CARE HOME ADULTS 18-65
Tosh Lodge 215 Faversham Road Kennington Ashford Kent TN24 9AF Lead Inspector
Mrs Sue Gaskell Announced Inspection 20th September 2005 09:45
Date Tosh Lodge DS0000049316.V251160.R01.S.doc Version 5.0 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.V251160.R01.S.doc Version 5.0 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.V251160.R01.S.doc Version 5.0 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.V251160.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st March 2005 Brief Description of the Service: Tosh Lodge provides residential care for 5 people with mental health problems. The home is a detached house on two floors, with a large usable garden. Residents have their own bedrooms, most of which have en-suite facilities, and there is a WC on each floor. The home, which has access to all necessary healthcare services within the community, is situated in a residential area on the outskirts of Ashford. It is within easy travelling distance of local amenities such as health centres, shops, churches, pubs, clubs, colleges, a cinema, library and bowling alley. Staffing comprises the registered owner, who manages the home, and 5 support staff. Tosh Lodge DS0000049316.V251160.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection, carried out by Sue Gaskell and Lois Tozer over a period of 6 hours. The inspectors acknowledged that the registered person may have been disadvantaged by the timing of the 2 previous inspections, and were satisfied that most of the requirements and recommendations made at those inspections have been implemented. The inspectors looked at the building, examined records and spoke with the registered person, several residents and 2 staff. The inspectors and registered person also discussed various issues arising from the recent adult protection investigation at the home. These allegations, made by a resident, were found to be unsubstantiated, and the inspectors were satisfied that comprehensive risk assessments had been carried out. However the registered person was reminded of the requirement to advise the CSCI of any events or incidents which affect residents’ wellbeing. What the service does well: What has improved since the last inspection? What they could do better:
Residents’ contracts must state the individual contract price. The individual’s home insurance cover should be stated and an inventory of property and valuables sheets should be completed for each resident on their admission, and periodically reviewed. Bedrooms should be fitted with safe and appropriate locks of a type to enable residents to have control of access to their rooms but also allow staff to have access in the event of an emergency. If fire doors are to be left open they must be fitted with a device that will ensure quick and safe
Tosh Lodge DS0000049316.V251160.R01.S.doc Version 5.0 Page 6 closure in the event of the fire alarm sounding. References for staff must be acceptable and there must be evidence of verification. Evidence must be obtained to ensure that employees from non EEC counties have received employment approval from the home office. Induction training for staff must be appropriate to care practice and evidenced. Evidence should be kept of individual staff supervision sessions. Any incidents or unusual events which may affect residents’ well-being should be reported to the CSCI within 24 hours. 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.V251160.R01.S.doc Version 5.0 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.V251160.R01.S.doc Version 5.0 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): 1,2, 4 and 5 Prospective residents are provided with the information they need prior to making a decision about whether the home will suit them. The residents’ needs are assessed to ensure their needs can be met. Residents’ contracts do not provide prospective residents with an individualised cost of the services provided. EVIDENCE: The home’s statement of purpose and service user guide have been reviewed to reflect the requirements of the standards. Although the registered person does not generally visit residents in their existing placement, the residents’ health, care, and social needs are assessed by the registered person during a short period that they spend in the home prior to admission. Residents’ contracts did not state the individual contract price or the individual’s home insurance cover. Tosh Lodge DS0000049316.V251160.R01.S.doc Version 5.0 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,and 9 The health care and social needs of residents are met and they are consulted and encouraged to contribute to any decisions that affect their lives. Residents are supported in taking risks in the daily and social activities that form part of an independent lifestyle. EVIDENCE: The individual care plans are reviewed regularly and include details on short and long term goals and how the home will assist residents in achieving their goals. Each care plan contains clear and comprehensive risk assessments and guidelines and these are reviewed regularly. Tosh Lodge DS0000049316.V251160.R01.S.doc Version 5.0 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 Residents have the opportunity to participate in a range of activities appropriate to their age and peer group. Meals in the home offer a healthy, nutritious diet with choice and variety. EVIDENCE: Staff confirmed that residents are consulted about activities. Some activities are carried out with the assistance of staff but residents are encouraged to be independent whenever appropriate. The menus and contents of the store cupboard were seen to be varied and appropriate for a balanced diet. Tosh Lodge DS0000049316.V251160.R01.S.doc Version 5.0 Page 11 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 The registered person and staff have a good knowledge and understanding of residents’ physical, emotional and support needs and provide this according to residents’ wishes and preferences. The medication administration and storage systems are sound and appropriate to residents’ needs and wishes. EVIDENCE: There were specific guidelines in some residents’ care plans and staff confirmed that they are advised to put these into practice in a practical and sensitive manner. The residents appeared comfortable with staff and able to talk about serious issues. There was also appropriate cheerful banter between the registered person, staff and residents. The medication is stored safely and the administration of medication was clearly and appropriately recorded. Tosh Lodge DS0000049316.V251160.