Inspection on 12/01/10 for The Lodge

This inspection was carried out on 12th January 2010.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Lodge 19/02/09

The Lodge 17/09/07

The Lodge 30/08/06

The Lodge 29/06/05

The Lodge 08/12/04

The Lodge 24/08/04

The Lodge 01/03/04

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 03/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Lodge Lodge, The Bridge End Eldersfield Gloucestershire GL19 4PN The quality rating for this care home is: zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Dianne Thompson Date: 0 2 0 2 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 45 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 45 Information about the care home Name of care home: Address: The Lodge Lodge, The Bridge End Eldersfield Gloucestershire GL19 4PN 01452840088 01452840088 eddavies53@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Glevum Farm Trust care home 9 Number of places (if applicable): Under 65 Over 65 9 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 9 Date of last inspection 1 9 0 2 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 45 A bit about the care home The Lodge is a home for a maximum of six adults who have learning disabilities. Mr E Davies is the Trust Manager, Company Secretary and Responsible Individual. People can ask The Lodge for details of the fees for their service. Each person has their own bedroom that is decorated in the way they want it to be. They have the space in their bedroom to keep their personal things there. Care Homes for Adults (18-65 years) Page 5 of 45 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 45 How we did our inspection: This is what the inspector did when they were at the care home The inspection was carried out by one inspector who visited the home without telling anyone she was coming. This inspection was to look at what life is like for people who live at The Lodge. The inspection took place over two days. Time was spent talking to some of the people living at the home and some of the staff providing their support. Care Homes for Adults (18-65 years) Page 7 of 45 We looked at some of the records, policies and procedures in the office. We looked at other records that told us how the home is run. This included staff records and health and safety records. We sent our surveys to people to get their views of the service. Care Homes for Adults (18-65 years) Page 8 of 45 We looked around the home. Mr Ed Davies completed an Annual Quality Assurance Assessment (AQAA) and sent this to us when we asked for it. This is a form the manager fills in and sends to the Care Quality Commission telling the inspector how the home is meeting the needs of the people who live there. Care Homes for Adults (18-65 years) Page 9 of 45 What the care home does well Staff treat people well and with respect. People take part in regular activities. People are supported to keep in touch with family and friends. Care Homes for Adults (18-65 years) Page 10 of 45 Fresh food is provided which people enjoy. Medication records show that medication is given as it should be. Staff do some training. People say they are happy living at the home. Care Homes for Adults (18-65 years) Page 11 of 45 What has got better from the last inspection A manager is in post and has made an application to become registered with the Care Quality Commission (CQC). First Aid supplies are kept in stock and checked regularly. Care Homes for Adults (18-65 years) Page 12 of 45 What the care home could do better Information about the home is not kept up to date so people cannot be sure they have the right information. A full assessment of each persons needs must be done before people move into the home. This makes sure they will get the care they need. Care Homes for Adults (18-65 years) Page 13 of 45 Care Plans do not have enough information in them to show how the range of health care needs for each person is to be met. Health Action Plans need to be done as part of individual care plans and kept up to date. Risk assessments must be up to date to make sure people can live as independently and safely as possible. Care Homes for Adults (18-65 years) Page 14 of 45 Health checks should be carried out routinely. Everyone living at The Lodge should have access to their finances and records about their accounts at all times. Some areas of the home need to be redecorated. There are problems with the heating system that need to be put right. Health and safety needs to be improved so that people are kept safe. Care Homes for Adults (18-65 years) Page 15 of 45 Staff need to be better trained and supervised to make sure they are able to support people well. The number of hours that some staff are working on some shifts need to be shorter so they give the best support to people living at The Lodge. Care Homes for Adults (18-65 years) Page 16 of 45 Recruitment checks should be carried out at all times to make sure that suitable staff are employed. Reports about the home should be available so that people know what the quality of the service is like. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 17 of 45 If you want to speak to the inspector please contact Dianne Thompson CQC (West Midlands) Citygate Gallowgate Newcastle Upon Tyne NE1 4PA If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 18 of 45 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 19 of 45 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although Information is available to help people making their choice of service to use information is not up to date. This means that people looking for a service will not have access to accurate information. People cannot be confident the service will be able to fully meet their needs because admission procedures are not followed to make sure the service can meet their needs before they move into the home. Evidence: We looked at a copy of the Statement of Purpose and a Service User Guide. The Statement of Purpose was out of date and last reviewed in March 2006. The Lodge was advised to review their Statement of Purpose and Service User guide at the previous inspection. The welcome guide needs to be readily available for people living at the home and their families in a clear and accessible format, providing them with information about services and costs so they will know how their needs will be met. We looked at the files belonging to 3 people living at The Lodge including the last person to move into the home. We looked at records to show how individual needs had been Care Homes for Adults (18-65 years) Page 20 of 45 Evidence: assessed, how The Lodge had determined they could meet those needs and provide the support required. The Statement of Purpose says that a full assessment is carried out to make sure that The Lodge will be able to meet peoples needs before offering a service. We found no evidence to show that a detailed needs assessment had been completed for the last person admitted to the home. We saw no evidence to show how information gathered had been used to support the decision to offer a place in the home. We saw a copy of the Local Authoritys Community care assessment but there was no evidence to show that this had been used to support an assessment carried out by the service. We saw a copy of the licence agreement between the Local Authority and The Lodge. There was no profile information, such as the date of admission. We found the date of admission within the contract agreement between the Local Authority and the service, completed some 11 months ago in April 2009. We did not see a contract on file between the service and the resident. We saw that information from a previous provider was in use giving details of support for one resident. We were told by staff that this information is currently used to guide staff to provide the support needed. All information in this file was still on the previous providers paperwork and included a copy of their complaints procedure. We saw no evidence to demonstrate that introductory visits took place to give the prospective resident the opportunity to try out the home. We saw no evidence to show that admission procedures had been followed, to determine staff skills, experience and ability to deliver care support needed. The Lodge clearly has not followed their referral and admission policy, last reviewed November 2008, as confirmed in their Annual Quality Assurance Assessment (AQAA). The responsible individual states in the AQAA that evidence shows they have the proven ability to accept and integrate new and challenging residents. Three surveys out of six completed by people living at The Lodge confirmed they had been asked if they wanted to move to the home, and that information was provided before they moved in. Care Homes for Adults (18-65 years) Page 21 of 45 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at The Lodge are cared for by staff who make them feel cared for and respect their privacy. Care records are in place to help staff give people who use the service support, although information given is limited, and the plans are not as up to date as they should be. This means that staff do not have all the information they may need to help support people to make informed choices. Although assessments are in place to manage risks they are not kept up to date to make sure that everyone is kept safe. Evidence: A care plan tells staff about individuals care and social needs and the level of support required for maintaining their health and independence. Each person living at The Lodge has a strengths and needs care plan. At previous inspections it had been identified that there was not enough information in the care plans to show how the range of health care needs that people have are being met, and this remains outstanding. Care Homes for Adults (18-65 years) Page 22 of 45 Evidence: The responsible individual states in the services Annual Quality Assurance Assessment (AQAA) that they have extensive knowledge of our residents. We have managed to gain the support of valuable volunteers and others in the wider community to improve the quality of life of our residents. We have also significantly increased the support that residents families feel able to offer their loved ones. We have done this by supporting their efforts to remain in touch with the lives of residents. We plan to improve record keeping to ensure that information is shared to benefit all concerned. We case tracked care for 3 people. This is where we look at what life is like at The Lodge for the people who live there. This includes looking at care plans, and seeing how health and social care needs are being met. Information in care plans is not always as detailed and up to date as it should be. Care plans we looked at did not give details such as likes and dislikes, diet, communication, personal care and individuals preferred routines. We found that vague and inconsistent comments had been made throughout these care plans, such as those referring to challenging behaviour. We saw no guidelines in place to support staff to work in a consistent way, or guidelines that encourage monitoring and assessing the effectiveness of procedures. This is particularly important where people have a diagnosis such as autism, so staff can understand how and why support should be given in an agreed way. Regular reviews of care plans have not been carried out. This was discussed