Inspection on 28/10/08 for The Lodge

This inspection was carried out on 28th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Lodge 18/10/06

The Lodge 09/11/05

The Lodge 19/04/05

The Lodge 26/10/04

The Lodge 17/06/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Lodge 21 Roundshead Drive, Off Jiggs Lane Warfield Bracknell Berkshire RG42 3RZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Debieux     Date: 2 8 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: The Lodge 21 Roundshead Drive, Off Jiggs Lane Warfield Bracknell Berkshire RG42 3RZ 01344424982 01344424982 lichunrong@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Milbury Care Services Ltd The registered provider is responsible for running the service Name of registered manager (if applicable) Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category/ies of service only: Care home only - 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 Date of last inspection Brief description of the care home The Lodge is situated close to Bracknell town centre and local amenities. The home provides care and accommodation for up to five service users with learning and associated physical disabilities. The service users all have single bedrooms with three bedrooms located on the ground floor and two bedrooms on the first floor. There are Care Homes for Adults (18-65 years) Page 4 of 37 5 Over 65 0 Brief description of the care home bathroom facilities located on the ground and first floor and one bedroom has en suite facilities. The home has a lounge with dining area, large kitchen with dining area, conservatory and a large secluded garden. There is some off road parking available to the front of the property. Care Homes for Adults (18-65 years) Page 5 of 37 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: one star adequate 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 peterchart Poor Adequate Good Excellent How we did our inspection: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out by Denise Debieux, Regulation Inspector. A senior support worker was present as the representative for the establishment as the manager was on annual leave. It was a thorough look at how well the service is doing. It took into account detailed information provided by the home and any information that CSCI has received about the service since the last inspection on 18th October 2006. People living at this home prefer to be referred to as service users. For clarity and consistency this term will be used throughout this report. Care Homes for Adults (18-65 years) Page 6 of 37 A tour of the premises took place. On the day of this visit the inspector spoke with four of the five service users and four on-duty staff. Prior to the inspection, survey forms were sent to service users and to staff employed at the home. Survey forms were returned by five service users and seven members of staff. Some of the comments made to the inspector and made on the survey forms are quoted in this report. Not all service users are able to fully communicate verbally and observations of the interactions between staff and these service users were also used to form the judgements reached in this report. The manager had completed an annual quality assurance assessment (AQAA) and service users care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all sampled on the day of this visit. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Fees range from 1266.64 to 1322.90 pounds per week. This information was provided on 28th October 2008. The inspector would like to thank the service users and staff for their time, assistance and hospitality during this visit and the service users and staff who participated in the surveys. What the care home does well: What has improved since the last inspection? What they could do better: 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 37 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 9 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre-admission procedures at the home ensure that service users needs and aspirations are fully assessed prior to admission to make sure that their needs can be met. Evidence: There have been no new service users move into the home since the last inspection. Four people moved in when the home opened in 1997 and the fifth person moved in two years later. The home have an in depth procedure for the pre admission assessment and admission of new service users and it was confirmed that this procedure would always be followed. In the AQAA, to demonstrate what the home does well, the manager stated that: New service users are offered introductory visits to the service, service users are involved in and agree to their individual plan. The home provides individual service user guides in a format appropriate to the individuals needs. Care Homes for Adults (18-65 years) Page 10 of 37 Evidence: Data provided in the homes AQAA does not identify any service users with specific religious, racial or cultural needs at this time. However, from the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Four of the service users surveyed felt they had received enough information prior to moving to the home and they all confirmed they had been asked if they wanted to move to The Lodge. Care Homes for Adults (18-65 years) Page 11 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users individual plans are clear and comprehensive including details of needs and goals. They also incorporate known or indicated preferences. Service users are supported to take risks as part of an independent lifestyle. Evidence: Care plans for two service users were sampled and both were seen to be comprehensive, well set out and easy to follow. Care plans and person centred plans are drawn up with service users and are reviewed on a three monthly basis, or more often, if needs change or a new concern arises. The staff document daily in a separate diary for each service user to evidence that individual goals and needs are being met. The care plans were all seen to be very individualised and included the service users personal preferences and also risk assessments for all activities, with clear guidelines for staff to follow to minimise any associated risks. Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: The manager and staff are in the process of renewing all care plans into a new format and layout. As they are doing this, the senior support worker told the inspector that key workers sit with service users and go through their care plans with them, trying to make sure they understand. At present no record of these meetings are kept and service users have not signed the care plans to show that they have been involved and that they agree with the content. The new care plan format has a space on each sheet for the service user or their representative to sign their agreement but, at present these spaces have been left blank. The senior support worker said he would discuss with the manager making sure that the new care plans are signed, where possible, by service users and/or their representatives and that the key worker meetings would be documented to evidence that service users have been fully involved. On the survey forms, when asked if they make decisions about what they do each day, four service users answered always and one answered sometimes. Of the staff surveyed, six said they were always given information about the needs of the service users and one answered usually. On the day of this visit, service users were seen to be choosing what they did and where they went within the home. Staff were seen to be helpful and offered assistance where needed or requested. It was also observed that staff had a good rapport with service users that were not able to communicate their wishes verbally, where they indicated that they wanted assistance, this was quickly understood by the staff and the assistance provided. In the AQAA, to demonstrate what the home does well, the manager stated that they: Provide an individual plan based on the assessment of need, clearly indicating individualised procedures that may be necessary. The plan is drawn up with the involvement of the service user, family/friends/advocate and relevant agencies as appropriate. Service users are enabled and supported to make decisions in all areas of their lives. Staff support/enable service users to take responsible assessed risks. Confidentiality of information is incorporated in the induction and training of all staff members. Care Homes for Adults (18-65 years) Page 13 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users have opportunities for personal development and to take part in appropriate activities within the home and in the local community. They are supported and enabled to maintain and develop appropriate personal and family relationships. Systems are in place to ensure that service users rights are respected. Meals are well-balanced and varied. Evidence: The daily routines at the home reflect the requirement to promote independence, individual choice and freedom of movement. Service users confirmed they could choose what to do, when they wanted. This was also confirmed by observations made by the inspector on the day of this visit. Each term time the service users have the opportunity to attend short courses of their Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: choice at the local college. This term two service users attend a cookery course once a week. The inspector was advised that this is an ongoing activity and usually three service users participate but this term had been difficult as one course chosen had been withdrawn at short notice. In the AQAA, to demonstrate what the home does well, the manager stated that they: Provide individual activity plans, facilitate attendance at external learning opportunities, enable service users to experience a wide range of leisure activities, support to continue with existing activities and provide opportunities within individual activity plans to participate in the local community. Provide access to vehicles, assist and support in accessing local transport, support to be politically aware and to vote, flexibility in rotas to support chosen activities, choice of external activities brought into the home. Provide the support to access annual holiday of individual choices, day trips. Ensure activities are support by trained staff, open access (no visiting times) support opportunity to welcome visitors in private or in a chosen communal area, family and friends are encouraged to participate in daily routines (with service user agreement), support and develop service user to develop and maintain relationships, ensure staff respect service users privacy and dignity. The home ensures that the service users lead as positive and fulfilling a lifestyle as possible. They involve the service users, as far as they are able, in the planning and quality of their lifestyle. Each service user has a weekly activity schedule that is based on his or her known interests and hobbies. The activity schedules sampled were seen to be varied and included activities both within and outside the home in the local community. During the day service users were going out and returning. It was obvious during this inspection that the staff team are open and flexible and that no two days are the same. Although each service user has an activity schedule, this is treated more as a guide. Service users were seen to be making decisions, at the time, as to whether they wanted to do what was on their schedule or to do something different. Five completed service user survey forms were received prior to this inspection. All service users stated that they could do what they wanted to do during the day, in the evening and