Inspection on 13/05/08 for Sennen Lodge

This inspection was carried out on 13th May 2008.

CSCI found this care home to be providing an Good service.

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

Sennen Lodge 15/05/07

Sennen Lodge 22/01/07

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Sennen Lodge Kanes Hill Southampton Hampshire SO19 6AJ Lead Inspector Sue Kinch Unannounced Inspection 13th May 2008 10:25 Sennen Lodge DS0000067982.V363720.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 Sennen Lodge DS0000067982.V363720.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. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sennen Lodge Address Kanes Hill Southampton Hampshire SO19 6AJ 02380 471 725 02380 472 361 manager.sennen@truecare.co.uk 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) Truecare Group Ltd Post Vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th May 2007 Brief Description of the Service: Sennen Lodge provides care and support to up to eight people with learning disabilities and specialises in autism. It is a large detached two-storey property situated in a semi-rural position on the outskirts of the city of Southampton, with reasonable access to local facilities. Whilst large, the building is domestic in nature and provides eight single bedrooms each having its own en-suite facility of bathroom and toilet. On the ground floor are a lounge/dining area and a small ‘quiet area’, together with an activity room and sensory room. The home’s kitchen, laundry and staff office are also all located on this floor. There is access to the rear patio and garden, which contains a summerhouse. Car parking for several vehicles is available immediately to the front of the property. Fees were reported by the manager at the inspection to range from £1700 £2139 per week depending on needs. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced inspection, which took seven hours and involved a review of information held by the Commission about the home and received since the last key unannounced inspection. We also had pre inspection information from the manager provided in an Annual Quality Assurance Assessment (AQAA) form and written and verbal feedback from three care professionals. We also had surveys forms from two people living in the home and five staff. When the home was visited we viewed some of the shared and individual areas, observed interactions between staff and people living in the home, obtained verbal information from several staff, sampled records and policies and had information from the manager and the operations manager. We were not able to have conversations with the people living in the home during our visit because although all three were present for some of the time and were observed interacting with staff, none wished to have a conversation with the inspector. What the service does well: What has improved since the last inspection? A number of requirements were in the last inspection report and action taken in relation to these was considered. We found that they had all been worked on and completed or sufficient progress made. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 6 ‘As required ‘ guidance for staff to assist in decisions about administering medication had been provided. The home was required to consider how it supports the residents to express their views and concerns. There is evidence of the involvement of a speech therapist and development of communication skills. It was required that staff must receive training in moving and handling and infection control to prevent harm and risk of injury and infection to the residents and themselves. We found evidence of this training in records. Three requirements were made about fire procedures and checks, improvements to fire doors, and seeking advice from the fire officer. We have found that progress had been made. 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. The summary of this inspection report can be made available in other formats on request. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 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 Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has improved it’s admissions process and has a good assessment procedure which has been used well recently but the home needs to monitor to ensure that all people admitted to the home are compatible with the people in the home and that the staff team is developed enough to meet needs. EVIDENCE: There is assessment process that takes place before the admission of a resident and there was evidence that the company policy has recently been followed. A member of staff commented on the amount of information at the home for the person and that information was available before the admission. There had also been opportunities to talk about the needs of that person and there was verbal evidence from staff and a care professional and a record of visits to the previous accommodation and of the person visiting Sennen Lodge before the admission. The manager said that the process had taken two and a half months and a care professional said that this had included a visit to the home and meeting other people and the consideration of the matching of needs. They also said that a guide to the service had been provided which the person was able to understand. We noted that there were risk assessments and care plans available to for that person for staff to follow on admission. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 9 One care professional spoken with had expressed concern about the homes matching process for one person who had moved out after a short period of time. Another said that the transition had been short. But the manager, who said she had not been part of that admission decision, said that the home still needed to ‘ ensure that with all information received, all referrals are compatible with the service provided and other service users.’ She also said that work had been underway for several months for another admission currently planned in June 2008. In discussion she showed an understanding of the impact of change on people with autism. The operations manager gave assurances that in light of the newly developing staff team, some with no previous experience, admissions to the home would be monitored to ensure that needs are met. