Inspection on 26/11/07 for Tomswood Lodge

This inspection was carried out on 26th 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 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

Tomswood Lodge 01/11/06

Tomswood Lodge 11/05/06

Tomswood Lodge 30/06/05

Tomswood Lodge 01/12/04

Tomswood Lodge 24/06/04

Tomswood Lodge 10/07/03

Tomswood Lodge 29/04/03

Tomswood Lodge 21/05/02

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

CARE HOME ADULTS 18-65 Tomswood Lodge 154 Tomswood Hill Hainault Ilford Essex IG6 2QP Lead Inspector Julie Legg Unannounced Inspection 26th November 2007 12:30 Tomswood Lodge DS0000025932.V355296.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 Tomswood Lodge DS0000025932.V355296.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. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tomswood Lodge Address 154 Tomswood Hill Hainault Ilford Essex IG6 2QP 020 8500 7554 020 8262 5295 tomswoodlodge@aol.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) Mr Jackdeo Meetaroo Mrs Sushita Meetaroo Mr Jackdeo Meetaroo Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to eight adults with low to moderate learning disabilities, excluding adults exhibiting severe challenging behaviours. May include residents with associated mental health problems and a maximum of two residents who are wheelchair bound. 1st November 2006 Date of last inspection Brief Description of the Service: Tomswood Lodge is a care home for eight people aged between 18 and 65 who have low to moderate learning disabilities; they may also have associated mental health problems. The home is privately owned and one of the proprietors is also the registered manager. The house is detached and in keeping with others in the road. It is situated in a residential part of Hainault, on a bus route and within a 20-minute walk of the underground station. Shops and other local community resources are within walking distance. There are three bedrooms on the ground floor, along with two toilets and two showers, one of these showers has been adapted to enable a wheel chair user to access bathing facilities. Also on the ground floor is a dining/lounge area, domestic style kitchen, conservatory, staff room and office. The upper floor has five bedrooms, two toilets, a shower and a bathroom. There is parking space to the front of the house, a large garden to the rear and a utility room, which is accessed via the garden. Activities are organised both within the home and in the local community, residents are encouraged to attend day centres and local clubs. The Statement of Purpose and the Service User Guide are issued to every prospective resident and these documents can be found on the residents’ notice board, which is situated in the lounge. A copy of the most recent inspection report is also available. The fees for the home are from £750 a week according to residents’ needs. The proprietor/manager made this information available on 26th November 2007. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection took place over a day. The manager was present for the duration of the inspection and was available for feedback at the end of the inspection. Discussions took place with the manager and the staff who were on duty. Care staff were asked about the care that residents receive and were also observed carrying out their duties. The inspector spoke to relatives and received comments from health professionals via a survey regarding the service provided at Tomswood Lodge. Social care professionals and an advocate were contacted and comments were “Currently I don’t have any concerns, things have improved”. “Tomswood is meeting his needs, he is very happy living there”. A tour of the home was undertaken and all of the rooms were seen to be clean and tidy. Residents’ files were case tracked; including risk assessments and care plans, together with the examination of staff files and other home records. These included medication records, staff rotas, menus, accident/incident forms, staff recruitment procedures and health & safety records. Additional information relevant to this inspection has been gained from the Annual Quality Assurance Assessment and Regulation 37 notifications. The inspector had a discussion with the manager on the broad spectrum of equality & diversity issues and he was able to demonstrate an understanding of the varied needs around religion, sexuality, culture, disability and gender. The inspector also had a discussion with the manager, staff and people using this service as to how they wished to be referred to in this report. They expressed a wish to be referred to as resident/s. this is reflected accordingly throughout this report. The inspector would like to thank the residents and staff for their input during this inspection. What the service does well: The service is small and flexible and is able to respond effectively to the needs of the residents. The home has very good staff retention and this reflects in the care being provided, as the staff are very aware of the residents and their needs. The manager and staff are working with the residents to enable them to Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 6 retain a level of independence and to express their wishes and needs. All of the residents have a comprehensive care plan together with any associated risk assessments. Some of the residents require a high level of support in meeting some of their health needs and every effort has been made in ensuring their