at weekends. The menu for the week of this visit was seen to be varied and well-balanced, advice is sought from a local dietician, for individual service users, as and when needed. The inspector was advised that service users plan and prepare their meals, taking it in turns to choose a different evening meal. The home have worked hard and developed photograph and picture cards of different foods, these cards are used to enable service users, who have difficulty communicating, participate in and make choices when planning meals. There is a menu board in the kitchen/dining area and the days meals Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: are set out, using picture cards so that all service users can see at a glance what the meals will be. One service user showed the inspector the board and explained that he had chosen the cottage pie for that evening and that it was his favourite. All service users spoken with said they had enjoyed their lunch. The lunchtime meal was taking place during this visit, and was staggered over a length of time to fit in with service users activities and choice of time of eating. The food was presented in an appetising manner, staff were assisting service users where needed and there was a relaxed family atmosphere. Care Homes for Adults (18-65 years) Page 16 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care and healthcare support and assistance was seen to be provided, where needed, in a respectful and sensitive manner. Sound policies and practices are in place for the administration and management of medications. Evidence: During this visit two care plans were sampled and it was seen that all health care needs were incorporated into the care plans. Diary notes evidenced that staff take prompt action to deal with any new health problem that may occur and care plans were specific with information for staff to follow when supporting service users to manage any long-term conditions. The senior support worker showed the inspector a new diary sheet they plan to introduce shortly. The form has been designed to ensure that staff consistently record all relevant information so that staff on the next shift can quickly access any information they may need. The diary notes were also seen to contain details of any activities people have been doing during the day, meeting a recommendation made at the last inspection. Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: One service user has difficulty swallowing and is not able to eat. All nutrition is provided via a percutaneous endoscopic gastrostomy (PEG) tube. Until recently the service user would have his feeds through the day, this meant that his daytime activities were restricted as he would have to return to the home when a feed was due. It was also very restrictive as the feed has to be administered via a special pump, meaning he had to stay in one place. After talking with the service user and consulting relevant professionals, a regime was set up that gradually moved the times for the feed to be overnight while he sleeps. This has led to his days now being free of restriction and him being able to do what he wants to during the day without having to worry about the limitations the previous feeding regime imposed. The service user confirmed that he is much happier having his feeds overnight and is able to go out more. Only staff that have received professional training and been judged as competent deal with the care of the PEG tube and the overnight feeding regime. In a telephone call with care managers, prior to the inspection, one care manager told the inspector how well she felt all staff at the home provide the care required in this area for the service user. Evidence of staff training and certificates of competence were seen in the homes training file. At the last inspection it was noted that this service user had a hospital bed with bed rails and the home were asked to reassess the suitability of this bed. The inspector was advised that the bed rails have been removed as they were not needed. The bed is an old style, metal hospital bed with a pull out back rest, it is very institutional in appearance although the domestic linen and bedcovers that the service user has chosen help to disguise the appearance somewhat. However, the service users needs have now changed, having his PEG feeds overnight require that his upper body is raised to a certain level to reduce the risk of the feed going into his lungs. It is vital that the home consult with suitably qualified professionals as soon as possible (e.g. the nurse overseeing the PEG feeding, occupational therapist etc) and arrange an assessment to ensure that this bed is suitable and safe for the service user to continue to use. It should also be noted that there are a number of hospital beds available now that are domestic in appearance and would be more appropriate and homely for a small care home setting. Medication is provided mostly in the blister pack system. The administration of some medications was observed and the medication administration records (MAR), medication storage, policies and procedures were all sampled and found to be in good order. Although no service user is currently prescribed controlled drugs, the legislation relating to the storage of controlled drugs in care homes changed in August 2007 and the home needs to check that their medication cupboard complies with the new Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: requirements. Guidance relating to the new requirements can be downloaded from the CSCI website, however, as the home do not have a computer, the inspector left a copy of the guidance with the senior support worker to avoid delay. In the AQAA, to demonstrate what the home does well, the manager stated that they: Provide service users with the personal support they require in their preferred way, meet the physical