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are benefiting from reviews of their care needs and the developments of plans based on their individual wishes and preferences whilst taking risks into account and developing plans to support them safely. EVIDENCE: A sample of the care plans, risk assessments and personal records held at the home were viewed. The manager had said in the AQAA that all people living in the home had been reviewed by funding agencies in the last twelve months and all have care plans including restrictions and long-term objectives. She said she was planning to ‘ Ensure reviews and monitoring are completed and actioned’. We found evidence of reviews of risk assessments and care plans and of changes to the care plans format based on aims and objectives and interventions. This format made information clearer and easier to find although needed further work to expand on likes, dislikes and preferences within the Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 11 range of areas covered. The new care plan viewed included personal care, activities, diet and nutrition, communication, behaviour and anxiety, epilepsy and medication with areas for budgeting, daily living and an activity plan to be developed. There were also detailed risk assessments including restrictions and interventions with details of physical interventions. We also received evidence that the care manager was aware of these. The other care plan viewed had accessible risk assessments and strategies and information about communication was developing. Other information was in the care plan but had too many sections and was difficult to follow as described by a member of staff. The manager was aware and said that this would be rectified within her current plans. Not all care plans reflect clear goals. Comments were received from a care professional raising issues about risk management due to number of incidents in the home. The manager confirmed that records are required to be held of such incidents including de-escalation techniques and interventions used. She gave examples of the action taken such as using a door alarm following risk assessment to minimise further risks and of requirements of staff to work to care plans. Comments were also received from her and the staff that the stress levels in the home had reduced with recent changes in the people living in the home and an increase in activities. We received comments from one care manager that for their client the home did not manage risks well at the beginning of the placement but after reviews the risk assessments improved and the risk situation was managed better. It is recognised by the new manager that more work is needed to develop communication tools for people to use to assist with choice. We noted some boards in use in the home with signs and moveable pictures (such as for the menu) and staff spoke of learning Makaton. The manager’s view is that this could be developed much more. In the AQAA she spoke of the need for greater use of communication boards and other aids but also of involvement of a speech and language therapist who visits the home weekly and was there at the time of our visit. Prompt cards were used when an external person to the home assisted one of the people living there to complete a comment card for the inspection. We were also told of plans to take pictures of various activities to aid the decision-making processes. Staff spoken with held positive views about the aims of the service such as to ‘give people good life’, to be person centred and focus on individual needs. New staff spoke of being supernumerary in the first week with opportunities to read care- plans and work alongside staff while getting to know residents. All staff spoken with talked of working with non- verbal communication and assisting choice for those who were less vocal. They also spoke of other people being very decisive about what they want and elements of discussion and negotiation were evident during the inspection visit. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 12 The manager demonstrated a commitment to monitoring care practices in the home and staff who are given feedback about their practices commented on this. The manager’s monitoring includes spot checks . Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Work is taking place to improve the range of activities and stimulation available for people living in the home using the local community and taking rights and responsibilities into account. Contact with families and relationships are supported. The home provides a healthy diet with choice for the people who use the service. EVIDENCE: A care professional said that there needs to be more robust daytime activities. Some staff and the manager have said that people living at Sennen Lodge need more to do. Activities are increasingly provided with a member of staff responsible for organising them and plans are being developed but staff said that people do have a choice over the activities they want to do and gave examples of this including a number of in-house activities such as using the Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 14 computers, listening to music, using the sensory room, cooking, and arts and crafts. They also said that it depends on individual needs and wishes. They also spoke of external activities of swimming, shopping and going to the beach and recently taking one person on the train. The manager said that there had been a recent increase in activities for people and that they were being given new experiences. Evidence of the range of experiences was recorded in documents sampled. There is one vehicle for the home and the manager, in the AQAA said that she is trying to obtain another. The manager spoke of developing pictures of activities to aid the process of decision-making and gave holiday planning as an example of this to take place at the next resident’s meeting. There are activity plans in files but this need to be developed and, as the manager has identified, recorded in a pictorial form, to aid choice for those with communication difficulties. On the morning of the inspection one of the people living at the home was out swimming and shopping with staff. Another person was listening to music, using the sensory room and staff were working to help him find things to do. The third person wanted to be alone and was in the process of settling into the home but engaging with staff at different points in the day. Staff said that family contact is encouraged and staff are involved in taking people for visits to them. When talking about relationships a member of staff commented on communication being a source of much frustration and spoke about work taking place on developing communication for some people. Staff spoken with are aware of their role in promoting rights, choice and decision–making and assisting with this. When talking about this they referred to the individual needs of people and their varying communication abilities and understanding people with autism. One said that promoting responsibility is more difficult with some people but gave examples of involvement in the kitchen and in daily chores based on choice and encouragement. Another spoke of trying to up hold choice made by people living in the home and advocating when necessary. Staff said that food is plentiful and there is variety. There is a menu for the evening meal based on the preferences of the people living in the home and they are given some choices at lunchtime. Staff showed an awareness of likes and dislikes and the choices that people often make. There was evidence in the daily records of food intake monitoring and of variation provided. One person was seen having lunch during the inspection. Staff showed flexibility and made lunch for another person who made a different choice of food and ate later. