Inspection on 21/05/08 for St Davids Lodge

This inspection was carried out on 21st May 2008.

CSCI found this care home to be providing an Adequate 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

St Davids Lodge 19/05/09

St Davids Lodge 23/05/07

St Davids Lodge 16/05/06

St Davids Lodge 02/11/05

St Davids Lodge 01/06/05

St Davids Lodge 08/02/05

St Davids Lodge 26/08/04

St Davids Lodge 04/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOMES FOR OLDER PEOPLE St Davids Lodge 98 Lodge Causeway Bristol BS16 3JP Lead Inspector Sandra Jones Key Unannounced Inspection 21st May 2008 09:30 X10015.doc Version 1.40 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 St Davids Lodge DS0000026625.V361977.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 Older People. 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. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Davids Lodge Address 98 Lodge Causeway Bristol BS16 3JP 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) 0117 9656965 0117 9656965 hazelprycejones@hotmail.com Mrs Hazel Lilian Pryce-Jones Mr Clive Pryce-Jones Post Vacant Care Home 11 Category(ies) of Learning disability (11), Learning disability over registration, with number 65 years of age (11) of places St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 11 persons aged 50 years and over Date of last inspection 23rd May 2007 Brief Description of the Service: St Davids Lodge is a care home for people with learning disabilities. Since conducting the last inspection, the service provider has sought to increase the registered numbers. The application was successful and the home is now registered to accommodate 11 people with learning disabilities over 50 years. The property is situated on the Lodge Causeway, close to the Fishponds Road, shops, other amenities and bus routes. The property is detached and arranged over two floors with shared space on the ground floor and personal space on both floors. It has the appearance of a domestic dwelling and blends well with its local environment. St Davids Lodge DS0000026625.V361977.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 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection was conducted unannounced in May 2008 over one day and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection. This information was used to plan the inspection visit. “Have your say” surveys were sent to people who use the service, their relatives and health care professionals. However, the surveys were not received at the home in sufficient time for them to be completed and returned before the inspection visit. Ten individuals were living at the home at the time of the inspection and four people were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The home’s policies and procedures were also used to confirm the findings. The views of the people living at the home, members of staff and the service provider were gathered through face-to-face discussions. What the service does well: The people consulted said that the staff know what to do to meet their needs, they participate in a variety of community activities and who to approach with complaints. People consulted knew the name of their keyworker and the role they performed. Their health care needs are met and are accompanied by the staff and knew their rights in respect of privacy and dignity. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (3) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Pre-admission assessments enable staff to assess the individual’s suitability to live at the home. Individuals can be reassured that the home will have the skills and resources to meet their assessed needs. EVIDENCE: The home has an Admission policy and the purpose and approach used for individuals wishing to live at the home is described. The procedure must be reviewed to include the assessments that are used to determine the individual’s suitability to live at the home. Case records examined contained pre-service assessments conducted by the home and social workers needs assessments demonstrate that individuals needs are assessed before admission to the home. The member of staff on duty and records examined confirmed that since the last inspection there were no new admissions to the home. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (7), (8), (9) & (10). Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. Care planning systems must be further developed so that individuals can benefit from receiving an individualised and consistent service. They can expect sensitive and prompt support for their personal and health care needs from a skilled staff team. Medication systems are safe. EVIDENCE: Four people were case tracked and their files were reviewed to assess the consistency of the care provided. Case files are sectioned into pre-assessments, care planning, daily reports, health care, risk assessments, Quality Assurance and other documentation. The service provider said that individual’s needs are reviewed annually and monitored monthly. The needs of the people funded by the Local Authority were reviewed within the last twelve months by their social worker. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 10 Individuals are invited to their review meetings and sign their care plans to indicate agreement with the plan of action and generally the individual’s needs are discussed with their relatives when visits take place. Care plans list the identified need and the action plans provide guidance on the actions that must be taken to meet the identified need. The care plans viewed were not consistent with the level of information that is needed to meet the individual’s needs. Specific detail about the likes and preferred routines must be incorporated into the action plans. For example, the supported needed and when tasks are to be completed. Personal care form part of the care planning process and for some individuals the action plans are more detailed and specific about their preferred routines. For example, one person prefers to have a bath and not a shower. The service provider must ensure that that action plans are specific, detailed and incorporate the individuals preferred routine. Two people were consulted about the way staff meet their needs. One person said that staff know what to do and another said that staff assist with personal care. Individuals were able to name their keywoker and describe the role they perform. A care assistant consulted said that the keyworker system is in operation at the home and staff have responsibility for updating care plans and making entries on daily reports. For people that may become aggressive or violent strategies are in place. It is evident from the daily reports that one person can become violent towards other people