Inspection on 20/07/05 for Tilehurst Lodge

This inspection was carried out on 20th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tilehurst Lodge 05/11/07

Tilehurst Lodge 30/01/07

Tilehurst Lodge 09/01/06

Tilehurst Lodge 25/01/05

Tilehurst Lodge 22/06/04

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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 TILEHURST LODGE 142 Tilehurst Road Reading Berks RG30 2XL Lead Inspector Jill Chapman Unannounced 20 July 2005, 12-10pm 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 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 Stationary 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. TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Tilehurst Lodge Address 142 Tilehurst Road, Reading, Berkshire, RG30 2XL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0118 9674675 TACT Sarah Darlow- Acting Manager Care Home (CRH) 6 Category(ies) of Learning disability (LD) registration, with number of places TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 25 January 2005 Brief Description of the Service: Tilehurst Lodge provides 24-hour support for up to 6 men with learning disabilities, some of whom also have mental health issues. The men at Tilehurst Lodge are encouraged to participate in a variety of experiences and opportunities to enable them to lead fulfilled lives, which in most cases includes employment unsupported by staff from the home. These experiences and opportunities are underpinned by ‘The Five Accomplishments to Ordinary Living’ by John O’Brien.‘The aim at Tilehurst Lodge is to provide a high quality service with comprehensive care planning and risk assessing to reflect individuals needs and preferences. We are committed to working to the highest professional standards on a multi-disciplinary basis to offer real community living.The objective is to provide an environment where people with learning disabilities are able to develop independence and to enjoy the everyday experiences and opportunities that the wider community enjoys and be seen in society as valued individuals.’ (Extract taken from the homes statement of purpose.) TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out over a four-hour period on a weekday afternoon. The focus was to follow up progress from the last inspection and to inspect a number of the standards. Four out of five requirements have been met, one regarding regulation 26 reports has not been carried out. Four residents were at home at the time of the visit and two were willing to give their views about the home. The inspector spoke with the acting manager, acting deputy and staff on duty. A staff handover was observed. A resident and the acting manager showed the inspector the house and garden. What the service does well: What has improved since the last inspection? There is ongoing refurbishment of the home and residents have been involved in the choice of décor. Access to staff training has improved and the acting manager is training to be an NVQ Assessor. TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 Page 6 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. TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 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 standard(s) Not inspected on this visit. EVIDENCE: TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 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 standard(s) 6, 7 & 9 There is a system in place to help staff know how to meet residents’ needs. The red/yellow card sanction system needs review to make sure the reasons and guidelines for using this are clearly documented for each resident. There is a system in place to help staff identify and prevent risk to residents’ safety. EVIDENCE: The care plans of two residents were sampled and these clearly show their needs and how staff can meet them. They are monitored monthly and annual reviews are held. Some residents described how staff help them. The home operates a red and yellow card system, which is related to the behaviour of individual residents and can result in sanctions such as temporarily withdrawing staff support to help them access the community. The Acting manager said that the residents’ Psychiatrist has agreed this system and that these sanctions are reviewed at staff meetings. The guidelines for using this system should be clearly documented for each resident, as part of individual risk assessments and care plans and reviewed regularly by the professionals involved. TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 Page 10 There is a system for assessing risk and risk assessments sampled were up to date and had the next review date shown. It was clear that bathing risks had been assessed because different residents told of varying levels of staff support. Not all residents’ files have written risk assessments to support these differing needs. These should be developed to show that the risks of drowning and scalding have been assessed. It was seen that risk assessments are in place to support restrictions in access to one cupboard in the kitchen. TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 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 standard(s) 12 Staff are good at helping residents to lead an interesting and fulfilling life in the local community. EVIDENCE: Residents told of their many activities in the local community, which includes therapeutic employment. An activities timetable helps staff and residents remember what is planned for each day. This shows that residents work at local supermarkets, garden centres, private gardening jobs and an office removal company. Residents have good access to other facilities such as a day centre, shops, restaurants, and swimming pool. Residents told of recent and planned holidays. Staff help tailor these to individual likes and needs and they usually have two breaks a year. At the time of the inspection two residents were on holiday in London with two staff. They had phoned to say that they were enjoying boat trips, theatre and other tourist activities. TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 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 standard(s) 18 , 19 & 20 Staff know how residents like to be helped to carry out their personal care. Staff help