Inspection on 23/10/07 for Titchfield Lodge

This inspection was carried out on 23rd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Titchfield Lodge 19/07/06

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 Craig Willis Key Unannounced Inspection 23rd October 2007 09:30 Titchfield Lodge DS0000063468.V347378.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.V347378.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.V347378.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 01489 576299 titchfield@iliace.com 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.V347378.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. 19th July 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 person has their own single bedroom and shares the use of kitchen, lounge, conservatory and gardens. The home has a car which staff support people to access. The weekly fees for a place in the home range from £1686.86 to £1945.86 depending on people’s needs. Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The evidence used to write this report was gained from a review of the information the provider sent to us since the last visit. This information included incident reports sent to us, an annual quality assurance assessment and comment cards from relatives of people who live in the home. A site visit to the home was made on 23 October 2007. During the visit the inspector met three people who live in the home and observed their interactions with staff. Due to people’s communication needs, the inspector did not have a direct conversation with people who live in the home. The inspector also spoke with the manager and staff on duty. The communal areas of the building were viewed and documents relating to the running of the home were inspected during the visit. What the service does well: People’s needs are thoroughly assessed before they move into the home. This reassures people that the home will be able to meet their needs. People’s needs are set out in good care plans and risk assessments. This supports people to make decisions about their lives and helps staff to provide the support that they need. People are supported to take part in a range of activities and to keep in contact with their family and friends. People are supported to take their medication safely and to attend the health services they need. There are good systems for dealing with complaints and responding to allegations of abuse. This gives people confidence that any complaints will be taken seriously. The home is well maintained and provides a clean, comfortable and safe environment for people. Staff are well trained, which helps to give them the skills they need to provide the right support for people. Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Titchfield Lodge DS0000063468.V347378.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.V347378.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. 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 are comprehensive assessments of people’s needs before they move into the home, which reassures people that the home will be able to meet their needs. EVIDENCE: The manager reported in the annual quality assurance assessment that people have a full needs assessment before they move into the home. There are currently four people living in the home, who moved in shortly after the service opened. The assessments for these people have been inspected on previous visits and so were not looked at in detail during this visit. The assessments cover all aspects of the people’s needs, including health, self help skills, academic skills, participation in activities, social skills, community skills, personal relationships and sexuality and challenging behaviour. Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 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. 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. There are good care planning and risk assessment systems, which supports people to make decisions about their lives and helps staff to provide the support that people need. EVIDENCE: The records of all four people who live in the home were inspected during the visit. People had a care plan, which set out how their assessed needs should be met. The care plans seen reflected the information that was included in the initial assessment. There was a programme for regularly reviewing the care plans and it was clearly recorded where people’s needs had changed. Details of how people should be supported to make decisions are set out in the care plans, for example, through the use of objects of reference. A number of the objects of reference are kept in drawers by the front door, and used to support people to make decisions about the activities they take part in. Seven Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 10 relatives of people living in the home completed a CSCI survey. Three said the home always meets the needs of their relative and four said they usually do. Risk assessments have been completed for all people living in the home and include actions that should be taken to minimise the identified hazards. These assessments have been regularly reviewed and amended where necessary. There have been two recent allegations of abuse by staff towards people who live in the home. These allegations were investigated and found that staff had not abused people. The investigation did find that some of the information in care plans and risk assessments did not give enough detail about how to support people. As a result of this, the care plans and risk assessments for two people who live in the home have been re-written. Staff spoken with said they thought the information in care plans and risk assessments was accurate and helped them support people. Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 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. 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. The home provides good support for people to take part in a range of activities, to maintain contact with family and friends and to maintain a healthy diet. Greater flexibility about support in the evenings would improve the service people receive. EVIDENCE: People are supported to take part in a wide range of activities, including trampolining, swimming, bowling, attending a local activity centre and cookery. Each person has a programme of activities run through the Adults Continuing Education (ACE) service, which is operated by the company. One member of staff spoken with said they thought some people living at the home did not enjoy some of the activities, as they did not participate in them. The manager reported that these concerns have been expressed to the co-ordinator of the ACE programme and alternatives are being investigated. One relative expressed concern that there were not sufficient staff available in the evenings Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 12 to support their son to stay up late when he wants to. The manager said she had previously enquired about making the staffing rota more flexible, but this had not been possible. The manager raised this issue again with senior managers following this visit. It has been agreed that an assessment will be completed to determine whether staffing rotas need to be changed to meet the person’s needs. People take part in activities in their local community, such as visits to the local pub and shops. People are supported to maintain contact with their friends and family, with staff providing support for service users to visit family where necessary. The home has a planned menu, which provides a balanced and nutritious diet. People’s likes and dislikes are recorded as part of their care plans and alternative meals are offered if people want them. Mealtimes are flexible to fit round activities and snacks are available at any time. Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 13 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. People’s personal care is well met by staff who know what their needs are and people attend the health services they need. There are good medication systems, which help to ensure people receive the medication they are prescribed. EVIDENCE: Care plans contain details of the personal care support people need and how it should be provided. People are supported to attend a range of health services, including GP, nurse, dentist, psychiatrist and specialist hospital appointments. Details of consultations are recorded, including any advice given by the practitioner. The manager reported that all of the people living in the home need support to administer any medication they are prescribed. Medication is securely stored Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 14 in a locked cupboard and most tablets are supplied in a monitored dosage system. A record is kept of medication coming into the home, administered to people and returned to the pharmacist for disposal. All staff administering medication have received training. There was an incident in July 2007 when the wrong strength of medication was dispensed by the pharmacist and administered to a person who lives in the home. Staff consulted with the person’s GP and took their advice, which was followed. The manager has now introduced a new system for staff to check the strength of medication received from the pharmacist. Three of the home’s staff have not yet completed the medication training. The manager confirmed that these staff do not administer any medication to people and training for them has been requested. Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 15 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. There are good systems for dealing with complaints and responding to allegations of abuse. This gives people confidence that any complaints will be taken seriously and responded to. EVIDENCE: The home has a complaints procedure, which is provided to all people living at the home and their representatives. Seven relatives completed a CSCI survey. Six said they know how to make a complaint and one said they couldn’t remember. The manager reported in the annual quality assurance assessment that the home has not received any complaints in the last year. There is a complaints log in the home, which confirmed no complaints have been received. Staff have completed training in safeguarding adults. Staff spoken with demonstrated a good understanding of the action they should take if abuse is witnessed, reported or suspected. There is a policy and procedure on safeguarding adults and the prevention of abuse. There have been two recent allegations of abuse by staff towards people who live in the home. These allegations were reported to adult social services under the safeguarding adults procedures, who decided on both occasions that the provider should investigate the allegations. The investigations found that staff had not abused people, although did find that some of the information in care plans and risk assessments did not give enough detail about how to support people. As a Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 16 result of this, the care plans and risk assessments for two people who live in the home have been re-written. The home looks after money for all the people who live there, which is individually stored in a safe and records are kept of expenditure. Two people have a bank account in their name, with two senior managers as signatories. Bank statements were available. The records of two people’s money were checked and the cash held matched the balance recorded. Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 is well maintained and provides a clean, comfortable and safe environment for people. EVIDENCE: All of the home’s communal areas were viewed during the visit. The home is maintained to a high standard, with good quality, domestic furniture and fittings. People living in the home have access to a lounge, dining room, and sensory room. Due to people’s needs, a gate restricts access to the kitchen. There are guidelines as to when the gate should be used, so that people are only excluded from the kitchen when it is assessed as too dangerous, for example when the cooker is being used. A gate was used so that people who live in the home could still see what is happening and smell food being prepared. Details of this restriction are included in people’s personal records. There is a planned maintenance and renewal programme and staff reported that the maintenance team responds quickly to requests. There is a bathroom Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 18 with shower on the first floor of the home and a shower room on the ground floor. The manager reported that it is planned to convert the ground floor shower room into a ‘wet room’, which will make it easier for one person to use. There is a large garden to the rear of the home. The home has a separate, domestic laundry that is situated in a utility room next to the kitchen. There are procedures in place to ensure that laundry is not taken through the kitchen whilst food is being prepared. The home is clean throughout and there are no offensive odours. Hand washing facilities are suitably situated in the kitchen, laundry, toilets and bathrooms. Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are well trained and there are good systems to check staff before they work in the home. The staff rota ensures there are sufficient staff during the day but is not flexible enough to ensure people’s choices about evening activities are supported. EVIDENCE: The manager reported in the annual quality assurance assessment that three of the eight staff have achieved the National Vocational Qualification (NVQ) at level 2 or above and two are currently completing the award. Staff spoken with said they felt there were sufficient staff on each shift to provide the support that people need. As reported in the lifestyle section of this report one relative expressed concern that there were not sufficient staff available in the evenings to support their son to stay up late when he wants to. The manager reported in the annual quality assurance assessment that all staff who have worked in the home over the last twelve months have had satisfactory pre-employment checks. The files of four members of staff were Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 20 checked. All four had a Criminal Records Bureau enhanced disclosure, Protection of Vulnerable Adults list check and two written references. The home has an on-going training programme and staff reported that they receive good training, which helps them meet people’s needs. Staff training records indicated people had completed an induction and courses in medication administration, first aid, safeguarding adults, food hygiene, strategies for crisis intervention and prevention, epilepsy, autism, infection control, moving and handling and fire safety. The manager completes a monthly analysis of training, which is used by the company to plan courses that are needed. These records indicated that people had been booked onto training courses where gaps had been identified. Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 well managed, safe and there are some good systems to check on the quality of the service being provided. These will be improved by systems to consult people who use the service and their representatives and plan developments to the service. EVIDENCE: The manager has completed the NVQ assessor’s award and reported that she expects to complete the registered manager’s award in the next month. Staff spoken with said they receive good support from the manager. An area manager visits the home every month to assess the quality of the service that is being provided. Reports of these visits are made and sent to the manager, including any actions that are required. The company has Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 22 recently employed a quality assurance manager, who is currently completing a ‘health check’ of all their services. This assessment has been completed for Titchfield Lodge, but the manager has not yet received the report. The results of these audits will be used to write a development plan. The manager reported that there is currently not a system for formally surveying people who live in the home, their relatives and other stakeholders about the quality of the service that is provided. The home has previously had a set of annual development objectives. These are now out of date and the manager reported she planned to write a new plan. The manager reported in the annual quality assurance assessment that the electrical system, portable electrical equipment, fire detection and fighting equipment, heating and gas system are regularly serviced and maintained. These records were sampled during the visit and confirmed the manager’s report. Titchfield Lodge DS0000063468.V347378.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 3 33 2 34 3 35 3 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 2 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 Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 24 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. 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.V347378.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: 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 Titchfield Lodge DS0000063468.V347378.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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