and health needs of the service user, that the policies and procedure of the organisation are implemented to protect the service user. The home offers service users excellent support to ensure they stay well and healthy, so that they are able to maintain positive lifestyles. During this inspection, all interactions observed between staff and service users were polite and respectful. Staff always knocked on service users doors and asked permission to enter. All personal care was carried out behind closed doors. Care Homes for Adults (18-65 years) Page 19 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All required policies and procedures are in place to ensure that service users feel their views will be listened to. Policies and practices are in place to protect service users and their finances from abuse and neglect. Evidence: The home has a complaints procedure in place that is available to all service users, has been individualised to the home and is available in an easy read, picture format if required. One complaint has been made to the home since the last inspection. This was dealt with promptly and in line with the companys and local procedures and is currently being looked into. No complainant has contacted the Commission with information regarding a complaint or allegation made to the service since the last inspection. There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults Policy and Procedure, which is available in the office for all staff to refer to. All staff have received training or updates in safeguarding adults, this is clearly recorded in the homes training record. In the AQAA, to demonstrate what the home does well, the manager stated that they: Provide a clear and effective complaints policy and ensure all service users are aware Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: of its existence and how to use it. Complaints are dealt with in a specified time frame. All service users and their families are provided with an accessible version of letting us know what you think policy and service users are each provided with help cards. We facilitate house meetings to offer another arena for service users to express their views/concerns with notes produced and evidence of any actions taken recorded. Provide a robust procedure for responding to any suspicion, allegation or evidence of any type of abuse. Provide appropriate training to staff for any necessary physical intervention. Clear recording of service user finances following company procedure. Finances are audited by Operations Manager on a regular basis. Procedure on acceptance of gifts from service users and/or their relations. Staff surveyed all said they knew what to do if a service user or their representative had concerns about the home. Service users surveyed all stated that they knew who to talk to if they were not happy. On the day of this inspection, on a number of occasions, service users were observed approaching staff with requests or concerns on day to day matters. On each occasion the staff quickly understood what was wrong and worked with the service user until a solution was reached. Care Homes for Adults (18-65 years) Page 21 of 37 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 location and layout of the home enables service users to live in a homely environment which promotes independence but problems with damp within the home remain an issue and need to be dealt with in order to improve the environmental outcomes for the service users. Evidence: The Lodge is situated close to Bracknell town centre and local amenities. The service users all have single bedrooms, one with en suite facilities; there are three bedrooms located on the ground floor and two bedrooms on the first floor. There are bathroom facilities located on the ground and first floor. The home has a lounge with dining area, large kitchen with dining area, conservatory and a large secluded garden. The home was toured during this visit. The communal areas are well furnished with domestic furniture of good quality. All areas were clean and tidy and a number of rooms have been redecorated, with the service users helping to choose the colour schemes. The large kitchen is easily accessible to all service users allowing them to participate in meal preparation if they wish to do so. The home are expecting the kitchen to be replaced in the near future and are now just waiting for the start date. The laundry room is sited on the ground floor with a washing machine suitable to the Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: needs of those living at the home. The boiler has been repaired and the missing part has been replaced, meeting a requirement made at the last inspection. The bedrooms are spacious and the service users have personalised their rooms with many personal items and some of their own pieces of furniture. The inspector was advised that service users chose their own colour schemes for their bedrooms, this was confirmed by two of the service users spoken with. The furniture and furnishings in the bedrooms were seen to be domestic in nature with the exception of the hospital bed mentioned earlier in this report, this bed dominates the room and gives an institutional feel to the otherwise homely room and a recommendation has been made. One bedroom has patio doors leading on to the garden and, following a requirement made at the last inspection, a ramp has been built that now enables the service user to access the garden directly from his room. Two of the service users surveyed said that the home was always fresh and clean and three answered sometimes. Other work carried out at the home to meet previous requirements include laying of gravel over the car parking area to resolve the flooding problem and the repair of a ceiling in one bedroom. Work is ongoing to resolve the damp and damp smell in one bedroom as mentioned