with the responsible individual who said that all care plan reviews are due to be completed in February. We looked at the records for the care plan review that had been completed. Staff commented that these reviews are being rushed through at short notice and not every key worker has been as involved as they would have liked. Comments included these reviews are being rushed through following your first visit to the home. This review meeting was attended by the resident, family members, the responsible individual and some staff. We saw an improvement to the content of the care plan but the improvements do not cover all requirements as listed in National Minimum Standard number 2. An action plan has been produced from this review meeting which identifies aims for the coming year. We are assured that care plan reviews will be completed for all residents, as we were assured at the previous two inspections of this service. We saw risk assessments in place where risks had been identified, such as those associated with travelling in vehicles and for responses to challenging behaviour. We saw that crossing the road was identified as a risk for one person but no risk assessment or support plan had been included in their care plan. Those risk assessments we checked had not been reviewed and it was unclear whether these assessments were still valid. For example, one risk assessment relating to an obsession with a member of staff dated 7/12/06 was due to be reviewed within 3 months of the date of completion. This had not been done. Another risk assessment related to an incident of challenging behaviour dated October 2008 had not been reviewed. Further to the concerns about these risks we saw that the care plan being used by staff from another provider identified a risk of choking Care Homes for Adults (18-65 years) Page 23 of 45 Evidence: dated 25/10/08. We saw no evidence to show that The Lodge had completed their own risk assessment or put in place guidelines for staff to give appropriate support. The Lodge has not completed Mental Capacity Act assessments where people are unable to comprehend or make their own decisions. Care plans do not set out any restrictions on choice and freedom in accordance with the Mental Capacity Act. Staff said they give people information they need to help them make decisions about their lives, but records need to demonstrate how people have been supported in their decisions. Staff said they had not completed training in relation to the Mental Capacity Act. The previous inspection report stated that there is a need for The Lodge to develop staff skills in assessing the capability of people to make decisions in accordance with the Mental Capacity Act, to ensure the right of people to make decisions is only withdrawn or restricted once an appropriate assessment has been completed. Staff were observed supporting residents in the home with respect and in a ways to encourage their independence. Time was spent talking with residents who said that staff treat them well, get on well with the staff and that staff are good here. Survey comments include staff look after the clients and their needs most of the time, and the house is made comfortable for them, it is a lovely house to live in. Care Homes for Adults (18-65 years) Page 24 of 45 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to lead active and interesting lives. Staff encourage people to maintain links with their families and to develop friendships. People who live at The Lodge are offered a varied and healthy diet, although nutritional monitoring would make sure that individual diets are appropriate. Evidence: The responsible individual said in the services Annual Quality Assurance Assessment (AQAA) that residents are offered individual packages of care which encompass all aspects of their lives including suitable day care, family relations and social/recreational activities. Individual activities schedule. The frequency of holidays/outings/free supported association with family members e.g. a family birthday party for a resident, held at The Lodge but attended by the extended family. This was his first experience of such an event as a resident of a care home. We have continued with the current programme of improvement with particular emphasis on building on our broad support contained in the wider community and in the network of local groups involved with learning disability. In particular, we have introduced additional younger service users to use of our farm Care Homes for Adults (18-65 years) Page 25 of 45 Evidence: facilities. Time was spent talking with residents in the lounge. Residents were happy to talk about their life at The Lodge and what they do. Residents have an activities plan that gives an overview of their daily routines. Residents say they enjoy going out to the pub or a cafe. Nearly all of the residents work on the farm, although daily routines are being changed for one resident as he no longer wants to work on the farm. Other activities have included visits to Cadbury World, the Severn Valley Railway, air museums and air shows. Residents regularly attend rainbow club, or go to the pictures. A computer is now available in the lounge for residents to use. Although residents and staff talked about the activities they do records do not support this. Glevum Farm Trust provides day care working on the farm for people in the community as well as people living at The Lodge. Residents said they dont like working on the farm in the winter, its cold and wet and get bored. Staff commented that if the weather is bad people are out in the cold and wet with nothing to do. They cant come back into the house, as there are no day staff at the house. They