Inspection on 14/08/08 for Stonesby Lodge

This inspection was carried out on 14th August 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stonesby Lodge 03/08/09

Stonesby Lodge 19/09/07

Stonesby Lodge 25/07/06

Stonesby Lodge 04/01/06

Stonesby Lodge 14/04/05

Stonesby Lodge 09/09/04

Stonesby Lodge 06/05/04

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Stonesby Lodge 109 Stonesby Avenue Leicester LE2 6TY Lead Inspector Ms Rajshree Mistry Unannounced Inspection 14 August 2008 11:00 th Stonesby Lodge DS0000006370.V370113.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 Stonesby Lodge DS0000006370.V370113.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. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stonesby Lodge Address 109 Stonesby Avenue Leicester LE2 6TY 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) 0116 2830128/2701744 gbonom@dmu.ac.uk Mr R Bonomaully Mrs S Bates Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No additional conditions of registration. Date of last inspection 19th September 2007 Brief Description of the Service: Stonesby Lodge provides a service for 12 people with mental health problems. The home, opened in 1989, is an extended detached house located on the edge of the Saffron Lodge estate. It has a large lounge-diner and a smaller lounge where staff and residents may smoke. The majority of residents rooms (7 single and 1 double) are located on the ground floor. There is one single and one double room located on the first floor. All rooms have wash hand basins and double rooms have appropriate screening for privacy. There bathrooms, a shower room and toilets close to the bedrooms. The home has two internal courtyards, accessible to people to use with patio furniture. The home is situated on a main road, close to shops, churches, day services, the library and other amenities. There are regular bus services to Leicester and Wigston. The charges are assessed according to people’s needs, which are currently £250.00 per week. The Registered Manager provided this information during the site visit to the Home. The last inspection report from the Commission for Social Care Inspection is available at the Home. Stonesby Lodge DS0000006370.V370113.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. ‘We’ as it appears throughout the Inspection Report refers to ‘The Commission for Social Care Inspection.’ The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA), which is a selfassessment tool, completed by the Registered Manager; review of the last inspection report dated 19th September 2007 and the review of the significant events that affect the people living at the Home and the management of the service. We carried out an unannounced site visit to the Home, on 14th August 2008, which took place between the hours of 11:00 and 17:30hrs. An ‘Expert by Experience’, assisted us during this site visit. The Expert by Experience is a person who has used similar services, trained to gather views from the people using the service and how it has benefited them. The Registered Manager assisted us during the site visit to the service. The main method of inspection we used was ‘case tracking’. This means looking at the care given to people in different ways. This was done by: • Selecting people who receive a range of care and support from the Home; people that have diverse needs; are new to Home and those that have been receiving care for some time. • Talking with the people we identified for case tracking; • The Expert by Experience spoke with all the people living at the Home and a number of staff on duty. • Making observations of how people are supported by the staff; • Reading the care files which contained information about the individual people and their choice of lifestyle and support required; • Talking to the staff and the Registered Manager; • Reading the written records relating to people living at the Home, staff records, the policies and procedures and records that demonstrate the effective day-to-day management of the service. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. We sent ‘Have Your Say About Wisteria House’ surveys to twelve people who use the service, of which none were returned. We sent out ten surveys for staff, of which none were returned. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 6 We received comments directly from the people living at the Home who were present at the time of the visit, the staff and the Registered Manager. The comments have been included in the relevant sections throughout this report. What the service does well: What has improved since the last inspection? The information we received from the manager before the site visit stated there have been a number of improvements made at Stonesby Lodge. These were confirmed during the site visit and included: increased contact with the health and social care professionals to benefit the residents, having positive feedback from the General Practitioner Surgery of the care people received at the Home and a number of people having a ‘healthy eating plan’, who are healthier from healthy eating and exercise. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 7 The manager has involved the health professionals to review people’s medication. As a result, a number of people’s medication and doses have been changed, which has benefited the individuals. At present 50 of staff have attained National Vocational Qualification level 2 and above in care. The manager has confirmed her place to start the Registered Manager’s Award. The shower room on the ground floor has been upgraded and some bedrooms have been decorated. The information provided to people known as the ‘service user guide and the statement of purpose’ has been updated and given to everyone living at the Home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 8 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. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 9 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 Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 10 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 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have information about the Home and are involved in the assessment and the moving-in process to ensure their needs can be met. EVIDENCE: We read the home’s statement of purpose, which includes the ‘service user guide’. This gives information about the Home; facilities and the type of support people can expect to receive if they choose to live at the Home. The document has been updated, written in an easy read style and includes how people can make a complaint. Two people we spoke with said the manager had recently given them the new ‘service user guide’ and we saw copies in the people’s bedrooms. The ‘service user guide’ did not have details of any Advocacy services, which people could use should they need advice. The manager said she would ensure the Advocacy contact details are included in the document. People living at the Home introduced themselves and told us about how they came to live at the Home. Many people had been living at the Home for a number of years. We case tracked four people, with different level of care and Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 11 support needs including a new person that had recently moved to the Home in an emergency. We were unable to speak with this person as they were out at the time of our visit. The manager told us they spoke with the social worker, after having a copy of the assessment of needs. The person visited the Home and met the other residents and staff before agreeing to move to the Home. We spoke to one person who said “I visited with my social worker and felt it was the right place for me as the manager was welcoming”. We read the care files for the people we case tracked. All the files had a copy of the assessment of needs carried out by the social worker. We read the information gathered by the manager from the assessment about the person’s mental health needs and how to support the person to ensure their wellbeing. This varied from individuals that we case tracked such how an emotional experience has affected them and how best to support them. The information we received from the manager before the site visit stated ‘all prospective clients are assessed before admission to ensure their needs can be met, use their own assessment form with the information from the social worker with the involvement of a professional, the individual and their representative’. This was consistent with the information we gathered during our visit. We spoke with two staff individually, who said they met the new person when they visited, read the care file and receive other information from the manager when the person is about to move in. Staff said they read the assessment and the manager shares additional information about the new person. Staff said they do not always have much time to spend to read the individual care files so are reliant on information shared at ‘handover meetings’ amongst staff. A number of people we spoke with had been living at the home for a number of years ranging from several weeks to nineteen years. We received no responses from the surveys we sent out to the people living at the Home and the staff. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 12 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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are involved in making decisions about their life, care planning and staff that support and promote independence. EVIDENCE: We spoke with the people we case tracked and other people living in the Home about how their health and personal care needs are met. People told us they got the amount of support they need, which ranged from help with bathing to talking with staff for support to help them make personal decisions. We read the care plans, which whilst these were basic; they gave clear information on how to support the individual people we case tracked. Individual plans and risk assessments were available for the people who we case tracked. The care plans contained important information about their lifestyle choice, interests and aspirations, including preference of drinks to keeping in contact with family or the church. There was good recording of Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 13 changes in people’s health and wellbeing and what support was given. This showed people’s needs were reviewed regularly. Each person had been offered the opportunity to sign their individual plan but in some cases had declined. This was consistent with the information we received from the manager before the site visit stating that the person is involved in the care planning. The staff said they receive up to date information about the needs of the people they support from the manager and which is in the care files. Staff demonstrated the different needs of people with mental health and described how they support them. Staff said although they had no received training in mental health other than it being briefly covered in the national vocational qualification training and had learnt about mental health through working with people. Everyone we spoke with felt they have a fulfilling life living at the Home, having the individual support and recognising their own development. Several people told they decide how to spend their day, for example when to get up and go to bed. One person stated they visit their parent daily and is able to do this independently following a risk assessment. Another person said she has gained “more dignity and respect since moving to Stonesby Lodge”. Other people living at the Home told us about they lifestyle and daily routines that were varied. People said staff respected them and their personal information. This confirmed confidentiality was kept. We observed staff reassuring one person when they wanted to share some personal experiences with us and became emotional. The comments we received from the people living at the Home included; “this is my home and we are a family”. It was evident during the visit that people who live at Stonesby Lodge are able to make full use of communal areas and their bedrooms. A number of people made their own drinks using a kitchen. People told us they could choose to sit in the ‘sports lounge, which is the designated smoking lounge or the music lounge. We saw a number of people preferring to smoke out in the shingled garden area. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People make decisions about their life; are part of the community, having a full and active life that promotes their independence. EVIDENCE: People told us their what they do on a day-to-day basis, which ranged from keeping the Home tidy to going visit family, Bible reading, the day centre such as Four West and Age Concern to going to college. People’s interests and goals were detailed care plan. Everyone we case tracked had personal interests and aspirations. People said they recognised how they use to behave and what they have done whilst living at the Home to make themselves into ‘better people’, in control, confident and achieving personal goals. One person recognised they have the same rights as other people and if they choose to should be allowed to work. Comments received were “I don’t feel Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 15 there’s anything wrong with me so I don’t see why I should be able to work and have a life”. A number of people commented on their rights, which showed they knew about their rights and opportunities. A number of people attend various Churches and they told us they either make their own way to the Church or are collected by people from the Church. From the discussions had with people living at the Home, individually and as a group we found that everyone lived an active life. There were people that were studying an IT qualification (CLAIT), computer skills, Performance Arts and discovering Shakespeare, carpentry and doing voluntary work. Many people spoken with had a keen interest in sports and music. One person had remarkable knowledge on pop music, artists, song title and the year in which the song was released. This showed people’s interests and wellbeing was promoted. People told us about the holidays they go on to Skegness and showed us pictures of the various festivals celebrated ranging from Halloween, Easter, Diwali and Christmas. People told us about they visit to the circus, traditional pantomime and a to trip to Melton Road for the Diwali celebrations. People are encouraged to worship according to their faith. We saw one person continuing her hobby in painting and drawing and showed us her folder full of drawings from Tom Jones to the Queen. Staff members were observed to spend individual time with people who use the service and address them by their preferred name. This was consistent with the information we received from the manager before the site visit and from reading the care files. Many people spoke about their family and friends, one person said they visit their relative daily and others go out with their relatives and some have visitors to the Home. The daily records read showed people had visitors and others have friends in the community. One person told us they feel part of the local community as they use the local facilities. People showed care and affection towards each other and treated each person as a family member. This was confirmed with comments received from one person who said, “this is my home and we are a family” and “you shouldn’t judge a book by its cover”. People told us they feel safe both in the Home and being out in the community or shopping with staff. People said they know staff would act quickly if they felt unsafe in the community. Staff said people living in the residential area were not aware that this was care home and gave people privacy and respect. All the comments we received about the meals provided were positive. People said they always had a choice and showed us the menu for the week. We saw photographs of the social events at the Home and saw that a number of people had lost weight. They told us they all changed to a ‘healthy eating diet and exercise’ and for the majority they have lost weight and are happy with their new lifestyle. Comments we received about the food included “cannot fault the food”. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 16 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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have their individual health and personal care needs met through improving care planning systems. EVIDENCE: People we spoke with told us that about the personal support they have from the staff. People described the support they had when they first moved to the Home and the level of support they need now. The care records we read for one person we tracked showed how staff noted changes in their health and sought advice from the General Practitioner. The manager told us that the family were involved, with consent and evidence in the care file showed this is ongoing as the care plan are developing with the new support needed. Staff we spoke with demonstrated a good understanding of supporting people living at the Home, which was based on the rights of dignity and respect. The individual plans that were inspected detailed the level of personal care support required, preferences and sets out the health care needs such as the psychiatric nurses visiting to give medication. The care plans whilst brief gave Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 17 guidance to staff to make sure people’s independence was promoted. For example one care plan stated “ . . . . should wear his hearing aid . . . .” Records were available of regular health checks and ongoing monitoring of people’s physical health. This was consistent with the information we received from the manager before the site visit. People spoke positively about the staff and we observed people being supported and respected by the staff on duty. We looked the arrangement for people to have their medication. All medication is stored securely in the office and the manager told us trained staff give people their medication. We looked at the records and medication for the three people we case tracked and all were correct, which showed the system in place was safe and reflected the Home’s policy and procedures for medication. We looked at the staff files, for evidence of the medication training completed by the staff. The manager told us the staff files were not at the