Inspection on 05/11/07 for Tilehurst Lodge

This inspection was carried out on 5th November 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tilehurst Lodge 30/01/07

Tilehurst Lodge 09/01/06

Tilehurst Lodge 20/07/05

Tilehurst Lodge 25/01/05

Tilehurst Lodge 22/06/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Tilehurst Lodge 142 Tilehurst Road Reading Berkshire RG30 2LX Lead Inspector Stephen Webb Unannounced Inspection 5th November 2007 09:30 Tilehurst Lodge DS0000011066.V348754.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 Tilehurst Lodge DS0000011066.V348754.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. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tilehurst Lodge Address 142 Tilehurst Road Reading Berkshire RG30 2LX 0118 967 4675 0118 967 4675 tilehurstlodge@tactltd.org 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) TACT UK Ltd Mrs Sarah Hazel Darlow Care Home 6 Category(ies) of Learning disability (0) registration, with number of places Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Learning disability (LD). The maximum number of service users to be accommodated is 6. Date of last inspection 30th January 2007 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 home is operated by TACT UK Limited, in a three storey, converted period building, which retains a lot of its original features and character. Most of the rooms are of a good size, and five of the six bedrooms have en suite shower/bath facilities and a toilet. The residents are encouraged to participate in a variety of experiences and opportunities to enable them to lead fulfilled lives, which includes external employment. These experiences and opportunities are underpinned by The Five Accomplishments to Ordinary Living by John OBrien. The home now has a registered manager who has made changes in the home, to increase the individualisation of their approach, and improve the level of resident involvement and consultation. At the time of inspection the annual fees range from £59,383 and £66,557. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 9.30 am until 6.15 pm on the 5th November 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager, some of the staff members on duty during the day, and some feedback from service users. The inspector also observed the interactions between service users and staff at various points during the inspection. The interactions observed between residents and staff, were positive and appropriate, though there had been a serious incident over the weekend. The inspector examined the majority of the premises, including some of the bedrooms, with the consent of residents. It was evident that the service is well managed on a day-to-day basis by the manager who had worked to change the ways of working to increase the focus on the wishes of individual residents. What the service does well: It was evident from the care plans that the individual needs, wishes and preferences of residents are currently addressed by the home, wherever possible. Residents are encouraged to make daily decisions about all aspects of their life and lifestyle and are increasingly supported in this. They are supported to take appropriate risks in order to enrich their life experience and develop their skills, within a risk assessment framework. Residents are supported and enabled to access paid employment and take part in appropriate educational and social activities to provide a fulfilling lifestyle. Contact with families is supported and the staff advocate for the independence and rights of individual residents. The physical and emotional healthcare needs of residents are met effectively by the home for the most part, though the home has had to advocate for residents to try to obtain necessary support from external agencies has not been forthcoming. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 6 One of the residents manages his own medication, and an appropriate system is in place to manage this on behalf of the others. Residents felt that any complaints or concerns would be dealt with, though one did not appear to be aware of the complaints system, whilst others had actually made use of it. The home has systems and procedures in place to protect residents from abuse, and all but one of the current staff have received training on the protection of vulnerable adults. The home provides a safe, comfortable and fairly homely environment for residents, who are consulted about the décor and encouraged to personalise their bedroom. No specialist adaptations are needed to meet their needs. Standards of hygiene were observed to be good and though the laundry was cramped it was appropriately equipped. The residents are supported by a motivated and enthusiastic staff group, who have now embraced the changes in ways of working towards greater resident self-determination. The involvement of residents in the interview process enhances their influence over their own lives. Staff members receive an induction and a range of core training to meet the needs of residents. The health and safety of residents are promoted by the systems and monitoring in place in the home. What has improved since the last inspection? The approach of staff towards the new person-centred approach has become more positive. Some staff have moved on, while others have remained to be part of the service as it develops. The views of residents are sought as part of the new person-centred approach and are increasingly being incorporated within care planning, to improve the outcomes for individuals. The recently improved Regulation 26 monitoring forms also indicate that the views of residents are sought more systematically as part of monitoring visits. Tilehurst Lodge DS0000011066.V348754.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. Tilehurst Lodge DS0000011066.V348754.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 Tilehurst Lodge DS0000011066.V348754.