Inspection on 10/10/05 for The Lodge

This inspection was carried out on 10th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Lodge 09/10/06

The Lodge 15/04/05

The Lodge 26/10/04

The Lodge 24/05/04

The Lodge 08/12/03

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 The Lodge Clayton Road Clayton Newcastle Staffordshire ST5 4AD Lead Inspector Mr Berwyn Babb Unannounced Inspection 10th October 2005 09:00 The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 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 The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 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. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Lodge Address Clayton Road Clayton Newcastle Staffordshire ST5 4AD 01782 616961 01782 254001 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) Choices Housing Association Limited Mrs Dawn Patricia Hughes Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (2), Physical disability (4), of places Physical disability over 65 years of age (2) The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users admitted must have a Learning Disability or a Learning Disability and a Physical Disability. 15th April 2005 Date of last inspection Brief Description of the Service: The Lodge is a detached bungalow set in its own picturesque and well maintained grounds, located on a busy main road, which gives easy access by car or bus to the town of Newcastle-u-Lyme, approximately 11/2 miles away and a variety of local shops. It provides accommodation for four adults who have a learning difficulty, and sets out to be as domestic in character as circumstances allow. There is a small private car park. The home consists of two single and one shared bedroom, a large lounge, kitchen / diner, a shower with WC, and a fully adapted toilet / bathroom and a small laundry. The building is in a good internal and external state of repair and all furnishings and fittings are appropriate and in good condition. Choices have a commitment to the personalisation of residents bedrooms that reflects the individuals special interests and hobbies. Redecoration and minor maintenance is carried out by the handyperson, and larger tasks are undertaken by outside contractors. Other privately owned properties, and a large comprehensive school close by do not intrude on residents privacy. The large storage shed mentioned in previous reports is now finished, and will provide much needed storage space for wheelchairs and specialist equipment for this home, and also provide some general storage space for the choices handy person. All areas of the home facilitate wheelchair access. The staff have worked hard to successfully create a domestic atmosphere. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Lodge is risk assessed as a green home, and currently presents no causes for concern. This inspection therefore, whilst pre-arranged with the care manager, was conducted using the new key standards methodology, and concentrated on those key standards not assessed at the previous inspection of 15/04/05, thus ensuring that each has been examined at least once in the inspection year. This home continues to be well run on the most domestic style that was possible for a group of people with profound difficulties. Maintenance of the building was to a high standard, and the Person Centred Plans exhibited evidence of wide ranging and lengthy consultations, and an awareness by staff of the needs and choices of residents. The informal interaction of the staff never compromised the dignity of the residents, and demonstrated their respect for the privacy of the individual. Everyone on duty was most helpful in contributing to the inspection process, as were the residents within the boundaries of their abilities. The inspector was not able to hold any extensive conversation, as the only resident with an easily accessible level of verbal communication, chose to limit private discussion to a few minutes only on this occasion. Staff were observed to be using extensive knowledge of body language and the restricted vocabulary of residents in a most skilful way to determine their opinions, choices, and care needs. What the service does well: The home meets the needs of four residents with profound needs due to Learning Disability in the least institutional way possible, and provides those whose previous experiences have been in large hospitals, with a higher level of privacy, independence, and one to one care than they will ever have known. Records demonstrated the investment of exponential amounts of time in order to enhance the life potential of residents, and those risk assessments reviewed had been used to enable an activity rather than prevent it in all but a tiny minority of occasions. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 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 The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 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): 5 The licence agreement used by Choices set out for residents the legal aspects required under the standard. EVIDENCE: There had been no new residents admitted in the past two years, so this standard was checked against documentary evidence in care plans. The evidence showed that the details set out in standard five for the protection of, and giving information for, new and existing residents, was provided by the licence agreement between Choices and the individual resident. The home offers discretely specialised services, and records and discussion revealed the training was based on best practice recommended by The British Institute for Learning Disability. The care manager and new deputy manager are both qualified L. D. nurses. The care manager has completed [and the deputy manager was undertaking], the N. V. Q. Level 4 in management and care, and was currently engaged in study for a Mentorship Award at the School of Nursing at the local hospital. