Inspection on 24/09/07 for Stewart Lodge

This inspection was carried out on 24th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stewart Lodge 09/09/08

Stewart Lodge 13/02/07

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Stewart Lodge 24 Rosecourt Road Croydon Surrey CR0 3BS Lead Inspector Liz O`Reilly Key Unannounced Inspection 24th September 2007 10:30 Stewart Lodge DS0000068073.V350296.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 Stewart Lodge DS0000068073.V350296.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. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stewart Lodge Address 24 Rosecourt Road Croydon Surrey CR0 3BS 020 8684 7333 020 8684 7333 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) Harvey Stewart & Smith Ltd Angela Doreen Gordon Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th February 2007 Brief Description of the Service: Stewart Lodge is a residential care home for adults 18 - 65 years of age who have experienced long-term mental health problems. The home is a 3 bed roomed terraced house situated in a quiet residential road in Croydon. Local transport facilities are good which means this home is easily accessible. Fees for this service are from £1,100 per week. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one regulation inspector. The inspector had the opportunity to visit the home and meet with the two people using the service at the time and the registered person. Questionnaires were provided for the people using the service and the care manager involved from the local authority. Each of the people using the service returned their completed questionnaires. Information received from people during the visit to the service, observations made at the time and questionnaires have been used to make the judgements on this service. What the service does well: What has improved since the last inspection? At the time of the last inspection six requirements were made. These have all been met. Improvements have been made to the laundry area, this has now been fully separated from the kitchen. Amendments have been made to the policies and procedures to show the practical steps on whistleblowing by staff and reporting any suspicion or allegation of abuse. A log book is now in place to record any complaint about the service with actions taken and outcomes. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 6 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. Stewart Lodge DS0000068073.V350296.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 Stewart Lodge DS0000068073.V350296.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): 1, 2, 4 & 5 People who use this service receive adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has developed a Statement of Purpose and Service User Guide which is made available to individuals in a standard format. Information on what people can expect from the service is provided. However this information is not fully up to date. Assessments are carried out before anyone moves in to the home. Staff have not used all of this information to inform risk assessments. EVIDENCE: The home has a Statement of Purpose and Service User Guide which provides information for prospective residents on what they can expect from the service. It was noted that in eligibility section of the Statement of Purpose it is stated that the home provides support for people who have mental health problems or learning disabilities. The present registration for this home excludes learning disabilities. The home owner must change this information so that it is in line with the registration. The licence agreement provided for each person using the service includes a designated bedroom for their personal use. The information on the fees did not make clear who would be expected to make the payment. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 9 People who use this service told us that they were asked if they wanted to move into the home. One person told us they visited the home with a family member and had a meal there before deciding to move in. Both people living at the home said that they had enough information about the service before making their decision about moving. To make sure that the service can meet the needs and wishes of each person the home obtains copies of the local authority care management assessment and provides their own referral form. Some of this information was not included in the risk assessments in place. Stewart Lodge DS0000068073.V350296.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 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The service recognises the right of individuals to take control of their lives and to make their own decisions and choices. Each individual has a care plan but these need to be more person centred and in a format which is more easily accessible to people who use the service. Risk assessments are in place but need to cover all assessed risk areas. EVIDENCE: Each person is provided with care plan. These set out the individual needs, aims or objectives and agreed actions. Care plans are signed by the person using the service, the manager and the keyworker. Staff are provided with a personal record for each person which includes a social history, personal likes and dislikes and domestic skills. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 11 Information on the individual strengths, wishes and aspirations of people who use the service should be included in the care planning. Consideration should be given to including the more personal goals of people who use the service. Staff need to work on making care plans more person centred and accessible to people who use the service. We observed and people who use the service confirmed, that they were encouraged to make their own decisions about their lives. Staff were observed to be supportive about day to day decisions made by individuals and to encourage people to make decisions about their future. Staff were seen to be keeping good notes on the day to day activities A resident profile includes information on any risk factors and how these will be managed. However it was noted that not all information provided before admission had been included e.g. indicators of relapse, previous aggression and vulnerability. In order to manage risks appropriately more care needs to be taken to include all information. It was noted that one person had an essential lifestyle plan but this was compiled by staff from a previous home. Staff must take care to ensure that information is up to date and accurate. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 & 17 People who use this service receive good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use this service are fully involved in the planning of their lifestyle and quality of life. Educational opportunities are promoted and supported. The service has a strong commitment to enabling people to develop their skills including social, emotional and independent living. EVIDENCE: People who use the service told us that they usually or always made their own decisions about what they do each day. We observed people being given the opportunity to say what they would like to do and being offered choices. People are also supported to contribute to the running of the home by helping with domestic chores such as shopping, cleaning and cooking. Both people who live in the home felt they did what they wished in the evenings and weekends. One person was particularly pleased about starting a Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 13 college course and joining the local library. Staff are provided with information on the interests and hobbies of people who use the service. People told us they enjoyed going out to local shopping centres, parks, restaurants and a city farm. Individuals were looking forward to taking part in some voluntary work in the future. People told us that they can have visitors at any time. Individuals confirmed they were supported to keep in touch with family and friends. One person said they make regular visits to see family members and that people can visit them at any time. The menu showed a good variety of food was on offer. Comments on the food from people who use the service were very positive. The food was described as “much better” than what was provided at their previous home. Information on the individual likes and dislikes of people is available to staff. Individuals were also consulted on a day to day basis about what they might like for meals. The cultural needs and wishes of individuals are included in the menu planning. One person was making plans to take a holiday with staff support. Staff were observed to help this person make an informed choice on where they might go for a short break. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use this service receive good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use this service have access to community health care services. Individuals are supported and helped to be independent and take responsibility for their own personal care needs. Staff have taken time to listen to people who use the service and take account of what is important to them. EVIDENCE: Each person is registered with local GP practice and arrangements are in place for people to access dental care in the community. The home has contact with the community mental health team who can be called upon for advice and who will visit the home. Staff will support people to keep appointments and monitor the health of individuals. A record of each persons weight is kept so that any problems with nutrition can be dealt with. At the time of this visit all medication was held and administered by staff. People who use the service told us that this was what they wanted. Staff keep good records of medication held in the home and the record of administration Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 15 was up to date. The arrangements for the storage of medication were not seen at this visit. The Registered Person is aware of the need to provide a medication storage cupboard in line with good practice guidance. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use this service receive good outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use the service say they feel safe and well supported. A complaints procedure with systems for recording is in place. A more accessible procedure should be made available to people who use the service and visitors. All staff have received training on safeguarding adults. EVIDENCE: The people who use the service told us that if they have any complaints or problems they will speak to the staff. Positive comments were made about the registered person and how she would “hear me out”. We were also told that they could go to their care manager or their family if they were unhappy with something and could not speak to the Registered Person. Consideration should be given to making the complaints system more accessible and including information on raising concerns with the placing authority. Systems are in place for all concerns or complaints to be recorded with information on actions taken and outcomes. A whistleblowing procedure is in place. All staff have received training on Safeguarding adults and are provided with information on their responsibilities to report any suspicion or allegation of abuse. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 17 The Statement of Purpose should clearly state that any allegation of abuse will be reported and investigated under the local authority safeguarding adults procedure. A copy of the local authority procedure is held in the home. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 18 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 People who use this service receive excellent quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use this service made very positive comments on the environment. The home is very well maintained with good quality furnishings and décor. Individuals said they were very pleased with their own bedrooms. EVIDENCE: People who use the service are provided with good communal space, a large kitchen/dining room, a lounge, laundry room and bathroom. An outbuilding is fitted out as a small gym with various exercise equipment. One person who uses the service told us that they enjoyed using the gym to “get fit”. The home is domestic in scale and style which fits in with the aims of the service. Since the last inspection the laundry floor has been sealed and a window has been fitted to totally separate the laundry from the kitchen. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 19 There is a small well maintained garden at the back of the building. People who use the service told us that the home was always fresh and clean and that they were involved in keeping their room and the kitchen clean. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 20 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, 34 & 35 People who use this service receive adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use the service gave positive comments about the staff and their approach. Work needs to be done to make sure that the staffing levels match those indicated in the Statement of Purpose. Further work needs to be done to make sure that staff have the training to meet the needs of people who use the service. Care must be taken to make sure that the appropriate checks are carried out and recorded before staff start work. EVIDENCE: At the time of the visit the staffing levels as set out in the Statement of Purpose were not being met. One member of staff, the Registered Person, was on duty. The Statement of Purpose indicates that a support worker and an activities officer would be on duty along with the home manager. It is also indicated that domestic staff would be employed. The manager is at present unable to work in the home. The registered person must make sure that the intended staffing levels are clearly stated and met. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 21 People who use the service told us that staff always treat them well. One person told us that the staff were “very good” and another told us that all of the staff “are nice to me”. One person told us that this home was much better than the previous place they lived, that staff listened to them and acted on what was said. The staff rota shows only one member of staff on duty at weekends. Information on file states that one person needs one to one support for group activities when in crowded places. The Registered Person must provide information on how the needs of this person will be met when only one member of staff is on duty. We looked at a sample of staff records. The majority or records were seen were in line with regulations however in one instance there was only one reference on file and the employment history for one person was not complete with no explanations for gaps in employment. In order to safeguard people using the service information on staff must be obtained before they start work. A review of the staff training needs to be carried out to ensure that all staff have received accredited training on medication. Staff must be provided with appropriate training on first aid to make sure that a qualified first aider is on duty at all times. Staff need to be provided with on going training and have access to information on mental health care and good practice. The induction programme currently in place should be up dated to meet Skills for Care standards. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 22 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 People who use this service receive adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Due to an incident in their previous employment the manager is unable to work in this service at present. The Registered Person has therefore stepped in to fill this gap in the short term. Good work has started on quality monitoring. Staff make regular checks on the environment to ensure the health and welfare of people who use and visit the service. EVIDENCE: In order to assess the quality of the service the Registered Person has provided questionnaires for those people living in the home. The questionnaires used were seen to be easily read and filled in. An action plan is compiled once feedback has been received. Further work on the quality monitoring system could include finding the views of other professionals and visitors involved with the home. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 23 People who use the service told us that they were regularly consulted on the day to day running of the home and future plans. This is done through one to one and group meetings. Each resident is supported by local authority with their personal finances. The care manager from local authority checks records monthly and takes original receipts for expenditure. When a person needs money contact is made with the care manager and money is transferred into individual post office accounts. Records of checks on the fire alarm system are in place. Fire drills have taken place and risk assessments have been done for those people who are less likely to respond to the fire alarm. A record of fridge and freezer temperatures is kept to ensure the safe storage of food. First aid boxes are in place and are checked regularly. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 3 5 2 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 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 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 3 X 2 X 3 X X 3 X Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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 YA1 Regulation 4&5 Requirement To make sure that people have the information they need to make a decision on moving into the home the Statement of Purpose and Service User Guide must include up to date and accurate information. • Information on the staffing levels in the home must be accurate. • Information on eligibility must be accurate. • Information that any allegation of abuse will be referred to the local authority. Information must be provided on the amount of fees payable and by whom. In order to make sure that people are protected a review of the risk assessments must be carried out. Risk assessments must cover all the assessed risk identified for each person. Written information must be provided to the CSCI on how the present staffing levels will meet the needs of individuals who DS0000068073.V350296.R01.S.doc Timescale for action 01/12/07 2. 3. YA5 YA9 5 13(4) 01/12/07 01/12/07 4. YA32 18 01/12/07 Stewart Lodge Version 5.2 Page 26 5. YA34 19 have been assessed as requiring one to one support in certain situations. Staff records must include a full employment history and two satisfactory written references. A review of the training programme for staff must be carried out. • All staff must be provided with accredited training on medication. • Sufficient staff must be provided with appropriate training to ensure a qualified first aider is available on each shift. • All staff must be provided with on going training on mental health care. 01/12/07 6. YA35 18 05/01/08 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. 2. YA22 Refer to Standard YA6 Good Practice Recommendations Work should continue on making care planning documentation more person centred and accessible. Consideration should be given to making key policy documents and procedures including the complaints procedure more accessible. Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Stewart Lodge DS0000068073.V350296.R01.S.doc Version 5.2 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!