needs are being met by working closely with the psychiatrists and other health professionals. All of the residents are encouraged to participate in daily activities within the home and leisure activities within the community. Contact with families is also seen as a priority and some residents visit their families with support from staff. Both residents and relatives were complimentary of the care being provided at Tomswood Lodge. Residents comments were “I love living here, this is my place”, “I want to be here forever”, “I don’t ever want to move”. Relatives comments were “There is a high standard of care at Tomswood”, “I am very happy with the care”, “I have no complaints at all, he is well looked after”. What has improved since the last inspection? What they could do better: There are no Requirements from this inspection, though there are three Recommendations, which are seen as good practice for the registered provider to carry out. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 7 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. Tomswood Lodge DS0000025932.V355296.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 Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 3 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Prospective residents and their relatives have the information they need to be able to make an informed decision. The assessment of needs and other information received from health and social care professionals means that staff have detailed information to enable them to determine whether or not they can meet the needs of prospective service users. Prospective service users know that the home can meet their needs. EVIDENCE: The Statement of Purpose and the Service User Guide are now two separate documents. The Statement of Purpose is now a comprehensive document and states that only male residents live at the home. The Service User Guide is in a pictorial format. This information enables prospective residents and relatives to know what the home is like and what services they can offer. The current five residents have been living together at Tomswood Lodge for a number of years. Therefore the home has not had any admissions for more than five years. The home has a comprehensive admission policy and Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 10 procedure. The admission policy states that all prospective residents’ needs would be assessed prior to them moving into the home. The manager stated that all prospective residents would be appropriately assessed prior to admission and that information would also be gathered from health and social care professionals as well as relatives and other significent people. The admission process would be designed around the needs of the prospective resident. The prospective resident may make several visits to the home and possibly overnight and weekend stays. This would enable the prospective resident to meet the other service users and to see whether liked the home. This transition period would also allow staff to get to know the prospective resident and to know whether they can meet their needs. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 and 9 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents’ needs are identified and reflected in up to date care plans and risk assessments, this safeguards the residents and others. The residents with assistance are able to participate in all aspects of life in the home and to make decisions about their lives. EVIDENCE: The manager and staff have ensured that the residents are involved in all decisions about their lives. There is a care planning system in place that is clear and concise. These care plans were completed with the involvement of the service user and their relatives (if appropriate). The care plans cover in sufficient details all aspects of health and personal care needs, mobility as well as social, religious and recreational needs and goals are clearly identified. It is Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 12 a recommendation that the care plans are expanded to cover dietary and cultural needs (though this information is available elsewhere it needs to be recorded in the care plans). This is Recommendation 1. Other documentation includes likes and dislikes. Dislikes of the residents included; people touching my bag, changing my clothes, people staring at me and I don’t like to watch television unless it’s my choice. Likes of residents included; going out with the staff, singing, colouring, playing bingo and going on holiday. All of the residents, to varying degrees are able to participate in activities within the home. They assist with making cups of tea, dusting, hoovering, loading and unloading the dishwasher, putting the dishes away, making their beds and keeping their bedrooms tidy. The manager and staff with the involvement of the residents have developed a skills training programme; one task is broken down into several steps e.g. ‘tidy own bedroom’ is broken down into sixteen steps and each step is marked as to how much or how little assistance the person required. This is to improve the daily living skills of the residents. Residents are also involved with menu planning and shopping trips. One of the residents goes with the manager to a local market to buy Caribbean food. One resident told the inspector, “I like to keep my room tidy”; another resident was seen taking his cup out to the kitchen. Another resident said, “ I can load the dishwasher”. Some of the