sit in the dirty tea room with nothing to do. The responsible individual said that the farm is a working farm and it is run separately from The Lodge. Surveys confirmed that residents can do what they want to do most of the time. The AQAA tells us that The Lodges plans for the next year include the provision of still more varied opportunities to offer even more real choice to service users both at The Lodge and elsewhere. It is evident that visits and contact with family and friends is supported. Staff support people to visit their family members where they are unable to visit at The Lodge. Records show that varied and nutritional meals are provided with alternative meals recorded where these have been chosen. People who live at The Lodge take their main meal in the evening. The meal at the time of the inspection was sausages, with mashed potatoes, peas and gravy. Apple pie and custard was offered for desert. The meal was eaten at the table in the kitchen. Everyone said they enjoyed their food and one person said sausages are my favourite. At the last inspection it was identified that it was difficult to link weight gain or loss to nutritional monitoring because only one person had their food intake recorded. The service should evidence that nutritional needs are being met and that people receive a nutritionally balanced diet. Information in the AQAA confirms that a food safety and nutrition policy is in place but staff confirmed they have not received nutrition training. Care Homes for Adults (18-65 years) Page 26 of 45 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Lodge has a medication policy and procedure in place for staff to follow so that medication is administered and stored safely. Some staff are trained in basic medication awareness. All staff should complete accredited medication administration training to make sure that people are kept well and safe. Evidence: The responsible individual says in the Annual Quality Assurance Assessment (AQAA) that all our residents are registered with the local G.P. of their choice and in addition they access chiropody and dental services of their choice. Their records are kept confidentially and their individual health issues are carefully monitored. We saw that although Health Action Plans are available to help and support people with their health care and appointments, these have not been fully completed or updated. These plans should set out how individual health needs are to be met. We saw no records to show how personal and health care support is to be given. At the previous inspection it had been identified that the service was to monitor peoples health and show how they do this in the healthcare section of the care plan. This has not been actioned. Care Homes for Adults (18-65 years) Page 27 of 45 Evidence: People have access to medical support through their doctor, psychologist, behavioural team, community health care team, and dentist as required. We saw that routine medical checks had not been carried out regularly. For example, for one person the last opticians appointment is recorded as 13/6/07. For another person a medical check up had been carried out 20/1/10, but there were gaps for previous check ups done 8/4/09 and 3/7/06. We saw that flu vaccinations for one person had been recorded as completed for 2003, 2004 and 2005 but found no records of these having been carried out since. This was confirmed by staff. Regular health checks should be an integral part of individual care plans to make sure appropriate support is given to help people maintain their health and well being. The AQAA tells us that the Lodge plans to improve record keeping and develop individual health plans as appropriate with the support of health professionals. Despite such intentions for improvement, care plans and health action plans have not been developed following the last two inspections of the home. Staff have known and worked with the residents of The Lodge for a number of years and have gained knowledge and experience in providing support for their needs. There is a potential risk that too much reliance is placed on such knowledge and experience and valuable, important information is not included in individual care plans. There is an increased risk that knowledge and information is not fully communicated and this does not ensure staff work in a consistent way. Staff were observed providing support for people in a respectful way, making sure that each persons dignity and self esteem was important. Time was spent talking with residents who spoke about their health care and the support staff give them in a positive way. Staff help me when I need it and I can tell staff if I am not well. Medication is well managed by staff at The Lodge. Medication is stored securely and given to people at the right time and full records are kept which show this. A medication policy and procedure is in place and was last reviewed in May 2009. First aid supplies are now maintained as recommended at the previous inspection. We checked the administration of medication records and found that all medication given had been signed for. At the previous inspection the need for accredited administration of medication training was identified for all staff to make sure that people continue to be fully safeguarded from medication errors. We saw from training records that some staff had completed a basic introduction to medicines course in July 2009. It was unclear from the training records or from talking to staff that this course, provided by the local pharmacist, constituted accredited training. Care Homes for Adults (18-65 years) Page 28 of 45 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff give people living at