Inspecting for better lives Key inspection report
Care homes for adults (18-65 years)
Name: Address: Throwleigh Lodge The Ridgeway Horsell Woking Surrey GU21 4QR The quality rating for this care home is:
two star good 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: Patricia Collins
Date: 1 0 1 1 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 34 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 34 Information about the care home
Name of care home: Address: Throwleigh Lodge The Ridgeway Horsell Woking Surrey GU21 4QR 01483772901 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Wingreach Limited The registered provider is responsible for running the service Name of registered manager (if applicable) Mr Hassam Gora Soliman Type of registration: Number of places registered: care home 17 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: 17 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 Throwleigh Lodge is a care home with nursing for adults whose primary needs on admission are learning disabilities. The home is registered for the provision of accommodation and care for up to seventeen people of both gender. The building is a large detached property set in a quiet residential area, close to Woking town centre. Care Homes for Adults (18-65 years) Page 4 of 34 17 Over 65 0 Brief description of the care home The accommodation is arranged on two floors in two living units, accessible by passenger lift. Each unit has a communal lounge, separate dining rooms, bathrooms, toilets, kitchen and activity room. Bedrooms are all single occupancy with washbasins and emrgency call bells. Other facilities include a well - equipped sensory room, ultility rooms and offices. There is a furnished patio and garden to the rear of the premises and off street parking at the front. Care Homes for Adults (18-65 years) Page 5 of 34 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: two star good 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 last inspection of this service was completed on 28th November 2007. Current fee charges range between 1,200 pounds and 1,550 pounds per week. This unannounced inspection visit formed part of the key inspection process using the ‘Inspecting for Better Lives’ (IBL) methodology. The visit was carried out by one inspector over seven hours. An Expert by Experience and her assistant were involved in this process. Their visit was on the same day, lasting two hours during which time two people using services and three staff members were consulted. The report will say what ‘we’ found as it is written on behalf of the Commission for Care Homes for Adults (18-65 years)
Page 6 of 34 Social Care Inspection (CSCI). The inspection process incorporated discussions between the inspector and the registered manager who was present for part of the visit. Also with the nurse in charge, staff and some people using services. Because we were not able to communicate with all people using the homes services we spent time indirectly observing care practice, behaviours and their body language, assessing their state of wellbeing. We looked at the quality of interactions between these individuals and staff, with others using services and with their environment. Practice observations were carried out whilst touring the home and at lunch time. We have taken all available information into account when forming judgements about how well the home is meeting the national minimum standards for adults. This includes the cumulative assessment, knowledge and experience of the home since its last key inspection. The inspection process involved sampling records, a tour of all areas of the building and observation of the garden. We considered the responses to our survey received from nine people using services. Their questionnaires were completed with staff assistance, also feedback from a general practitioner (GP) and seven relatives. The inspection outcomes were also informed by the homes Annual Quality Assurance Assessment (AQAA). Each year providers registered with the Commission for Social Care Inspection must ensure completion of an AQAA and send it to us. It provides quantitative information about their service. Also an assessment of the service against the National Minimum Standards (NMS) outcome areas, demonstrating both areas of strength and where improvement is needed. We wish to thank all who contributed information to the inspection process. Also people using the home’s services and staff for their time, hospitality and assistance throughout the visit. What the care home does well: The atmosphere of the home is friendly, warm and inclusive. The home manager and staff provide an environment in which each person living there is seen as an individual. There is a core group of staff who have worked many years at the home. They know the people using services very well and have an in depth understanding of their needs. Relatives and representatives of people using services were very complimentary in their feedback about the home. Examples of comments received were, The home promotes a very caring and friendly atmosphere, I am very happy to say my relative is taken great care of at Throwleigh Lodge. Hassam (the manager) and his staff have managed to create a relaxed and homely feel in which my relative has thrived. I feel confident that all his medical and personal needs are being met. I am always kept informed about his needs, this in turn allows me and my family to relax which is something we never thought would happen. There is an holistic, person centred approach to meeting needs.The homes operation ensures people using services have a community presence and their leisure interests are identified and met, offering quality time and stimulation. There are links with various organisations that facilitate and promote leisure and recreational opportunities. A weekly plan of activities is displayed in both living units, portrayed in pictorial form and include, painting, craft-work, use of community facilities and various games. The quality survey carried out by management demonstrated arrangements made for meet spiritual and religious needs. Some people using services attend