Inspection on 01/12/05 for The Lodge, Exmouth

This inspection was carried out on 1st December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Lodge, Exmouth 30/11/09

The Lodge, Exmouth 29/11/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Lodge, Exmouth 207 Exeter Road Exmouth Devon EX8 3DZ Lead Inspector Belinda Heginworth Unannounced Inspection 1st December 2005 11:45 The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Lodge, Exmouth Address 207 Exeter Road Exmouth Devon EX8 3DZ 01392 462512 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Devon Partnership NHS Trust Mrs Deborah Louise Brown Care Home 4 Category(ies) of Learning disability (4) registration, with number of places The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The registered manager must obtain the Registered Manager’s Award by the 30th November 2006. The age range category is 18 to 40 years. Date of last inspection N/A Brief Description of the Service: The Lodge provides personal care and support for up to four residents with a learning disability. Although the house is on two levels, all accommodation is on the ground level. The second floor is not accessible. The home has four en-suite bedrooms, a large kitchen / dining room, a lounge and an office / sleep in room. There is a pleasant garden to the rear of the property. The home is decorated and furnished to good standard creating a warm and homely atmosphere. The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was the first inspection since the home’s registration category changed from being a children’s service to an Adult service. The inspection took place over two hours and fifteen minutes with the manager being present throughout. There are currently two residents living in the home; only one resident was present during this inspection. Due to the resident having extremely limited communication skills they were unable to contribute fully to the inspection process. Observations were made and some time was spent with the resident and staff. The inspector looked around parts of the building and some records were inspected. What the service does well: What has improved since the last inspection? What they could do better: Restrictions on choice, privacy or freedom of movement should be discussed, agreed and recorded with relatives, residents’ representatives and other professionals. For example a Good Practice Committee. This is particularly important given that residents have limited capacity to contribute to plans and decisions. The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 6 The locking device on the medication cupboard must be more secure. Staff should be regularly assessed for competencies in relation to the safe administration of medicines. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Not inspected on this occasion, as the home has had no new admissions. EVIDENCE: The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Staff are provided with excellent information to help meet residents’ needs safely. The decision making process needs to improve in relation to alarms fitted to some bedroom doors. This is particularly important given that residents have limited capacity to contribute to plans and decisions. EVIDENCE: Some residents have limited communication skills and have a limited understanding of care plans and are therefore unable to contribute to their formulation or reviews. The information in the care plans is detailed, clear and provides staff with the information they would need to look after residents safely. The manager said they are currently reviewing the plans to ensure that they become a better working tool. A daily diary is kept for each resident, where activities and events are recorded. The staff said they are looking into providing additional activities for those residents who have recently left fulltime education. Any hazards to residents are clearly assessed with detailed information for staff to follow to reduce any risks. The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 10 Two of the bedrooms have alarms that are used at night and are set off if residents leave their bedrooms. The alarm sounds in a room where one of the staff sleep-in. The alarms have been installed because the home currently has two staff sleeping in, rather than what they had previously, which was one staff sleeping in and one staff awake. The manager said that this is a temporary measure until March 2006, when the home will have more residents and will go back to the previous arrangements. The decision to fit these alarms is carried out with good intention and with the safety of residents in mind. However, any restrictions, which might impact upon a resident’s freedom of choice and movement, or privacy, should always be discussed and agreed with families and community professionals such as a Good Practice Committee. The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Residents benefit from a healthy diet. EVIDENCE: Menus are displayed in the kitchen where it is clear that a healthy and varied diet is offered. Staff are aware of residents’ likes and dislikes and alternatives are offered. Each resident has a daily diary where a record is kept of all foods eaten. This means that staff have a method to ensure residents are eating healthily and can easily monitor any changes. The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Residents’ personal and health care needs are well met. Improvements are needed in the security of stored medication. EVIDENCE: Residents’ care plans describe how residents liked to receive support and personal care. Health needs are recorded in care plans and are well met through a record