Inspection on 10/08/06 for Tosh Lodge

This inspection was carried out on 10th August 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 found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tosh Lodge 09/02/06

Tosh Lodge 20/09/05

Tosh Lodge 21/03/05

Tosh Lodge 16/03/05

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

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

CARE HOME ADULTS 18-65 Tosh Lodge 215 Faversham Road Kennington Ashford Kent TN24 9AF Lead Inspector Sally Gill Unannounced Inspection 10 August 2006 09:00 th Tosh Lodge DS0000049316.V299342.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 Tosh Lodge DS0000049316.V299342.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. Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tosh Lodge Address 215 Faversham Road Kennington Ashford Kent TN24 9AF 01233 629225 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) Fola Omotosho Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users over age of 65 years to be restricted to one (1) whose DOB is 14/09/1940. 9th February 2006 Date of last inspection Brief Description of the Service: Tosh Lodge is registered to provide residential care for up to five people with mental health problems and service users are currently settled and have low dependency needs. The home is a detached house on two floors, with a usable garden. Service users have their own bedrooms, four of which have en-suite facilities, and access to an additional toilet, a lounge, kitchen/diner, laundry, garden/smoking room and a quiet room. The home is not suitable for those with mobility problems. The home, which has access to all necessary healthcare services within the community, is situated in a residential area on the outskirts of Ashford. There is car parking to the front. It is within easy travelling distance of local amenities such as health centres, shops, churches, pubs, clubs, colleges, a cinema, library, bowling alley and a bus stop just outside. The Owner, Mrs Omotosho is also the registered manager. There are currently four service users and one vacancy. The range of fees is currently £500.00 to £700.00 per week. Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced site visit took place on 10th August between 9.00am and 1.45pm, the registered provider, Mrs Omotosho and two staff assisted with the process. The inspector spoke to two service users (one only briefly) during the inspection. The inspector accessed the communal areas of the home. The inspection process consisted of information collected before and during the visit to the home. Surveys were sent to all service users, families, doctors and a CPN. Surveys were received from all service users (completed with support from staff) a GP and two relatives. Feedback was positive and everyone is happy with the overall care and support received. Various records were viewed during the inspection. What the service does well: What has improved since the last inspection? A quality assurance questionnaire has been completed by each service user and a development plan for the home to further improve the service is now in place. The provider stated that staff training on specific service users needs and illnesses is informally delivered on a day to day basis. Information regarding specific mental health issues is available to staff and was seen in the home. Tosh Lodge DS0000049316.V299342.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. Tosh Lodge DS0000049316.V299342.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 Tosh Lodge DS0000049316.V299342.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 this service. Prospective SU have their individual aspirations and needs assessed. EVIDENCE: A service user described their planned admission which included an assessment and visits to the home. CPA care plans were in place on service users files. The home undertakes their own assessment a copy of which is held on file and used to feed the care plan and risk assessments. A contract of terms and conditions was not yet in place for one service users as their trial period had been extended to ensure the home is able to fully meet their needs. Tosh Lodge DS0000049316.V299342.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs and goals are reflected in their individual care plans. Service users are able make decisions about their day to day lives. Service users are supported to take risks in their everyday life. EVIDENCE: A care plan is in place for each service user which is generated from the homes own assessment of needs and the CPA care plan. The care plan is reviewed regularly although the evidencing of reviews is not always clear. A key worker system is in place. Reviews with service users and professionals are held regularly. Service users confirmed they are able to make decisions about their day to day life and are able to make choices. Risk assessments are in place for service users which detail steps to be taken to minimise the risk and also action for staff should the risk materialise. Risk assessments were reviewed and up to date. Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 10 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 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities are available for service users to access the local community and enjoy appropriate activities. Daily routines are flexible and service users are able to make choices about their day to day lives. Service users enjoy a varied and healthy diet. EVIDENCE: Some service users go out independently and others are accompanied by staff. A service user confirmed that routines at the home are flexible and they can pretty much come and go or spend time as they please. One service user said they ‘can pop to the daycentre or the town’ where there are a variety of activity opportunities and/or a drop in centre both of which they can either walk to or catch the bus which stops just outside the home. Another service user said they would like to go into town and the provider was heard arranging Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 11 this during the inspection. Records indicated that other activities include walks, local shops, going into town or spending time in the garden. A service said that ‘staff are sociable’. The provider stated that in-house activities include table tennis and various board games although these had not been recorded as recent activities but television, music and socialising with other service users had. Service users do not have responsibility for household tasks these are completed by staff. Four service users smoke either in the garden or garden room. Service users talked about their relatives and contact is supported by staff although lead by service users. Feedback from both relatives was positive and included a comment ‘X has improved a 100 since being at the home. They have a real understanding of X needs and always work with X if s/he is having any difficulties. I want to thank the staff for making X life so precious and happy’. Service users confirmed that ‘the meals are nice and we are asked if we want to change the menus or want anything else and we get a cooked breakfast on Sundays’. Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported in a way they wish and their health care needs are met within the community. To fully protect service users an improvement is required to the medication recording system. EVIDENCE: Service users need varying levels of support from staff which is detailed in their care plans. A service user confirmed that the downstairs lounge ‘closes at 9.30pm’ service users then go to their own rooms but times for going to bed and getting up were flexible. The home feel supported by the local health care professionals. Feedback from a GP was positive and they were satisfied with the overall care provided. A service user confirmed that if they need to go to the dentist or opticians they do. The medication system was viewed. Storage and administration recording appeared in order. There must be evidence that all medication is logged into Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 13 and out of the home and this is a requirement. The competency checks for administration of medication should be evidenced. Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 14 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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel their views are listened to and would be acted on. Staffs knowledge must be improved to fully protect service users from abuse. EVIDENCE: No complaints have been received since the last inspection. One service user said that ‘staff tell you if anything is wrong to talk to them’ but they have not had a problem. The service users said ‘we all get along fairly well , we’ve all got our own ways’. Service users receive their own benefits although the home does hold monies sent by one family at the families request, records were in order. Staff files evidenced that CRB disclosures are in place. The provider stated that all staff have had adult protection training however one staff member spoken to was not aware of where to report abuse outside of the home and this needs to be addressed and is a requirement. Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 15 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service uses live in a nice and comfortable home which is safe, clean and well maintained. EVIDENCE: The inspector visited the communal areas downstairs and viewed the garden. The home is decorated and furnished to a good standard and is homely and comfortable. Four bedrooms have an ensuites and the inspector was advised that bedrooms are large. A service user confirmed that they ‘had a nice room and could bring their own things’. In addition to the spacious lounge there is a quiet room. The home was clean and hygienic. Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 16 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): 32, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported by staff that feel supported some of which are qualified but additional training/competency checks are required to ensure staff are fully able to meet the needs of all service users. Service users are protected by a robust recruitment procedure. EVIDENCE: When the inspector arrive two staff were on duty. The provider arrived shortly afterwards. There is one member of staff on duty 7am until 9am and then two staff from 9am until 10pm with a sleep in through the night. The provider stated that staffing is reviewed in line with service users needs. Two staff files were viewed. These evidenced a robust recruitment process is in place. The home has undertaken the appropriate checks including work permits, references and CRB disclosures. There was a recommendation at the last inspection to deliver specialist training. The provider stated that this has been achieved informally and geared towards existing service users needs. The provider should evidence this informal training process and also the checking staffs competency. In Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 17 addition information regarding mental health conditions was seen around the home. Induction programmes were discussed and the owner must ensure that the induction programme followed in the home is to the new Skills for Care specification and also follow the new timescales. As previously stated staff spoken to lacked knowledge of adult protection and further training is required in this area. There are currently seven staff plus the provider. Two staff have NVQ level 2 or above and one is a qualified nurse this is just short of the 50 target. The checking of staffs competency where they have received training from other providers was discussed in relation to medication however this is relevant to all subjects. The staff member spoken to confirmed that they felt well supported. However staff supervision records evidenced that formal supervision had fallen behind timescales. One record highlighted a need for health and safety training however the provider said this had not yet been achieved to date. Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 18 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 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home where they feel their views unpin what happens. The health, safety and welfare of service users is promoted. EVIDENCE: The provider is a registered mental nurse with over sixteen years experience within this field. She demonstrated a commitment to improving the lives of the service users and providing a stable homely environment. Service users comments included ‘since I’ve been here I’ve been better than I have been’. Feedback indicated a good working relationship with health care professionals. In addition to informal processes the service users periodically complete quality questionnaires which are used in the development plan for the home. Feedback from relatives was positive. Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 19 Appropriate regular checks are in place to ensure the health and safety of all. The fire safety logbook evidence all checks were completed to timescales. The accident book showed no accidents since the last inspection. The inspector was advised there have been no incidents either. The reporting of incidents was discussed in relation to the outstanding requirement. The provider stated that all staff have received fire, infection control, food hygiene and health and safety training and five are trained in manual handling see previous comments regarding training delivered by other providers. Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 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 2 X 3 X 3 X X 3 X Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement Timescale for action 2 YA23 YA35 13(6) There must be evidence that all medication is logged into and out 17/08/06 of the home and staff competency checks for medication administration should be evidenced Staff must have knowledge of local adult protection protocols and where to report any 30/09/06 suspicions of abuse outside of the home 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 Refer to Standard YA35 YA35 YA32 Good Practice Recommendations The home should ensure that the induction programme delivered is to the new Skills for Care specification and undertaken within the new timescales The home should evidencing informal training sessions and staff competencies in these areas Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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. Extracts may not be used or reproduced without the express permission of CSCI Tosh Lodge DS0000049316.V299342.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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