church and a local Vicar provides a monthly communion service at the home. There are two vehicles, a car and a mini bus, enabling access to the community and social inclusion. The Expert by Experience found staff to be friendly and was told by people using services that they treat them well, supporting them to do what they do want to, on a daily basis. One person using services told her, I would not want to change anything here. When I want to go out for a cigarette, the staff take me. Comments in surveys from people using services indicated a good level of satisfaction with their lifestyles. Examples of comments included, The staff are nice to me, I choose what I like to wear, I like to listen to my music, watch TV, read my daily newspaper and go to Church on Sundays. If am not happy I go and talk to staff and they help me or I call my sister. Assessment records, care plans and risk assessments are well documented and are regularly reviewed and updated. They support staff with clear guidance in meeting needs and take account of the individual preferences of people using services. Records demonstrate that medical and nursing needs are met. The GP was positive in his feedback about the way the home manages healthcare needs. The decor and furnishings is of a good standard and domestic in style, affording an attractive, comfortable and overall suitably equipped environment. The home is clean and bathrooms have been adapted to meet the needs of people with physical disabilities. Shower chairs are provided for those who need them. Bedrooms are tastefully decorated and personalised, reflecting the individuality and interests of their Care Homes for Adults (18-65 years) Page 8 of 34 occupants. The mealtime observed was a pleasant, social experience for people using services. Dining rooms are comfortable, with good quality soft furnishings. The dining tables were nicely presented, laid with bright tablecloths, condiments and crockery.Staff constantly interacted with people using services during their meal, promoting independence and providing discreet assistance with eating, where necessary. The meal served was substantial and well presented. Easy read coloured menu boards were displayed. There is a high level of commitment to staff training and development. A learning opportunities guide is available for staff, which includes a training plan and log for staff to attend training sessions. Discussions with staff demonstrated a clear understanding of their role. Staff morale was perceived to be good and effective teamwork was evident. Comments from staff confirmed they receive support and encouragement from senior staff and the home manager. What has improved since the last inspection? What they could do better: There is a need for management to be more proactive in trying to recruit to the deputy manager vacancy, to ensure the management structure is sufficiently robust. The good practice of giving all people using services a personal copy of their care plan Care Homes for Adults (18-65 years) Page 9 of 34 to keep would be further enhanced by producing these in a more accessible format, to meet individual communication needs. The inspection evidenced a high level of commitment in the homes ethos and philosophy of care to enabling choices in the daily lives of people using services; also opportunities for their personal development and independence. However, discussions between some people using services and the Expert by Experience suggested this is an area for further development. It was felt that the homes routines do not fully support the social model of disability. It is suggested that management considers ways for enabling and supporting people using services with capacity and who wish to do so, to engage in the preparation of their meals and domestic tasks. A comment from a person using services also indicated the need for more flexibility in routines, for example, the times of meals. The Expert by Experience formed the impression, during these discussions, that staff are in charge and people using services went by what they decide. One example was when a person using services said, I go to bed at 9.00 p.m. because that is when the night staff come in. It was suggested that the home manager may wish to explore this further with people using services. This will ensure an appropriate balance between essential structures and routines and opportunities for people using services to have control over their lives, within individual levels of capacity. The organisations safeguarding procedures are still in need of review and updating to ensure compatibility with the local multi-agency procedure. This observation was made at the time of the last inspection. The home also needs to have the latest edition of the multi-agency safeguarding procedures. Though mostly odour is satisfactory, malodour in one bedroom required attention. The Expert by Experience, who is a wheelchair user, also identified that wash basins and paper towel holders in bathrooms were too high and unsuited to promoting independence of wheelchair users. We also received one adverse comment in a survey from a relative about the visitors toilet, which was stated need upgrading. 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 10 of 34 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 11 of 34 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. Information about the home is accessible to prospective people using services and their representatives. This enables informed decisions about its suitability to meet needs and aspirations. Needs assessments are carried out before admission to be confident these can be met by the home. Each person using services is issued with individual terms and conditions of residency. Evidence: Most people using the homes services were admitted eleven years ago at the time of registration. There were no vacancies at the time of the inspection visit. Admission rates are low and there had been just two admissions since the last inspection. The age range of the homes population at the time of the visit was between 51 and 83 years and the gender mix, 10 males and 7 females. The majority of people using the homes services require a significant amount of support from someone who knows them well, to help communicate their views and choices. The views and choices made vary, dependent on the individual. Not all of the
Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: people using services would have had capacity to make a decision about where they wished to live. The homes Statement of Purpose and Service User Guide enable prospective people using services and their representatives to have the information needed to make an informed choice of home. Admission and assessment procedures are underpinned by a clear admission criteria. Comprehensive needs assessments are carried out before admissions take place, to ensure individual needs can be met. The organisations admission procedure ensures a summary is obtained of assessments carried out by care managers and the primary health care team. On the basis of this information a decision is then made whether to accept the application for admission. Pre-assessment procedures include a visit to prospective people using services to find out, using appropriate communication strategies, what is important to and for that individual, consulting them, relatives, carers and relevant professionals. People using services have been issued with a copy of the homes terms and conditions of residency. Care Homes for Adults (18-65 years) Page 13 of 34 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 assessed and changing needs of people using services are reflected in individualised support plans. Staff assist them in making decisions, promoting independence and informed risk-taking within individual levels of capacity. Evidence: The homes care planning process is person centred and generated from comprehensive needs and risk assessments. Care plans have been produced using a range of tools to identify what is important to each individual, recording likes and dislikes, interests and care and support needs. There is input to this process from other disciplines, as necessary, for example, occupational and speech and language therapists. The care plans sampled were well written, detailed and holistic, describing how the service will meet current and changing needs and goals of people using services. They covered all aspects of daily living, including communication methods or needs, mobility, personal care and nursing needs, activities and leisure and eating and drinking. All people using services had received a personal copy of their care plans
Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: which they keep in binders in their bedrooms. It was positive to note the practice of summaries of care plans also kept discreetly in bedrooms for staffs reference. These provide concise and accurate information about individual needs and how these are to be met, taking into account individual preferences. It was suggested to the nurse in charge for consideration to be given to making the content of the care plan issued to people using services more accessible, by producing these in formats meeting individual communication needs. People using services receive the information, assistance and communication support they need to make decisions in their daily lives. The importance of transparency of record keeping practice specific to restrictions of choice and freedom agreed with people using services was discussed with the nurse in charge. This must be addressed in a care plan and be subject to regular review. The care plans sampled were up to date, having been reviewed at review meetings twice this year. Records of these meetings demonstrate an inclusive care planning approach, involving people using services, family members and other representatives. Eight reviews had been carried out for people using services in the past twelve months, by professionals, on behalf of agencies funding their placements. A flexible and individualised approach to the care and support of people using services was evident, ensuring continuity of structures and routines needed in their lives. A responsible approach is taken to risk taking, enabling people to lead ordinary lives as much as possible and promoting independence. Where risks to health, safety and welfare have been identified, these had been assessed and recorded with action to be taken to minimise that risk. Care Homes for Adults (18-65 years) Page 15 of 34 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. People using services have opportunities to take part in a variety of activities at home and in the community.They are supported in keeping contact with relatives and their friends. Meals are varied and balanced and afford choice. Evidence: It was evident that people using services are actively encouraged and supported in maintaining contact with their families and friends. Feedback from relatives and representatives of people using services, without exception, commended the home for its high standard of care and management also the happy, friendly and welcoming atmosphere. People using services have a choice of social activities in the home and in the community. They are supported to take part in age, peer and culturally appropriate
Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: social and leisure activities, including shopping, various outings and visits to the pub. On the morning of the visit two people were observed sat in recliner chairs in the wellequipped sensory room. This has a music system and equipment to stimulate the senses, including a bubble column, a colour light display and massage mat. They appeared stimulated and were taking an interest in their surrounding. There are activities rooms in each of the living units. A staff member in one was observed to support a person in reading his daily newspaper, which he said he enjoyed doing, taking an interest in current affairs. A number of people using services are artistically talented and their work was displayed in bedrooms and in the activity rooms. Another staff member was assisting a person colouring a picture, which he appeared to find satisfying. Another person using services was in his room doing a puzzle and another, enjoying his