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 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): 7 Staff were seen to be using their knowledge of residents, and skills in the care of people with Learning Disabilities, to assist them to express what they wanted. EVIDENCE: As outlined in the introduction, the current residents of The Lodge experience profound difficulties, some of which limit their powers of communication. The inspector concentrated on observing the lengths to which carers needed to go, to ensure that even the smallest expression of choice that could be discerned from a resident, could be channelled into the decision about what was going to happen to them. Records showed that specialist advocates had been used to promote the individual decisions of residents at key times in the past, and observation confirmed that staff were in the role of advocate on a day to day basis, in the interest of residents. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 10 In the care plan of one resident there was a digest of all the words and phrases he used, together with the meanings for them that had been determined over a number of years. For another gentleman there was a record of activities and events that had been tried with him, and his body language responses to these, building up a profile of likes and dislikes. For all residents a 24 hour profile had been produced recording their needs and choices at different times during the day and the night. Resident choice was seen in action, when one gentleman who had already been out during the morning, declined the offer of going to the shops, because he wanted to stop in for a cup of tea. Another resident chose not to continue with a conversation when he no longer wanted to engage with the inspector, and staff were able to read his body language and assist accordingly. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 11 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): 16 The extent of the commitment of staff to residents rights went beyond recognising them and extended to promoting them with this group of highly dependent people. EVIDENCE: The recurring requirements of each person were recorded in the their personal care profiles, including the activities of daily living that could, and were willing, to engage in. Postal voting slips had been obtained on their behalf, but none have exercised right in this area so far. One gentleman has a lock of the appropriate type on his bedroom door, and sometimes uses this, but not always. The same person is able to benefit from provision of an alarm call, but none of the others would. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 12 For this reason staff on waking night duty had developed an awareness of the usual patens of sleep for each resident, and were briefed to be vigilant for indications that assistance was not required. One man had made it plain that he did not want routine monitoring, so he was not disturbed unless he made sounds to attract the attention of staff. Two of the men were said to open their own mail, though one required assistance with knowing the content. As mentioned earlier in this report, one man did not wish to go out again, and his right to choose was seen to be respected. The bathroom and toilet doors had the appropriate locks, and the statement of purpose informed would be residents and their supporters that choices have a No Smoking policy. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 13 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): 19,20 The physical, the medication, and to the extent that they could be determined, the emotional needs, of residents were adjudged to be met by the care provided for at The Lodge. EVIDENCE: The inspector examined the Personal Care Profiles of the residents, and compared the needs assessed and identified, with the care that staff members had recorded, and found that these tallied. There was evidence of both “O. K. man” checks, and “O. K. Health” checks for all the residents, and assistance given to enable them to attend one off, and regularly programmed, hospital, clinic, and doctors’ appointments, as well as arrangements for access to such tertiary health care as; dentists, opticians, chiropodists, and hearing aid centres. [One gentleman attended his G. P.’s practise nurse to have his ears syringed whilst the inspection was proceeding]. Two residents have regular hydro-therapy sessions, and both were enabled to access these during the inspection. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 14 The building recently of a combined health centre near by, has enabled one resident to access his doctor without the need for transport to be arranged. Medication . None of the current residents were administering their medication, and in addition to annual “In House” training from the company, all staff members attended a course every three years, run by “Boots” the chemist. This training has been supplemented by the care manager, who gives additional instruction regarding specific, and/or newly available drugs, their expected effects, and possible adverse side effects. She had also provided sessions on the implication and possible effects of misadministration. Observation of one carer administering medication confirmed the appropriateness of the techniques being used. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 15 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 The home continue to work with residents to enable them to express dissatisfaction, and to maximise their protection from abuse. EVIDENCE: The inspector was able to access the complaints procedure and observe the different formats in which it had been made available, but was mostly encouraged by the responses of staff he spoke to, who recognised that for most of their residents, they needed to be pro-active in advocating for them. A member of staff engaged in a formal interview, correctly identified many forms of abuse, the clues to look for, the procedure to follow, and the manifold range of people who could abuse the vulnerable adults who live at The Lodge. [Anybody can] The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 16 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 This well maintained