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 There is a sound complaints system and the home makes every effort to protect residents from abuse or harm. EVIDENCE: The staff said that they were aware of the home’s complaints procedure, and two residents said that they would feel comfortable in mentioning anything that they were not happy with. Staff said that they have been provided with training to enable them to recognise different forms of adult abuse and the correct way of responding. Tosh Lodge DS0000049316.V251160.R01.S.doc Version 5.0 Page 13 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): 24,26, and 30 Whilst the general standard regarding the environment is adequate, there are specific issues which could affect residents’ safety that require attention. EVIDENCE: The registered person acknowledged that one resident insists on leaving his bedroom door open at night but that it is not fitted with a device that will ensure quick and safe closure in the event of the fire alarm sounding. The lock on this resident’s bedroom door had been reversed so that it did not enable that resident to have control of access to his room. Further, with the lock reversed, it could be possible for the resident to be locked in his room by someone moving the mechanism from the outside. The registered person explained that she alone has a spare key to residents’ rooms Therefore, there is a risk that when she is not on the premises staff will not been able to gain access to residents’ rooms in the event of an emergency. Tosh Lodge DS0000049316.V251160.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34,35,36 Although residents are supported by some competent and appropriately trained staff, support staff would benefit from improved induction training. Recruitment practices are not sufficiently sound to ensure complete confidence and require improved checking systems. EVIDENCE: Although one staff file contained 2 references neither was from a former employer. Whilst both references appeared to be written in the same handwriting and have the same signature, the registered person said that one was from the person’s grandfather and the other from another close relative. There was no evidence of verification of the references. Further, there was no evidence that this person had received employment approval from the home office. Although there was an induction training form, this was not specifically appropriate to care practice or in line with the Skills for Care requirements. There was no recorded evidence of individual staff supervision sessions. Tosh Lodge DS0000049316.V251160.R01.S.doc Version 5.0 Page 15 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 The home regularly reviews aspects of its performance, which includes seeking the views of residents, their relatives and staff. While generally of an adequate standard, there are some health and safety and welfare issues that require attention. EVIDENCE: There were concerns around access to residents’ rooms and the use of fire doors - see Standards 24 and 26. A recent incident concerning a resident and a subsequent allegation had been reported to the CSCI by a 3rd party rather than by the home. Tosh Lodge DS0000049316.V251160.R01.S.doc Version 5.0 Page 16 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X 3 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X 2 X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Tosh Lodge Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 2 x DS0000049316.V251160.R01.S.doc Version 5.0 Page 17 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 5 Requirement Residents’ contracts must state the individual contract price and the individual’s home insurance cover should be stated. If fire doors are to be left open they must be fitted with a device that will ensure quick and safe closure in the event of the fire alarm sounding. Bedrooms should be fitted with safe and appropriate locks of a type to enable residents to have control of access to their rooms but also allow staff to have access in the event of an emergency. References for staff must be acceptable and there must be evidence of verification. Evidence must be obtained prior to employment to ensure that employees from non EEC countries have received employment approval from the home office. Induction training for staff must be appropriate to care practice and evidenced. Evidence should be kept of individual staff supervision
DS0000049316.V251160.R01.S.doc Timescale for action 01/12/05 2 YA24 12 27/09/05 3 YA26 12/13 27/09/05 4 YA34 19 20/10/05 5 6 YA35 YA36 18 18 20/11/05 20/11/05 Tosh Lodge Version 5.0 Page 18 sessions. 7 YA42 12 Any incidents or unusual events which may affect residents’ wellbeing should be reported to the CSCI within 24 hours. 20/11/05 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 Tosh Lodge DS0000049316.V251160.R01.S.doc Version 5.0 Page 19 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
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