music in his room. Pictorial information was displayed on both living units, suitable to meet the communication needs of people using services, including the menu. A person using services told the Expert by Experience involved in the inspection that staff support the people who live at the home to do what they want, on a daily basis. He said, I would not want to change anything here. When I go out for a cigarette, staff take me. There is a choice of meals, in that people using services are offered choices of what is cooked on the day. If they do not want it they are given an alternative, offered an option they like, according to dietary needs. Other comments however from people using services to the Expert by Experience suggested the need for review of the homes day to day operation to ensure sufficient opportunities for autonomy in their daily lives. Staff were observed to respect the privacy of people using services. Some have keys to their bedrooms and staff have access to a master key to open their doors when they are not physically able to do so themselves. Staff were observed to knock on bedroom doors and waited to be invited in, before entering. The quality survey carried out by management demonstrated arrangements made to meet religious needs. Individuals attend church and a monthly communion service is held at the home by a local Vicar. The home has two vehicles, a car and a mini bus, enabling access to the community and social inclusion. Nutritional assessments are routinely carried out for all people using services and records confirmed the practice of regular monitoring of weights. Special dietary needs are accommodated. People using services are supported and encouraged to be as independent as possibly with eating and drinking. Observations at lunch time confirmed individuals were using eating aids including adapted crockery and cutlery, enabling them to eat and drink with minimal assistance. Lunch was served in a number of dining rooms, enabling staff to accommodate individual preferences of eating alone
Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: or in company. The dining rooms were suitably furnished and tables attractively laid with tablecloths and flowers. A person using services was supported by staff in laying up the tables for lunch on one unit. A cook is employed daily who prepares lunch and the evening meal. The home has two domestic style kitchens, one in each living unit. These were clean and hygienic and suitably equipped for their purpose. The Environmental Health Inspector had undertaken an inspection of food safety at the home the week of this inspection. The cook uses the ground floor kitchen and meals are transported to the living unit on the first floor on a trolley, using the passenger lift. The home would benefit from the provision of a heated trolley for this purpose. The meals viewed were attractively presented and substantial, provided in alternative forms to meet individual needs, such as soft and pureed diets. A four weekly, varied menu plan was being followed. This was stated to be under continuous review and changed in response to popularity of meals. The Expert by Experience commented on some of the homes routines not fully supporting the social model of disability. Examples given were that people using services with capacity and who wished to do so, did not have choice of engaging in the preparation of meals and domestic work, as this was the role of designated staff. Also the lack of flexibility around the times of meals, observing a person using services to comment, its nearly half past two, we shall be getting our tea soon. Observations and information obtained by the Expert by Experience left her with the impression that staff are in charge and people using services went by what they decide. One example was when a person using services said, I go to bed at 9.00 p.m. because that is when the night staff come in. The nurse in charge advised that this perception was not an accurate reflection of how the home is run. It was noted that the survey carried out by the home this year contained feedback recorded by staff, after consulting people using services, that confirmed they choose when they they go to bed. It is suggested, given the information obtained during this inspection that the homes management may wish to review routines to ensure appropriate balance between essential structures and opportunities for people using services to engage in the running of their home and have control over their lifestyles. Care Homes for Adults (18-65 years) Page 18 of 34 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. The health and personal care that people using services receive is based on their individual needs. The management of medication is safe and the principles of respect, dignity and privacy are put into practice. The ageing, illness and death of people using services is handled with sensitivity and respect. Evidence: People using services are registered with a general practitioner (GP). They receive effective personal and healthcare support, using a person centred approach. Personal and healthcare support is underpinned by quality principles and the right to privacy and dignity is respected. The GP who completed our survey commented positively on the homes management of healthcare needs; also on the way staff overcome communication barriers for individuals unable to verbally express themselves. The home was involved in an audit looking at pain recognition and its management for people with learning disabilities. Some staff attended training sessions and a check list had been produced, to ensure their understanding and implementation of pain management, in accordance with policies and procedures in place. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: Staff are consulted as part of the care planning process, their views and opinions valued by management. The home had recently acquired a copy of the Basic Personal Care MOT Tool for people with learning disabilities. It is planned for this to be used to further develop care plans and as a tool to ensure the highest quality of care. Since the last inspection care files had been reorganised and healthcare records are now in separate files. Personal and intimate support needs are recorded in care plans, based on individual needs assessments and known preferences. The care plans sampled had been formulated based on comprehensive needs and risk assessments. These included nutritional and pressure sore prevention, moving an handling, falls, choking, multiple seizures, scalding and financial abuse. There was evidence of good quality physical and mental health care and compliance with professional assessments and guidance. Clear protocols were in place for the safe management of epileptic seizures and diabetes. The home manager ensures staff have the information they need about various disorders and syndromes affecting people using services. This is available on individual files and in training manuals. Record keeping practices ensure an audit trail of the care and support provided. Daily records of significant information are made, for example deviation from care plans for any reason, changes in needs, health or behavioural problems and falls.These records are kept in a current file and later transfered to individual files. There was evidence of staff training to enable safe and appropriate personal and healthcare. Staffing arrangements ensure a registered nurse on duty on all shifts. Aids and equipment are provided in accordance with assessed needs.These include wheelchairs, profiling beds, pressure relieving mattresses and cushions and hoists. The home has an efficient medication policy and procedure, which nurses understand and follow. Medication records sampled were fully completed, containing required entries and signed by nurses. Medication was securely and appropriately stored. Other discussions with the nurse in charge included end of life care plans and how the home deals with ageing, illness, death and bereavement. Observations confirmed good practice in these areas. We received feedback from a relative who said the manager could not have been more helpful when her relative who had lived at the home, had died. She was comforted by the managers genuine affection for her relative and arrangements for other people using services to attend his funeral. She most appreciated the tea and home made cakes organised at the home, after the funeral, stating everyone involved had been so kind and respectful. On the day of the
Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: inspection visit, the manager and a staff escort supported a person using services to attend her brothers funeral some distance away. It was noted she had been supported to visit him in hospital during his final illness. Care Homes for Adults (18-65 years) Page 21 of 34 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. People using services are assisted by staff and advocates to express any concerns and to access the homes complaint procedure. Staff are trained to identify and respond to indicators of abuse and the manager is clear of the local safeguarding procedure. The organisations safeguarding procedure must be reviewed to ensure this is in line with Surreys safeguarding adults multi agency procedures. Evidence: We have not received any complaints about this service since the last inspection. The home has a corporate complaint policy and procedure. An easy read complaint procedure had been supplied to each person using services, kept with a copy of their care plans in their bedrooms. The person using services told the Expert by Experience he was aware of how to make a complaint. He said if he had a problem or was not happy, he would tell the manager or staff on duty. Staff assisting people using services in completing our survey recorded they would also tell the manager or staff if they were not happy, some said they would also tell their relatives. Six out of seven relatives who responded to our survey were informed of the complaint procedure. The home had not received any complaints since the last inspection. It was evident that a significant number of people using services would not be able to express any concerns, and would need to rely on staff and others to recognise they were unhappy or in distress. Staff who had worked at the home some time were confident they would know from changes in behaviours and would report this to the nurse in charge, and
Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: look for the reason, through a process of elimination. There has been one safeguarding alert made by the home since the last inspection which had been investigated and was unsubstantiated. This investigation into an allegation of physical abuse had been undertaken by the Trust and not the police. When queried during the inspection, the manager said he had followed Surreys safeguarding procedure through an alert to Care Management and this was their decision. The manager and the organisation was stated to be aware that internal investigations into safeguarding allegations must only take place if agreed by the safeguarding team. It was not clear whether Surreys safeguarding team had been involved in decisions relating to this incident. In examining the organisations safeguarding procedures this was found to require review to remove inappropriate, out of date information and ensure it dovetails into Surreys local procedure. The manager agreed to take this up with head office and to obtain the latest 2008 edition of Surreys safeguarding procedure. Since the last inspection staff had received safeguarding adults training. The majority of people using services do not have capacity to manage their own finances, independently. Risk assessments were in place to safeguard them from financial abuse and exploitation. Robust policies and procedures are in place for the management of personal finances of people using services. Care Homes for Adults (18-65 years) Page 23 of 34 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 good 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 is suited to its stated purpose. The home environment is a safe, attractive and comfortable place to live and is maintained to a high standard of cleanliness. Areas for review include odour management in