at the last inspection. It should be noted that that inspection was two years ago and the inspector then was told that the home are just waiting for the walls to dry out. The home have carried out additional work outside the room and fitted a drainage pipe to take away the standing water. There is a de-humidifier in the room that is on most of the time. This problem has not been resolved and although the service user said the smell was much better than before, the room still smelt musty and wallpaper was peeling apart at the joins in numerous places. Damp is a problem throughout the home, windows are old and single glazed and, although all windows were open and it was not a cold day, there was condensation on all windows that was pooling on the frames and in one room on the window sill. Net curtains were acting as a wick and soaking up water and there was mould/mildew noted on a number of window frames, in two rooms mould/mildew was also noted along the bottom of the net curtains. The inspector was advised that, following a leak through a ceiling, a hidden flat roof had been found that was full of water with the drainage channel blocked, this had been cleared and resolved the leak at that time, in their AQAA the home have also identified that gutters need clearing and repairing. Staff advised that the provider is aware of the issues with the hidden flat roof; the Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: work needed on the guttering and the problem of condensation and mould/mildew on the windows, although they did not know if the provider is looking at the problem of damp in the house overall. No requirement has been made regarding work to be carried out but a requirement has been made for the provider to advise CSCI of work that is planned to deal with these issues, the information provided will be assessed and monitored as part of the CSCI regulatory process. In the AQAA, to demonstrate what the home does well, the manager stated that they: Provide an accessible, homely, clean, hygienic, safe, well maintained, and comfortable environment to meet individual service users needs and current legislation. Provide a home that is well located to access local facilities and transport networks and is fit for purpose. Provide all service users with their own personal space in a self contained single room, with suitable furniture and fittings and encourage/support them to add their own personal belongings that reflect their culture, beliefs and personalities. Provide comfortable and fully accessible communal facilities that reflect service users needs and preferences. Review environment yearly (Annual Service Review), also visual review by operation manager monthly. Care Homes for Adults (18-65 years) Page 24 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current staff recruitment practices do not meet the requirements of legislation and are placing service users at risk of harm or abuse. The home has a staff training which is designed to ensure that service users are supported by competent and qualified staff and that, as far as reasonably possible, they are protected from harm. Evidence: The staff group is made up of the manager, one senior support worker, four permanent support workers and three bank support workers. The staff rota evidenced that staff are provided in sufficient numbers to meet the needs of the service users at the home. The morning (7.30am – 2.30pm) shift is covered by two or three support workers (dependant on service users planned activities), two or three support workers cover the afternoon/evening shift (2.30pm – 10pm) and the night staff consists of one waking support worker and one sleeping on the premises and available if needed. Of the eight care staff, the senior support worker holds a National Vocational Qualification (NVQ) level 3 in care, two support workers hold NVQ 2, with a further two currently undertaking NVQ level 2. The organisation have an agreement with CSCI for staff recruitment records to be held Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: centrally at their regional office in Henley. Part of this agreement is that the home must have a completed front sheet to the file at the home containing specific recruitment details. This form must be signed by a registered person. During this visit the files of two recently recruited members of staff were sampled. Both files had a front sheet and both had copies of some of the persons recruitment information but neither contained all information required of the agreement with CSCI to be kept in the home. In neither file was the front sheet completed and only one was signed. In the first file looked at, the front sheet was signed by the previous registered manager and gave the reference number and date obtained for an enhanced Criminal Record Bureau (CRB) certificate but, in the space provided for POVA (Protection of Vulnerable Adults list) no had been entered implying that no check of the POVA list had been carried out. At this point the head office of the organisation were contacted and given the opportunity to bring the full recruitment files for these two people, including CRB certificates, to the home so that a full assessment could be made. Photocopies of the files were delivered by hand later in the day although CRB certificates were not included. In the first file, as the CRB certificate was not available, it was not possible to verify that a POVA list check had been carried out. Only the first page of the application form was on record, showing that there was a gap of twenty-two years in the employment history that was unexplained and there was no evidence that reasons for leaving previous employment working with vulnerable people had been verified or ascertained. Two references were present but the dates for leaving these employments did not tally between the application form and the