Inspection on 01/09/05 for Norfolk Lodge

This inspection was carried out on 1st September 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

Norfolk Lodge 10/05/05

Norfolk Lodge 19/03/05

Norfolk Lodge 23/11/04

Norfolk Lodge 23/06/04

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Insight - Eastchurch

Southfields

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Seabourne House

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

CARE HOME ADULTS 18-65 Norfolk Lodge 9 Norfolk Road Horsham West Sussex RH12 1BZ Lead Inspector Annette Turner Announced 01 September 2005 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 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 Stationary 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. Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Norfolk Lodge Address 9 Norfolk Road, Horsham, West Sussex, RH12 1BZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01403 218876 Dr Shafik Hussien Sachedina Mr Shiraz Boghani Ms Anne Bicknell Care Home 8 Category(ies) of LD Learning disability - 8 registration, with number of places Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10 May 2005 Brief Description of the Service: Norfolk Lodge is registered to provide personal care for up to eight service users between the ages of eighteen and sixty-five years who have a learning disability (LD). Norfolk Lodge is a semi-detached building in a residential road in the town of Horsham. Service users are accommodated in rooms on the ground and first floors. The laundry room and staff office are on the second floor. There are three rooms on the ground floor that are set aside for communal use including the dining room. There is a communal room on the first floor that is used for staff on sleeping in duties; this room is also used for meetings and other events. There is a secluded garden at the back of the building. Sussex Health Care owns the service; Mr Boghani and Dr Sachedina are the registered providers. Ms Anne Bicknell is the registered manager responsible for the day-to-day running of the home. Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place during the day of Thursday 1st September. The service users were all at home for a part of the day; six people were out for a drive or were having lunch in town at times during the day. All the service users at home were seen and four were spoken with. One service user assisted with a tour of the building and the garden. Comment cards were received from three relatives and two health and social care professionals. The majority of comments received were extremely positive about the services provided at Norfolk Lodge. The manager assisted throughout the day and four members of staff were spoken with. All the staff spoken with said that Norfolk Lodge is a happy place to work and that they feel well supported. Case records were seen and other documents relating to the running of the home were read. This report should be read in conjunction with the report of the unannounced inspection carried out on 10th May 2005. What the service does well: The atmosphere in the house was calm and service users were being given the attention and support they needed. The staff team at Norfolk Lodge are committed to their work and support each other well. The manager has created an open and inclusive atmosphere with service users at the centre of all planning and practice. The care staff said they understand how to provide the care that people need. They receive training and encouragement to help them to do this well. There are efficient systems in place for recording information. Care plans are person centred and extremely detailed to ensure that staff understand people’s needs. One service user has been supported with special care through a period of ill health and is now on the road to recovery avoiding the need for a hospital admission. People who live at Norfolk Lodge are supported to enjoy everyday community activities and holidays. People are encouraged to help with tasks at home where they are able to and one person takes pride in the work he does in the garden. Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 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 standard(s) 2, 3, 4 and 5 The needs and aspirations of people living at Norfolk Lodge have been assessed prior to admission. Prospective service users are provided with the information to ensure that they know that their needs will be met. People have an opportunity to visit the home prior to admission and are provided with a statement about the terms and conditions of their accommodation when they move in. EVIDENCE: Samples of the pre-assessments were seen and it was evident that service users’ needs and aspirations were noted prior to admission. Information from relatives and other health and social care professionals had been taken into account to ensure that people’s needs could be met at Norfolk Lodge. The service users and staff spoken with were clear that the needs and aspirations of each person are understood and that every effort is made to help them fulfil them. There was evidence to show that people are supported to visit Norfolk Lodge before a decision about a move is made; this is to ensure that the person’s needs could be met and that their needs are compatible with the other people already living in the home. Each service user has a copy of the terms and conditions of their accommodation; this is provided in symbol format for people who more easily understand this form of communication. Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 Page 9 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 standard(s) 6, 7, 8 and 10 Norfolk Lodge carry out detailed person centred care planning. Service users’ needs are reviewed and changes are responded to. Individual goals and aspirations are reflected in the care plans. Service users are consulted and involved in aspects of life at Norfolk Lodge where they are able to express their views. The confidentiality policy and procedures ensure that people know that their personal information will be handled appropriately. EVIDENCE: A sample of care plans were read. A person centred approach is taken to care planning and review. Service users’ goals are clearly noted and staff are provided with detailed guidance about the way that care should be provided. This guidance is based on service users’ wishes and also professional advice to ensure that behaviours are managed and service users’ needs are met. It was clear that care plans are reviewed regularly and changes in need are noted and responded to. Service users have spoken about their involvement in reviews. Staff and service users indicated that their views are taken into account in the day-to-day running of the home. Informal discussions after lunch on Sunday have been identified as the most successful way to involve service users in decision-making. People who live at Norfolk Lodge are involved in the selection of staff at an early stage because of the particular needs of the Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 Page 10 people who live there it is essential that every person is comfortable with the staff who are employed. There is a confidentiality policy and procedure for keeping service users’ information locked when not in use. Staff spoken with were clear about the need to respect the privacy of people who live at Norfolk Lodge. Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12, 14, and 16 People living at Norfolk Lodge are supported to take part in activities that help them to develop their skills. Individual interests and hobbies are noted and people are encouraged to pursue activities of their choice. Service users’ rights and responsibilities are recognised and respected. EVIDENCE: Several service users are due to begin a new programme of college courses. It is clear that staff have accessed information about particular courses that will meet the needs of individuals. The service users spoken with were very excited about the courses that they have chosen. The programme is part of an adult education programme accessed by anyone in the community and buddies are provided for people who have special needs. There is a programme of activities available in the home. A part time activities coordinator is employed to organise the programme to meet individual need. It was clear from observation and discussion that individuals are encouraged to pursue activities of their choice. Everyone has had the opportunity to go away on holiday this year. The manager said that it was more appropriate for two people to have short outings instead of overnight stays away from home. Daily routines are Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 Page 12 flexible and staff respond to individual need and choice as far as staffing levels allow. The interaction between staff and service users was seen to be relaxed and respectful. Some service users prefer clear routine and privacy in their lives and this is documented and respected by staff. Service users have plenty of space in the home and garden to spend time with others or to be alone. Staff on duty are constantly aware of service users’ whereabouts to ensure their safety. Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 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 standard(s) 19, 20 and 21 Service users’ physical and emotional needs are understood and met. The medication policy and procedures protect the wellbeing of service users. Ageing, illness and death are handled with respect. EVIDENCE: Service users’ healthcare needs were documented in detail on their case records. It was clear from observation, discussion and documents read that the healthcare needs of service users are carefully monitored and advice and guidance is sought when necessary. The manager said that the local primary care teams and especially the GPs respond well to service users’ needs. An example was provided where an individual has been supported through a period of poor health and a hospital admission has been avoided due to the commitment of the staff team and medical support provided. Policies and guidance regarding medication has been provided for staff. Seven members of staff have received training in the administration of medication. The local pharmacy has recently carried out an inspection at the home and found medication practice to be in order. A new system for moving medication safely around the building has been implemented. There are policies and guidance provided regarding supporting those who are unwell or may be dying. It is clear that staff understand these policies and support people to remain in the home for as long as they are able to. Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 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 standard(s) 22 It was clear that service users feel that they are listened to and their concerns are acted on. EVIDENCE: There is a complaints policy that is provided in symbol format for those who understand this form of communication. There is a system for recording complaints that have been received. The manager confirmed that no complaints have been received in the past twelve months. Due to the high needs and communication difficulties of service users accommodated at Norfolk Lodge it is important that ways are found to identify any concerns that they have and to address these issues. It was clear from discussion and observation that service users have opportunities on a one-to-one basis or in small groups to indicate any concerns. It is often through behaviour that people indicate that they are not happy and documents showed that any changes in behaviour are noted and addressed. Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 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 standard(s) 30 The home is clean and hygienic and suitable laundry facilities have been provided. EVIDENCE: The home was clean and welcoming during the inspection. The laundry room is on the second floor well away from the kitchen and dining area. The laundry room is well equipped. This room is kept locked for safety reasons. None of the service users are able to use the machines without staff support however some people bring their dirty laundry upstairs when they have cleaned their rooms. Staff have been provided with guidance about health and safety and infection control. Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34 and 35 Service users receive their care from staff who understand their roles and responsibilities. The recruitment policies protect the welfare of service users. People who live at Norfolk Lodge are supported by competent staff who are provided with opportunities for training. EVIDENCE: Sussex Health Care has provided clear job descriptions and staff spoken with were very clear about their roles and responsibilities. Seven staff have achieved the NVQ level two award or above. A sample of staffing rotas were seen and discussed. It appeared that staff are employed in sufficient numbers to provide for the individual needs of service users. It was clear from discussion with staff that the team work well together and respond to emergency situations by covering additional shifts. A recruitment policy and procedure has been provided and the manager confirmed that all the necessary checks are carried out prior to someone starting in post. A sample of staff records were seen and included all the required information. A member of staff takes responsibility for ensuring that staff receive induction and foundation training and that training records are kept up to date. The induction takes the form of videos and questionnaires. A newly appointed member of staff confirmed that she had been given sufficient time and guidance to ensure she was confident about the way to meet service users’ Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 Page 17 needs. The issue of specialist training was discussed with the manager and the need to ensure that all staff have the understanding and skills to meet the special needs of service users accommodated. Several staff are due to undertake training in autism awareness and epilepsy. Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40 and 43 Service users benefit from a well run home with strong leadership and a sound ethos. The views of service users and their advocates are sought. The policies and procedures protect the welfare of service users. The management systems provided by Sussex Health Care ensure the protection of service users. EVIDENCE: The manager is well qualified and experienced to run the home. Ms Bicknell has provided strong leadership and guidance to staff and service users to ensure a good quality of life at Norfolk Lodge. It was clear from discussion with service users and staff that people feel included in decision-making and that they are valued. Ms Bicknell is enthusiastic about her own personal development and is keen to ensure that she keeps her knowledge updated. The views of service users are sought through a survey every year and any comments or concerns are acted on. Sussex Health Care employs an external Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 Page 19 quality monitoring company to inspect the home every three years. An audit was carried out early this year and the results were favourable. There is a comprehensive set of policies and procedures provided by Sussex Health Care; there are also local policies and guidance for staff regarding issues that affect Norfolk Lodge. Staff spoken with were clear about where to find policy guidance. Financial and accounting systems have been set up at head office. The manager said that there is adequate insurance in place. There is a development plan in place for the organisation and a local plan for Norfolk Lodge; this was discussed with the manager. Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 3 Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 3 x 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 x 3 x 3 x Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Norfolk Lodge Score x 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 4 3 3 x x 3 H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 Page 21 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Norfolk Lodge H60-H11 S14640 Norfolk Lodge V239061 010905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY 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. 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