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Work is taking place to ensure that people are consulted about their personal routines and preferences and to ensure that health needs are met. However, staff must follow medication procedures at all times to ensure that prescribed medication is received at stated times. EVIDENCE: Routines for each person including daily living and specific activities were recorded in the care plans viewed and staff spoken with were able to give some details about the preferences of the people living in the home including personal care. During the inspection visit staff were working to encourage people to engage in various activities. When asked, a staff member described the general health needs of two people living in the home said that there are annual health checks for people that these had just been booked. These would include reviews of medication. The manager had said that one of the people living in the home had been behaving in an unusual manner in the previous week leading to some incidents Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 16 and this had led to the involvement of health professionals with a further appointment for the week after the inspection visit. We noted these checks to have been documented in the records for that person. Other aspects of health care were also recorded. Care plans also include the management of epilepsy and staff spoke of receiving training in emergency treatment for it. The manager reported that the home liaises well with health professionals but plans for more face to face contact. We noted that the company psychologist is involved in assessing and planning services for people living in the home and the use of a speech and language therapist is also referred to in other sections of this report. The manager said in the AQAA that she has improved the medication procedures in the home and that this included guidance for as required medication. A requirement was made following the last inspection, which stated that the staff must be provided with guidance on when to give “as required” medications to ensure the residents receive their medication when they need it. At this inspection samples of as required guidance were available with the medication records available for staff. Staff said that only staff who have been trained in giving medication are carrying out the task. The manager showed paper records of assessments of competence, which are supposed to be reviewed every six months, and she said that these are being worked through. There was evidence of her own competence being assessed in 2008. She has plans for more medication training for staff. The manager reported a medication error to us in a regulation 37 notice on 5/5/08. She said that her investigation had found that this was a recording error and the medication had been given. In a discussion after the inspection she said that she had introduced a witnessing procedure. On 16/5/08 she reported that another error had been made and she was carrying out an investigation but that a person living in the home had missed two doses of medication. Guidance had been obtained from the doctor. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home are benefiting from a manager who is training staff in adult safeguarding, monitoring, reporting incidents attending safeguarding meetings and taking action to improve care practices in the home. EVIDENCE: The manager has not reported to have received any formal complaints since the last inspection although there is a complaints log in the home for recording them. At the last inspection a requirement was made about the home needing to consider how it supports the people living there to express their views and concerns. As referred to in the sections above staff and the manager demonstrated that they are working to increase the communication systems within the home and therefore the requirement has not been repeated. The manager said that the people living in the home should be able to learn about their rights through the complaints procedure, terms and conditions of residence, and the service user guide. Staff said that they are promoting rights by helping people living in the home to pursue choices. Safeguarding was discussed individually with three staff and all would report concerns, two of the three had received training had some understanding of what safeguarding is, what they should do and were committed to acting if they saw something and would tell the manager but they were not sure about the local procedures. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 18 Records were sampled for three people for safeguarding training and all three had received it. The manager agreed that there is training for staff on safeguarding. She said she also discusses issues with them to inform them and they gave examples of things they knew about current safeguarding issues being dealt with by management. She said information is also given during induction in the General Social Care Council (GSCC) code of conduct and in the staff handbook. When told that we found that some staff were not so clear about the local safeguarding procedures she agreed that she would be able to provide that information and began to plan it. The manager said she had training in safeguarding last year. She has been reporting using the local safeguarding procedures and has attended safeguarding meetings. She is aware of the outcomes of those meetings and she said that she brings issues back from them and is guiding staff ‘to keep on top of what is happening’, to take note of people’s emotional states and gave an example of altering activity plans due to how a person was and changing