit, any expressions of concern from the various local mental health services about any aspect of their working relationships with the Home. Nickleby Lodge (Welcome House) DS0000028989.V300833.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 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. The health and personal care which service users receive, is based upon their individual needs and generally is appropriate. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The Inspectors noted there to be various systems in place to enable each service user to liaise with support workers in order to identify and to plan for the provision of the assistance they need. These measures include the preparation for each person of a written individual plan of care. The service users said that they had been involved adequately in the preparation of their individual plans and also that they had been invited to contribute to their occasional review. The Inspectors examined selected elements of two of the plans to see if particular items had been considered in adequate detail. The adequacy of the information was found to vary and in some places it was noted to be rather thin. In these places, more detail would have produced a more definite account of the subject in hand. Also, it might indicate the need for more (or different) Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 12 assistance to be provided. There were two specific omissions in relation to Service User A. This is important because the absence was reflected in the fact that the service user in question was not quite sure about the assistance he would receive in relation to this matter. Also, there was some uncertainty on the part of the staff team about the response which was supposed to be offered to the matters in question. The Registered Provider should address this matter within the timescale established in the relevant Required Development listed at the end of this Report. More generally, the Inspectors noted that the plans did not always give sufficient weight to the need to consider and reflect service users’ aims and ambitions. This is important, because without this perspective, written plans can just become about how things are now rather than what might be achievable in the future. Previously, the Registered Provider has said that all of the plans are to be reconsidered as part of an exercise which will see the adoption of a new and more easy-to-follow layout. Given the categories of omissions and the specific omissions noted, the Inspectors think that this will be a worthwhile exercise and they will examine its results when they are in the Home next. The Registered Manager anticipated that the exercise would be completed by 1 September 2006. There is a recommended development in relation to this matter listed at the end of this Report. The Inspectors noted that the support workers keep diary records of how things are going in the Home. These records are important because they can reveal patterns in how someone is doing which can be useful both for the person concerned and for support workers. The Inspectors examined a selection of the entries, some of which were noted to be rather brief. However, the support workers were able to give a much more detailed account and plainly they carry successfully a lot of information in their heads. There is a balance to be struck here about the amount of this information which needs to be recorded. The Inspectors spoke with support workers about various elements of the support provided for some of the service users. They were noted generally to have an adequate knowledge of the material in question. The Inspectors observed episodes when they assisted some of the service users. Their practice was noted to be appropriate and to be consistent broadly with the Registered Provider’s assessment of the needs to be met. The Inspectors understand that none of the service users are assisted directly by the Registered Provider to manage their financial affairs. What assistance they do receive, is provided by family and by advocates. It is a good idea to keep these functions separate like this, so that registered providers do get involved in more areas of a service user’s life than is necessary. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 13 The Registered Manager said that support workers assist some of the service users to manage their weekly spending allowance. She said that this is done to help ensure that monies do not get mislaid and that people have enough to last them through the week. The Inspectors think that this is a reasonable and helpful thing to do. They sample checked some of the records kept of the various transactions involved and things were found to be in order. Service users said that they are satisfied with this aspect of the assistance they receive. The Registered Provider is responsible for assisting the service users to avoid undue risks to their wellbeing. The Inspectors noted that the Registered Provider uses a system which involves each service user liaising with support workers to identify potential risks so that they can be managed effectively. The Inspectors examined a selection of the written records which summarise this process. In general, they were found to describe an adequate arrangement. This, in that particular risk situations were identified and in that basic information was given about the response to be provided. The Inspectors noted that some of the risk assessment process seemed to have been completed informally without being recorded as such. The Inspectors accept that not everything can or should be written down. However, the Registered Provider will need to keep under review the adequacy of the balance achieved in the Home. This, to ensure that organised provision has been made in relation to significant risks. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 14 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 and 17. Quality in this outcome area is adequate. This judgement is made using available evidence including a visit to this Service. Service users are able generally to choose their life style, social activities and to keep in touch with family and friends. Service users receive a healthy and varied diet according to their requirements and choice. EVIDENCE: Most of the service users undertake a range of activities each week, some of which have an explicit vocational element. The service users who spoke with the Inspectors about this matter, said that they are satisfied in general with their respective calendars of activities. However, there were some comments to the effect that they would like to do rather more things than they do at the moment. The Registered Manager said that for each of the service users there is a written calendar which lists the commitments they have chosen to attend most weeks. The Inspectors examined various parts of these written calendars, within the context of the need to have a sensible balance between