Inspection on 08/07/09 for Unique Lodge

This inspection was carried out on 8th July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Unique Lodge 16/07/07

Unique Lodge 11/05/06

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Unique Lodge 8 Llanthony Road Morden Surrey SM4 6DX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jon Fry     Date: 0 8 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Unique Lodge 8 Llanthony Road Morden Surrey SM4 6DX 02086483871 02086483728 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Grace Aghoghovbia care home 4 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 4 The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Unique Lodge is registered with the Care Quality Commission to provide care and support for up to four people who have mental health problems. The home is located in a residential road in Morden and is in keeping with neighbouring homes. It is situated close to bus routes and local amenities at Morden and Sutton. Accommodation is provided over three floors and includes a lounge, kitchen/dining area, bathroom and separate shower area. There is a paved area to the rear of the property. The home is staffed twenty-four hours a day. Information about the service is available in the Statement of Purpose and Service Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home User Guide. Unique Lodge charges fees which range from £550 to £800 per week. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We spent just over five and a half hours in the home over two visits and spoke to three people who live there, the manager and two staff members. We looked at records and documents kept by the service including two peoples care plans. The service sent us an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. This also gave us some numerical information about the service. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available about the home and the services it provides. Assessments could be improved to make sure that detailed information is captured at the time of admission. Evidence: Comments from the people who live there included I feel I have no alternative but to live here, I like it here and not a lot. Unique Lodge has information available for people who come to live there in the form of the Statement of Purpose and Service User Guide. We looked at the care files for two people. These contained satisfactory assessment information about each individual but they could be made more detailed. The assessment completed for one person contained information about their history, current needs, goals and potential risk areas. We did see that background information had been obtained from the placing authority but this document was slightly out of Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: date. We have recommended that the service reviews its own assessment format to make sure that detailed information is captured to inform the care plan. The manager also needs to make sure that any assessments supplied from other agencies are up to date to fully inform the admission process. It is important that care plans contain full detailed information for staff particularly where there are identified risks. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning could be improved to be more detailed and person centred. This will help to make sure that individual needs and goals are being fully addressed Evidence: The home told us in the AQAA that our service users needs and choices are highly respected and taken into consideration. We looked at two care plans and saw that the people living there had been involved in the planning process. As stated previously regarding assessments, we think the care plans could be made more personalised, detailed and up to date. A goal for one person was for them to be encouraged to cook for themselves and a plan had been put in place in February 2009. We saw that there was no real detail recorded as to how the person was to be supported with this goal - ie. when, where and how this was to be facilitated and who was responsible for doing this. The notes regarding progress with achieving the plan were basic and were not helpful in evaluating the care and support Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: being provided. The service needs to make sure that the care plans record what works and what doesnt with each individual. Goals and plans that have been achieved or are just not working should be stopped and new ones started in their place. We saw that each person living there has a key worker and regular meetings take place to look at how things are going for the individual. We have recommended that these meetings be used to update the care plan and evaluate the goals each person has. Staff should regularly meet to evaluate the support being given and what is working well. Risk assessments are completed but these could be made more detailed. As stated previously, it is important that full background information is obtained when someone comes to live at the service. The homes own assessments look at potential risks but we thought that these could give more information about any actions required from staff members. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals living there are able to lead independent lives with support as necessary. The food budget and meal provision needs to be reviewed to make sure that people have a healthy diet and enjoy their meals. Evidence: The homes AQAA told us that people are encouraged to visit friends, attend colleges, also they are encouraged to bring their friends to the home and staff occasionally go on outings with them. We saw that the people who live there are able to come and go as they please. The people we spoke to said they had their own keys and were able to have visitors. One person told us how much they enjoyed going out for walks with staff and would like more to do. Another individual said that they attend a drop in centre and go on trips Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: with others there. We have recommended that the home look at how they can support more activity and occupation with individuals. This could be linked to the care plans and structured time scheduled each week. Feedback about the food provided was mixed. Comments included its alright, the portions are a bit small, basic meals - the same all the time and we have the odd good meal. We saw that a menu planner was displayed and individual records are kept of the meals people eat. Staff told us that the food budget for the week was £30 and this limited both the amount of food that could be purchased as well as the quality. We have made a Requirement for the food budgets and provision to be reviewed as the service needs to make sure that each person is provided with nutritious, varied, balanced and attractively presented meals. There may also be opportunities for the people living there to take more part in menu planning, shopping and cooking. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good support is provided around individual health needs. Practice around medication needs sustained improvement. Evidence: We saw that good records are kept for individual health appointments. The people who live there told us that staff support them to attend appointments and one person had seen a health professional on the day of our visit. Individuals are supported with their personal care where needed. The care plans we looked at made reference to prompting and encouragement with personal hygiene needs but these lacked detail. As stated previously, staff should try to record in detail the support required and how to provide this effectively in practice. All individual medication was being administered by care staff at the time of our visit. We saw that the majority of records were well maintained and this showed that people were being generally well supported in getting their prescribed medication. However we did find a number of instances on two seperate days where mediaction had been Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: signed for but not given. We also found one instance where medication quantities did not correspond with the records kept . We made an Immediate Requirement about these issues and went back to check that practice had improved. We will be looking to make sure that the improvements made are sustained in the long term. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using 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. People who live there can access a complaints procedure. Staff have training in Safeguarding Adults. Evidence: The home told us in the AQAA that our policy and procedure is made available in the home, all staff have undergone training on protection of vulnerable adults, and when there is a refresher course, they are encouraged to attend. The complaints procedure is made available in the guide about the service. The home has polices regarding Safeguarding Adults and we saw that appropriate recruitment checks take place including a Criminal Records Bureau (CRB) check. The AQAA stated that there have been no complaints in the last twelve months. The CQC have not received any complaints directly about Unique Lodge. Care Homes for Adults (18-65 years) Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely environment that is generally kept clean and in an adequate state of decoration. Evidence: The people we spoke to said that they were happy with their bedrooms. Unique lodge is laid out over three floors. The main living areas are on the ground floor and there is a communal lounge and Kitchen provided for the people who live there. A smoking lounge is provided in a shed at the end of the garden. The kitchen was being kept locked at the time of our visit and staff told us that this was for hygiene and safety reasons. Each person has a fridge in their own bedroom and staff open up the kitchen at mealtimes to allow people access. We have recommended that this arrangement is kept under review and the kitchen kept open as much as possible. A review of staffing levels may also impact on this practice. We saw that the home was generally kept clean and in a satisfactory state of decoration at the time we visited. The oven and hob were however seen to require deep cleaning. A Health and Safety issue was highlighted concerning the location of a Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: bathroom light near a shower outlet. This issue was addressed by the home when we asked them to take immediate action. Care Homes for Adults (18-65 years) Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels need to be reviewed. Good recruitment checks take place to help protect the people living there. Staff members have access to training to help them do their jobs. Evidence: Feedback from the people who live there included not very helpful, we need more variation in staff and its very supportive. There is one staff member on duty for each shift in addition to the manager who works days during the week. There are two permanent staff members who told us that they work alternate sleep-in shifts to cover the service. We have made a Requirement for the home to review the staffing levels provided. This is in relation to making sure that everyone at the home is kept safe and that there is scope for proactive work with the people who live there. As stated previously, increased staffing levels may impact on practices such as keeping the kitchen locked for periods during the day and overnight. The staff we spoke to said that they received good levels of training. In the AQAA, the home told us that training in the last twelve months included infection control, Dual diagnosis, cultural awareness in relation to mental health and Safeguarding. one staff Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: member told us that had just completed their NVQ Level three award whilst another individual said they had just begun this qualification. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager needs to register with the Care Quality Commission. Systems around Health and Safety need sustained improvement. Evidence: The manager has been in post since 2007 but is not yet registered with the CQC. She told us that she was completing her studies for a management qualification before applying. An application for registration needs to be submitted as soon as possible. We saw that staff members have regular supervision and records are kept of these sessions. Meetings are held for the people who live there and we saw that the last one had taken place in April 2009. Minutes of previous meetings were held on the computer and other recent minutes could not be found at the time of our visit. The small size of the home also means that alot of the consultation is informal and ongoing. We have strongly recommended that meetings take place at least monthly for the people who Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: live there and that full records are kept. Actions required need to be clearly signposted and reviewed at the next meeting. Different formats could be used for the meetings to encourage people to participate - ie. over a meal or social occasion. Regular practice meetings for staff also need to be held to allow for proactive work with the people who live there. Practice around Health and Safety needs to be improved. We found poor practice around the storage and labelling of food in the kitchen fridge freezer and irregular testing of the fire alarm. We also found a light fitting situated close to a shower outlet in the top floor bathroom that was potentially dangerous. We made Requirements about these issues and went back to make sure they had been actioned. We will be looking at these areas again to make sure that practice has improved at the service. We recommend that hot water temperatures of baths and showers be monitored regularly. A risk assessment concerning this area should be put in place that could then inform how often outlets are checked. Care Homes for Adults (18-65 years) Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 The manager must register with the Care Quality Commission. This is to make sure that people who live there benefit from a well run home. 04/09/2009 2 17 16 Weekly food budgets and meal provision must be reviewed. This is to make sure that people living there are provided with nutritious, varied, balanced and attractively presented meals. 04/09/2009 3 33 18 Staffing levels must be reviewed. This to ensure that staffing levels are safe and suitable at all times 04/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of Care Homes for Adults (18-65 years) Page 25 of 27 improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The home should review its assessment format to make sure that full and detailed information is captured. The service should make sure that assessments from other agencies are up to date. 2 6 Care plans need to be made more detailed and person centred. Each plan needs to clearly say how the goal is to be achieved - by who, when, where and how. Care plans need to regularly evaluated to see if they are still working and progress fully recorded. 3 9 Risk assessments should be made more detailed. Actions required by staff need to be fully recorded and the assessment regularly reviewed to make sure it is up to date. The home should look at how it can provided more structured opportunities for activity and occupation both in and outside of the home. People living there should continue to be encouraged to take part in menu planning, shopping and cooking. this needs to be part of the care planning process. 4 12 5 39 Meetings should be held at least monthly with the people who live there and full records kept of this consultation. Different formats could be used to engage with people creatively. 6 42 Regular checks should be made around hot water temperatures at bath and shower outlets. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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