references provided, there was no evidence that this had been identified or followed up. There was proof of identity and a current photograph. In the second file the front sheet was unsigned and not completed. There was a record of the date the CRB and POVA list checks had been received. However, there was no photograph in the file at the home although there was one in the regional office file. The employment history looked complete although some entries were only the year of starting and leaving and should have been explored further. There were two references in the file, both from previous employers in non care employment, the applicant had recorded one period working with vulnerable people but the reason for leaving had not been verified and no reference had been sought from this employer, as required by legislation. In July 2004 the recruitment requirements of The Care Homes Regulations 2001 were amended and Schedule 2 of those regulations was replaced with a new schedule setting out exactly what recruitment checks and documents are required. The copy of The Care Homes Regulations 2001 used at the home does not include any amendments made since the regulations first came into effect and staff were not aware that any amendments had been made. The senior support worker was advised that updated copies of The Care Homes Regulations 2001 can be downloaded from the Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: CSCI website: www.CSCI.org.uk. As the senior support worker is not responsible for recruitment the inspector spoke with the operations manager for the home on the telephone. The shortfalls in the files sampled were outlined, i.e. that there were at least two people working at the home without all required checks and information in place, one possibly working without having been checked against the POVA list for suitability to work with vulnerable adults. A copy of the amended Schedule 2 was explained to and left with the senior support worker and a link to the in depth guidance on the CSCI website relating to the amended recruitment regulations was provided to the operations manager. It is positive to note that the operations manager took prompt action following this inspection to ensure that staff working with the service users had all the required checks and information in place. On the day following the inspection the inspector received the following written information from the operations manager: All staff working at The Lodge have an enhanced CRB check and a log of the CRB reference is written on each of the individuals proforma (front) sheet. There is a computer administration issue when the proforma is printed that in the POVA box it records no I have discussed this with the business manager who is making sure this is resolved and that yes is indicated clearly stating that a POVA check has been carried out. The operations manager also confirmed by telephone that they have almost completed rechecking all staff files to make sure the information and checks carried out fully meet the requirements of the amended Schedule 2, any discrepancies found have been followed up, for example a telephone reference for the second applicant has already been obtained and is to be followed by a written reference. Although staff recruitment involves different people and departments within the organisation, it must be noted that the legal accountability for making sure that recruitment practice meets all legal requirements stays with the registered manager/persons. The operations manager is to be commended for taking such prompt action but the organisation must take note that this lack of compliance with the legislation is an offence under Regulations 19 and 43 of The Care Homes Regulations 2001 and the lack of robust verification of information obtained during the recruitment process is placing service users at risk of harm or abuse. Steps must now be taken to ensure that they do not, in future, allow any person to work at the home without first obtaining and verifying all the information and documents required. A requirement has been made that all staff involved in recruitment must be fully aware of, and adhere to the requirements of the amended regulations relating to recruitment. The organisation must also ensure that all aspects of their agreement with CSCI to hold recruitment records centrally are fully complied with. Being a large organisation, Milbury Care Services Ltd have an allocated CSCI provider relationship manager (PRM), part of the role of the PRM is to oversee agreements with providers relating to Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: central storage of records. No requirement has been made in this report relating to the incomplete front sheets as the identified concerns in this area will be taken forward by the allocated PRM. Staff induction is in line with the new, mandatory Skills for Care common induction standards and the inspector was advised that staff are supervised until they have completed their induction. Staff are booked on additional training and updates as the courses become available. The training records were sampled and showed that all staff are up to date with required training. In the AQAA, to demonstrate what the home does well, the manager stated that: All staff have a defined job description and understand their role and responsibilities which are linked to achieving individual service users goals. All staff have appropriate standards relevant to their roles, staff are familiar with and comply with General Social Care Council standards. Flexible rota indicates skill mix to collective assessed needs of service users. Service user involvement in interviewing, equal opportunity/disability training. Of the five service users surveyed, four said that the staff always listened and acted on what they said with one answering sometimes. All staff surveyed