the Lodge the support they need to keep them safe. Staff are trained to know what to do should they have any concerns about the safety of people living in The Lodge. A complaints procedure is made available to everyone although contact details are not up to date which means that people living at The Lodge do not have accurate information for people they can contact should they need to. Evidence: The Annual Quality Assurance Assessment (AQAA) tells us that the complaints and abuse procedures are incorporated in the service users guide. Opening up the use of facilities to additional service users allows for our services to be monitored by an even wider range of supportive professionals who can see the quality of service the Trust offers. The responsible individual told us they had received one complaint which was being investigated. The Care Quality Commission (CQC) has received no complaints about The Lodge since the last inspection. The complaints procedure is made available to everyone who uses the service, although this is not in a suitable format for residents to understand, and the procedure remains out of date with information such as references to the CSCI (Commission for Social Care Inspection) which ceased to exist as of April 2009. Surveys told us that people would know how to make a complaint should they need to. We spoke to residents and they said they knew how to make a complaint if they were unhappy about anything. One resident said that he felt a complaint would not be listened to and would be ignored as this has happened before. This was discussed with the responsible individual who said they would take all complaints seriously and respond Care Homes for Adults (18-65 years) Page 29 of 45 Evidence: accordingly. Staff say they have access to The Lodges safeguarding policy. This policy tells staff how to recognise different forms of abuse and how to protect people. Staff training records and staff confirmed that they had completed Protection of Vulnerable Adults training. Discussions with staff showed they have sufficient knowledge and understanding about basic procedures and adult protection to keep people safe. Staff confirmed they would know what to do if they had any concerns or suspicions of abuse. We looked at residents financial records. These records are kept in the office and not in the home. Residents have access to money in the home via a petty cash system. We checked records for these and found them to be correct. Residents do not have copies of their bank statements in their file or easy access to these. All residents should have access to their personal financial records. Bank withdrawals are carried out by the responsible individual and the acting manager. The responsible individual said that he completes audits of all financial records in between the accountants annual checks. We were told that daily checks are carried out by the acting manager although we did not see any records to show that these checks were being done. At the previous inspection the report stated that although people are encouraged and supported to manage financial transactions as independently as possible, this level of capacity needs to be formally assessed in accordance with the Mental Capacity Act, to ensure that people continue to be safeguarded in an area of their lives where lack of capability could potentially leave them vulnerable. Care Homes for Adults (18-65 years) Page 30 of 45 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Lodge is spacious and is kept clean, although some repairs are needed to make sure the home is comfortable and warm to live in. Hygiene and infection control monitoring needs to be completed to make sure everyone is kept safe and well. Evidence: The Lodge is located on a farm in a rural area near Tewkesbury. The Lodge has two comfortable lounges and a kitchen/dining room. The bedrooms are single and individually furnished and decorated. There is an enclosed garden to the front and rear of the house with table and chairs available for use. The Annual Quality Assurance Assessment (AQAA) tells us that residents each have a lockable bedroom to ensure privacy with decor and furnishing of their own choice. There is a lockable bathroom on each floor. The house is decorated on a regular basis with the residents being consulted over colours. The residents have free access to an extensive area of land and outbuildings for recreation in a very attractive and safe location. The home is clean and tidy. Surveys confirmed that the home is always fresh and clean. Policies and procedures for infection control are in place, although these need to be reviewed and updated. Staff are provided with disposable gloves and aprons. Paper Care Homes for Adults (18-65 years) Page 31 of 45 Evidence: towels and liquid soap are available in the communal bathrooms. Staff confirmed they have not completed infection control training. The Lodge has in place the safer food, better business system for monitoring hygiene and infection control, but this is not being used as it is intended. It was identified at the last inspection that this system was not being used as fully as it should to show how risks associated with infection control and cross contamination are being reduced or eliminated to safeguard people living at the home. Although fridge and freezer temperatures are being monitored and recorded regularly, there is no evidence to show that a cleaning schedule is completed and followed. This was discussed with staff who confirmed that no cleaning schedule is in place. We looked at some of the rooms in the home and found that areas of maintenance and repairs are needed. Some of the radiators are rusting and need to be addressed. There