single story residence was structurally enhanced to suit the needs of intended service users prior to registration. It was scrupulously clean. EVIDENCE: The Lodge is a spacious bungalow with two single and one shared bedroom, and adequate compensatory communal space. There is a large kitchen/dining room where residents were observed to locate themselves when not in their own rooms. This area has a good view of the entrance and of the main road, and people passing by. The car park can also be viewed from here, and this leads to a large shed that has been clad with half timbers to resemble a chalet, and which acts not only as a storage area for the home, but is the depot for the maintenance team. Before registration, the bathrooms in this home had been altered to meet the requirements of the proposed service users, and meet current specifications. The home was clean and infection control policies were in place. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 17 There was a separate laundry room, and hand washing facilities were seen located at convenient positions throughout the home. Ramped access has been provided to the car park, all other areas of the home being accessible on the level. The building is a former lodge to what is now a large adjacent college, and parts of it have listed building status. It has therefore been accepted as a part of the locality for many years, and whist adapted internally to meet the needs of residents in the most domestic style compatible, it has not been stigmatised in any way externally to identify it as a care home, or detract from the ambience of the local community. Bedrooms reflected the need for sensory stimulation as identified in the care plans, with examples of “Snoezelen” products such as their projection discs, and the use of light tubes and ceiling mounted “Disco” ball. There were examples of standard and nursing beds, as dictated by individual need, and the whole home was very thoroughly cleaned by the carers [no dedicated domestic staff were employed], and no obnoxious odours were encountered at any time. Infection control training had been received, and staff on duty were observed to wash their hands after every task, and to wear appropriate protective clothing for the task being undertaken. Choices have a charming practice for ensuring that mops and buckets are confined to specific types of areas, they colour code them. Blue is for loo, and pink is for sink [kitchen areas]. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 18 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): 35 The employment practice and training schedule ensured that residents assessed needs were being appropriately met. EVIDENCE: An interview with a member of staff confirmed the robustness of the induction and post employment training procedures, and written records from personnel files and the training schedule agreed with her testimony. The induction scheme had been accredited by The British Institute for Learning Disability, and all in house training was said to be founded on their principles and measured by their L. A. D. A. F. standards. Records and anecdote showed that all mandatory subjects were reviewed and renewed at the intervals required, and that expanded specific specialist training was sourced when circumstances indicated a need. Anti-discriminatory, equal opportunities, and race awareness training and refreshers were recorded as recurring and standard practice. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 19 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): 39,42 This home benefited from good management structures that in turn assured that residents experienced a well run home. EVIDENCE: The care manager holds the N. V. Q. level four in management and care, and her new deputy was completing her studies for this award. The manager demonstrated that she had a continuing commitment to keep abreast of current development and thinking by engaging in further training at the school of nursing, to qualify her as an “Enabler”. Levels of service user satisfaction were monitored during P. C. P. reviews, and supporters of the residents were lobbied for their views at this time. These had been supplemented with emotional needs surveys conducted by the staff. P. C. P. ‘s also recorded the inclusion of day centre and officers and other professionals at reviews, and the sending out of surveys to family members. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 20 The health, welfare, and safety of residents had been enhanced by; regular fire safety training and testing of alarms, equipment, and emergency lighting, by having hand rails to all walkways and in toilets, by installation of non-slip safe flooring, by regular servicing of disability equipment such as the hoists, by using moulded, and electric, wheel chairs after assessment of suitability by a professional, by training all staff in medication administration, moving and handling, infection control including food hygiene procedures, the use of slide sheets and turners, and of high rise beds as necessary, by continuous review and maintenance of the environment, a curtain chair for a gentleman with an unsafe posture, and a bath raiser. Contracts were in place for boiler servicing, electrical appliance testing, general waste disposal, clinical waste disposal, and Legionella testing, and water temperatures were tested in house nightly. [A spot test produced hot water that was comfortable to the hand, and without the usual “surge”. The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x 4 x x x Standard No 24 25 26 27 28 29 30 STAFFING Score 4 x x x x x 4 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score x x x 4 x x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Lodge Score x 4 x x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 4 x DS0000005016.V258950.R01.S.doc Version 5.0 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 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 The Lodge DS0000005016.V258950.R01.S.doc Version 5.0 Page 24 - 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!