doing things and being at home. The Inspectors did consider that some of the calendars Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 15 were rather limited in that a more extensive range of opportunities should have been offered. The Registered Manager said that the calendars have not been reviewed for some time. As noted earlier, she reported that they would be revisited as part of the more general reconsideration of each service user’s individual plan of care. There is a recommended development in relation to this latter matter listed at the end of this Report. The Inspectors observe that enhancements to this aspect of the calendars may require the provision of additional staffing resources, if service users are to be assisted to undertake more activities. The Inspectors noted that most of the service users leave the Home regularly in order to do various things such as going to shops and visiting friends. The service users said that they are satisfied with the degree to which they can access the local community if they wish to do so. Part of the calendars referred to above, identifies the everyday household activities and leisure pursuits undertaken by each of the service users. Some of the service users said that they are satisfied with the way they undertake these activities. However, others said that in the absence of gentle encouragement they can spend rather too much time at home doing not that much. Some of the written calendars seemed to reflect elements of this vagueness. Consequently, the Registered Manager should return to this matter as part of the review noted above. There is a recommended development in relation to this latter matter at the end of this Report. Again, the Inspectors note that enhancements to this aspect of the calendars may require the provision of additional staffing resources, if service users are to be assisted to undertake more activities. The service users said that support workers assist them to keep in touch with members of their families. This includes helping them to use the telephone and to engage in written correspondence. The Inspectors reviewed the circumstances of the service user who presently has the least such contact. They are satisfied that the Registered Manager has kept the matter under review and that the service user in question remains content with the contacts that are available at the moment. The service users said that the support workers are kind and approachable in their manner. Also, they observed that support workers are not intrusive and that they respect their needs for private space. During the course of the site visit, the Inspectors had the opportunity to observe a number of instances when support workers interacted with service users. They noted these events to be characterised by a quiet but confident informality. This was consistent with the service users’ accounts. Also, the Inspectors recognise it to constitute good care practice because it acknowledges service users’ simultaneous needs for both independence and support. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 16 The service users said that they are provided with suitable meals. The Inspectors joined some of them for lunch and they noted the meal served to be adequate in quantity and quality. The mealtime itself was a relaxed affair with service users dining at their own pace. There was no sense of them being rushed or overly organised. The Registered Manager said that the Registered Provider gives the Home sufficient funds to purchase supplies and the Inspectors noted the larder to be adequately stocked. The record of food provided in the Home was consistent with the Registered Manager’s account that the service user are offered the opportunity to have a normally balanced diet. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 17 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 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. Service users’ emotional, physical and health care needs are met. Service users generally are assisted to take medicines in the correct manner. EVIDENCE: The service users said that the pace of daily life in the Home is relaxed without there being any unnecessary rules to disturb their experience of a normal domestic setting. They observed that within reason, they can decide on the pattern of their day. They spoke about things such as them being free to decide when to retire to their bedroom and choosing what clothes to wear. The Registered Manager said that the support workers keep a tactful eye open so that service users can be assisted to seek and to follow medical advice should it be needed. The Inspectors reviewed the arrangements which had been implemented since the last site visit to assist one of the service users to access medical attention. They noted that suitable provision had been made available to ensure that the person concerned attended various medical appointments. Also noted, was the way in which support workers had discreetly monitored his health in between times. The Inspectors note that the Commission has not received since the last inspection visit, any expressions of Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 18 concern from the local primary health care team about its working relationship with the Home. The Inspectors noted that all of the service users have elected to have support workers retain and dispense their medication. The Inspectors think that this is a reasonable arrangement given the interests of the people concerned. The Inspectors examined a selection of the administrative arrangements operated by the Registered Provider in relation to this task. They were noted generally to work sensibly so as to ensure that service users take medicines in the manner intended. However in relation to Service User A, there was some confusion about the way in which a particular medicine should be administered. The written administration instructions and the records of the medicine’s use, were contradictory. There was not any real evidence that the service user had given his assent to the use of the medicine. This is very important because the preparation in question is something which can alter someone’s mood and disposition. The Registered Provider should address this matter within the timescale established in the relevant Required Development listed at the end of this Report. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 19 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 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. Service users have an effective complaints procedure and they are protected from abuse. EVIDENCE: There is a complaints procedure which explains how service users and other stakeholders can make a complaint about any aspect of the facilities and services provided in the Home. Service users said that they are confident that any matter they raise will receive serious attention and that if possible they will be addressed. The Registered Manager said that the Registered Provider operates various systems which should enable all complaints to be investigated promptly and fully. The Inspectors noted that the Registered Provider had not received a formal complaint since the last site visit. Therefore, it was not possible for them to determine how well these systems will work in practice. The Commission has not received any complaints in relation to the Home, since the date of the last inspection visit. The support workers were noted to have a reasonable understanding of what constitutes good care practice. As part of this, they were aware of the need to be alert to instances which might jeopardise the well-being of a service user. None of them said that they had witnessed anything in the Home which had given them cause for concern. They were less confident about the agencies external to the Registered Provider to whom referral could be made if they were to become concerned about someone’s wellbeing. The Registered Manager said that she would address this omission. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 20 The service users said that they feel safe living in Nickleby Lodge. They observed that they are confident that support workers will act in their best interests. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 21 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, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. The physical layout of the Home enables service users to live in a generally well-maintained and comfortable environment, which promotes independence. EVIDENCE: Service users said that they are comfortable living in Nickleby Lodge. The Inspectors noted that in general the accommodation is welcoming and pleasant. However, there were some defects to note. These included quite obvious things, which really should have been identified and corrected long before the inspection visit. For example, one of the toilets seat was damaged and looked to be most unsightly. Also, the Inspectors were disappointed to note that there was not any soap or towels provided in some of the toilets and bathrooms. The Registered Provider should address these matters within the timescale established in the relevant Required Development listed at the end of this Report. A tour of the premises was conducted during which a number of service users agreed to show their bedrooms to the Inspectors. All of the rooms viewed, had sufficient and good quality furniture and fittings, which met the needs of the individuals. Service users confirmed that their bedrooms are comfortable Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 22 spaces and that they are happy in their current accommodation. Two of the bedrooms are shared currently. In discussion with the service users who share these rooms, it was clear that this is a satisfactory arrangement. However, it was noted that both of the shared bedrooms are relatively small for their purpose. The Responsible Individual was advised that should the occupancy of these rooms change, due consideration should be given to the continuing use of these rooms for shared occupancy. There are sufficient toilet bathroom facilities throughout the home, which are adequate to ensure that the needs of service users are met. There are toilets and bathrooms on each floor, which means that they are situated conveniently. The bathrooms were noted to be clean and hygienic. The home has the benefit of a large lounge/dining room which is comfortable and homely. One of the service users stated that they are happy with the new dining furniture that has recently been purchased. There is a small room on the first floor which is available for private meeting and has a telephone available for private calls. There is a designated smoking room which is annexed off the ground floor lounge. The Inspectors understand that the Kent Fire and Rescue Service has said that the Registered Provider has installed sufficient equipment in the Home to help prevent the occurrence of a fire safety emergency and to respond effectively to one should the need arise. The Inspectors understand also that the Home complies with the principal requirements of the local Department of Environmental Health. The Registered Manager said that none of the people currently in residence, experience significant difficulties with getting about. The support workers confirmed this account, as did the Inspectors’ own observations. The Registered Manager said that she is aware of the need to keep this matter under review. This is so that suitable provision can be made promptly to assist someone, should the need arise. The service users said that support workers assist them to put their clothes in the washing machine, to dry them and to iron them. The Inspectors noted that the service users were dressed appropriately in clothes of their own choice. The Inspectors examined the laundry facilities. These were noted to be adequate given the size of the Home. All residential care homes now need to comply with revised regulations which have been introduced to help better ensure the purity of drinking water. In particular, the new provisions are intended to prevent water syphoning back from items such as washing machines into the main pipe-work. The Inspectors understand that the Registered Provider has completed the work necessary to ensure that the Home complies in relation to this matter. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 23 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, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. Support workers are skilled sufficiently. Generally, they are present in suitable numbers to enable service users to receive the main assistance they need. EVIDENCE: Of the four support workers employed in the Home, two have acquired a National Vocational Qualification (NVQ) in health and social care. This Award is useful because it provides support workers with a range of opportunities to confirm elements of good care practice and to extend their range of skills. The Inspectors understand that the Registered Provider intends to continue to encourage additional support workers to study for the Award. There is always a staff presence in the Home. The support workers are expected to work across roles and so they undertake both catering and housekeeping duties. The Registered Manager said that there are not any vacant posts in the Home and that the staff team is of a sufficient size to enable all of the shifts indicated on the roster to be filled. The Inspectors generally confirmed this account by examining the roster and by speaking with the support workers. As noted earlier in this Report, service users generally observed that they receive all the assistance that they need from support workers. The Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 24 Responsible Individual and the Registered Manager said that they consider that sufficient support workers are present in the Home. The Inspectors are much less confident about