residents are able to handle small amounts of money and are encouraged to pay for their newspapers and beverages when visiting the café. Other records seen showed residents’ choice of meals and whether or not they participated in activities within the home and the community. Residents’ files indicated that care plans are being reviewed at least three monthly or if a change in need is identified. The manager has written to one of the funding authorities, as three of the residents’ annual placement reviews are overdue. The inspector advised the manager to arrange the reviews and invite the local authority. The manager agreed to do this and will arrange the three reviews with the residents, their families and any significent others. Care plans were examined alongside the daily records and compared with the support being given. The care staff know the residents extremely well and give a verbal handover. Each resident has their own daily log sheet, which is completed by the care staff. The daily logs are completed at the end of each shift; they were of a good standard and reflect the care that is being given and activities that have been undertaken. All of the service users are in regular formal meetings with the manager and their key workers. In a recent survey one of the residents said he would also like informal meetings as well as the formal meetings, these are now taking place. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 13 Staff were observed interacting with the service users, their relationship was easy going and friendly but in a professional manner. Staff were seen to ask service users what they wanted and gave the service users ample time to express their wishes. Residents are encouraged to take reasonable risks and there were detailed risk assessments, guidelines and protocols in place. These cover areas, such as, behaviour, tasks and activities within the home and in the community, health risks and medication and what action is needed to be taken. One resident has a 1:1 worker when accessing the community; this has proved to be successful because of the work that has been undertaken by his advocate and the staff at Tomswood Lodge in assisting him to understand the reasons for this measure. The resident is still able to exercise choice in accessing the community and he told the inspector, “It doesn’t bother me staff being with me because it has stopped me getting into any trouble”. The advocate also felt that these measures have not taken away the resident’s choice and felt that in fact his quality of life had improved because he was not able to put himself or others in a vulnerable position. There was evidence that risk assessments have been regularly reviewed or when a change in a risk has been identified. These risk assessments have been forwarded to the residents’ care plans. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 14 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): 11,12,13,14,15,16 and 17 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents have the opportunity for personal development within the home and access activities within the local community that are appropriate to their age and culture. Residents have appropriate personal and family relationships. Their rights are respected and they are supported to take responsibility for their actions. Service users are offered and encouraged to eat a healthy diet. EVIDENCE: Residents’ care plans identify lifestyle choices, such as, going to church, clubs, and local leisure activities and visiting families. The daily log sheets record whether these activities have taken place and who has participated. All of the residents have opportunities for personal development and a varied activity Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 15 programme, which takes into account their preferences and interests. One resident attends a local day centre and attends a club three evenings a week. All of the residents participate in activities within the home and the local community. Two of the residents enjoy delivering a local newspaper with the assistance of a member of staff and the other residents help by putting leaflets into the newspaper before it is delivered. They all enjoy earning some additional pocket money. Residents enjoy a variety of activities within the community; playing bingo at the local bingo hall, trips to the local cinema, snooker and billiards at the local leisure centre, Walthamstow dog stadium (greyhound racing) and visiting garden centres. One of the residents accompanied by a member of staff goes to buy his daily newspaper and magazines and they have a cup of tea and a cake in the cafeteria. One of the other residents enjoys going to the gym twice a week, again accompanied by a member of staff. Some of the residents enjoy shopping for their clothes and toiletries and all go to the local barber to have their hair cut. All of the residents have enjoyed a day trip to France and a week at a holiday camp at Camber Sands. Residents told the inspector “We had a brilliant time, we wanted to stay there”, “The staff take me out for coffee, we go to the café”, “We go out all the time, I like going to restaurants”. Photographs on the dining room wall showed residents on the beach and visiting local places of interest. The manager is currently buying a seven-seater people carrier; this will allow those residents with some mobility difficulties easier access to the community. All of the residents attend church, but different services