activities to take account of this. A care professional said that reporting incidents had improved and another that strategies to work with one person had been developed. The manager has also introduced a number of checks of staff practices and gave examples of actions taken based on findings where changes are needed. She was advised to consider making a POVA referral based on a recent event and agreed to discuss it with her line manager. She was also reminded to check that all such incidents that may affect the safety of people living in the home are reported to us and if a safeguarding matter to social services. Some matters had yet to be fully investigated at the time of our visit. The manager confirmed that the organisation does monitor records of incidents and of the de-escalation techniques used for dealing with challenging behaviour, which she said, have been deployed in incidents. These techniques as well as physical interventions are recorded in risk assessments and accorded with the interventions that the staff spoke about during our visit. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a comfortable, spacious hygienic and clean environment but would benefit from the attention planned for the garden to increase the range of spaces that they can use. EVIDENCE: The people living in the home have access to a large spacious, open planned, dining room and lounge to use and additional smaller rooms accessed from this area. There are four of these and they include a sensory room, computer room, craft room and quiet room. These are freely accessible except for the computer room. There is a risk assessment for this but the need to ensure that free access to those not at risk was discussed and the manager agreed to address this. These shared areas were clean with some areas recently decorated and plans were in place for those needing a fresh coat of paint. There was evidence of ongoing improvements and flooring to one bedroom was being replaced during our visit. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 20 There is a large rear garden for people to use with wide decking and paved areas. The garden is in an untidy state and in recognised by the management as in need of attention. At the last inspection improvements were discussed including landscaping but this has not been done. People can use the grounds but they are uneven and areas of the decking are damaged. An unused trampoline was at the rear and risks needed to be reviewed which the manager agreed to do, as she believed that the risks were perceived to have become higher that week. The manager said that she had a budget for the garden and that this area would be improved this year and that it would include sensory garden equipment and a vegetable plot. People have their own bedrooms and staff said that all of them have en suite facilties. Two bedrooms were viewed and contained peoples’ personal effects and items for activities. There is a maintenance record book for things that need to be addressed and staff said that things that need fixing are generally attended to promptly. A comment however was received about the time it took for the keypad to be fixed on the front door. From observation of the records and discussion with staff there was evidence that the manager has been reviewing all of the training that staff have received at this home and for relevant new staff, in previous care roles, and has been providing initial guidance in infection control during induction. Infection control was raised in a requirement after the last inspection. A new staff member confirmed that protective equipment had been provided and was aware of what it was used for. In the regulation 26 report for April 2008 it was noted that infection control training had been arranged for staff. The manager said in the AQAA that 3 staff had completed specific training and this would continue. Due to progress a further requirement has not been made. The manager also reported to have trained and to be training staff in food hygiene, health and safety and safer foods. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home are protected by the staff recruitment process, which is well managed. People living in the home are benefiting from a newly developed staff group and less reliance on agency staff. However, work is needed to ensure that the training programme is robust and equips staff with the skills required, and to ensure that people are supported at all times by effective staff committed to meeting their needs. EVIDENCE: The home has had a large turnover of staff and the manager reported that 15 had left in the last 12 months, that recruitment has been ongoing, that she has recruited a group of bank staff and has one more vacancy to fill. Some new staff are in their first care post and some have previous experience. Induction has been taking place with new staff being additional to the shift for a week when commencing employment. The manager is now relying less on agency staff. She is working to increase staff training and to develop them as Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 22 a team. The home’s policy is to ensure that all staff have been trained in challenging behaviour including physical interventions within six weeks and there is evidence in records that this is being followed through. The operations manager and the manager said that other staff have been used from within the company to ensure that staff trained in physical interventions have been available on shift. Records were not assessed to check this during this visit. Some of the regulation 37 incidents reported by the home have indicated that the manager has needed to take action to address some care practices such as with medication and nights tasks. The manager was able to give details of action being taken to promote procedures required being followed. Staff comments in surveys indicated that there seemed to be some disparity regarding whether staffing levels are adequate. Most felt there was usually enough staff but an emphasis was made upon improvements being made by new management to address issues. At the time of the inspection visit there were three residents and the rota indicated that three staff were on duty during the day shifts with two at night. The manager said that this may vary according to needs and that 1-1 staffing was provided when identified as needed. She said that a 1-1 staff ratio is not required all of the time but for specific things. She has flexibility to use a fourth member of staff if needed. Recruitment records are held and although some of the information such as CRB checks, references