Inspection on 19/07/06 for Titchfield Lodge

This inspection was carried out on 19th July 2006.

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

Titchfield Lodge 23/10/07

Titchfield Lodge 16/01/06

Titchfield Lodge 30/08/05

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 Titchfield Lodge 66 Titchfield Park Road Titchfield Park Titchfield Hampshire PO15 5RN Lead Inspector Debbie Oliver Unannounced Inspection 19th July 2006 10:00 Titchfield Lodge DS0000063468.V298046.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 Titchfield Lodge DS0000063468.V298046.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. Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Titchfield Lodge Address 66 Titchfield Park Road Titchfield Park Titchfield Hampshire PO15 5RN 01420 544118 01420 544140 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) ILIACE Limited Mrs Sharon Walton Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1.One named service user, date of birth 12.01.1989, may be accommodated. 16th January 2006 Date of last inspection Brief Description of the Service: Titchfield Lodge is registered to provide care and accommodation to four people with learning disabilities, between the age of 18 and 65. The accommodation is provided in a large detached house in Titchfield Park, approximately half a mile from local shops and transport links. Each service user has their own single bedroom and share the use of kitchen, lounge, conservatory and gardens. The home has a car which staff support service users to access. The home is managed by ILIACE, who have a number of similar services in Hampshire. Although requested from the manager the home’s fees have not been given to the Commission. Information about the service provided at the home would be made available to potential service users by providing a copy of the home’s service users guide and statement of purpose. A copy of the last inspection report is available in the home. Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was unannounced and took place over six hours. During the visit, records and documents were examined, an opportunity was taken to tour the premises and staff working practice was observed. The inspector met all four service users, but due to their communication needs did not have direct conversations with them. Observation enabled the inspector to gain a better understanding of how the needs of service users were being met. There were no service users from ethnic minority groups. Four relative comment cards were received and the relatives also completed the four service user comment cards on their behalf. What the service does well: What has improved since the last inspection? All the radiators in the home have now been covered ensuring the safety of the service users living in the home. A copy of the complaints procedure has been given to service users’ representatives ensuring they can support service users to make a complaint if necessary. Some relatives stated in their comment cards sent to the Commission they were unclear of the complaints procedure, so the manager agreed to discuss this with them. Each staff member has now completed their medication assessments ensuring their competence to support service users with their medication needs. Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 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. Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home’s systems and procedures ensure the needs of existing and prospective service users are identified. EVIDENCE: Two service users were case tracked and one had only moved in a few months previous. All service users had a care management assessment and an assessment completed by the service development co-ordinator that includes information on personal care, mobility, contact with families and activities. This information was then used to compile the relevant care plans and risk assessments. Additionally the two service users who had lived at the home for a significant period of time had evidence of regular reviews within their plans. The newest service user had a long transition in to the home due to their age. This allowed for many visits to the home to get to know the other service users and ascertain if they liked the home. There was also information in the service users’ plan detailing the visits. The staff member spoken to said they felt the admission process to be appropriate for the service user and gave them time to settle. Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 9 On observation throughout the day it was evident staff can meet service users’ needs. The manager confirmed that the service user who had their previous placement kept open has since moved from the home. Titchfield Lodge DS0000063468.V298046.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 at least once during a 12 month period. 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 the service. There is a clear and consistent care planning system in place that adequately provides staff with the information they need to satisfactorily meet service user’s needs and enables them to support service users to make decisions about their lives. Risk assessments are in place and ensure service users are able to take risks as part of an independent lifestyle. EVIDENCE: Two service users were case tracked and the relevant plans contained information relating to health, self help skills, social skills, communication skills, personal relationships and sexuality, academic skills, domestic skills, participation in activities, environment and challenging behaviour. The plans also showed they were being reviewed on a regular basis and although the service users were not able to sign the plans it was discussed with the Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 11 manager that the staff writing the plans should sign them off. There are also evaluation records in place but it was discussed these could be more detailed or state ‘nothing to add’ rather than leaving sections blank. The manager confirmed that Iliace are in the process of organising training on