appears to be a problem with heating throughout the home, with hot and cold spots in areas. For example, it is very warm in one of the bedrooms and very cold in the small lounge. Staff confirmed this as an ongoing problem with the heating system that has not been resolved. We looked at the bathrooms and found that they need decorating. We noted that the tiling to one of the bathrooms appears unfinished. The communal areas of the home are comfortably furnished, homely and spacious. Residents said they like living here and liked their own room. Care Homes for Adults (18-65 years) Page 32 of 45 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Regular supervision and appropriate staff training will help people feel confident that the support they receive will be delivered by well supervised and skilled staff to help maintain their health and independence. Robust recruitment checks will make sure that suitable staff are employed to protect people who live at The Lodge. Evidence: The responsible individual said in the services Annual Quality Assurance Assessment (AQAA) that we have very good staffing ratios which offers many opportunities for one to one attention. The staff is well established with many years experience and training between them. The staff are well motivated and committed to the service we offer. We do not use agency staff. We have increased levels of staffing. Introduced new staff members. Introduced a more flexible system of staff hours to enhance day care opportunities for residents. Future development: Further improve communication within the staff group. Provide enhanced training to deal with specialist areas such as autism and ageing. Further improve staff training. Establish a more effective staff meeting programme. Staff surveys were completed and submitted to the Care Quality Commission (CQC) prior to the inspection. In addition time was spent talking to staff during the inspection. Although The Lodge has a committed staff team it is apparent that staff morale is very Care Homes for Adults (18-65 years) Page 33 of 45 Evidence: low. There appears to be a number of reasons for this including lack of management structure and support; a gender division between members of staff; and feeling undervalued. The management of the home is discussed in the conduct and management section of this report. The responsible individual said in the services AQAA that we have continued to train residential staff in this approach [equality and diversity] and there is a focus in staff supervision on the need to promote equality and diversity in the work-place. There is an overall, ongoing emphasis on integrating these principles into working practices. Practical evidence of this is that we have improved staffing ratios and transport facilities in order to allow us to develop very specific individual packages of care to ensure equality and meet diverse needs. Staff supervision is not being carried out and this was confirmed by staff. Supervision records were not available at the time of the inspection and the responsible individual did acknowledge that supervision sessions had not been taking place. This continues to be an issue identified from two previous inspections of this service and needs to be addressed to affect changes in staff morale and respect for the management team. Staff meetings are not taking place regularly. Staff confirmed that a staff meeting had been held recently, taking place prior in between these inspection visits. Staff confirmed this meeting had been called at short notice and was rushed. Staff felt they did not have the opportunity to talk about issues within the home as the meeting was not long enough. Staff said that meetings need to take place monthly, they need to be planned, with agendas that everyone can contribute to. Through discussions with many members of the staff team and from information provided in staff surveys it is clear staff feel there are gender issues within the staff team that are affecting morale and team work within the home. These issues are causing divisions within the team, feelings that working conditions are unfair, disrespectful and discriminatory. Working practices should be fair and equitable, taking into account existing skills, knowledge and experience, with training and opportunities provided where skill areas need developing. Practices that are gender based can become discriminatory and promote ill feeling and resentment within the team if staff are not listened to and their concerns addressed. We looked at staff rotas for the two months prior to the inspection. From these rotas we could see there were times when a member of staff worked alone with all residents of the home when there should be have been two staff on duty. This was discussed with staff who confirmed this does happen. Additionally, some staff are working exceptionally long shifts/continuous shifts over a period of days, an average of 3 or 4 days with back to back shifts and sleep ins. This is not good practice and must be reviewed, as working Care Homes for Adults (18-65 years) Page 34 of 45 Evidence: patterns such as these can reduce an individuals ability to work effectively and respond to peoples complex needs and behaviours. Staff comments include long shifts tend to lead to lack of motivation and drive, which means that things dont get done. Training records show that staff complete mandatory training such as Health and Safety (29/6/09), Fire Safety (6/7/09), First Aid (15/6/09), Food Hygiene (9/6/09), and Vulnerable Adults (10/7/09). We did not see a training needs assessment to identify individual staff training needs, and no training matrix to give an overall indication of staff training