living at the home. However, the risk assessment does not include the steps that must be taken by the staff to safeguard individuals from physical abuse. Risk assessments for people that become aggressive and violent must include reactive strategies that safeguard individuals from abuse. Other risk assessments are in place to restrict one person from leaving the property through the front door. The service provider said that this was because one person may leave the building without staff support. It was further stated that one person is independent within the local community and staff will open the door for this person. Manual handling risk assessments are completed for people with mobility impairments. Risk assessments would benefit from being reviewed and for the person that is supported with a walking belt, a risk assessments must be completed. Members of staff record their observations of the individuals at the home, outcome of health care visits and tasks undertaken. Decisions made by the individuals are not currently recorded and to demonstrate that people are supported to make decisions, members of staff must record these choices. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 11 A record of medical appointments is kept for each person, which show that people access GP’s visits, district nurses and NHS facilities including chiropody, optician and dental visits. Documentation kept in files evidence that people access psychiatrists through the Community Learning Disability Team (CLDT). Individuals giving feedback about their health care needs said that members of staff arrange appointments and are accompanied on all these visits. The individual’s rights are specified within the home’s Statement of Purpose, with a policy on Privacy and Dignity. The policy sets out the purpose and expectation of the staff to ensure that individual’s rights are respected. Individuals that agreed to give feedback gave examples of the way staff respect their rights to privacy and dignity. Individuals said that they have keys to bedrooms, staff knock before entering bedrooms and they addressed correctly. Medication profiles lists the medication prescribed, the purpose of the medications and possible side effects. Medications are administered through a monitored dosage system and the records of administration were used to check against the medications held within the dosage system. Correct use of codes and the absence of gaps in the recording of medications administration indicate that staff sign the records immediately after administering medications. Homely remedies are not kept at the home. Records of medications no longer required is maintained and the pharmacist signs the record to indicate receipt of the medication for disposal. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (12), (13), (14) & (15). Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. There are good support systems in place for individuals to lead active and interesting lifestyles and to be valued members of the community. EVIDENCE: There is an activity rota in place in the home and it shows that four people attend day care centres between 1-2 times per week. Outings and pottery are arranged for the people at the home by the staff. A record of activities undertaken is kept and people at the home go on outings to shops, trips to places of interest and people at the home watch T.V. knit and do puzzles. The two people consulted about the activities organised at the home described the activities undertaken. One person said that they visit the day centre twice weekly, go on outings arranged by the staff and watch television. Another person said that they are independent in the local community and go on walks, visit shops and cafes. This individual also attends a day care centre, participates in outings arranged by the home and knits. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 13 The home’s visitor’s policy acknowledges that maintaining contact is essential to the people living at the home. The arrangements for visiting are open and individual’s friends and family are welcome to the home. There is a visitor’s book and visitors to the home must record the date and nature of their visit to the home. The service provider said that the people at the home are encouraged to have personal possessions to make their private space more homely. The service provider acts, as appointee for a number of people living at the home and for this reason a procedure on managing individuals finances must be developed. The policy must be clear about acting as appointee and the responsibilities of the role and other financial responsibilities undertaken. The daily diet sheets show that individuals have a choice of meals at each mealtime and a varied diet is served to the people living at the home. The range of fresh, frozen and tinned foods support that people at the home have a varied and wholesome diet. Catering staff seek from the individuals at the home their likes and dislikes to ensure that preferred meals are served. Individuals said that the food was adequate and alternatives are provided. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): (16) & (18) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Individuals can expect their concerns to be listened to and to be protected from abuse. EVIDENCE: The home’s Complaints procedure is included within the Statement of Purpose and a simple format with large print is used so that people living at the home can understand it. A symbolised format that uses pictures and works must be considered to ensure that the people for whom its intended can understand the procedure for making complaints. There were no complaints received at the home since the last inspection. People at the home named the person they would approach with complaints and their comments indicated confidence with the actions that would be taken to resolve their complaints. A member of staff consulted said that the complaints procedure was recently explained to individual at the home to make sure they were clear about their rights. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 15 Safeguarding Adults policies and procedures that commit to protecting individuals from abuse are in place. Staff have attended Safeguarding Adults training to raise their awareness on their responsibilities towards protecting individuals from abuse. Members of staff consulted were clear about their responsibility to report poor practice, the principles of abuse and the actions to be taken for reporting alleged abuse. One person made an allegation of abuse by an agency member of staff and the service provider reported the incident to the lead agency. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (19) & (26) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. The home is well maintained so individuals can benefit from living in a comfortable and clean environment. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 17 EVIDENCE: St David’s Lodge is located on Lodge Causeway, close to the Fishponds Road, shops, amenities and bus routes. The property is surrounded by residential and industrial environment and, maintains an appearance of a domestic dwelling. It is arranged over two floors with bedrooms on both floors and shared space on the ground floor. Shared facilities consist of a lounge/dining area and conservatory. The lounge has seating for eleven people and in the dining room there is sufficient seating for the residents to have their meals together. Two individuals were consulted about their personal space and both individuals stated their satisfaction with their accommodation. During the tour of the property it was noted that in one double bedroom there was a previous leak and the service provider said that the wall must dry before its redecorated. The laundry room is sited upstairs away from the kitchen. The floor covering is impermeable and the walls are painted making the surface readily cleanable. The washing machine is suitable for the number of residents accommodated and has a specified programme for disinfection St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (27), (28), (29) & (30) Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. Individuals are supported by a competent staff team that are well supervised. Specific training that increases insight into the needs of the people accommodated and maintains their skills to meet the individuals changing needs must be provided. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 19 EVIDENCE: The service provider said that there are two care assistant vacancies and existing members of staff and at a last agency staff are covering the vacant hours. Two staff are rostered throughout the day and at night there is a waking member of staff on duty. A driver was employed since the last inspection to provide regular outings, arrange visits to relatives and transport for health care appointments. The home has not recruited any new staff to provide personal care for the people living at the home. Previous inspections have confirmed that completed application forms, two references and certificates are held within staff’s personal records with Criminal Record Bureau (CRB) disclosures obtained. their Members of staff have attended statutory training. However, no further training as taken place since the last inspection. The service provider is aware that members of staff must develop skills and insight to meet the changing needs of the people at the home. The people at the home were consulted about the staff and positive comments were made about the staff abilities to meet their needs. Individuals supervision occurs eight weekly with the service provider and records show that staff’s performance is monitored at the home. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (31), (33), (35) & (38) Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. Individuals can expect to live in a safe environment and can be re-assured that standards will be the subject of ongoing monitoring. The home benefits from day to day presence from senior staff. The service provider must inform the Commission about the management changes. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 21 EVIDENCE: The service provider visits four times per week to maintain a presence. Two senior staff share the day-to-day responsibilities of the home and they take over the on call. The member of staff on duty said that two deputies are in day-to-day control of the home and together they provide strong leadership. It was also stated that the deputies are approachable and respected by the people living at the home and the members of staff employed. The service provider stated that changes in the management of the home are imminent and the Commission must be informed about the future management arrangements of the home. A Quality Assurance system was introduced and surveys were used to seek information from individuals and their relatives about the standards of care. The Quality Assurance system must be kept under review to ensure that standards of care remain suitable to the people living at the home. Facilities for the safekeeping of cash and valuables exist at the home and the cash records examined cross referenced with the cash held. Receipts further evidenced the purchased made on behalf of the people at the home. Fire Risk Assessments that evaluate the potential for fire at the home were developed and must be reviewed to ensure that the actions prevent the risk of fire. The home continues to complete health and safety checks and records show gas checks, hoists passenger lifts and portable appliance testing by outside contractors are conducted and evidenced that the home promotes health and safety within the workplace. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 3 3 X X X X X X X STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement For individuals to receive a consistent service, care plans must be more detailed. Care plans must be more specific about the individuals preferred routines, the staff’s assistance needed and when tasks are to be completed. Timescale for action 30/08/08 2. OP8 13 (4) (b) 3. OP8 13 (5) 4. 5. OP27 OP31 18 (c) (i) 39 6. OP33 24 Risk assessments for people that exhibit aggressive and violent behaviour must include strategies on that safeguard individual’s from physical abuse. Manual handling risk assessments must be reviewed and updated for people that have mobility impairments. Members of staff must attend training that is appropriate to the role they are to perform The service provider must inform the Commission about the management arrangements of the home. The registered person shall DS0000026625.V361977.R01.S.doc 30/06/08 30/08/08 30/09/08 30/06/08 30/09/08 Page 24 St Davids Lodge Version 5.2 establish and maintain a system for evaluating the quality of the services provided at the care home. A Quality Assurance cycle that measures the success of the aims and objective of the home must be introduces. 7. OP38 23 (4A) Fire risk assessments must be reviewed to ensure that precautions against the risk of fire are taken. 30/06/08 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 OP7 Good Practice Recommendations Consideration must be given to using a format that can be understood by the person. St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. Extracts may not be used or reproduced without the express permission of CSCI St Davids Lodge DS0000026625.V361977.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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