person centred planning. One staff member spoken to said they feel the plans give staff the information they need to support service users. It was apparent throughout the visit that service users are supported to make decisions using object of reference, Makaton and PECS. It was also stated in one plan how an individual makes their needs known using various noises. All service users are offered choice using John O’Brien’s service accomplishments. There is also information on how to support the individual when they become unhappy. Evidence was seen within the files to support that risk assessments are available and that service users are supported to take risks including taking part in various activities. It was discussed with the manager the need for a risk assessment for the front door that can only be opened using a card. The manager completed this on the day of the visit and it explained the reason for the restriction and how service users will be supported to go out as needed. One relative comment card stated they were not involved in decision making and in discussion with the manager she felt this was not the case as she speaks to the family regularly but agreed to discuss this matter with the family. Titchfield Lodge DS0000063468.V298046.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 at least once during a 12 month period. 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 the service. Service users have opportunities to engage in suitable activities and are part of the local community, so promoting independence and choice. Contact with families is well supported, and nutritional needs of service users are well managed. EVIDENCE: It details in the daily diaries what activities have been undertaken such as ‘went for a walk’ and ‘out in the garden touching plants and smelling flowers’. During the visit service users were seen going out and about such as swimming and sensory classes. Some service users also had annual passes to Marwell Zoological Park. There is a list of activities in each plan detailing what service users likes to do and a timetable of activities that corresponds to what is happening with each service user. Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 13 The home uses objects of reference for activities such as a wooden spoon to indicate cooking and the service users respond to this. The comment cards completed stated service users have lots of things to do. Contact with families is very positive. All service users have regular contact with their families and this is documented in their plans. Service users are also supported to write letters to their families. Service users were seen accessing all parts of the home and staff were seen using appropriate language for service users and asking rather than demanding things of service users. There was an issue in the comment cards relating to lack of privacy but the manager confirmed this was due to another service user accessing people’s bedrooms and they have since moved on. There was a discussion about the use of the word ‘compliant’ on the various forms used by the organisation. The manager agreed to discuss this with the senior managers. A menu was seen and offered a varied and nutritious diet with space for alternatives as needed. The manager joined service users for lunch and there was positive interaction between staff and service users with the use of appropriate physical support. Titchfield Lodge DS0000063468.V298046.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 at least once during a 12 month period. 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 the service. The personal, physical and health care needs of service users are well met and the procedure for the receiving and administering of medication is robust ensuring a safe system for service users. EVIDENCE: Care plans show how service users like to be supported in regard to their personal care including what they need help with and what they can do for themselves. Staff spoken to confirmed service users have positive input from opticians, general practitioners, dentists and chiropodists and there was evidence in the plans to show this happens. Daily records show visits to health professionals and the outcomes of these visits. Each service user also has a cross gender care statement in place. Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 15 The home has a policy on medication and the pre-inspection questionnaire stated there have been no changes so the policy was not viewed during this visit. Only one service user receives medication and this is kept in a locked cupboard with the appropriate guidelines in place. Additionally there are guidelines relating to the use of ‘as required’ medication. It was discussed this would need to happen if any service user ever needed ‘as required’ medication. All staff have received training in administering medication and the two staff members spoken to confirmed this. It was discussed that medication received in needs to include quantity and staff must be reminded to sign once they have booked the medication in. There was also a discussion that a running total of ‘as required’ medication should be kept so as to monitor how much an individual is taking during a 28 day period. No one in the home is prescribed any controlled medication. Titchfield Lodge DS0000063468.V298046.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 at least once during a 12 month period. 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 the service. Arrangements for protecting service users and responding to concerns are satisfactory. EVIDENCE: The complaints procedure is available and each service user has one within their contract. The manager also confirmed that all relatives were sent a copy but she will resend to those who said they were unaware of the complaints procedure in the comment cards received by the Commission. All staff spoken to were clear on what to do if they received a complaint or had a complaint themselves. The families act on the service users’ behalf and advocacy is not accessed at the present time. The complaints log was also seen and there have been no complaints. The home has the relevant procedures and policies and all staff have received training in adult and child protection. The manager is appointee for one service user and she confirmed all the relevant documentation is in place. There is an issue with one service user’s disability living allowance and this is currently trying to be resolved by the manager. The service users’ care manager is also involved. Titchfield Lodge DS0000063468.V298046.