stated that they receive training which is relevant to their role, helps them to understand and meet service users needs and keeps them keep up to date with new ways of working. Five said their induction had covered everything they needed to know to do their job when they started and two answered mostly. When asked on the staff survey form What does the service do well comments made included: Staff are trained well and always informed, Giving as much support as necessary by the organisation, Provide relevant training and equipment and Communication is very effective, training is up to date. Care Homes for Adults (18-65 years) Page 28 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from the management approach at the home providing an open, positive and inclusive atmosphere but the organisation needs to address overall management issues that are outside the control of the staff at the home. The home has a quality assurance and monitoring system in place that is based on seeking the views of the service users. Policies and procedures are in place to ensure, so far as is reasonably practicable, the health, safety and welfare of service users and staff. Evidence: The previous registered manager left the home at the end of April 2008. A new manager was appointed and started work at the home in time to have a full handover from the previous manager. The new manager was not available on the day of this inspection but in their AQAA she stated that she had six years management experience and holds Registered Learning Disability Nursing and Registered Managers Award qualifications. However, to date CSCI have not received an application for the new manager to become registered, this means that the fitness of the manager to run the Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: service has not yet been assessed by CSCI. The inspector was advised by the operations manager that the new managers registration application process will be started without any further delay. The inspector was advised by staff at the home that there have been many positive changes since the new manager started at the home. The AQAA completed and returned to CSCI by the manager was well written and showed that the manager has a clear idea of improvements needed at the home and is taking steps to ensure improvements take place. Staff commented that they now felt very involved in any decisions being made and that, as a team, they are working together to improve the quality of the service provided to all service users. A number of improvements specifically commented on by the staff were: new care planning system being easier to follow; improved communication within the team; more organised administration files; increased awareness of organisational decisions and changes that effect the home. Staff spoken with were enthusiastic about the changes being made and staff surveyed all said that they were well supported by the manager and met with her regularly. All administration has to be either done by hand or taken to the regional office in Henley-on-Thames to be typed as the home do not have a computer. The only means of providing a photocopy involves either using the fax machine or, as on the day of this inspection, taking documents to the local supermarket and paying to use the photocopier there. The staff explained that this was time consuming and took them away from direct support with service users, especially as many administrative tasks are repetitive. The lack of a computer also means that the home has no access to the internet or e-mail facility. One member of staff explained that one relative would like to send e-mails to their relative at the home but is not able to, one of the service users used to enjoy computer work at his day centre but now is not able to continue this pastime as he no longer attends the day centre. As stated above, the AQAA demonstrates that the manager has a clear idea of improvements needed to improve the quality of life for the service users. The AQAA also evidences that the manager has a good understanding of and commitment to meeting the equality and diversity needs of the service users and increasing their independence. Specifically relevant to equality and diversity, the manager has identified areas that the home could do better and that the staff wish to improve, these improvements include: The home needs to develop service user guides in a pictorial format relevant to individuals. Ensure every service user has a copy of their individual plan in a format appropriate to their needs. Develop pictorial activity plans. Develop policies in more formats to meet a wider range of needs. Develop a satisfaction questionnaire for service users, by reviewing current format and making necessary adjustments. The staff are gradually working on these areas, as described earlier in this report the Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: picture menus are understood and liked by the service users. At present the staff are limited to cutting food pictures out of magazines, going to the regional office or using their own computers in their own time which, although commendable, denies the service users the opportunity of being fully involved and choosing their own pictures that they can relate to. Service users spoken with were positive about recent changes and one service user explained the menu picture board and also the board with pictures of staff that clearly showed who was working that day. A recommendation has been made that the organisation provide the home with a computer system and internet access. Also of concern is that the staff at the home are unaware of important changes in legislation and guidance e.g. The home still work to the original version of The Care Homes Regulations and were unaware that there have been at least eight amendments since they first came into force, including