according to their faith. After church all of the residents go out for Sunday lunch, each resident takes it in turn to choose which restaurant they wish to go to. As stated earlier in this report the residents are fully involved with the day-today activities within the home as well as improving their numeracy and literacy skills. One resident has a daily newspaper and he cuts out articles on football (in particular one team). One of the residents enjoys gardening with the manager and he is responsible for sweeping up the leaves, another resident is responsible for alerting the staff when the coach comes to collect another resident and it is also his job to collect the post each morning. On the day of the inspection, two of the residents had been Christmas shopping in the morning with a member of staff and one of the residents was attending a day centre. In the afternoon one resident went out with a member of staff to buy his newspaper and magazines and another resident went with a member of staff to visit a resident who is in hospital (staff have visited nearly every day since his admission). Every resident has a party for their birthday and they are involved in organising this celebration. Currently the residents are rehearsing for their Christmas concert, which they perform to their families. Residents are encouraged and assisted to stay in contact with friends and relatives. Most of the residents have family visit (some more regularly than others). One resident visits his mother every week and the manager regularly Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 16 takes another resident to see his mother. Relatives’ surveys show that ‘staff make me feel very welcome when I visit Tomswood Lodge and that the home is good at communicating with me’, ‘ He is encouraged to keep in touch with all of his relatives’. One relative stated, “Tomswood is excellent at making family and friends feel welcome”. Residents are involved with planning the weekly menus; these take into consideration residents’ likes and dislikes, as well as dietary and cultural requirements. The inspector examined the menus and there is a choice of two meals, one was sausages, mashed potatoes and baked beans, the alternative was salad and cold meats. The manager advised the inspector that an alternative would be cooked if the resident did not want either of the meals. One of the residents is diabetic and Asian and on some of the days he chooses alternatives such as, rice, sag aloo, okra and curries. Another resident is AfroCaribbean and he goes to a local market with the manager to buy yams, plantain and anything else he wants. The home grows a lot of their own vegetables including marrow, cabbage, and corn on the cob, beetroot, tomatoes, runner beans, courgettes, carrots and spinach. Fresh fruit is available daily as are cakes, biscuits and crisps. Food store cupboards, the refrigerator and freezer were inspected and all foods were appropriately stored. Residents were complimentary about the food and stated “I enjoy my food the meals are nice”, “We have lovely food and I have Quavers and I have hot chocolate at bedtime”, “I have samosas and rice”. A relative commented, “He really enjoys his food and seems to have enough to eat”. There are written menus but it is recommended that these should also be in pictorial format. This is Recommendation 2. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, 20 and 21 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents receive personal care support in the way they prefer and their physical and emotional needs are met. Residents wishes regarding their death are recorded, however these could be more person centred. None of the residents are able to administer their own medication. There are policies and procedures in place to ensure that staff administers medication safely. EVIDENCE: Care plans and daily records were examined and discussed with the manager. The care plans identify health and personal care needs and there clear guidelines on how staff should support the residents. Most of the residents require some form of support or verbal prompts with their personal care, though they are encouraged to participate wherever possible. The daily Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 18 records are written to show how each of these needs have been met. There is evidence of personal choice as some of the residents prefer to bath and others prefer to shower. Residents were seen to be dressed in clothes that were appropriate for the time of the year and which suited their personalities. Most of the residents are able to buy their own clothes with assistance from the staff. All of the residents go to the local barber to gat their hair cut. One resident stated, “I buy all my own clothes”. Relatives’ comments were “He always looks nice and clean”, “his clothes are always clean, and he looks nice and tidy”. Records that were inspected showed that all of the residents’ health care needs are being recorded in their personal health care plans. All residents are supported to access dental care, opticians, chiropodist, psychiatrist, audiologist, physiotherapist, psychologist and any out patient hospital appointments. One resident is awaiting new orthopaedic boots and another is awaiting a psychiatric appointment. Currently two of the residents are in hospital and the staff are visiting both residents regularly. In a recent survey the practice nurse stated, ‘All of the residents appear happy and are extremely