one bedroom and accessibility to wheelchair users of washbasins and paper towel holders in communal bathrooms. Evidence: Since the last inspection, Throwleigh Lodge had participated in The Downs Syndrome and Dementia Environmental Audit Project, carried out by Surrey Borders Partnership NHS Trust. The aim was to assess care homes and their suitability for people with learning disabilities and dementia. The results of the audit are being assessed and implemented to provide a positive environment for people with both learning disabilities and dementia. A tour of all areas of the home confirmed a high standard of decoration, furnishings and cleanliness. Communal rooms were spacious, attractively decorated with coordinating furnishings, in a homely style. Suitable specialist equipment was provided to meet the individual assessed needs of people using services. These included electrically operated beds and hoists, pressure relieving equipment, hand and grab
Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: rails and bedrails. All areas were light and bright and the temperature maintained at a level comfortable to people using services. Overall odour control was well managed though attention necessary to malodour in one bedroom. It was evident that staff had washed and aired the mattress, which was a daily duty, however the need to look at the suitability of the floor covering should be considered. This should be in consultation with this individual and other relevant stakeholders. Bedrooms were nicely personalised, reflecting the individual tastes and interests of their occupants. Staff were observed to respect the privacy of people using services, knocking on bedrooms doors and waiting for a response before entering. Some people had been issued with keys to their bedrooms. Bathrooms and toilets were hygienic and easy access baths, showers and shower chairs were provided. The wash basins and paper towel holders in bathrooms however were very high, which is unsuitable to meet the needs of wheelchair users. The Expert by Experience, who is a wheelchair user, had been unable to reach the washbasin in one bathroom to be able to wash her hands. This was discussed at the feedback and management requested to review this shortfall in standards. Universal infection control procedures are practiced by staff. Liquid soap and paper towels are available in communal toilet facilities, for hand-washing. Supplies of disposable gloves and aprons are plentiful for staff engaging in the delivery of personal and nursing care, cleaning and food handling. We received on adverse comment from a relative about the visitors toilet which was stated to be in need of upgrading. Care Homes for Adults (18-65 years) Page 25 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained, skilled and in sufficient numbers to support people using services, in line with their terms and conditions, and to support the smooth running of the home. Whilst people using services are protected by the homes recruitment procedure attention is necessary to practice shortfalls. Evidence: The home manager and ancillary staff are employed by Wingreach Ltd, the registered provider. Nurses and care staff are currently employees of Surrey and Borders Partnership Trust. The homes management identified last year that staff shortages would be created owing to planned staff retirements and staff transfers to other homes. Due to contracting arrangements between the organisation and Surrey and Borders Partnership Trust they had been unable to recruit new staff. Staff shortages over the past twelve months had been a barrier to improvements. This has changed over recent months, however, with the decision by Surrey and Borders Partnership Trust to discontinue staff contracting arrangements. Currently staff are in the process of transferring their employment to the registered provider. Recruitment procedures and systems had been put in place. Whilst staff recruitment was reported to be a difficulty, some new staff had been appointed. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: The staff rota viewed was clearly recorded and staffing levels consistently maintained at six support workers, three deployed on each living unit, across the waking day, with a registered nurse in charge of each shift. The manager mostly works supernumerary, though sometimes he is necessary to the skill mix, owing to vacant nursing hours and nurse absences. Waking night staffing levels comprise of one registered nurse and two support workers. Ancillary staff include a cook every day, two house keeping staff and a visiting maintenance worker. The home has its own bank staff. New staff continue to have a basic induction however a new induction pack was ready to be rolled out, covering the common induction standards. The modules include understanding principles of care, organisation and role, experiences and needs of people using services, maintaining safety at work, abuse procedures and safe practice in the management of epilepsy. The manager confirmed the intention for the whole team to work through these training modules. Concerted effort had been made for all existing staff to attend mandatory training courses since the last inspection, also equality and diversity training. The ability for management to be in control of the staff training programme is a new and welcomed development. The organisation has access to its parent companys training department. Eight staff are enrolled and studying for National Vocational Qualifications in care (NVQ) and an external NVQ Assessor comes in weekly. A resource room had been created for staff to access information about the various conditions that people using services have, to educate them about best practice. Each member of staff has three hours a week designated for self-development. They each have a Lifelong Learning Personal Development folder to record and monitor their development. Discussions with individual staff established that although English was not their first language, they had a good command of the language.They also had an understanding of the culture of people using services who are all of White British ethnicity. Two new staff were on duty for the first time, one on the morning shift and one on the late shift, shadowing other experienced staff. Both described good practice recruitment and vetting procedures in their appointment. Examination of staff files identified the need to have current photographs of staff and for compliance with the Criminal Record Bureau (CRB) policy guidance in the storage, recording and disposal of CRB disclosures. These are currently held on staff files and the home has not yet produced a CRB record. These shortfalls were fully discussed with the home manager who agreed to take the necessary action. Staff consulted spoke well of the homes management and of training opportunities and stated they enjoyed working at the home. They were attentive to the needs of people using services and caring in their approach. The Expert by Experience reported
Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: her findings that staff were friendly and treated people using services, well. These observations were endorsed by the complimentary feedback from relatives about staff. A weakness however was that most of the staff consulted by the Expert by Experience were relatively new in post, some having started work on the day of the inspection visit. They had not been able to provide much information about how people using services were supported. Care Homes for Adults (18-65 years) Page 28 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is overall safe and efficient, ensuring the home runs in the best interest of people using services. Evidence: The homes management structure comprises of a full time manager and deputy manager post and a senior team of staff nurses. The deputy manager retired earlier this year and the post was vacant at the time of the inspection. The former deputy manager continues to work part time at the home as a staff nurse and was on duty, in charge of the home, on the day of the inspection. The home manager is a registered nurse with over twenty years relevant experience. He is currently working towards attaining the registered managers award qualification. The home manager participated in part of the inspection before leaving for a pre-arranged appointment. The nurse in charge facilitated the inspection process. Observations confirmed effective management systems are in place and compliance with the requirements made at the time of the last inspection. Areas of discussion with the manager and the nurse in charge included the failure to complete and return an improvement plan we asked for
Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: following the last inspection. The importance of keeping abreast of changes in regulation legislation was emphasised. The registered manager had not been aware that submission of an improvement plan had been a statutory requirement. He also confirmed he did not receive the letter we sent him, following up this omission. The home shares the same site as the organisations head office and he speculated the possibility this letter was delivered to the head office and not passed to him for attention. Other discussions with the manager included the need for a written request to remove conditions that are no longer relevant from the homes certificate of registration. It was confirmed by the manager that the primary condition, on admission to the home, continues to be learning disabilities and not old age. After this visit, it was established that an amended certificate removing conditions no longer relevant was issued on 10th October 2008 but had not been received. It was agreed that the manager would confirm this in writing so that another could be issued. The home has a full range of policies, procedures and guidance, including those promoting and protecting the health, safety and welfare of people using services and staff. With the exception of staff very new in post, the staff team had received all statutory training to ensure safe working practices. An appointed first aider is on duty at all times and basic first aid training is included in staffs induction. They also attend annual refresher training. Staff were in receipt of fire safety training however whilst touring the building with a staff member, she was not aware of how to open the fire exit door on the first floor, leading to the fire escape. This was discussed with the manager who agreed to ensure all staff know how to open fire exit doors. Observations confirmed a need to further develop risk assessments for the environment. Hazards specific to the storage of liquid detergent in laundry rooms, accessible to people using services and steps leading from the patio without handrails need to be included. The home has a range of effective quality assurance and monitoring systems. Since the last inspection a quality survey had been carried out and this was sampled. The need to date the surveys was identified. Also the need to record the analysis of the survey responses and produce an action plan to demonstrate the response to suggestions and comments in the survey. The survey questionnaire viewed indicated the overall satisfaction of people using services with the home. Letters from relatives to management were mostly complimentary and positive. The staff survey carried out in June also contained positive feedback. One area where staff were less than satisfied regarding lack of opportunity to study for national vocational qualifications in care, has been remedied. Statutory monthly visits are carried out by a designated senior
Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: manager, on behalf of the responsible individual. The findings are recorded in reports held in the home. Reports of the visits carried out in July and August, however, could not be located, though assurances received that they took place. Care Homes for Adults (18-65 years) Page 31 of 34 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 32 of 34 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 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 33 of 34 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 34 of 34 - 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!
