Inspection on 29/11/05 for Nickleby Lodge (Welcome House)

This inspection was carried out on 29th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Nickleby Lodge (Welcome House) 28/06/07

Nickleby Lodge (Welcome House) 22/06/06

Nickleby Lodge (Welcome House) 22/02/06

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 Announced Inspection 29th November 2005 09:30 Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 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.V260090.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd March 2005 Brief Description of the Service: Nickleby Lodge (the Home) is registered to provide accommodation and personal care for ten younger adults (service users) who experience or who have experienced difficulties with maintaining aspects of their mental health. The premises are a three storey older 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.V260090.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was announced and it took about six hours to complete. During this time, the Inspector spoke with or spent time with six service users. Also, he spoke with the Registered Manager. The Inspector examined various records and he spoke with two of the support workers. The Inspector looked at various parts of the accommodation. This included (by invitation) three service user’s bedrooms. The Home continues to provide the service users in residence with the support and assistance they need. Service users say that they remain satisfied with the provision made for them in Nickleby Lodge. There is one Required Development at the end of this Report. What the service does well: What has improved since the last inspection? Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 6 Since the last inspection visit, the Registered Provider has redecorated a number of areas of the accommodation. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Prospective service users are given the information they need to make an informed decision about living in the Home. Service users’ needs and aspirations are assessed before they move into the Home. Service users are confident that the Home will enable their needs for assistance and support to be met. Prospective service users have the opportunity to visit then Home before deciding about moving in. Each service user has a written account of their terms and conditions of residency. EVIDENCE: There is a Service Users’ Guide. This is a brochure which prospective service users are given and which outlines the facilities and services provided in Nickleby Lodge. In addition to this, the Registered Manager speaks with prospective service users to answer any remaining questions they may have. The Registered Manager meets with each prospective service user to assess their needs for assistance. This is done to ensure that these needs can be met reliably in the Home, should the admission proceed. Service users say that they were confident at the point of admission to the Home, that they knew what was on offer and that this would meet their needs. Also, they observed that their expectations of the services they hoped to receive, have been met in full. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 9 Service users say that they were encouraged to visit the Home at least once before they made a decision to move in. They consider this to have been useful because it gave them a first hand impression of what daily life in Nickleby Lodge is like. All of the service users have a copy of the contract of residence. This document gives a suitably detailed account of the terms and conditions in accordance with which the Registered Provider delivers accommodation and care services in the Home. The Inspector understands that the Registered Manager takes the time to speak with them about the document in order to answer any questions they may have had about its contents. Naturally, this is an example of good care practice. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. Service users are confident that their present and future needs for personal care will be met in a reliable and consistent manner. They are suitably consulted about both the assistance they receive and the day to day running of the Home. Service users are supported in taking prudent risks. Service users know that information about them is handled in a confidential manner. EVIDENCE: There is a service user plan for each service user. These documents describe the assistance the service user in question has agreed to receive. The Inspector sample checked several of these plans and he found them to be suitably detailed. Service users say that they are consulted about the contents of the plans and that they are fully involved in periodic reviews of their contents. Service users consider that they receive all the assistance they need. Support workers assist service users in a manner consistent with that described in the individual service user plans. Service users are assisted to take those reasonable risks which are part of everyday living. The Registered Manager is aware of the need to keep this Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 11 matter under specific and continuous review. This is so that service users are assisted to avoid situations in which their own welfare or those of others may become jeopardised. Service users say that private information about them is treated as being confidential. Support workers have a good understanding of how to ensure confidentiality in practice. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Service users have access to a suitably varied range of social and vocational activities, some of which involve engagement with the local community. Service users are assisted to maintain contacts with family and friends. Service users are enabled to exercise their citizenship rights and to respect those of other people. Service users are offered a suitably healthy diet. EVIDENCE: Service users undertake a range of social and vocational activities. Service users say that they are consulted about what they want to do and that staff assist them to access the necessary resources. The Inspector witnessed a several of these events taking place during the course of the inspection visit. Most of these involved service users leaving the Home in order to attend activities in the community. Service users consider their time to be appropriately occupied. The Registered Manager and the support workers are aware of the need to strike an appropriate balance between engaging with service users and Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 13 recognising their needs for quiet time. This is an essential element of good practice within the Home. Service users are assisted to maintain helpful contacts with members of their families and with friends who do not live in the Home. Service users say that they are provided with good quality meals and that they always have enough to eat. The Inspector took lunch with service users. He noted the meal served to be of a good standard and to be adequate in quantity. The written menu indicates that the service users are offered a normally balanced diet. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Service users receive assistance and support in a respectful and appropriate manner. Service users’ physical and emotional health care needs are met. Service users are assisted to handle their own medication, when this is appropriate. As necessary, suitable arrangements are in place to enable staff to retain and dispense medication on behalf of service users. EVIDENCE: Service users say that support workers are attentive to their needs without being intrusive. The Inspector witnessed various occasions on which support workers assisted service users. He noted these events to be characterised by a quiet informality which is consistent with good care practice. Service users who have problems with aspects of their physical health are assisted to seek and to follow the advice of their doctor. Staff keep a tactful eye open so that medical conditions are noted at an early point. The Inspector has not received any expressions of concern in relation to the Home from partner agencies such as members of the primary health care team. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 15 The Registered Manager said that if appropriate service users can be assisted to manage their own medication. At the time of the present inspection visit, none of the service users had elected to act in this manner. The Inspector examined selected aspects of the arrangements used by staff to administer service users’ medication. He found that suitable practices were in place to store medicines and to ensure that service users take them in the manner intended by their doctor. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 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): 22 and 23. Service users consider that their views are listened to and as necessary are acted upon. Service users are protected from abuse, neglect and self harm. 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 say that they are confident that any matter they raise will receive serious attention and if possible will be addressed. The Inspector notes that neither the Registered Provider nor the Commission is in receipt of any complaints relating to Nickleby Lodge which remain to be resolved. Support workers have a good understanding of what constitutes good care practice. As part of this, they are aware of the need to be alert to instances which might jeopardise the well-being of a service user. Also, they are aware of how to bring such a matter to the attention of the Registered Manager and/or to external regulatory bodies. Service users say that they feel safe living in Nickleby Lodge and that they trust members of staff to act in their best interests. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. The Home provides comfortable accommodation. Service users’ bedrooms are adequately presented and equipped. There is a sufficient number of toilets and bathrooms. There is adequate equipment in place to enable support workers to assist those service users who experience a measure of reduced mobility. The Home is cleaned to a normal domestic standard. EVIDENCE: Service users say that Nickleby Lodge provides them with comfortable accommodation in which they have been able to make their home. The Inspector noted the accommodation to be presented to a normal domestic standard. Service users say that they like their bedrooms and that they have all they need in order to use them as bed sitting areas. The Inspector visited three of the bedrooms. He noted them to be comfortable and that they reflected the preferences of their occupants. There is an adequate number of toilets and bathrooms. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 18 All of the people currently in residence are able to get about without assistance. The Registered Manager is aware of the need to keep this matter under review. This is so that aids and adaptations can be provided should service users’ need them in the future. The accommodation is cleaned to a normal domestic standard. The Inspector examined the kitchen and he noted it to be presented to a suitable standard of hygiene and to be operated appropriately. The Inspector understands that the local Department of Environmental Health has not recommended the completion of any improvements which remain outstanding. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 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): 31, 32, 33, 34, 35 and 36. Support workers have a good understanding on their duties and they work together well as a team. There is an adequate number of staff on duty. Support workers have the competencies they need and their practice is monitored. Appropriate steps are taken to ensure that only suitable people work in the Home. EVIDENCE: Support workers are provided with a written account of their duties. The staff team is relatively stable. This means that people have got used to working together and that service users know who is going to be around and what they are going to be doing. There are handover meetings at the beginning and end of each shift and support workers keep diary records of how things are going for each service user. There are regular staff meetings and support workers say that they are actively consulted by the Registered Manager about how the Home is administered. There are two support workers on duty during the day until the late evening period when the night time cover