well presented. I feel they are treated with respect and dignity’. The GP stated, ‘good quality care’ and the Pharmacist stated, ‘there is good quality care and the residents appear happy and content’. None of the residents are able to self medicate; therefore staff administers all medication they require. There are policies and procedures for the handling, administration and recording of medication within the home. Staff have received medication training as part of their induction programme and the Pharmacist also provides training. The inspector checked Medication Administration Record (MAR) charts and the medication cupboard. There were no gaps noted on the MAR charts and appropriate records in relation to medication received by the home and disposed of were also found to be in order. There are some details in residents’ care plans regarding as to whether they wished to be buried or cremated and what clothes they wished to be laid to rest in. This is a difficult subject for staff to talk to residents and relatives about, however it would be good practice for staff to take this further and to talk to residents and relatives about Preferred Place of Care plan. This would detail residents’ thoughts about their care and the choices they would like to make, including where they want to be when they die. Details on ‘End of life’ programme manager were left with the manager. This is Recommendation 3. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The residents’ views are listened to and acted upon. Residents are protected by the policies and procedures and the monitoring systems within the home. EVIDENCE: The home has a complaints procedure, which is also available in pictorial format. A copy of the procedure has been made available to all of the residents and to their relatives. The complaints procedure is also available in the Service User Guide. The home maintains a complaints book and since the last inspection there has been three complaints. All of the complaints were about one resident going into other residents’ bedrooms. These three complaints have been dealt with by the manager to the satisfaction of the complainants. The manager welcomes complaints and suggestions about the service. Relatives who were surveyed said that, ‘I have had no concerns and I haven’t made a complaint but would tell Jack (manager) if I had a problem’. ‘ I have no concerns whatsoever and would have no problem in talking to Jack (manager) or the inspector if I had’. Residents said either “I would tell Jack”, or “I would tell Y (member of staff)”. The three residents that were present during the inspection told the inspector that they were very happy living at Tomswood Lodge and didn’t want to live anywhere else. One resident stated, “I want to live here for ever, this is my place”. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 20 The home has policies and procedures for the safekeeping and expenditure of residents’ money. Staff assist residents to make purchases, receipts are kept for all expenditure and records of money held. During this inspection two residents’ accounts were inspected and all were in order. The inspector viewed the records of accidents and incidents and these correlated with the Regulation 37 notifications that are being submitted to the Commission. Residents have regular meetings with the manager and staff, some of these meetings are formal and others are informal (weekly coffee morning). They discuss activities, menu planning, future outings and holidays. An advocate from the Daffodil Project has visited the home to talk to the residents about ‘safeguarding adults’, to ensure they understand the different forms abuse can take and to ensure they know who they can go to if they fell they or anyone else is being subject to abuse. Most of the residents have relatives who visit, one resident has a social worker and an advocate who are in regular contact, one resident attends a local day service and clubs and they all attend their local churches, which means that they can talk to people outside of the home, if they wish. The home has a comprehensive safeguarding Adults policies and procedures; these include the local authority (London Borough of Redbridge) policy and procedure as well as their own. The manager was clear in what incidents needed to be referred to the Local Authority as part of the local safeguarding procedures. Staff members that were spoken to were very clear on what constituted abuse and their responsibility in reporting any potential or actual abuse. Staff files indicated that all members of staff have attended safeguarding adults training and this subject has been dealt with through individual supervisions and staff meetings. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28 and 30 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is very homely and provides the residents with a comfortable and safe environment. The standard of cleanliness was high and the home was free from any offensive odours. Residents’ bedrooms suit their needs and are decorated and furnished in a way that suits their lifestyles. The communal rooms and the garden complement and supplement the residents’ individual rooms. EVIDENCE: The home is in keeping with the other properties in the road; it is a large detached bungalow, there is no signage that states it is a residential care home. A tour of the home was undertaken including the residents’ bedrooms. The home is furnished in a homely and comfortable fashion and the entire home was clean and tidy. On the ground floor of the home there is a lounge/dining room, a family sized kitchen, a conservatory, a shower room and toilet, also a separate shower room that has wheelchair access and another Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 22 separate toilet. Three of the residents’ bedrooms are also on the ground floor. On the first floor there are further bathing and toileting facilities as well as the remaining five bedrooms. In the lounge/dining room there are pictures and photographs on the walls, tablecloths on the dining room tables and pictures in the hallway. This gives the home a real feeling of ‘home’. The kitchen is of a good size and is suitable for the residents to undertake domestic tasks such as, loading and unloading the dishwasher, peeling the vegetables etc. The downstairs toilet has recently been tiled and new flooring has been laid and the upstairs bathroom has also been retiled. New carpet has also been fitted on the stairs. All of the residents’ bedrooms meet their needs and bedding and furniture is of a good standard. All of the bedrooms are personalised with posters, pictures, family photographs, football memorabilia, televisions, DVD and video players and music centres. One of the residents has a desk in his room that belonged to his parents. One resident told the inspector, “I like to spend time in my room watching the television”; another resident said “I have put loads of posters in my room”. Another resident said, “I love my room, all my friends are in there to (soft toys)”. Relatives stated, “The manager and his staff provide a very comfortable home”, “The house is spotlessly clean and the garden is well-kept”. A utility room at the back of the garage is accessed via the large well-kept garden. The garden contains a large vegetable patch were the manager with the assistance of two of the residents grows a large variety of vegetables. The front garden is also well kept and offers off road parking. As stated earlier the home was very clean and tidy and appeared to be well maintained. The home has an infection control policy, staff have attended infection control training and advice would be sought from externalist specialist if and when required. There are appointed staff that undertake regular health & safety checks and also ensure that there are no outstanding repairs. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 23 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): 32,33,34,35 and 36 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Qualified and competent staff support the residents. Staffing levels are satisfactory and there is sufficient staff on duty. The staff have the skills and training to ensure that they are able to meet the individual needs of the residents. Staff are being regularly supervised and annual appraisals have taken place. EVIDENCE: The manager confirmed that the home is fully staffed and that only permanent staff are used to cover emergencies, sickness and annual leave; this affords the residents continuity of care by staff who are known to them. Duty rotas were inspected and they correlated with the staff members on duty and on the day of the inspection there were sufficient staff on duty the meet the needs of the residents (the manager and two care staff). During the day there are two care staff and one waking night staff, as well as the manager who normally works Monday-Friday. The staff group consists of members from Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 24 varying age groups and from different ethnic backgrounds; this reflects the diverse ages and cultural backgrounds of the residents. There is good staff retention and sickness levels are low. There are clear recruitment policies and procedures. There has been no new staff employed since the last inspection (November 2006). At this inspection staff files showed that appropriate recruitment procedures are being followed; all of the files have an upto date Criminal Records Bureau (CRB) checks and the most recent member of staff had completed application form and two satisfactory written references and her Protection of Vulnerable Adults (POPVA) check had been undertaken prior to her employment. She confirmed that she had a face-to-face interview with the manager and had undertaken an induction programme. Staff have undergone appropriate training including ‘breakaway techniques’, which is in line with the home’s policy on physical restraint. There are ten members of staff and seven of the staff have either completed or completing their NVQ 2, two members of staff have completed their NVQ 3. Three members of staff have commenced their Registered Manager’s Award. Staff files indicated that staff are receiving supervision every two months and annual appraisals have taken place. This was confirmed by staff who also stated that Jack (manager) had an open door policy and that they could talk to him at anytime. There were also minutes of regular team meetings. Residents and relatives were very complimentary of the staff. Residents’ comments were “The staff are lovely”, “They take proper care”, “They are kind and take me out”. Relatives’ comments were “The staff provide a high standard of care”, “The care staff have the right skills to care for the residents”, and “Nothing is too much trouble”, “The care staff are caring and I appreciate what they are doing”. A health professional comment from a survey, “The staff are friendly, respectful and very professional”. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 and 42 People who use this service receive good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is managed by a qualified and experienced manager, this means that residents’ health, safety and welfare are protected. Systems have been put in place to ensure that residents can be confident that their views underpin the review and the development of the home. The home’s record keeping, policies and procedures safeguard the rights and best interests of the residents. EVIDENCE: The manager is an experienced and qualified person. He holds the Registered Manager’s Award (RMA) and has many years experience of working with Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 26 people with a learning disability and associated mental health needs. He continues to improve his own personal and management skills; he has recently completed the NVQ A1 Assessors course, which means he is able to supervise and support staff who are currently undertaking NVQ 2 and the RMA. The day after the inspection he is attending a ‘Leadership and Management’ course and has attended various other courses and fact-finding days that have been organised by the local authority and the Commission. A trainer from the Skills for Care has visited the home to advise the manager on induction and ongoing training for the care staff. The manager has taken very positive steps to ensure that residents are safe and that their well-being is clearly recorded. He has worked closely with the Commission advising them of any significent events within the home, which could adversely affect the well-being or safety of any resident. Staff have undergone appropriate training in regard to ‘breakaway techniques’ and formal NVQ training. The home is jointly owned, with one owner being the registered manager and the other working as a member of the care staff. Both are very ‘hands on’. Both the manager and his wife are very well regarded by residents and relatives and there has been significent improvements in the managing of the service over the last eighteen months. It was recommended in the last inspection report that the manager developed a system of support from an independence source e.g. a consultant or mentor, to ensure that the service to residents fully complies with all National Minimum Standards and Regulations. The manager has taken this recommendation on board and has arranged support from an independent source e.g. consultant. In April 2006 the proprietor/manager was served with a Statutory Requirement Notice to reduce the number of residents that the home is registered to accommodate to a maximum of five. This notice has been withdrawn and the home is now registered to take eight (this was the original number that the home was registered for) people. Tomswood Lodge is a small home and offers a flexible service; residents can go to bed and get up when they, they are able to eat at times that suit them and have some 1:1 time with their key worker. The residents are encouraged and supported in keeping in contact with families and accessing leisure facilities in the community. Residents’ meetings are regular and information from these meetings, complaints and compliments, together with an annual survey (information gathered from residents, relatives, health professionals and the funding authority) has been collated and this information will advise the manager on the quality of the service being provided and will enable him to develop a development plan for the home. One of the suggestions from a resident was Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 27 that ‘Our meetings not to be so serious’ these meetings are now part of a coffee morning in a more informal atmosphere. The home has responsibility for the personal allowances for the residents and secure facilities are provided for their safekeeping, with records being maintained and accurate. Residents’ accounts were checked and were found to be accurate with financial recordings up to date. The home is kept in a safe condition. A wide range of records were looked at including fire safety, emergency lighting, health & safety checks and accident/incident reports. Portable electrical equipment, the gas heating system, gas appliances and electrical circuits have all been tested this year. Refrigerator and freezer temperatures are also regularly taken. The home has also had satisfactory visits from the Fire agency and the environment agency; where they received four stars for good food safety management. Staff comments regarding the manager were positive “He is supportive”, “I can always go and talk to him”, “he has really encouraged me with my training, and I can’t believe what I have achieved”. A Relative commented “I have every confidence in Jack, he always contacts me if there is a concern”. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X 3 3 X Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA6 YA17 YA21 Good Practice Recommendations That care plans are expanded to cover dietary and cultural needs (though this information is available elsewhere it should be recorded in the care plans) That written menus are also provided in a pictorial format. It is recommended that ‘End of life’ care plans be developed for all residents. This should include informatio0n about the individuals’ wishes, choices and decisions. Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Tomswood Lodge DS0000025932.V355296.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!