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): Standard 2: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was evidence from the care plans that the individual needs, wishes and preferences of residents are currently addressed by the home, and that the views of residents have more recently been incorporated to a greater degree within care planning, to improve the outcomes for individuals. EVIDENCE: The most recent admission to the service took place three years ago, and the preadmission assessment undertaken at the time was not available in the current file. The manager described the preadmission process, as she understood it, which included introductory visits, the completion of a written assessment format and the preparation of an appropriate individual transition plan, paced to suit the individual’s needs. The two files examined contained current care plans that had been developed from information provided at referral and subsequently reviewed and updated, to include evidence of the needs, wishes and preferences of the residents. This standard was also assessed as being met at the last two inspections. Tilehurst Lodge DS0000011066.V348754.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): Standards 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. The care plans continue to improve and increasingly indicate consultation to reflect the views, and wishes of residents about how they are supported, in order to develop their personal skills and control over their own daily lives. Residents are encouraged to make daily decisions about all aspects of their life and lifestyle and are increasingly supported in this, rather than following rigid plans and routines. They are supported to take appropriate risks through relevant risk assessments in order to enrich their life experience and develop their skills. EVIDENCE: As noted above each resident has an individual care plan file in place. Since the appointment of the current manager, improvements to the care plans have continued, in terms of the depth of information available, and the Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 11 increased focus on the views and wishes of the resident themselves, which now feature more prominently. The manager acknowledged that there remains room for further development and improvement, but they are moving more towards Person-Centred care plans and now provide information to care staff on “how” to support the individual residents, as well as identifying their needs. This is identified in the business plan for the home for 2007/8. Feedback from staff was that the new care plans were significantly better than in the past, and that relevant information was now much more accessible. One file contained a pictorial sheet explaining the purpose of a care plan to support its explanation to the individual. Within the care plan is a range of formats containing relevant information about the individual’s needs, their wishes, likes and dislikes, and some information about their life history. Residents are increasingly being involved in planning their care and the staff interviewed appeared motivated to continue to develop the residents’ say in their own lives. The plans also include a range of relevant individual risk assessments, and in one case, an individual fire evacuation plan to address their possible lack of response to the fire alarm. Risk assessments identify ‘how’ the identified issue should be addressed rather than just identifying a specific risk, so as to enable appropriate risk taking to enrich residents’ quality of life. Detailed guidance was also in place on specific aspects of care and daily routines, which provide staff with the necessary information to offer appropriate support with regard to the resident’s wishes. Each resident had a recently completed skills assessment checklist. An ongoing record of identified goals for each individual’s development was also in place, which included evidence of these goals being addressed and achieved by the team. Details of the current goals for the residents are kept together in a separate file for ready access by the staff to guide their day-to-day work. The care plan files also contain copies of the individual’s contract and of the accessible complaints procedure format. Both of the files examined contained copies of recent formal reviews of the resident’s care, and of recent in-house monthly reviews. Although a lot of the newer elements of these care plans had been reviewed, dated and signed, some parts of the files had yet to be dated and signed. All care documents should be reviewed, dated and signed on an ongoing basis. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 12 From the care plans, observation during the inspection and feedback from residents, it was evident that they are involved in making day-to-day decisions about their lives and lifestyle. Staff members were seen to encourage individual decision-making, either between various options, or freely without guidance, according to the individual’s needs. A staff member confirmed that residents were given their own mail to open, but often ask for support in reading the contents. They have ready access to the home’s phone and three residents have their own mobile phones as part of developing their independence. One has ongoing support from an external advocate, (advocate support for one other resident was provided short-term in the past), but similar support has been sought on behalf of others without success, due to funding issues. A volunteer independent visitor, who himself has a learning disability, supports one resident to access the community, to provide a positive role model. One resident has signed an agreement regarding the boundaries around him going out into the community without staff support, which provides a useful framework for discussion with him, when he finds it difficult to manage this independence effectively. The provider’s regional director is the official appointee for five of the residents regarding their benefits, and one has a family member in this role. Four of the residents receive all of their weekly personal allowance and any wages directly in their hand, and are provided with a locked tin, (to which they have the only key), in which to store it securely in a lockable space in their bedroom, while two have their money held securely in the safe on their behalf and given to them as required. It was evident that these arrangements were flexible and could be reviewed. Individual residents each have a bank account in their name, where disability living allowance (DLA), benefits are deposited. The ‘bank-books’ are held in the safe. Five of the residents are the sole signatories on their accounts, while one has a relative who visits regularly and takes this role. Each has an individual finance record book with details of any deposits and withdrawals of funds held by the home, and of the balance of their bank account. These are checked at handover and said to be subject to annual external audit. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 13 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): Standards 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. Residents are supported and enabled to access paid employment, take part in appropriate educational and social activities, and to access a range of events and facilities in the community, in order to provide a fulfilling lifestyle. Contact with families is supported and the staff advocate for the independence and rights of individual residents. Residents are actively engaged in decision making about the food provided, and also in shopping for and preparing meals, as part of developing their independent living skills. EVIDENCE: All of the residents have some part-time paid employment across a variety of settings in the community, varying from one to three days per week. Some are supported for their journeys to and from work, while others travel alone Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 14 having developed the necessary skills to do so, and subject to appropriate risk assessments. Three residents also attend college part-time, for pottery, music, art and craft, literacy and cooking. Three of the residents have their own mobile phone to enable them to contact the home if they need to, when out in the community. The manager indicated that she was moving away from reliance on fixed daily activity planners towards increased spontaneity and input from residents on an ongoing basis. At the point of inspection the home had three full time staff and three parttime staff able to drive the unit vehicles, which helped to ensure that a driver is usually available, but this was complicated by having three vacant posts, which were covered by agency where necessary. On occasions, the combination of permanent and agency staffing has meant the permanent staff were unable to leave the building so activities etc. could not be attended. It is understood that three new permanent staff have now been recruited, and are awaiting CRB clearance, which will alleviate this issue. Activities have included visits to restaurants and pubs, cinema, the Hexagon Theatre, a bus trip to London, shopping trips, visits to other homes for social events, and watching live reserve football matches. Some are also members of football supporters clubs. Within the house there is Sky TV available in the lounge, and two of the residents pay for this service within their bedroom. Four of the residents are able to go out independently without staff support, one of whom is supported when out in the community after 5pm. The other two are supported whenever they go out of the unit. Decisions are made subject to risk assessment. Each resident has their own bus pass, and staff have “companion” passes for when they are supporting a resident in the community. Two of the residents confirmed that they go out often and one said he enjoyed going to the local pub. One resident likes to relax in the house when he is not working, and likes to watch TV, some of the others visit a local gym. One goes out with a volunteer to various activities on a one-to-one basis. None of the residents has any identified spiritual needs, and the manager said that none had expressed a wish to attend any places of worship, though various such venues were available locally. The manager was clear that support would be provided for residents to attend places of worship if they expressed a wish to do so. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 15 From discussion and observation it is likely that the home would be proactive in addressing any specific cultural or spiritual diversity needs identified. All of the residents have been on individual holidays, which they have chosen, and there are plans for further holidays. Recent holidays have included trips to Euro-Disney, Disneyland, Florida, Jersey and a trip to a holiday camp. The first £700 of the cost of each resident’s annual holiday is funded from residential fees, with the individual resident making up any difference. Contact with family varies between the residents from regular to very infrequent, and one resident has no family. The home supports this contact wherever possible though at times, has to work sensitively to advocate for the rights of the resident to make their own decisions, with which parents may not always agree. The manager indicated some understanding of the implications of the new Mental Capacity Act in this regard, and was clear that the goal of the service was supporting the residents to develop their independent living skills and enabling them to enjoy a fulfilling lifestyle. The home supports residents to maintain mutually consenting relationships, and residents’ privacy is appropriately respected. The home has a flexible menu and evening meals are planned in consultation with residents, on a weekly basis, with a healthy eating overview by staff. At lunchtimes, when residents are in, they choose what they would like to eat and make it themselves, with support from staff where necessary. This was observed to happen during the inspection. (On Sundays the main meal is at lunchtime). There were no specialist dietary requirements at the time of inspection. Residents are expected to take part in shopping for food, meal preparation, cooking and clearing up, which is consistent with the aim of increasing their independent living skills, and some confirmed that they did this in conversation with the inspector. They are also expected to clean and tidy their bedroom and, in turn, to clean the house vehicles, which are provided to support them accessing the community. Three of the residents buy their own food, one day at a time, with staff support to encourage increased healthy eating options, and prepare their own meals with support as required. The other three shop collectively for the house, in their turn. Residents all have their own bedroom and front door keys. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 16 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): Standards 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. Residents are supported according to their needs, and increasingly with regard to their individual preferences, as part of improving consultation and increasing their skills and independence. The physical and emotional healthcare needs of residents are met effectively by the home for the most part, though at times, necessary support from external agencies has not been forthcoming. The home has advocated appropriately on behalf of residents in these situations, to try to optimise the outcomes for the individual. One of the current residents is supported to manage his own medication, and an appropriate system is in place to manage this on behalf of the others to protect residents. EVIDENCE: As noted above the care plans include increased evidence of consultation with individual residents about how they wish to be supported. Specific guidance Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 17 was evident for key situations for individual residents, to enable staff to work effectively with them to offer any necessary support. However, in order to ensure these guidelines are readily available, it is suggested they could be filed individually within plastic wallets, rather than collectively behind other documents. The ethos of the home continues to reflect an increased focus on the rights of the individual resident and on continually developing their skills to increase their independence. This has been accompanied by regular reviews of medication and gradual reductions in dosages with some success. The staff spoken to confirmed the improvements in approach and the improved accessibility of key information and guidance within the records, and that this was having a positive impact on behavioural issues, and leading to a more relaxed atmosphere in the home. The two relatives who completed inspection surveys were pleased with the care provided by the staff and felt they were kept appropriately informed, though one expressed some anxiety about their son going out unsupervised. Specialist support has been sought from speech and language therapists, and other external professionals, including attempts to obtain advocacy support for each individual, which have not yet been achieved, owing to funding issues. One resident receives support from an external volunteer to access the local community. The manager has made a complaint on behalf of one resident regarding the non-provision of promised psychologist support, following their return from a period of reassessment in hospital, whilst awaiting a move to a more appropriate service. The manager has also had to advocate on behalf of the resident, regarding the detrimental effect of delays in their move to a more appropriate placement, owing to funding issues between two local authorities. Where necessary residents’ individual communication methods and repertoire are detailed within their file, to support staff in communicating effectively with them. However, one resident is reported to use Makaton when becoming distressed, and it is evident from training records that the majority of staff have not received recent Makaton training. In order to ensure effective communication it is suggested that the remaining staff are provided with this training. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 18 Residents indicated, both verbally and via the inspection surveys, that they were happy with the support they received from the staff, though one has had issues with being supported by younger female staff, which have been specifically addressed. All of the residents have a recorded history of complex needs and behaviours in past placements, though the incidence of major incidents in recent times was generally reported to be low, because of the improvements in the way the residents are now supported and involved in decision-making, and through responding effectively to evidence of distress or anger. Staff were seen to use deflection techniques and to tackle any issues as they arose. However, an incident had occurred over the preceding weekend, where one of the residents assaulted the manager, necessitating the police being called. The incident appeared to have been responded to appropriately and the manager sought appropriately to discuss the matter with the resident during the period of the inspection to ensure that it was properly concluded. The health section of the residents’ care plan files includes a medication profile and a combined healthcare appointment record for all external practitioner appointments. These indicated recent appointments for periodic checkups and specific needs. There are also weight charts with recent entries, and details of support from psychiatrist, psychologist, speech and language therapists, etc. Copies of incident and accident report forms were also on file as required. The “Vital Information” formats, which provide essential information to be taken to hospital with a resident in the event of an emergency, were undated and it was unclear when they had last been updated. These documents should be reviewed, dated and signed to enable monitoring of their status. One resident manages their own medication, and changes in administration times have been agreed with the GP to help support him in doing so more effectively. An appropriate risk assessment is in place. His medication is provided a week at a time in a labelled dosette box, and signed off. It is stored securely in his bedroom, and the storage location is temperature checked on a daily basis. The medication is managed on behalf of the other residents, via an appropriate procedure and recording system, which provides the required audit trail for the medication received by the home. Records are kept of the quantities of medication received, its administration and any returns to the pharmacist, and appropriate records are also in place for homely remedies, which have all been signed off by the GP as suitable. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 19 Administration is by two staff, one to administer and one to witness, and both initial the records. There are written guidelines for staff on how to address medication refusals for one resident, and on the procedure around use of the dosette box for another. Staff also sign a medication stock-check log, which provides a ‘live’ count of current stock at any time. Returns are separately logged and signed for by the pharmacy. The pharmacist visits periodically to check the home’s medication systems, and last visited in December 2006. Two medication errors had occurred since the last inspection, though only one appeared to have been notified to the Commission under Regulation 37. The manager should ensure that any future medication errors are notified. Staff receive medication training from the pharmacist and also undergo an in house assessment of competence. All staff had received the medication training according to their training records. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 20 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): Standards 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 residents felt that any concerns would be dealt with and all but one confirmed they were aware of the complaints procedure. The complaints log indicates use of the system by residents. Other systems are also in place that would provide opportunities for residents to raise any concerns. The home has systems and procedures in place to protect residents from abuse, and all but one of the current staff have received training on the protection of vulnerable adults. EVIDENCE: The home has an appropriate complaints procedure in place. Both of the relatives who responded to the inspection survey confirmed they were aware of the complaints procedure. Copies of an adapted, more accessible version of the complaints procedure, provided for residents were present on the two case files examined. Two of the residents confirmed they would go to the manager if they had any complaints. Four of the five residents that completed inspection surveys confirmed they were aware of the complaints procedure, but one said they were not aware of this. Staff should ensure that this procedure is explained regularly to residents, perhaps as part of a residents’ meeting. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 21 Examination of the complaints log indicated three complaints by residents since the last inspection, all of which had been addressed appropriately. One further issue had been logged, which had been an anonymous phone call from a member of the public, expressing concerns regarding one of the residents, but giving no details or specific information to enable investigation. The matter was looked into informally, and discussed with the appropriate agencies, but no further contact has been made, and no evidence of any concern was found. The matter remains recorded in the complaints log should any further information come to light. Residents also have other avenues through which they could raise any concern, including residents’ meetings, quality assurance surveys and via the monitoring visitor, who now actively seeks feedback from residents as part of these visits. The Commission has received no complaints about Tilehurst Lodge for forwarding to the home for investigation, since the last inspection. The home operates within the local multi-agency vulnerable adults protection procedure, which was available in the office. All but one of the staff had received training on protecting vulnerable adults in either 2005 or more recently. This training must be provided to the remaining staff member who has not received it, and also to the three new staff who are soon to complete their recruitment. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 22 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): Standards 24 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 provides a safe, comfortable and fairly homely environment for residents, who are consulted about the décor and encouraged to personalise their bedroom. No specialist adaptations are needed to meet their needs. Standards of hygiene were observed to be good and though the laundry was cramped it was appropriately equipped. EVIDENCE: The building retains many of its original period features and the majority of the rooms are of a good size, though the laundry room is rather cramped. There are two lounges on the ground floor, both of which are provided with Sky TV, and there is also a dining room and a kitchen, which is equipped appropriately for residents to take part in food preparation and cooking with appropriate support from staff. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 23 Standards of décor and furnishings are satisfactory though some areas might benefit from additional pictures and other homely touches. Where the doors to communal rooms need to be open during the day they are fitted with holdback devices integrated with the fire alarm so that they close in the event of the alarm sounding. Each of the six single bedrooms is provided with appropriate furniture, which includes the provision of a double bed for each room in response to residents’ choice. Residents have also been consulted on the colour scheme in both their bedrooms and the communal areas. Five of the six bedrooms have en suite shower/bath facilities and toilets, with one having access to facilities close by. The bedrooms are personalised by their occupant. Two residents have chosen to pay for Sky TV in their bedrooms. The residents have a key to their bedroom and also to the front door. Three of the bedrooms were reported to be due for redecoration in 2008. At the rear of the home is a terraced garden with a large patio area on two levels with garden furniture, and an area of lawn and borders below, where residents have grown some fresh vegetables. There is a further area of garden, beyond this, which is fenced off, as it very much overlooks the neighbouring gardens beneath owing to the sloping plot. To the front of the house is a gravelled area with parking for several cars. At present no physical adaptations are needed to meet the needs of residents. As noted above, the laundry room is rather cramped but it is equipped appropriately to meet the current needs. Standards of hygiene were good and there were no residual odours apart from in one toilet, where the flooring has not been sealed appropriately. The remedial work is awaiting a decision on an insurance claim. There are two staff sleeping in rooms, and a ground floor visitors/staff toilet. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 24 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): Standards 32. 34 and 35: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are supported by a motivated and enthusiastic staff group, who have now embraced the changes in ways of working towards greater resident self-determination. However, further progress on NVQ attainment is necessary, and consolidation of the new team, will be needed, once the recent appointees take up their posts. The available evidence of CRB checks is not sufficient to confirm that “enhanced” CRB checks have been undertaken on all staff, which could potentially compromise the safety of residents. The involvement of residents in the interview process enhances their influence over their own lives. Staff receive an appropriate induction and core training for the most part, to meet the needs of residents, though some shortfalls are identified in this report, which need to be addressed. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 25 EVIDENCE: The staff on duty appeared positive and motivated and interacted freely with residents. In conversation two of the staff indicated they were very positive about the more person-centred approach now being adopted. They felt this was beneficial to the residents and supported them to develop their individual independence, much more effectively than what they perceived as the more rigid, staff driven previous systems and routines. They did acknowledge that some staff had been lost through the process of change but felt that the benefits to the residents were significant. A number of staff had indeed left since the change of approach introduced by the manager, and there were three full time equivalent posts vacant at the point of inspection, which had necessitated the use of agency staff, which had sometimes impacted on residents’ levels of community access, in order to maintain safe and appropriate staffing both in and outside the unit. The regular staffing was described as being three staff on duty in the morning, two throughout the afternoon and evening, and two staff sleeping in nightly, but at times recently there had been only two staff available in the mornings. However, the manager indicted that two full time and two part time appointments had been made and the new staff members were now only awaiting CRB clearance, before being able to start in post. Feedback from residents was positive about the staff and the support they offer. Observation indicated that the residents had invested in the relationship with staff and there was evident warmth in the positive interactions seen at various points during the inspection. Of the current team of six staff, one already has NVQ level 2 and one is undertaking their NVQ level 2, which falls short of the expected proportion of the team. The manager did not know whether the new staff due to start had yet attained NVQ. The manager had introduced more regular team meetings to support the changes in ways of working and maintain communication. The manager indicated that three of the residents had taken part in the recent recruitment process, and were part of the formal interview process, which is good practice. Examination of a sample of one previous recruitment record, and records for one of the recent recruits (records for the other recent appointees were not yet Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 26 complete), indicated that the majority of required recruitment checks and records were in place, including a record of interview and copies of photo ID. However, it was not possible from the CRBs available had been undertaken at “enhanced” level as required provider must confirm that all care staff have current “enhanced” level. If this is not the case, such checks priority. to establish that these for all care staff. The CRB checks at must be undertaken as a Staff indicated they received an appropriate induction and core training package, and that training was regularly available. The possible benefits of Makaton training for the staff were identified, as previously noted. All of the staff received training on managing challenging behaviour in July according to the manager, but this was yet to be reflected on some of the training records. Staff training records should be maintained upto-date at all times. The need to ensure that all staff members have received training on safeguarding vulnerable adults is also noted earlier in this report and is the subject of an inspection requirement. The home accesses training from several external providers including accessing some of the local authority training courses. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 27 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): Standards 37, 39 and 42: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run effectively by the registered manager in the interests of the residents and furthering the development of their independence skills. The views of service users have previously been sought via quality assurance surveys, though it would be beneficial to broaden the surveys to include other relevant parties. The views of residents are also sought on a daily basis as part of the new, more person-centred approach. The recently improved Regulation 26 monitoring forms also indicate that the views of residents are sought more systematically as part of monitoring visits. The health and safety of residents are promoted by the systems and monitoring in place in the home, though the home’s fire risk assessment should be located and a copy made available in the home, to enable its regular review. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 28 EVIDENCE: The manager has been in post for almost two years, though she only became registered manager in August 2007. She is about to commence her NVQ level 4 and Registered Manager’s Award and has worked in the unit for around seven years. During the inspection she demonstrated a clear understanding about the direction of development of the unit and how the planned changes to the way of working would benefit the residents. The manager also continually updates her knowledge through attendance on relevant training courses and also attends meetings of the local provider association. The home has both an action plan and business plan for 2007/8, which identify targets for ongoing improvement and set timescales for their attainment. A cycle of quality assurance surveys was undertaken in June 2006, with surveys going to residents and next of kin. When the next cycle is undertaken it should be broadened to seek the views of care managers and external healthcare professionals to provide more of a 360-degree appraisal. It is also beneficial to seek the views of the staff on how the home is operating. Although a summary report of the findings of the last survey was not produced, the results were reportedly discussed in staff meetings and fed back verbally to residents. In future a summary report should be produced and made available to participants. The manager sought independent support for residents in completing the inspection surveys, from an external advocate, a volunteer, and a care manager, which is good practice. Since the recent appointment of a new operations manager, five weeks ago, there has been a notable improvement in the level of support provided to the unit by the provider. Indeed the operations manager also visited during the inspection to ensure the wellbeing of the manager, following her experience of an assault by a resident, at the weekend. The appointment of a new operations manager has also led to an improvement in the quality and depth of Regulation 26 monitoring reports. These reports had previously contained little information of substance and failed to evidence regular monitoring of the complaints log; but they are now Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 29 being completed to a more in-depth format, and also evidence discussion with residents and staff. However, although most of the required reports since the last inspection were available on file, the reports for July and September were not present. Copies should be obtained and filed in the unit. The provider also undertakes an internal annual service review. A sample of health and safety-related service certification was examined and indicated appropriate servicing intervals. Examination of the accident recording system in the home indicates an appropriate tear-off format and copies are filed both collectively and as part of the case record as required. One accident form in the recent numbered sequence could not be located, and the manager should try to establish what happened to this form. Appropriate risk assessments are recorded for individuals including a fire evacuation risk assessment for one individual. The manager was sure a unit fire risk assessment had also been undertaken, but the document could not be located. This document needs to be located and copied to the unit. Recent fire drills had been held in both July and August, and the alarms are tested weekly. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 30 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 X 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X 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 4 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 2 X X 3 X Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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 YA23 Regulation 13(6) Requirement Timescale for action 05/02/08 2. YA34 19 & Schedule 2 Appropriate training on the safeguarding of vulnerable adults must be provided to any staff member, who has not received it, to ensure they are fully aware of the procedure. The provider must ensure that 05/01/08 all care staff have a current CRB at “enhanced” level in order to maximise the protection offered to residents through the recruitment process. 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. 2. 3. Refer to Standard YA6 YA18 YA22 Good Practice Recommendations The manager should ensure that all elements of the care plans are, signed and dated to enable effective monitoring of their review. The manager should consider the benefits of all staff receiving Makaton training. The manager should consider the provision of periodic reminders of the complaints procedure to residents, to DS0000011066.V348754.R01.S.doc Version 5.2 Page 32 Tilehurst Lodge 4. 5. 6. YA32 YA35 YA39 7. 8. YA39 YA42 ensure that all of them feel confident in its use. The provider should work towards a greater proportion of care staff achieving at least NVQ level 2. The manager should ensure that staff training records are kept up to date. The quality assurance system should be broadened to seek feedback from other relevant parties and a summary report of the findings should be made available to participants. Copies of the missing Regulation 26 visit reports should be provided to the unit and filed therein. A copy of the home’s fire risk assessment should be available in the home to enable its periodic review. Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South East Regional Contact Team The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT 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 Tilehurst Lodge DS0000011066.V348754.R01.S.doc Version 5.2 Page 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. 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