and training had to be obtained from the company office during our visit, all of the information that was asked for was provided and accorded with the verbal information from the manager. Staff also confirmed that pre employment checks take place before commencement of employment and one who commenced work after a POVA first check and before the full CRB check was clear about the limits of their role. A requirement was made following the last inspection that staff should receive training in moving and handling and infection control. The latter has been addressed in the environment section. Moving and handling is covered in the LDQ course that new staff members have either attended or are attending in June 2008. Currently people living in the home are not in need of day-day moving and handling and consideration is being given to general training in this area. The manager is also planning to be trained to train staff on infection control and health and safety. Staff say that they are receiving training to carry out their work. There is a training record in the home, which showed that training needs are identified and work is taking place to send staff on courses with dates for some of the planned training. Information is also in place about training that staff have received before working at the home. A sample of three records were viewed for staff indicating that training received at this home or recently in previous employment, included adult protection, medication, epilepsy, fire, medication, Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 23 induction, challenging behaviour, (this includes physical intervention) and autism. The manager said that at the home currently has 33 of its’ staff trained to NVQ level 2 or above. A member of staff spoke of wanting to undertake an NVQ assessment and the manager spoke of plans to ensure that staff receive training suitable for the job. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the service are benefiting from increased consideration of their needs, and systems in place to take them into account as a result, of the recruitment of a manager with good leadership skills and an intention to improve care practices. EVIDENCE: Since the last inspection the manager withdrew his application to register with the commission and a temporary manager was in place until the current manager was recruited. The current manager said that her CRB had been completed and she would be shortly submitting her application form. She said that she has achieved the Registered Manager’s award and is a Registered Mental Nurse and is completing her NVQ level 4 in care. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 25 Some comments from staff in surveys were – “Things have improved significantly with arrival of new manager”. “I have recently started working with the service users in this home and have received a lot of support”. Staff said they find the manager approachable ‘hands on’ ‘knows what is going on’, gives feedback about practice and has direction. They said they are being given regular supervision and have regular staff meetings. The staff meetings were discussed with the manager who said that they are held in the lounge. It was established that this did not provide opportunities for staff to talk about working with people in the home. The manager said that there are other opportunities to do this but agreed that this should be reviewed. The manager said that she has been working on staff training and on improving standards. There are increased checks including spot checks when needed and an increase in management checks and checklists. Evidence of improvements was also noted in care planning and reviews, admissions and staff training. She has taken action to meet the requirements of the last inspection report and none of these are repeated at the end of this report. Regulation 26 visits are regular and identify improvements needed and action taken in respect of them and the operations manager said that the manager addresses issues raised promptly. The manager reported in the AQAA that she had ‘Identified the need for proactive working ensuring that care plans are being reviewed, better monitoring and reviewing of care plans, training according to the needs of Sennen Lodge.’ She has an interim plan that she has used to make improvements to the home and was aware of the need to develop a plan including changes arising from consultation which she said takes place annually. Staff and the manager talked of regular meetings for people living in the home. Staff said that the manager listens and is interested in their views. Three requirements were made following the last inspection regarding fire matters. These have been worked on with more areas identified to address by the management and have not been repeated in this report. The home was required to ensure that fire procedures and checks were in place including weekly checks on fire alarms. Records of these were sampled and found to be in place and in a regulation 26 report checks which also said that checks been made and had identified that a night time evacuation practice was needed. The operations manager in the regulation 26 reports said that the fire officer had been spoken with about fire safety procedures and all door closures had been completed. The manager said that the fire assembly point had been changed to be at the rear of the house. Door closing devices were noted to be in place and another had been purchased to put on a door where the flooring was being repaired. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 26 Since the last inspection requirements were made of the home by the environmental health officer and specifically on issues of staff dealing with challenging behaviour and violence. The organisation produced a health a safety policy in December 2007 and the operations manager said that this had satisfied the requirements of the environmental health officer. One new member of staff asked commented that they had read it. Staff are being trained in working with people with challenging behaviour and other matters in relation to health and safety. Elements of this are referred to in the environment and staffing sections above. Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 3 36 x 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 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x x 3 x Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 28 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sennen Lodge DS0000067982.V363720.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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