required and completed. Staff say they feel undervalued and have received no recognition (financial) on achieving their NVQ in Care. Staff training is needed in infection control, accredited administration of medication, equality and diversity, mental capacity, autism and challenging behaviour. Staff commented in surveys that they have had no training to respond to some peoples complex needs. Records show that Exploring Challenging Behaviour training was completed by the responsible individual in 2006. We did not see records to show that staff have completed this training. The AQAA tells us that The Lodge follows their staff recruitment and selection procedures. We looked at staff personnel files to check that recruitment procedures had been followed and appropriate safety checks had been made to make sure staff are suitable to work with vulnerable people. On one of the application forms we found gaps in employment and no record to show that this had been explored. The responsible individual said that this had been checked verbally, but there was no record to show this had been done. For another applicant no references were available. The responsible individual said that verbal references had been taken and these were at home, and not on file available for inspection. Staff commented in surveys that The Lodge is very good at meeting the needs and supporting the people we care for, The Lodge is the nicest home I have worked at, however the staff dont work well as a team. The home would benefit from standardized working practices. Care Homes for Adults (18-65 years) Page 35 of 45 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not feel the management of the home is effective as they feel they are not receiving the leadership and support they need. Regular monitoring and evaluation of the service is needed to help protect the health and welfare of the people they support. Evidence: The acting manager was on holiday at the time of the inspection. A registered manager application has been submitted to the Care Quality Commission (CQC) as required in the previous inspection. The responsible individual confirms in the AQAA that they plan to ensure current manager is fully registered and trained. Improve the financial standing of the Trust. Further improve staff development opportunities with particular reference to training and communications. The responsible individual Mr. E Davies is the Trust Manager and is very involved in the management of The Lodge. Time was spent with the responsible individual during the inspection. The Annual Quality Assurance Assessment (AQAA) was sent to us following a reminder letter from CQC. The content in the AQAA was brief and could usefully have provided Care Homes for Adults (18-65 years) Page 36 of 45 Evidence: more examples of evidence to support their assessment of the service. The responsible individual said in the services AQAA that they respond to the identified individual needs of residents in a flexible and innovative manner. Respond positively to new and changing needs of residents. Have the ability to settle a new resident into the house group after a difficult move from his previous residential home. Time was spent talking with the staff and residents who raised issues and concerns about the day to day management arrangements of the service. Staff comments included that they need the manager to be approachable and supportive need more time for meetings, communications could be improved, management need to work more effectively with support staff, the home would benefit from standardized practices, lack of leadership, more organisation needed for more motivation from staff, we have got an overall manager who works mainly outside. There is a senior support worker who has very little knowledge of running a care home and lacks motivation, no one seems to know whats going on and the staff are split, the manager is hardly here. We looked at staff rotas and it was difficult to see what management cover was available in the home. Some shifts are recorded on the rota showing approximately 20 hours per week for the weeks checked. All management hours worked should be recorded on the rota at all times so that staff and residents are informed and aware of management availability. Regulation 26 visits are carried out in the home and a form is completed. We found that these visits are not being undertaken in accordance with current regulations. Detailed reports of monthly visits should include all aspects of the guidance given in Regulation 26 (4) of the Care Standards Act. The form currently being completed constitutes a checklist and does not give details for example of interviews with residents and staff, or the monitoring and inspection of the home. A discussion about an effective Quality Assurance and quality monitoring system was had with the responsible individual. We saw no evidence to show that regular quality monitoring is taking place although the responsible individual said that this would be conducted as part of the care plan review process. An effective quality assurance and quality monitoring system based on seeking the views of people who use the service should be in place to measure the aims, objectives and statement of purpose of the home. This monitoring and evaluation process should be completed continuously with a report and action plan provided. We saw no evidence to show this has been completed in the past two years. The Lodge generally works to safe working practices although evidence shows that these practices are inconsistent. We found that regular fire drills are not being carried out and that staff are not receiving regular fire instruction. Where fire drills have resulted from