Home, so unable to check the training completed by staff. The manager said she trained the staff to do the medication. (See Staffing). We spoke to one person who takes her own medication. We saw that the manager had done a risk assessment and looked at the safety measures. The person showed us the locked drawer in which she keeps her medication and told us the arrangement to get her medication from the Pharmacy and said, “I feel able to do my tablets and don’t see the reason why they should have to give me my tablets all the time. Perhaps if in the future this may change but right now I’m ok”. This showed people are encouraged to be as independent, where people are able to do so, for as long as possible. The home does not have controlled medication at present. We spoke with the manager about the changes in legislation for storing controlled mediation. We recommended they seek advice from the Pharmacist to ensure the controlled medication storage complies with the new legislation. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 18 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 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are aware of the complaints process and are confident to raise concerns that are addressed. EVIDENCE: The procedure for people to express concerns or make a complaint is included in the statement of purpose. The complaints procedure is written in plain English although does not have the contact details of any Advocacy services. This would not help the people living at the home and prospective residents to know how to seek independent advice or advocacy should they require it. People we spoke with said they were confident to “tell the staff on duty or . . . the manager”. People told us that they didn’t think there was anything to complain about as they had a good relations with the manager and the staff and would only have to tell them if they were unhappy about anything. The complaint records kept at the Home, the information we received from the manager before the site visit confirmed the Home had received no complaints or concerns. The Commission for Social Care Inspection has not received any concerns or complaints about the service. One person described their individual arrangement to manage their own money with the support from the staff. The arrangement staff described to us Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 19 and the records completed showed there was a system in place to protect people’s money. There are policies and procedures regarding safeguarding, which means promoting the well being of people using the service from abuse are available to staff and give them clear guidance about what action should be taken. The manager showed us the old ‘adult protection’ multi-agency procedure and was not aware of the new revised safeguarding adults procedure that was published. The manager was advised that she gets a copy through the local authority and to ensure the Home’s procedure reflects this. People living at the Home knew about their individual vulnerability and said staff would protect them. One person told us staff do make sure they are safe at Home and in the community and confident staff would act quickly. We spoke with the staff on duty to see what understanding they had of safeguarding issues. Staff demonstrated awareness of the types of abuse and the vulnerability of the people living at the Home. Staff said they talk with the people living at the Home and explain to them how to be safe and that they should tell the staff or the manager if they feel unsafe. Staff gave us an example of one person returning from the shop after being asked by young children for cigarettes and they told them they were too young to smoke. This showed people felt safe to tell staff of incidents that happen to them when they are out and about. Staff we spoke with were aware of the policies and procedures and that issues of concerns should be reported to the person in charge. Staff said they were confident to report poor or bad care practices using the ‘Whistle-Blowing’ policy. Staff recruitment files and the training records did not clearly demonstrate that people were protected as the staff files had been taken home by the manager. The manager said she did have some staff records to demonstrate recruitment practice was safe such as the list of criminal records bureau disclosure numbers. However, two out of the three staff files seen were incomplete of some pre-employment checks and there was no evidence of regular training in the procedures for safeguarding adults. (See ‘Staffing’ and ‘Conduct and Management of the Home’). Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 20 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a clean home but parts of the Home are in need of repair, replacement and a planned programme of re-decoration. EVIDENCE: The Home is domestic in character and blends in with other residential properties in the area. The entrance to the Home is overshadowed by overgrown garden that darkens the front of the property. The manager showed us around the Home and the private bedrooms. Bedrooms are on the ground floor and first floor, which are accessible by the stairs. The majority of the bedrooms are single and all have a wash had basin and the use of the shared bathrooms and toilets. The double bedrooms have a dividing screen to ensure people have privacy. The manager pointed out that the loose curtains and fittings would be replaced in the double bedroom as part of the decoration programme. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 21 There were a number of areas in need of attention, which were pointed out to the manager. These included the overgrown garden to the front of the Home, which darkens the bedroom of the person living at the front of the house, window and door frames appeared to be rotting, causing draught and in need of replacement, a broken bedroom window on the first floor to the rear, which could place the person at risk if the window breaks and the hole in the flooring in the toilet that poses a trip hazard. The manager said the flooring had arrived, which was in the office and she would get the new flooring fitted as soon as possible. We saw that there were creases in the carpets in some areas of the Home, which could pose a trip hazard. There are two lounges on the ground floor, one is known as the ‘sports’ lounge and the other the ‘music lounge, which has a dining room and is next to the kitchen. The living areas are comfortable and homely. People have the use of the small garden areas and we saw a number of people sitting out in the garden having a cigarette. We saw the upgraded shower room on the ground floor, which we read in the information received from the manager before the site visit. We saw people shared the bars of soap in the shower room and bathroom. We spoke with the manager regarding good practice and preventing people from the risk of infection. The manager told us that they use to have liquid soap dispensers and would look into this again to ensure people’s health and safety. The bedrooms we saw were personalised from pictures of pets, sports, specifically football to drawings and paintings. Whilst most of the people living at the Home told us they didn’t want to have a key for their bedroom, one person said she preferred her own to have a key. We spoke to this person we case tracked about the home who said, “the windows are draughty and the room gets very cold”. Whilst they were happy that they had some privacy as the bedroom was at the front of the house, it was dark and cold because of the overgrown garden, the large tree and draughty windows. People living at the home are responsible with the support of staff to keep the communal areas and their bedrooms clean and tidy. People appeared to be happy and comfortable in their home surroundings. The information we received from the manager stated the Home complies with the fire service and the environmental health department. Whilst the manager identified areas for improvements, there was no planned programme of when these would take place or showed how areas of risks identified would be made safe for the people living at the home. This supported our findings during the site visit that the home was in need of maintenance and programme of redecoration. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 22 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 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff recruitment process, training and recording keeping does not protect the people living at the Home. EVIDENCE: People we spoke with said they thought the staff were “fantastic” and one person said they considered the manager to be “good care manager” who together with “good caring staff” have returned her “self esteem”. People gave examples of how they have been helped them to overcome some personal issues with the support from the staff. We spoke with two staff on duty who said they were appointed after they had satisfactory references, protection of vulnerable adults (pova) first check and criminal records bureau check. Staff told us they completed the induction workbook, otherwise known as the ‘First Common Induction Workbook. One member of staff who expects to attain the national vocational qualification level 3 in care, felt they “residents are cared for very well”. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 23 We asked to look at the staff recruitment and training files. In the first instance, the manager said the staff files had been taken home as she was reorganising them. Later the manager said she would be able to show some evidence of recruitment and training and put together three staff files. Two out of the three staff files we looked at did not contain application form, references, record of the induction and training certificates to support and demonstrate the training completed by staff, such as medication training, safeguarding adults training and mental health awareness. This showed the management of records did not support the Home’s recruitment process protected the people living at the Home. We spoke with the manager about maintaining records within the Home, as this was an issue raised at the last inspection of the service, and reflects on her ‘fitness’ as a manager. The information we received from the manager before the site visit stated the 50 of staff had attained national vocational qualifications level 2 and above in care. The manager told us on the day that further training had been identified for staff to attend that included first aid and food hygiene. The manager told us the responsible person for the Home plans to provide training in mental health awareness for all the staff at the Home, but the dates were not known. Staff said they receive regular supervision and have staff team meetings, where information is shared about changes in the service, development and issues affecting the people that live at the Home. The staff meeting minutes read supported the information we received from the manager before the site visit. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health, safety and wellbeing could be protected by improvements to the home environment, management and record keeping. EVIDENCE: The manager has many years experience of caring and managing Stonesby Lodge. The information we received from the manager before the site visit stated the service could be improved by completing the Registered Manager’s Award. On the day of the site visit the manager told us that a place had been confirmed for her to start the course. People we spoke with said, the manager was a “good care manager” and felt she was approachable. Staff said they had good support from the manager Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 25 and understood the needs and issues affecting the people living at the Home. Staff said they had clear roles and responsibilities and how to support the people living at the Home. Observations we made further supported the comments we received that the manager was open, friendly and supportive. People said they have ‘residents meetings’ to talk about issues and improvements in the Home. They said if they wanted to discuss something with the manager, they would ‘just go and see her’. We saw a number of people ‘popping in’ to see the manager, which further confirmed the manager was