arrangement starts. Staff say that enough support workers are deployed in the Home to enable an effective service to be provided. Service users say that support workers are always around when they Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 20 need them. The Inspector considers the Home to be staffed adequately given the needs for assistance of the service users currently in residence. None of the three support workers have yet completed a relevant National Vocational Qualification (NVQ). However, the Registered Manager said that all of them are hoped to complete the Award in 2006. This qualification is designed to validate that individual support workers have the skills they need to respond effectively to service users’ needs for assistance. The Registered Manager provides introductory training for all new support workers. Relatedly, she appraises their competencies before they work without direct supervision. The Registered Manager is going to review the way in which this exercise is completed. This will be done to ensure that it includes all of the subjects identified to be necessary by a model which has been adopted by the Standards. The Registered Provider arranges for support workers to undertake specific courses in subjects such as first aid and in how to respond to extreme situations. The Inspector considers that the support workers have the competencies they need in order to provide a reliable and effective response to the present service users’ needs for assistance. Each member of staff meets regularly with the Registered Manager to review their work. This is done so that any problems can be identified at an early point and addressed. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41 and 42. The Registered Manager runs the Home so as to reliably provide service users with appropriate assistance. The Registered Provider operates a quality assurance system. Service users’ rights and best interests are protected the operation of the Registered Provider’s recording systems and by the implementation of its policies and procedures. A suitable framework is in place to promote the health and safety of service users and staff. EVIDENCE: The Registered Manager has the competencies necessary to enable her to operate the Home in the best interests of the service users. She has almost acquired one of the formal management-related qualifications prescribed by the Standards. In addition to this, she has attended various training courses. The Registered Manager has a detailed understanding of the day to operation of the Home and of the particular needs of each of the service users. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 22 The Registered Provider operates a quality assurance system. This is designed to enable stakeholders in general and service users in particular to comment on the adequacy of the facilities and services available in the Home. The Registered Manager is going to consider how the existing annual consultation exercise might be strengthened further. Also, she is aware that the information generated by the exercise needs to be summarised in a Quality Report which can be given to the existing and to prospective service users. The first of these Quality Reports will be made available by the end of 2006. The Registered Manager maintains various recording systems to assist in the management of the Home. The Inspector examined the accident book and he noted that there were no patterns which indicated the need for him to make any further enquiries. The Inspector also examined the records which the Registered Manager keeps in relation to those service users who elect to receive assistance with the management of their weekly personal spending allowance. The various entries checked were found to be in order. Service users are confident that their monies are administered in an appropriate manner. There are various policies and procedures available in the Home. These are designed to support staff when undertaking their duties. The Inspector noted that support workers are conversant with the principles expressed in these documents. Also noted, was that they carry out their work in a manner which is consistent with their provisions. The Kent Fire Service has not recommended any improvements which remain outstanding. The Registered Manager completes the periodic checks which have to be made to ensure the continued serviceability of the Home’s fire safety regime. The Registered Provider does not have in place a system which is designed to validate periodically the competency of all members of staff to avoid the occurrence of a fire safety emergency and to respond effectively to one should the need arise. The Registered Manager said that this matter will be addressed within the timescale listed in the Required Development listed at the end of this Report. The Registered Provider has arranged for all appliances such as gas boilers to be serviced in accordance with the manufacturers’ instructions. The Registered Manager said that there are no significant hazards around the premises which could result in someone having an accident. Also, the Inspector did not notice any such hazards. Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 23 Nickleby Lodge (Welcome House) DS0000028989.V260090.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Nickleby Lodge (Welcome House) Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 3 3 X DS0000028989.V260090.R01.S.doc Version 5.0 Page 25 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 42 Regulation 23 Requirement The Registered Provider should ensure that all members of staff are included within a suitably specified programme of fire safety competency appraisal. This should be designed to validate that each person is aware of how to help avoid the occurrence of a fire safety emergency. Also, that each person has the competencies necessary to enable them to respond effectively to a fire safety emergency should the need arise. Timescale for action 01/01/06 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.V260090.R01.S.doc Version 5.0 Page 26 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.V260090.R01.S.doc Version 5.0 Page 27 - 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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