this conclusion. As noted earlier, they think that more staff resources may need to be made available to support the additional elements of one-to-one work which the review of the service user planning function might identify. Also to be considered, are the consequences of what might be the enhancements made to the calendars of vocational and social activities. Developments here may also require the provision of additional staffing resources. Previously, the Registered Provider has said that it is aware of these potential pressures upon the current deployment of staff in the Home and that this will be kept under review. The Inspectors agree with the need for this to be done. There is a recommended development in relation to this matter listed at the end of this Report. Having said all of this, the Inspectors noted that the evidence to hand currently is consistent with the conclusion that the Home is staffed adequately to enable its present operation to be sustained. The Registered Provider completes a number of security-related checks. These are designed to ensure that all members of staff employed in the Home are suitable to be entrusted with access to service users who may be vulnerable. The Inspectors examined aspects of the security checks which the Registered Provider has recorded as having been completed in relation to several of the support workers. Things were found to be in order. The Registered Manager said that all new support workers receive introductory training. This is designed to ensure that they have the basic knowledge and skills they need in order to be able to work without direct supervision. This is important because the quality of care which service users can expect to receive, depends largely upon the competencies which support workers can invest in the completion of their duties. The Inspectors examined the records of the induction training provided for several of the support workers. These indicated that most of the training subjects were completed on one day. Previously, the Registered Provider has accepted that this is not a particularly helpful system. This is because of the sheer volume of the information to be imparted and because of the complex nature of some of the subjects involved. It has been agreed that the induction system will be revised within the context of a new national model of good practice. This will entail the list of the subjects covered in the induction, being revised and extended. Also involved, will be the introduction of a more clear system by means of which to confirm the way in which judgements are reached about competence in each particular subject. Lastly, the induction process will be achieved within a more reasonable timescale of weeks rather than a single day. The Registered Provider has said that the development of the induction arrangements will be completed by 1 October 2006. There is a recommended development in relation to this matter listed at the end of this Report. The Inspectors will return to this matter to see what progress has been made when they next call to the Home. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 25 In addition to the introductory training, existing support workers undertake a number of training courses. These are designed to enhance their capacity to deliver care. The system used to organise the delivery of this training was noted to not be that well organised. The Inspectors noted that some of the support workers had not completed various of the training courses which the Registered Provider itself considers to be mandatory. The Responsible Individual said that the Registered Provider is aware of the specific responsibility placed upon it to ensure that all support workers are confirmed as having the skills they need to enable them to support effectively the service users currently in residence. In connection with this, the Responsible Individual said that the Registered Provider would ensure that the omissions noted above are rectified. There is a recommended development in relation to this matter listed at the end of this Report. The Inspectors understand that in addition to the receipt of training, each support worker completes an extended competency appraisal exercise. This is done to double check the adequacy of their knowledge and skills. In-spite of the omissions noted above, the Inspectors can conclude that the assistance they witnessed service users to receive, was provided in an appropriate and competent manner. The Inspectors noted that the support workers receive a good deal of informal guidance and assistance from the Registered Manager and from the Deputy Manager. However, this is not complemented by a system of formal supervision. This is an important omission because the support workers should be able to take time out, having planned sessions with someone senior to review their work and to iron out any problems should there be any. The Inspectors think that the delivery of this supervision is especially important in Nickleby Lodge, given the complexity and the subtlety of some of the support which the service users need. The Registered Provider should address this matter within the timescale established in the relevant Required Development listed at the end of this Report. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 26 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 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. The management of the Home is effective generally. There is a basic quality assurance system. EVIDENCE: The Registered Manager has been in post for some years now and she has acquired the formal qualifications which are required by the Standards. The Inspectors noted her to have a good grasp of the how the Home runs in practice. This is very important because managers need to know what is going on if they are to provide the effective guidance and direction which support workers need. The Registered Manager currently oversees the operation of another of the Registered Provider’s care homes in addition to the completion of her duties at Nickleby Lodge. The Inspectors will keep this arrangement under careful review. This will be done to ensure that the Registered Manager’s time does not become stretched too thinly, so that she can retain her command of the detail noted above. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 27 The Inspectors understand that a representative from the Registered Provider calls to the Home periodically to check out how things are going. The Registered Provider should have submitted reports of these visits to the Commission on a monthly basis. The Inspectors noted that copies of these reports were not submitted to the Commission between September 2005 and April 2006. Plainly, this is not satisfactory. The Registered Provider should address this matter within the timescale established in the relevant Required Development listed at the end of this Report. Service users said or indicated, that the Home is run without there being any intrusive rules or routines. This means that they can continue to experience a normal home life of their choosing. The Registered Provider operates a formal system by means of which service users are invited to comment about their home. This involves them completing questionnaires. However, the arrangements are not that well organised in that the questionnaires seem to have been given out as and when. Also, in that there is not a clear system to examine the responses given so that they can be taken forward. The Registered Provider needs to develop the system further. In particular, there should be an ongoing consultation exercise which involves each service user being asked to comment upon their home. The methods used to enable this process to be completed, should be designed specifically around the needs and interests of each person. The results of each annual round of consultations should be summarised in a written Quality Report. This Report should explain the Registered Provider’s proposed responses to any suggested improvements. Its contents should then be fed back to service users. This is necessary because people have the right to know what will be done in order to respond to their contributions. The Responsible Individual said that the Registered Provider was in the process of addressing this matter and he anticipated that it would be completed within the timescale established in the relevant Required Development listed at the end of this Report. The Registered Manager said that all items of equipment in use in the Home remain in good working order. The Inspectors reviewed a selection of items such as maintenance and servicing documents. They did not identify any information which led them to question further this statement. The Inspector noted that the Registered Provider since the last inspection visit, has completed all of the various checks which are designed to ensure that the Home’s fire safety equipment remains in a suitable operational condition. Naturally, it is essential that all of the various components of the system work reliably in the manner intended. The Registered Provider does not operate a system which is designed to confirm regularly that all members of staff know how to operate correctly the Home’s fire safety regime. This is important because the actions taken by members of staff, determine largely the level of fire safety protection provided in the Home. The Responsible Individual said that the Registered Provider Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 28 already had undertaken some work in relation to this matter. He said that this would be completed within the timescale established in the relevant Required Development listed at the end of this Report. The Registered Manager said that the Registered Provider monitors the premises so that potential hazards to health and safety can be identified and resolved. The Inspectors examined various parts of the premises. They did not notice any obvious hazards which led them to question further the Registered Provider’s reported assessment. Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 29 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 X 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 1 X X 2 X Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes (please see below) 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 YA6 Regulation 15 Requirement The Registered Provider should correct the two omissions noted to be present in the service user planning system relating to Service User A. The revised information should be shared with the service user and with the support workers (the need to operate a suitable system for evaluating service users’ needs for assistance and for planning a response to these, was identified at the time of the last inspection visit). The Registered Provider should address the omissions in the arrangements used in relation to Service User A, to administer one of his medicines. The Registered Provider should, 3.1 replace the damaged toilet seat and 3.2 ensure that adequate hand-washing facilities are provided in all of the toilets and bathrooms. Timescale for action 01/08/06 2. YA20 13 01/08/06 3. YA24 23 01/08/06 Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 31 4. YA39 26 5. YA39 12 6. YA42 23 7. YA36 18 The Registered Provider should ensure that it completes all of the monthly inspection visits to the Home, which are required by the Regulation. A copy of the subsequent Inspection Reports should be submitted to the Commission. The Registered Provider should strengthen aspects of the internal quality assurance system used in the Home. In particular, the following points should be addressed 1. appropriate methods should be introduced to enable all of the service users to comment meaningfully on the adequacy of their home 2. an annual Quality Report should be prepared which summarises the service users’ opinions and which gives the Registered Provider’s response to any suggested improvements 3. the Quality Report should be fed back to the service users so that they know what it going to be done to implement their suggestions. The Registered Provider should ensure that suitable provision is made to confirm that all members of staff know how best to avoid the occurrence of a fire safety emergency and that they know what to do should one occur. The Registered Provider should ensure that all of the support workers receive regular periods of formal professional supervision. 22/06/06 01/01/07 01/08/06 01/09/06 Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 32 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 YA6 Good Practice Recommendations The Registered Provider is recommended to complete as soon as possible, the programme which will see all of the service users’ individual plans of care reviewed and as necessary extended. This exercise should give focused consideration to the adequacy of the level of information carried in the various parts of the system. Also, it should include careful consideration of the adequacy of the calendars of vocational and social commitments undertaken. The Registered Provider is recommended to continue to give careful consideration to the adequacy of level of staff cover in the Home. This particularly is so in relation to those periods at the moment when there is a reduced staff presence. The Registered Provider is recommended to complete its planned improvement to the arrangements to be used to ensure the adequacy of the knowledge and skills of new support workers. The Registered Provider is recommended to progress its intentions to ensure that all of the current support workers receive tuition in all of the subjects prescribed for them. 2 YA33 3 YA35 4 YA35 Nickleby Lodge (Welcome House) DS0000028989.V300833.R01.S.doc Version 5.2 Page 33 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.V300833.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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