Inspection on 04/03/09 for St Andrews Lodge

This inspection was carried out on 4th March 2009.

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

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St Andrews Lodge St Andrews Lodge 184 St Andrews Avenue Colchester Essex CO4 3AG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: John Goodship     Date: 0 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: St Andrews Lodge 184 St Andrews Avenue St Andrews Lodge Colchester Essex CO4 3AG 07878285095 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Reed Care Homes Ltd Name of registered manager (if applicable) Sarah Louise Reed Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accomodated is: 8 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Mental disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home St Andrews Lodge is an adapted house for the rehabilitation of up to eight people with diagnosed mental health problems. It is situated on a main road close to the centre of Colchester, and close to shops. Each bedroom has en-suite facilities, and there are sufficient communal rooms to give service users a choice of which space to use. The fees at the time of this inspection were £950.00 per week. Care Homes for Adults (18-65 years) Page 4 of 27 care home 8 Over 65 0 8 Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited St Andrews Lodge on 4 March 2009 to do the first key inspection of the home since it was registered in September 2008. The visit lasted four hours. We concentrated on the outcomes for the service users, taking into account the fact that all of them had only been resident in the home for a short time. We spoke to two service users and two staff, and were helped throughout the visit by the manager. We examined two care plans, toured the home, and looked at staff records, training records and health and safety records. The manager had been required to complete an Annual Quality Assurance Assessment (AQAA). We have used information from all these sources in the preparation of this report. Care Homes for Adults (18-65 years) Page 6 of 27 Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can expect their needs to be assessed to ensure that the home is the most suitable place for them, and to be given sufficient information for them to decide if they wish to live there. Evidence: The home had produced a statement of purpose and service user guide as part of their application for registration in October 2008. The AQAA told us that these were in the process of being updated to reflect how the service had evolved since it started. At the time of writing this report, we had not received the updated versions. We noted that there was a lack of consistency in these documents in describing the age range criteria of the service. The statement of purpose said that the entry age was seventeen, but the homes registration for adult services specified that the lowest age was eighteen unless there were special conditions attached to the registration. This was not the case. However there were no service users below eighteen using the service at the time of our inspection nor since its opening. The information must be Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: correct to prevent inappropriate referrals to the home. The manager agreed to change these age ranges. The home had originally been registered in error as a care home with nursing. However the owners had not applied for this category. The Commission would be issuing the home with a replacement certificate as a care home. The home was registered on 29th September 2008 and admitted its first service user on 11th October 2008. At the time of our visit there were five service users living in the home. The manager told us in the AQAA that referrals were made initially through the joint Service Placement Team. The referral criteria were that the person had to be within the age range, have a diagnosed mental illness, be under the Care Programme Approach, and have an identified Care Co-ordinator. The manager undertook a preadmission assessment. We saw an example of this in a care plan. It included full details of the persons personal, social and medical history. It also included initial risk assessments for behavioural triggers, alcohol/substance misuse and risk of self-harm. The assessment also included the views of the service user on their needs. This process gave the home detailed information on the person and enabled the home to assess the suitability of the home to meet the persons needs. The manager told us about two referrals who had visited the home to try it out, but staff assessed that the home could not meet their needs. The manager confirmed that the aim of the home was to plan and undertake the rehabilitation of the service users to enable them to be ready for more independent living within 18 months to two years. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be assured that their assessed and changing needs and personal goals will be reflected in their individual plans. Evidence: We examined the care plans for two service users with differing needs. The plans took the descriptions of the assessed needs and converted them into a series of interventions and actions to meet those needs, with timescales and frequencies if appropriate. Examples of needs addressed in this way included depression, poor motivation, tendency to isolation, risk of self-harm and the need for community involvement. Action listed included observation, encouragement, and structured activities. The plans showed evidence that service users had been involved in what was in them and in identifying and agreeing the goals to be achieved. The AQAA told us that service users appear to be happy to express themselves on exactly what they want to Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: achieve. Although no one had been in the home long enough to have a major review, the plans had been updated regularly as needs and circumstances changed. Staff completed a daily record at the end of each shift.This was written as a narrative covering a description of the activities and tasks undertaken by each service user, as well as comments on their disposition. All was written in a non-judgemental way. The manager and the staff gave us examples of the decisions which service users could make. These covered, daily routines, meals, activities and relationaships. The home had a policy that no drugs or alcohol could be brought into the home. However service users could go out in the normal course of events. Service users were obliged to tell the home where they were going and there was a policy on absence without authority, and a failure to return. Service users told us how they spent their day and how the home was supporting them. The manager described how they encouraged and supported service users to budget their money. Each person had their own bank account and bank cards. Money was kept by them in lockable drawers. The manager told us that the home tried to balance the rights of the service users to choose how they spent their money, with their duty to protect them from the consequences of misusing it. Those who might need more support were subject to a risk assessment to ensure their needs were met in a planned way. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can expect to be offered the opportunity to take part in a variety of activities within the local community. They can expect to be supported to maintain family links, and to develop a healthy diet and lifestyle. Evidence: Each service user was provided with a full gym membership and access to a swimming pool. The costs of these facilities were included in the fees for the home. The manager told us that these facilities were well used by all. Service users had been encouraged to attend college courses, such as French lessons and a hairdressing course, and courses at the Aspire day centre, The manager was disappointed that she had not yet been able to agree with voluntary organisations opportunities for voluntary work to offer those service users expressing an interest. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: We were told that service users were encouraged to accompany staff to the shops. Healthy eating was encouraged and a local butcher provided meat for the home. The menu for each meal was agreed with the service users and each could have their own choice. We noted a range of meals listed on the kitchen wall for that week. This included a roast meal on Sunday. The manager explained to us that promoting a healthy lifestyle had a positive effect on the service users mental and physical health. She acknowledged that it was difficult for some of the service users who had drug and alcohol issues which had been part of their lifestyle for many years. The manager told us that she was hoping to enlist the services of an Occupational Therapist to advise on running some sessions at the home. This would increase the range of indoor activities for service users. Staff told us of examples where families had been involved with their relatives rehabilitation, and several service users went to their familys home on leave at weekends. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can expect their physical and mental health needs to be met, and to be protected by the homes safe medication procedures. Evidence: Each service user was registered with a GP, and a dentist. One service user required a chiropody appointment which was arranged by staff. Another service user with a severe medical condition received help from a clinical nurse specialist. In this case, the staff had all attended a training day to understand how best to support this person. All medication was administered by staff. it was supplied in blister packs. We saw the certificates confirming that all staff had received training on the safe administration of medication from the pharmacy supplier. A random sample of records and stock checks showed that all systems were operating according to the homes policy. If any medication marked as PRN (as required) had been given, the reason for this was recorded on the reverse of the medication administration record. Care Homes for Adults (18-65 years) Page 16 of 27 Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be assured that their concerns would be listened to, and their safety protected by the homes procedures. Evidence: The home had not received any complaints since it opened. It did have a complaints policy and procedure in place which explained how to make a complaint. All staff had been given training in the recognition of abuse with vulnerable people. Five out of the eight staff would have received it ialso in their NVQ training. Another training session was booked with an external trainer the week after this inspection. The manager was clear on the procedure she would follow if any alleged abuse was reported. The staff we spoke to were also clear what their responsibility was if they witnessed possible abuse. The home had two CCTV cameras showing the front door and front parking area, and one at the rear showing the rear of the house. These were for the security of the home and those within it. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be assured that they live in a safe and well-maintained home. Evidence: The home had been purposely adapted to be used as a rehabilitation unit. The amount, size and layout of the facilities had been approved during the registration process. Each of the eight bedrooms had an en-suite facility. There were several communal areas for different purposes, as well as a kitchen/dining room. We found the home to be decorated to a high standard, with furnishings which encouraged a homely feel. We found the home to be clean and tidy. The manager told us that all service users are encouraged to take responsibility for keeping their personal areas tidy. The back garden had not yet been landscaped. One of the service users had started to do some work on it, but the manager told us that a digger was coming in the next day to do the heavy work. The AQAA told us that the garden shed had been recently bought to keep all gardening equipment in as well as one service users bicycle. the manager told us that service users wanted to develop a vegetable patch, as well as a decking area for social use and barbecues. The laundry/utility room was clean and tidy. The manager told us that everyone did Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: their own laundry. No laundry was done at night. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be assured that their needs will be met by the numbers and skill mix of staff and that the home will provide training to ensure that the staff are competent to do their jobs. Evidence: The home had eight care staff (7.5 whole time equivalent), including one male carer. There were two or three staff on duty during the day depending on the activities of the service users. One person was on duty each night. The manager was currently part of the rota. but she told us that she would shortly start to allocate three days a week to her management role and on those days she will come off the rota. No agency staff were used, as the home had its own internal bank. We checked the recruitment file for a member of staff. It held all the identification and protection checks required, with two references and training certificates. Two staff were taking the NVQ Level 4, three staff held NVQ Level 3 and one person was about to start NVQ Level 3. Training certificates showed that staff had received training in medication, understanding Huntingtons disease, first aid, adult Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: safeguarding, and food hygiene. Sessions were planned the next week on control of infection, and further training on adult safeguarding. The manager told us that she had undertaken two supervision sessions with staff but had not yet typed them up. She showed us the template to be used. Sessions were booked in the communications book with staff. Staff told us that they were able to speak to the manager at any time if they had concerns. We noted that staff spoke to service users in a friendly way, and service users appeared at ease with staff. The manager told us that the home had been approved by Essex University and Anglia Ruskin University as a placement for pre-registration nurses and occupational therapy students. Students would be supernumerary and would keep the home up to date with trends in mental health care. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can expect the home to be well run, by competent staff. Their safety is assured by the homes health and safety practices. Evidence: The manager was assessed as a competent and experienced person to run this rehabilitation unit when she was registered by the Commission in September 2008. The manager told us that she had secured the services of an external clinical supervisor for herself from Essex University to ensure her skills and knowledge were up-to-date. The manager had been responsible for the setting up of the home and determining how it operated. She was highly committed to the welfare of the service users and their progress. Manager and staff were observed to be friendly and easy with service users and to interact well with them. We examined health and safety records which showed that systems were in place to Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: monitor accidents and equipment safety. House meetings were held as well as staff meetings. The AQAA told us that one result of these had been putting a suggestion box in the recreation room at service users request. It had not yet been used. The home had also provided an awning on the side of the house to provide some shelter for those service users who smoked out there. The manager told us about verbal feedback from service users, community psychiatric nurses and families which was very positive and appreciative of the work being done. She intended to develop a questionnaire which would capture these comments more formally. The certificate of registration, and the employers liability insurance certificate were displayed in the hall. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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