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A comfortable, safe and hygienic standard of accommodation is provided for the service users, which meet their needs. EVIDENCE: The inspector toured the home and it is well maintained and suited to the service users’ needs. It is decorated to a standard that creates a comfortable and homely ambience. The home is well furnished with good quality domestic fixtures and fittings. The mural has been painted up the stairs and looks very colourful. In the lounge there are four pictures of each of the people living in the home and also shows the four most important signs to them. The manager is ensuring the house is homely but wants to make sure the pictures and ornaments bought are relevant to the service users. Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 18 The laundry room is accessed by going through the kitchen but staff confirmed no laundry is taken through the kitchen whilst food is being prepared. The inspector viewed the infection control policy and it was discussed with the manager that the issue of taking laundry though the kitchen needs to be included and rules that are currently being implemented such as no laundry to be taken through when food is being prepared. The manager included this in the policy during the visit and will discuss this further with senior managers as all policies are currently under review. The laundry room is where the gloves and aprons are kept. Titchfield Lodge DS0000063468.V298046.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has procedures and systems in place that ensure staff are properly recruited and that there is always enough staff on duty. The training in place shows staff have the necessary skills and knowledge to meet the complex needs of service users accommodated in the home. Regular supervision for staff ensures they are well supported. EVIDENCE: From observation and discussion with staff members, they have built good relationships with service users and have a good understanding of their behaviours. Three staff were spoken to and they indicated that they have received good training since starting in the home. The training received included autism, communication, food hygiene and health and safety. The training records were sent to the Commission prior to the visit and they showed extensive training and where there were gaps the manager confirmed training courses were being booked. Additionally the manager confirmed all staff have now received medication training. Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 20 Five staff have either started or completed a National Vocational Qualification. Staff spoken to confirmed they receive regular supervision and annual appraisals and that the manager is approachable and easy to talk to. There was adequate staff on duty at the time of the visit and this was confirmed on the rota. The inspector sampled three staff files and they contained all the necessary information relating to recruitment. Titchfield Lodge DS0000063468.V298046.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from a well organised home and the quality assurance system ensures service users and their families are able to contribute their views for the development of the home. The system for maintaining the health, safety and welfare of service users is satisfactory. EVIDENCE: The manager has the NVQ assessor’s award and has started the registered managers award. Senior managers of Iliace visit the home every month to assess the service being provided. It was discussed the Commission have not received a copy of Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 22 the report since March 2006. The manager e-mailed head office to inform them and showed the inspector the reports for April, May and June of this year. One staff member spoken to said her thoughts regarding the service are asked during these visits. Families are fully involved and are asked their views on an informal basis. The manager confirmed if there were particular views from families these could be used as part of the objectives for the year. Staff discuss their views through supervision and team meetings, the minutes for these were seen by the inspector. The home has objectives for improvement that are set for the year and reviewed on a quarterly basis. Person Centred Planning is included for next year. The home’s fire alarm system and extinguishers are checked regularly by the maintenance team of Iliace and records are made of these checks. Fire safety training has been provided to staff. The gas and electrics have also been tested and the inspector saw the certificates. Food was suitably stored and daily checks of the fridge and freezer were recorded. All radiators have now been covered and hot water taps are fitted with thermostats to prevent scalding. Accident books were also seen but as the incident is filed away there was no indication on who had the accident and the outcome. The manager is going to design a form so an audit process is in place to track the accidents. Titchfield Lodge DS0000063468.V298046.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 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 3 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 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 X Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 24 No 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. Refer to Standard Good Practice Recommendations Titchfield Lodge DS0000063468.V298046.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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