of appropriate appointments. Medication is supplied in a monitored dosage system with accurate records. Over the counter medication is used, for example pain relief medication. The home has a Homely Remedy Policy that provides advice on what medication can be bought without a prescription and how much can be used. The policy included a lot of over the counter medicines, which may not always have been appropriate to use. The manager said that most of the medicine described on the list would not be used by the home. The manager was unsure of who had compiled the policy and agreed to take it to a pharmacy to ensure it was appropriate. Medicines are stored in a locked cupboard attached to a wall but the lock was not secure. The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 13 New staff receive an in depth induction that includes ensuring the staff have read and understood the medication policies and procedures. Senior staff observe new staff giving out medication on a number of occasions before signing to say they are competent. The CSCI’s pharmacy inspector has confirmed that this training is appropriate. During staffs’ annual development reviews medication is discussed and an assessment of competencies is completed. However, it is recommended that an assessment of competencies is carried out more frequently for new staff and six monthly for all staff. The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Residents benefit from a good complaints procedure and are protected for harm and abuse. EVIDENCE: The home has a good complaints procedure which staff have a good knowledge of. The complaints procedure is also in a format suitable to some of the residents’ communication needs. Staff have a good awareness of when residents are not happy, therefore those who are unable to understand the policy, rely on staff to recognise when they are unhappy. Residents’ concerns are therefore acted upon. All staff working at the home have received child protection training and all but 4 have received adult protection training. The 4 untrained staff are booked to attend this training in January 2006. The home also has good adult protection policies and procedures, including the local guidance on what to do if abuse is suspected. Staff sign to say they have read and understood these policies. Residents are therefore protected from potential abuse. Residents’ finances are managed well with some with their own bank account and some managed by families. Cash held by the home on behalf of residents is held securely with clear records kept. The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Residents benefit from a clean and comfortable home. EVIDENCE: The home is clean, comfortable and decorated and furnished to suit the needs and preferences of residents. The atmosphere is warm, friendly and fun. The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 35 Residents benefit from an experienced, competent and well-trained team of staff. EVIDENCE: The manager currently provides 2 staff per shift and 2 sleeping in staff at night for the 2 residents living in the home. Due to the complex needs of the residents, a high ratio of staff is necessary to ensure their needs are met at all times. The staff have received a good level of training that helps to meet residents’ needs safely. For example, health & safety training such as food & hygiene, fire safety, manual handling, as well as training specific to the needs of the residents, such as gentle teaching, conflict resolution, break away and many more. A well-trained team of staff therefore supports residents well. Staff were in the process of completing NVQ qualifications for children but since the home has now changed to adult services the NVQ qualifications have had to change. The manager is waiting for this to be arranged. The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 & 42 Residents benefit from a well run home, where their health, safety & welfare is promoted and protected. EVIDENCE: The manager has extensive experience of managing care homes and working with people with learning disabilities. The manager runs the home in an inclusive manner with all members of staff involved in decisions. The fire logbook was found to be accurate and up to date with a good record of fire safety training. There are good assessments of hazards around the home with clear action on what staff should do to reduce risk to residents. Staff had a good knowledge of them and had to sign to say they had read and understood them. Residents’ safety and welfare is therefore well protected. The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 2 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Lodge, Exmouth Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 3 X DS0000065098.V269531.R01.S.doc Version 5.0 Page 19 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 (2) Timescale for action The registered person shall make 31/12/05 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (This refers to the inappropriate lock on the medicines cupboard) Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA7 Good Practice Recommendations Practices that restrict freedom of choice, privacy or movement should be discussed and agreed with families and other professionals with records kept. (This relates to the alarms on bedrooms doors) New staff should be assessed for competencies in relation to medication regularly and thereafter six monthly. 2 YA20 The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Lodge, Exmouth DS0000065098.V269531.R01.S.doc Version 5.0 Page 21 - 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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