false alarms records have been completed, but these do not show who was present for these drills. Initials of all present for drills should be recorded for monitoring and ensuring Care Homes for Adults (18-65 years) Page 37 of 45 Evidence: that everyone is involved in regular drills for their own safety. We saw that regular servicing of equipment is completed, such as the fire alarm 6/11/09. Fridge, freezer and water temperature checks are being completed regularly. We saw that some generic risk assessments are in place. We saw care records which contained a number of risk assessments identifying potential hazards and control measures to reduce or eliminate identified risks. e saw that environmental risk assessments to keep people safe in the home have not been reviewed as required. We saw that a general risk assessment relating to flammable liquids dated 14/1/06 had not been reviewed and it was unclear if this risk assessment was still relevant. The fire risk assessment dated 26/7/05 should be reviewed annually or when new admissions are made to the home. Staff say they are very happy working at the lodge and like working there, but need more support and leadership to improve the working environment. Another comment from staff included I believe we can always strive to do better in all areas, this is the best way to maintain standards. Surveys completed by people living at The Lodge confirmed that the staff always treat them well and listen and act on what they say. Care Homes for Adults (18-65 years) Page 38 of 45 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 39 of 45 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 1 4 30/04/2010 The statement of purpose must be up to date and accurately reflect the service that is provided so that people will know what service they can expect to receive 2 2 14 Accommodation must not be 30/04/2010 provided until full assessments and introductory visits have been carried out so that people can be confident that the home can provide care and support to meet their needs, before they move into the home. 3 3 14 The home must make sure 16/04/2010 they can demonstrate their ability to meet the assessed needs of a person prior to their admission to the home. Page 40 of 45 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action to make sure that all staff have the experience and skills to deliver the services and care needed. 4 6 13 All risk assessments must be 30/04/2010 accurate and up to date to make sure that all residents are supported to take risks as part of an independent lifestyle safely. 5 8 15 Individual care plans must be 30/04/2010 reviewed every 6 months or sooner if needs change to make sure that care plans reflect the up to date needs for all residents 6 8 15 Individual care plans must 30/04/2010 reflect assessed needs and personal goals for everyone who uses the service as set out in Standard 2 of the Care Standards Act. to make sure that all needs are identified and shows how these needs are to be met. 7 17 16 The service should evidence that nutritional needs are being met 30/04/2010 Care Homes for Adults (18-65 years) Page 41 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action to make sure that people receive a nutritionally balanced diet. 8 17 16 staff training in food safety and nutrition should be completed 28/05/2010 so that staff make sure that individual nutritional needs are met. 9 19 12 There must be procedures in 30/04/2010 place to address the healthcare needs of all residents. to make sure that all physical and emotional health needs are fully met. 10 23 20 Arrangement must be made for all residents to have access to information about their bank accounts at all times. 30/04/2010 to make sure their right to financial support is promoted and maintained. 11 30 16 Records must show how risks 30/04/2010 associated with infection control and cross contamination are being reduced or eliminated Care Homes for Adults (18-65 years) Page 42 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action to safeguard people living at the home. 12 34 19 Thorough recruitment checks 30/04/2010 must be made at all times and details recorded to make sure that only suitable staff are employed 13 36 18 All staff working at the home 30/04/2010 are to be appropriately supervised so that residents benefit from well supported and supervised staff 14 38 12 the management of the home must create an open, positive and inclusive atmosphere 30/05/2010 so that people who live at The Lodge will benefit from staff with a sense of leadership and direction 15 39 24 30/05/2010 An effective quality assurance system must be in place to monitor and review the quality of the service provided so that people using the service can feel confident Care Homes for Adults (18-65 years) Page 43 of 45 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action that their views contribute to future development of the home. 16 39 26 Regulation 26 visits must include inspection and monitoring of all areas as given in the guidance Regulation 26 of the Care Standards Act 29/05/2010 so that regular, detailed monitoring of the service is carried out 17 42 13 The Lodge must make sure that regular fire drills and training are carried out 30/04/2010 to make sure that everyone is protected from harm 18 42 13 Risk assessments for all identified risks must be kept up to date and reviewed regularly 28/05/2010 to make sure that actions in place are up to date and keep people safe from harm Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 44 of 45 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 45 of 45 - 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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