Inspection on 20/02/07 for Throwleigh Lodge

This inspection was carried out on 20th February 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Throwleigh Lodge 10/11/08

Throwleigh Lodge 28/11/07

Throwleigh Lodge 13/10/05

Throwleigh Lodge 14/04/05

Throwleigh Lodge 23/09/04

Throwleigh Lodge 13/05/04

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

CARE HOME ADULTS 18-65 Throwleigh Lodge The Ridgeway Horsell Woking Surrey GU21 4QR Lead Inspector Mary Williamson Unannounced Inspection 20th February 2007 10:00 Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 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 Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 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. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Throwleigh Lodge Address The Ridgeway Horsell Woking Surrey GU21 4QR 01483 772901 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) Wingreach Limited Mr Hassam Gora Soliman Care Home 17 Category(ies) of Learning disability (17) registration, with number of places Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The age range of persons accommodated will be 40 - 65 years Accommodation and Services may be provided to eight (8) named residents over the age of 65 years. Accommodation may only be provided to the two (2) named residents with Dementia with prior written agreement of the CSCI. 13th October 2005 Date of last inspection Brief Description of the Service: Throwleigh Lodge is a large detached property set in a quiet residential area close to Woking town Centre. Care is provided to seventeen men and women who have learning difficulties, some of who may require nursing care. Accommodation is arranged over the ground floor and first floor, with each floor consisting of a shared lounge and dining areas, bedrooms, bathrooms and toilets. The home also has an activity room, cookery room and sensory room. The main office and kitchen are situated on the ground floor. The home has a garden to the rear, which is accessible to residents and ample off street parking at the front of the building. Wingreach Limited employs the Registered Manager, catering and housekeeping staff. Surrey Borders Partnership NHS Trust oversees the overall care responsibility of the home and employment of care staff. The current fees charged range from £1100, to £1380 per week. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first site visit of a key inspection and was unannounced. The inspection took place over five hours. The inspection was undertaken by Mary Williamson, Regulation Inspector. The Registered Manager Mr. Hassam Soliman represented the establishment. A tour of the premises was undertaken and a number of records relating to the care of the service users and the management of the home were examined. There ware various activities taking place in the home. Service users were undertaking a group activity in the ground floor activities room, and several service users were listening to music in the lounge on the first floor. One service user was having the newspaper read to him and others were enjoying the privacy of their own rooms. There was opportunity to meet all the service users and talk with them, some in more detail than others. Discussions were held with staff both in groups and individually. It was good to note that they had a sound understanding of individual service users needs and communicated effectively with words, gestures and signs. The recruitment procedures, employment records, and staff training files were sampled. These contained all the relevant documentation to comply with employment legislation. The manager completed a pre inspection questionnaire. Six relative comment cards were completed and sent to the inspector prior to the inspection. These included favourable comments for example “ my brother is getting better care now than ever before”, “we are very happy with the care provided to my brother, and “I don’t think my brother could be better cared for”. The Commission for Social Care Inspection would like to thank the service users, manager and the staff for their help and hospitality during the inspection. What the service does well: Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 6 The home provides a good standard of care and support for the service users living there. The staff were observed to be respectful and interact with service users in a positive and professional manner. Accommodation is arranged on two floors and provides ample communal areas to meet service users needs. Individual bedrooms are well decorated and comfortable. These are personalised to reflect individual personalities. The activities programme in place is appropriate to meet the individual and collective needs of service users. Relative support is encouraged and service users who have relatives are supported to maintain contact with them. The catering arrangements are good and the chef has a good understanding of the service users needs and likes. He is in daily contact with service users regarding their preferences, and he serves the main meal in the dining areas. The standard of record keeping regarding the care of the service users and the employment of staff are good. Care plans, risk assessments, medication records, menus, and needs assessments are all well maintained. Employment files sampled contained all the required documentation necessary to safeguard the service users. The home is managed well in the best interest of the service users. What has improved since the last inspection? Since the last inspection the manager and deputy manager have worked hard to meet the requirements made. The homes policies and procedures have been updated to include the new organisations details. The home has revised the homes policy with regard to the handling of service users money. The home has improved the staff duty rotas outlining the staff on duty and an account of the hours they work. The home now ensures that the housekeeping staff are included in the induction programme and all statutory training. The recruitment files now contain documented evidence of vetting in order to protect service users. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 8 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 Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service users guide in place provide prospective service users with appropriate information required in order to make an informed choice regarding living in the home. Pre admission needs assessments are undertaken. EVIDENCE: Prospective service users, relatives and designated representatives have appropriate information available to them in order that they can make an informed decision regarding living in the home. This is also available in symbol format to help service users understand the facilities available. Pre admission needs assessments are undertaken, and three of these assessments were randomly sampled. These are detailed and outline individual needs of prospective service users, and determines if the home can meet these needs. The service users living in the home have been there for several years and the rate of new admissions to the home is low. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs and goals are outlined in individual care plans, which include risk assessments. Service users are supported to make decisions regarding all aspects of their care. EVIDENCE: All service users have their individual care needs outlined in individual care plans. Three care plans were randomly sampled. These are well written by senior staff based on a detailed needs assessment, input from service users whenever possible, information from family and other health care professionals. Care plans are reviewed regularly and the inspector noted a review on care taking place with the care manager present during the inspection. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 11 Individual risk assessments are in place, which include manual handling, risk of falling, risk of choking, a nutritional risk assessment, and a Waterlow assessment for the care of the skin and the protection of pressure sores. Service users are encouraged to make decisions regarding all aspects of daily living. Some service users require more support then others. One service user stated that he likes to spend most of his time listening to classical music and colouring. Two service users spoken to stated that they are included in their care reviews, several service users stated that they attend house meetings to discuss the homes routine. One carer explained how she supports service users to choose their clothing daily and also stated that she helps service users choose their menu. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to participate in appropriate leisure activities either at home or community based. Family links are maintained and the nutritional needs of the service users are met. EVIDENCE: Each service user has an activities programme which, outlines their leisure and recreational needs. Activities include art and craft, drawing and colouring, listening to music, watching television and videos, reading the daily newspaper, one to one hobbies, and tapestry. There are two activities rooms provided for these activities and there is also a sensory room on site. Service users are supported to do their personal shopping in the nearby town of Woking. Two carers stated that they accompany service users shopping and to access local cafes. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 13 The service users told the inspector that they have not had a recent holiday but had several special trips to the coast instead. Family links are maintained and relatives are welcome to visit the home at any reasonable time. The manager stated that relatives are encouraged to participate in care planning ant to attend reviews of care. Some service users do not have relatives and the manager stated that finding advocated was proving difficult. Spiritual need of service users are acknowledged and six service users attend the local church on Sundays. There is also a Holy Communion service arranged monthly in the home. Staff and service users plan menus during house meetings. These are arranged over a four- week cycle and are overseen by the chef. The choice and variety of food offered is wholesome and nutritious. Lunch was observed being served and consisted of beef casserole, a selection of vegetables and creamed potatoes followed by pancakes. Staff were observed providing sensitive support to service users who required help with feeding. Several service users commented on the food stating that they liked the food, “I like pancakes” and “fish is my favourite”. The kitchen is well organised and was clean and orderly. The chef serves all the meals and has a good understanding of the service users needs and preferences. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users personal, emotional, and physical needs are met as outlined in individual care plans. The medication procedures in place protect the service users in the home. EVIDENCE: All the service users are registered with a local GP who will visit the home when necessary. It is also possible for service users to visit the surgery on appointment. Chiropody treatment and dental treatment is provided on a regular basis. Several service users wear glasses and one service user was able to explain that she has her eyes tested and how her two pairs of glasses help her. There is also access to a psychiatrist who visits the home and undertakes individual reviews of treatment. The home has a medication administration policy in place, and all staff who administer medication are familiar with this policy. The medication is provided in blister pack format by Boots the Chemist who undertake regular audits of medication and will also provide training for staff. Individual medication recording charts were sampled and these are well maintained. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 15 Each chart includes a photograph on the service user and the any known allergies. Medication is stored in a locked cupboard and there are two trolleys available for the administration of medication, one for each floor. There is a fridge available for the storage of insulin and other drugs that require refrigeration. Currently there are no service users in the home who self medicate. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s complaints procedure and the abuse awareness policy in place protest the service users. EVIDENCE: The home has a complaints procedure in place and all service users and their relatives have access to a copy of this, which is also available in symbol format to help service users understand the content. There have been no complaints recorded since the last inspection. The home has an abuse awareness policy in place and all staff are aware of this procedure, which is also included in their induction training. During discussion with staff on both floors they were quite clear about the process of implementing this procedure and felt confident about doing this. There is a copy of Surrey’s Multi Agencies Policies and Procedures on Safeguarding Vulnerable Adults in the home and the manager stated that most of the staff had attended local authority training relevant to these procedures. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28,29, and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and hygienic and provides a comfortable, well-maintained and homely environment for the service users to live in. EVIDENCE: The home is well maintained and provides a homely, safe and comfortable environment for service users to live in. Accommodation is arranged over two floors each with ample communal space including two comfortable lounges, and several dining areas, which are all tastefully decorated and furnished. Service users also have the use of an activities room. Some of the service users invited the inspector the visit their bedrooms. These are comfortably furnished and decorated according to individual choice. One service user told the inspector that the staff decorated her room and she choose all the colours and soft furnishings. Personal space reflects individual personalities and hobbies. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 18 The home has been adapted to meet the individual mobility needs of the service users. Toilet seats are raised, and some have been fitted with special surrounds. Bathrooms have been equipped with assisted baths and showers. It was noted that some service users have individual hoists. Grab rails have been fitted in appropriate areas, and there is a ramp to access outdoor facilities. The standard of cleanliness is well maintained by the housekeeping staff and all areas of the home are clean, and hygienic. The home has an infection control policy in place and staff are aware of this. Laundry facilities are provided on each floor and staff support some service users to undertake their personal laundry. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 34, 35, and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by a competent staff team in sufficient numbers to meet the assessed need of the current service users, who are also protected by the home’s recruitment procedures. EVIDENCE: The staff duty rota was examined and the number and skill mix of the staff on duty was appropriate to meet the assessed individual and collective needs of the service users. Most of the staff on duty were spoken to and all confirmed that they had been provided with a job description and contract of employment. All staff have been issued with a life long personal development folder. This is given to staff at their induction training during which they cover all the required mandatory training to include manual handling, food hygiene, abuse awareness, first aid, fire safety, and COSHH. Discussions took place between several staff and the inspector regarding the training provided and the frequency of this. Generally staff felt satisfied with the training they receive, but were disappointed that they were not able to undertake NVQ awards and stated that The Trust has suspended funding for this specific training. The manager and the deputy manager both confirmed this statement. It is Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 20 recommended that this policy be reviewed in accordance with national Minimum Standards, and in order to value the aspirations of the staff team. The home follows the recruitment policies and practices of Surrey and Borders Partnership Trust. Employment files were sampled for four care staff. These are well maintained and contain all the required employment documentation including two written references, and a CRB (Criminal Records Bureau) disclosure reference number. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42, and 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home which promotes their health, safety and welfare. EVIDENCE: The home is well managed and was functioning efficiently on the day of the inspection. The Registered Manager is a qualified nurse with several years experience in the provision and management of care. A deputy manager who is also a qualified nurse with an RNMH qualification supports him. They have both invested a lot of effort in improving and updating the homes policies and procedures as a requirement form the last inspection. Quality assurances is monitored by service users meetings when individual views are listened to and acted upon, for example choice of food and changes to menus, planning special trips out, and the general day to day decisions regarding the running of the home. Quality assurance survey questionnaires are sent to service users, relatives, health care professionals, and staff and the Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 22 returned comments are reviewed and acted upon. These are retained for reference. Small amounts of personal monies are kept in the home for individual service users. There is now an updated written policy in place with regard to handling service users money, which was highlighted during the last inspection. The home has a wide range of health and safety policies and procedures in place and these were sampled throughout the inspection. Staff are inducted in these procedures on commencement of employment, and attend regular update training. Risk assessments are in place for identified risks and safe working practice. The fire safety procedures were experienced first hand during the inspection. The fire alarm sounded and the manager implemented the fire safety procedures, which included a fire drill and the attendance of the fire fighters. It was good to observe the staff’s competence during this procedure. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 X 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 3 Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA32 Good Practice Recommendations It is recommended that the registered person reviews The Trust’ policy on training regarding NVQ for staff. Even though mandatory training is in place staff expressed their wish to undertake NVQ training. This should be seen as good practice and valuing staff. Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: 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 © 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 Throwleigh Lodge DS0000017648.V327686.R01.S.doc Version 5.2 Page 26 - 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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