CARE HOME ADULTS 18-65
Stonesby Lodge 109 Stonesby Avenue Leicester Leicestershire LE2 6TY Lead Inspector
Ruth Wood Unannounced Inspection 4th January 2006 01:00 Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 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.V270299.R01.S.doc Version 5.1 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.V270299.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Stonesby Lodge Address 109 Stonesby Avenue Leicester Leicestershire LE2 6TY 0116 2830128 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) 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.V270299.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No additional conditions of registration. Date of last inspection 14 April 2006 Brief Description of the Service: Stonesby Lodge provides a service for 12 people with mental health needs. 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 service users 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. There are two bathrooms, one shower room and two additional toilets. The home has two internal courtyards, accessible to residents which have recently been made more attractive with plants, paving and patio furniture. The home is well situated on a main road, close to shops, churches, day services, the library and other amenities. There is a regular bus service to Leicester and Wigston. Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Inspection took place on a weekday afternoon between 1.45 and 4.15 pm. This was a relatively brief inspection as the majority of key standards were assessed at the previous inspection in April. As neither the Registered Manager nor Provider were on duty at the time, the Inspector liaised directly with the Senior and other staff members on duty. Discussion was also held with residents and care plans and other documentation examined. Finally a tour of the home was conducted. Of the thirteen requirements made at the previous Inspection eleven have been met; five new requirements and two good practice recommendations have been made. What the service does well: What has improved since the last inspection? What they could do better:
Some improvements are needed in care planning; specifically that a system of regular review be implemented and that one resident’s care plan be updated to more accurately reflect the care they receive in relation to an aspect of their healthcare. It is also recommended that the resident’s placing social worker or community nurse be consulted about this aspect of the resident’s healthcare. Negotiated restrictions on certain residents’ behaviour also need to be clearly documented and a system of review implemented. Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 Page 6 Two key areas of health and safety practice need attention. Evidence must be provided that the fire systems and equipment have been serviced during the last 12 months and urgent arrangements must be made for all portable electrical appliances to be tested. Only one environmental requirement is outstanding; that the ceiling in the identified resident’s bedroom is redecorated following the repair of the leak in the roof. Finally a formal system of quality assurance must be implemented which takes into account the views of residents, relatives, staff and other stakeholders. 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. Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 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 Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Residents’ needs are effectively assessed. EVIDENCE: Four residents’ files were examined; all included an assessment of need. An assessment was in place for the resident identified at the previous inspection as not having this documentation. Social workers’ assessments were also in place for some residents. Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, Residents are supported to make decisions and the majority of their needs are reflected in their individual plans. EVIDENCE: One resident is supported in managing their finances with records being kept, as required at the previous Inspection. These records and the balance of money held was checked and found to be accurate. One resident spoke to the Inspector at some length about how well they felt the staff at the home supported them in achieving their goals. Discussion with staff members confirmed the work undertaken which was also reflected in the resident’s care plan. Discussion with residents and staff indicated that some residents’ access to items such as cigarettes is controlled, usually at the request of the resident themselves. Any such restrictions should be clearly documented, signed by the service user and be subject to a process of regular review. All four residents’ files examined contained a care plan outlining needs and how the home endeavours to meet these. There was no evidence of a system of regular review; the latest dated plan being February 2005. Discussion with staff indicated that one resident was experiencing particular issues in relation to continence. Their care plan did not accurately reflect the full extent of these issues and the home’s response to them. A more detailed plan of care should be drawn up for this resident.
Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15,17 Residents are well supported in maintaining their personal relationships and enjoy nutritious, well-cooked food. EVIDENCE: Staff members support residents in maintaining contact with family and friends either in person or on the telephone. Some residents’ relatives joined service users for Christmas lunch and there are no restrictions as when relatives may visit. One residents’ relative visited the home at the time of the Inspection. Several residents commented on the quality of the food in the home (without any prompting) and there seemed a general consensus that it was “very tasty” and that residents were “very well fed”. The main meal of the day is tea (served at 4.30pm) as many residents are engaged in daytime activities. On the day of the Inspection this was home made shepherds pie, broccoli and mixed vegetables followed by home made fruit crumble and cream. Suitable alternatives are offered for residents who have diabetes. Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 Residents’ personal support and healthcare needs are well met. EVIDENCE: The majority of residents manage their personal care independently but some need varying levels of support and/or prompting. Their needs in this area were reflected in care plans and confirmed through discussion with staff members and residents. Residents have access to regular dental, chiropody and optical appointments and some receive staff support in attending these. Two residents had experienced recent physical ill health and doctors had been called promptly by care staff and necessary medication obtained immediately. Information about these residents’ health needs was documented and clearly communicated at the formal staff handover period. Staff stated that they and residents were well supported by the General Practitioner who would always make a home visit if requested and by the manager who had visited to check on residents’ well being, even though she was on annual leave. Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Opportunities exist for residents to express concerns and policies and practices within the home safeguard residents from abuse, neglect or self-harm. EVIDENCE: A copy of the home’s Complaints Procedure is displayed on the lounge notice board. Residents would take complaints to the member of staff on duty; if they could not be resolved immediately the staff member would inform the manager at the earliest opportunity. The procedure also contains contact details for the Commission for Social Care Inspection. Whistle blowing, dealing with challenging behaviour and their understanding of the different kinds of abuse were all discussed with staff members. Some staff had received training in these areas as part of their National Vocational Qualification programmes. All staff demonstrated an understanding of whistle blowing but were unclear about the role of the Commission should they have any unresolved concerns. Staff demonstrated a good understanding of individual residents’ needs and the kind of emotional support required to maintain their mental health. One resident spoke extensively of the progress they had been able to make in the way they “presented themselves” with the support of the staff team. Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Residents live in a clean and comfortable environment. EVIDENCE: The home’s physical environment continues to improve with four of the five environmental requirements made at the previous Inspection being fully met. The downstairs bathroom has been redecorated, a new heater has been installed in the downstairs shower room, there are new settees in the lounge and exposed pipe work in the corridor has been covered. Christmas decorations were still in place and the home appeared warm, inviting and cosy. The ceiling in one resident’s bedroom still requires re-decoration following the repair of a leak. The home has a cleaner who visits every day except Sunday. The home appeared clean, tidy and fresh smelling throughout. Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33 Residents are well supported by a competent staff team. EVIDENCE: The rota was clearly displayed and appeared to be an accurate reflection of the actual number of staff on duty. Staff confirmed that there are always two members of staff on duty during the day and one waking night staff member. In addition, a cleaner comes to the home every morning except Sunday. Staff were observed to regularly spend time interacting in a positive manner with residents. Three staff have recently completed their National Vocational Qualification, level 2 which means that five of the home’s staff team now have a qualification at this level. Progression to level 3 is being actively considered. Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Although most aspects of the home are well managed, improvements are needed in health and safety and in consultation to ensure the safety and welfare of residents is promoted and protected. EVIDENCE: Neither the Registered Manager or Provider were on duty during the Inspection. The Manager is currently undertaking her Registered Manager’s Award and has several years’ relevant experience of working with adults with mental health needs. Staff said they felt well supported by both the manager and provider who, living locally, could be at the home within a matter of minutes if required. There was no evidence that a system of quality assurance had been implemented within the home. Neither was there evidence that the fire extinguishers and systems had been serviced last year. The Registered Provider stated the following day that this had been completed and he would forward evidence of this to the Commission. Testing of portable electrical systems has not been undertaken. This must be done as a matter of urgency.
Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 Page 16 Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 3 X 1 X X 2 X Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 Page 18 Yes 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 YA6 Regulation 15 Requirement A system of regular review of residents’ needs must be instigated and care plans updated accordingly. The identified residents’ care plan must be updated to accurately reflect their continence management. Restrictions on residents’ behaviour must be clearly documented and be regularly reviewed The identified resident’s ceiling requires redecoration following the damage caused by the leak, now repaired. (Previous timescale of 06/05/05 not met) A system for reviewing and improving the quality of care provided at the home must be implemented. It must include consultation with residents, their representatives and other stakeholders. (Previous deadlines of 16/12/04 & 31/05/05 not met.) The Registered Provider must ensure that all portable electrical
DS0000006370.V270299.R01.S.doc Timescale for action 31/01/06 2 YA6 15 31/01/06 3 YA7 15 31/01/06 4 YA24 23 31/01/06 5 YA39 24 28/02/06 6 YA42 13 13/01/06 Stonesby Lodge Version 5.1 Page 19 7 YA42 23 appliances be tested by a qualified electrician. Evidence must be provided to the Commission that fire systems and equipment have been serviced within the last 12 months. 13/01/06 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 YA18 Good Practice Recommendations It is recommended that the identified resident’s social worker and or community nurse be informed/consulted re the current arrangements for the management of their continence. It is recommended that staff be informed of the role of the Commission for Social Care Inspection and how they may be contacted. 2 YA23 Stonesby Lodge DS0000006370.V270299.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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