approachable. We read the minutes of the last meeting, which was held in February 2008 and saw the manager altering the typed minutes, without explanation. We observed the people sitting and talking to each other and staff throughout the day. This showed that everyone living at the home got on together and supported the comment received earlier “this is my home and we are a family”. We looked at the risk assessments carried out for the Home and individual assessments of risk for the people living at the Home. For example, one person had a self-medicating risk assessment in place and they told us the agreed arrangement helped them to be independent. People told us they prefer to manage their own money. The manager told us if people needed support to handle small amounts of money then they would follow procedures to ensure people’s money was protected and record kept of the money held on their behalf. Staff we spoke with told us they had received training in safe working practices. However, the staff files we looked at did not demonstrate safe recruitment practices and staff received regular training as the manager had taken the staff files home to re-organise. There was no other system of demonstrating staff recruitment practice was good or staff training record to show that staff receive regular training, including safe administration of medication, safeguarding adults and mental health awareness. This was an issue raised previously and reflects on the fitness of the manager. This showed the management and record keeping needs to be improved to protect the people living at the Home. The manager told us that the responsible person does the monthly visits. However, there was no record of the visit and the findings from the visit to demonstrate there was an internal checking system that people’s health, safety and wellbeing was protected. The information we received from the manager before the site visit stated they plan to implement a system of quality assurance and had received feedback from the General Practitioner surgery, who said ‘was quite satisfied that the residents were receiving good care’. However, during the site visit the manager told us the quality assurance system has not been introduced. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 26 Information received from the manager before the site visit indicated that regular servicing and testing of fire equipment and fire tests. Whilst people living at the Home had not expressed any concerns about the home environment, there were areas that needed attention such as the hole in the flooring in the toilet, broken window, rotting window and door frames and creased carpets in some parts of the Home that would pose a risk of trips or falls. The manager gave assurances that these areas would be raised with the responsible person and would be addressed. Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 1 X 1 1 X Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 YA20 Regulation Requirement Timescale for action 14/10/08 2 YA23 3 YA24 YA42 4. YA34 13(2)(6) Staff must receive regular 18(1)(c)(i) training in or by other measures to safely administer medication and records available to verify that trained staff meets their needs. To ensure resident’s health, safety and wellbeing. 13(6) Staff must receive regular 14/10/08 18(1)(c)(i) training in or by other measures to prevent residents from harm and abuse or being placed at risk of abuse and records available to verify that trained staff meets their needs. To ensure resident’s health, safety and wellbeing. 23(2) There must be a planned 14/10/08 programme of maintenance, repairs and decoration as already identified by the manager and must include: • The replacement of the flooring in the toilet; • The replacement of the broken window to the bedroom on the first floor. To ensure resident’s health, safety and wellbeing. 19 (4) The registered person must 14/10/08 DS0000006370.V370113.R01.S.doc Version 5.2 Stonesby Lodge Page 29 5. YA35 19 (5) 6. YA39 24 7. YA39 26 8. YA41 17 ensure staff are recruited with satisfactory pre-employment checks and records are available to verify that residents are protected by the home’s recruitment practices. The previous timescale of 17/10/07 was not met. The registered person must ensure staff training records are be available and can be verified to protect the residents and have their needs met by trained staff. The previous timescale of 17/10/07 was not met. The registered person must introduce a method of quality assurance to measure the standards are maintained and improved through seeking the views of people using the service and key stakeholders. To ensure the health, safety and wellbeing of the residents. The previous timescale of 19/09/07 was not met. The registered person must carry out the monthly visits to the Home and produce a report of the findings and action plan to address any issues. To ensure the health, safety and wellbeing of the residents. The registered person must ensure records specified in the regulation 17, schedule 4 are maintained, up to date and available for inspection. To ensure people are protected. 14/10/08 14/10/08 14/10/08 14/10/08 Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 30 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. 3. Refer to Standard YA20 YA22 YA23 Good Practice Recommendations To seek advice from the Pharmacy to ensure that the existing storage for controlled medication is appropriate in accordance with the new legislation. The contact details for advocacy services are included in the complaints procedure. To ensure the revised multi-agency safeguarding procedure is acquired, for the manager and staff to be familiar with the procedure and ensure it is reflected in the Home’s policies and procedures. Staff members should have access to training which develops their understanding of mental health to ensure that they continue to meet all present and future residents’ needs effectively. 4. YA35 Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Stonesby Lodge DS0000006370.V370113.R01.S.doc Version 5.2 Page 32 - 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. 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