residents to keep well and attend health appointments. There is a system in place to look after and help residents take their medication. EVIDENCE: There is good information on residents’ files that shows how they prefer to be supported to carry out their personal care. The activity timetable shows personal care routines. Residents described how staff help them to carry out personal care. Personal care and health needs were discussed at a staff handover meeting. Health care needs and appointments are well documented and there are monitoring charts or guidelines in place for specific healthcare needs. The pharmacy inspector carried out a specialist pharmacy inspection on March 1st 2005 and this was reported separately to the home. The arrangements for medication were found to be satisfactory. Three good practice recommendations were made from that report but as yet these not all of these have been carried out. TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 Page 13 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 standard(s) 22 & 23 Residents are aware that there is a system in place to deal with their concerns or complaints. Staff have attended an Abuse Awareness course to help them know how to protect residents from abuse. EVIDENCE: A resident confirmed that he would talk to staff if he had any concerns or complaints. Each resident has a copy of the complaints procedure. Discussion with staff and the training record shows that they have attended an Abuse Awareness course to help them know how to protect residents. There is a system in place to look after residents money and an inventory is kept on file to make sure that any furniture or belongings can be identified. TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 Page 14 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 standard(s) 24 Residents benefit from a large, well cared for home which is near to transport and local facilities. EVIDENCE: The home offers spacious and well-kept accommodation for six residents. Two lounges give the opportunity to keep one smoke free and give more personal choice and space. Residents were proud to show their accommodation and said they are involved in the choice of decoration. Bedrooms are large and five have en-suite baths or showers. There is an ongoing programme of redecoration and refurbishment. On this visit two bedrooms were being refurbished and redecorated with new windows, carpets, showers. Monthly maintenance checks are carried out. The home is well equipped and since the last inspection the washing machine and cooker have been replaced. Residents said that the home is near to local facilities and the bus to Reading town centre stops outside. TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 , 35 There are enough staff on duty to meet residents needs. Staff receive training so that they know how to meet residents needs. EVIDENCE: The staff team has 11 full time equivalent posts and there are no vacancies at present. There are three staff on each daytime shift and two sleep in staff at night. Current staffing levels appear to meet the needs of the residents. There appear good relationships between the staff and residents. Training records and discussion with staff show that there has been an improvement in staff training since the last inspection. As well as core training staff are trained in specific needs such as mental health, non violent crisis intervention and challenging behaviour. The acting manager has found a local free to learn provider. A programme of NVQ is in hand and the acting manager is undertaking the NVQ assessor’s course. TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 & 42 The home is benefiting from stability due to an acting manager being in post. The proprietors are failing to carry out their legal obligations under Regulation 26. There are systems in place to keep residents safe. EVIDENCE: The registered manager has been on long-term sick leave since the end of November 2004. There is an acting manager in post and this arrangement has provided stability for the team and residents. Systems in the home are well organised and records sampled were up to date. There is an outstanding requirement regarding Regulation 26 monitoring visits which are still not being carried out monthly as required. The most recent received is dated April 2005. Health and safety arrangements are mostly satisfactory. Regular audits are carried out and staff are trained in various aspects of health and safety. A sample of health and safety records was seen and these were up to date. TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 Page 17 Risk assessments need to be developed due to injuries received by staff as a result of challenging behaviour. TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 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 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 x x x x x Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 TILEHURST LODGE Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 1 x x 2 x H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 Page 19 yes 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 6 Regulation 15 Requirement The guidelines for using the red/yellow card system should be clearly documented for each resident as risk assessments and care plans and be reviewed regularly by the professionals involved. Written bathing risk assessments, which show that the risk of scalding and drowning have been assessed should be developed for each resident. Monthly monitoring takes place at least once a month. Timescale of 22/8/2004 not met. Risk assessments need to be developed due to injuries received by staff as a result of challenging behaviour. Timescale for action 20-09-05 2. 9 13© 20-09-05 3. 4. 39 42 26 13 20-08-05 20-08-05 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 36 Good Practice Recommendations That the acting manager receive regular supervision. H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 Page 20 TILEHURST LODGE TILEHURST LODGE H51-H01-S11066-Tilehurst Lodge-V235267200705-Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 1015 Arlington Business Park Theale Berks RG7 4SA 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. 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