substantial changes to the requirements for staff recruitment, training, supervision and important changes made by the Mental Capacity Act. The home were also unaware that there was new legislation regarding the storage of controlled drugs. The CSCI professional website has a latest guidance section which has been set up to enable managers and providers to keep up to date. In October alone there are eleven new guidance documents that would be relevant to The Lodge, including, coincidently, revised guidance relating to staff recruitment and new storage requirements for controlled drugs. The provider needs to develop an effective system to make sure that the manager and staff are kept up to date with any changes in legislation, can access new best practice guidance and can follow developments and upcoming changes in social care regulation, especially relevant with the new Care Quality Commission taking over the work of CSCI in April 2009 and a requirement has been made. As described above and elsewhere in this report a number of concerns have been identified during this inspection that relate to the conduct and management of The Lodge. These concerns are mostly outside the control of the manager and staff at the home and it is important that the organisation address these issues. The main areas of concern are: the lack of a registered manager; the failure to comply with the Care Homes Regulations 2001 relating to staff recruitment; the lack of a system to make sure that the manager and staff are kept up to date with any changes in legislation, can access new best practice guidance and can follow developments and upcoming changes in social care regulation and the long standing and unresolved problems at the home relating to damp. Service users views are sought on a regular basis and there are monthly service user meetings plus regular one to one key worker meetings. In the AQAA the manager Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: stated that: Service users views underpin monthly monitoring and annual service reviews. Service users spoken to felt they were involved in the running of the home and their care plans evidenced that their preferences and wishes are sought and taken notice of. All necessary health and safety checks are carried out by the staff at the home with documentary evidence inspected of routine fire practices and evacuations. Fire equipment checks, daily checks of fridge and freezer temperatures and a number of up to date maintenance certificates were seen. All records were up to date and well maintained. In the AQAA, to demonstrate what the home does well, the manager stated that: Polices and procedures are in place to ensure the health, safety and welfare of service users are protected and ensure that record keeping is of a standard required by the regulating body, legislation and policies and procedures of the organisation. All interactions observed between the staff and service users were inclusive, caring and respectful. Care Homes for Adults (18-65 years) Page 32 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R 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 33 of 37 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 Requirement 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 Requirement Timescale for action 1 18 16 The registered person must 30/11/2008 arrange for a suitably qualified person to carry out an assessment of the service user having PEG feeding overnight and ensure that the bed provided is suitable to meet his assessed needs. In order that any unnecessary risks to his health and welfare are identified and addressed. 2 24 23 The registered person must 19/12/2008 provide, to CSCI, details of work planned, with timescales, to address the problems of the hidden flat roof; work needed to the guttering; condensation and mould/mildew around windows and further work to fully resolve the residual odour in the service users bedroom identified. In order that service users can be confident that the Care Homes for Adults (18-65 years) Page 34 of 37 provider is taking a pro active approach towards ensuring they have a safe and well-maintained environment in which to live. 3 34 19 The registered person must 30/11/2008 ensure that all staff involved in recruitment are fully aware of, and adhere to, the requirements of the Care Homes Regulations 2001 as amended by The Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004. In order to protect the service users from the potential risk of harm or abuse. 4 37 10 The provider must ensure 30/01/2009 that systems are put in place to enable the manager and staff to keep up to date, and comply with, current and changing legislation, can access new best practice guidance and can follow developments and upcoming changes in social care regulation. In order that service users can benefit from having a staff team that is knowledgeable and working in their best interest. Recommendations Care Homes for Adults (18-65 years) Page 35 of 37 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 1 24 It is recommended that, irrespective of the outcome of the assessment required in Requirement 1, the provider looks to providing an alternative hospital bed (for the service user identified) so that the service user can benefit from having furniture that is as domestic and unobtrusive as is compatible with meeting his needs. It is recommended that the organisation provide the home with a computer system and internet access to facilitate identified improvements, reduce time taken away from direct support with service users in repetitive administration tasks and to enable service users to have the opportunity to participate fully in drawing up their new care plans and other documents in appropriate formats. 2 37 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 37 of 37 - 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!