Inspection on 15/06/06 for Wellington Lodge

This inspection was carried out on 15th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wellington Lodge 29/08/07

Wellington Lodge 24/01/06

Similar services:

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Herbert Street

Haven (The)

Charis

Hartley House

Brook Drive, 124

Rugby House Project

City Roads Crisis Intervention

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

CARE HOME ADULTS 18-65 Wellington Lodge 47 Wellington Road Hatch End Middlesex HA5 4NF Lead Inspector Julie Schofield Key Unannounced Inspection 15th June and 19th July 2006 09:15 Wellington Lodge DS0000065106.V291448.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 Wellington Lodge DS0000065106.V291448.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. Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wellington Lodge Address 47 Wellington Road Hatch End Middlesex HA5 4NF 020 8421 2266 020 8421 2266 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) Forini Limited Care Home 15 Category(ies) of Past or present alcohol dependence (14), Past or registration, with number present alcohol dependence over 65 years of of places age (1), Past or present drug dependence (15) Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Temporary variation to include one female service user over the age of 67 years for the duration of their stay. 24th January 2006 Date of last inspection Brief Description of the Service: Wellington Lodge is a registered care home that offers residential second-stage treatment to 15 adults aged 18 to 65 years who are recovering from drug/alcohol addiction. Structured therapeutic programmes are offered to residents for between 12 and 24-week periods. The aim of these programmes is to assist residents in their recovery from drug/alcohol abuse, maintain their long term abstinence and reintegration back into the community. There was no Registered Manager at the time of the inspection. The Registered Provider is Forino Limited and the Responsible Individual is Mrs Ciara Aylett. The care home is located on a quiet road in Hatch End. It is close to community recreational, shopping, leisure and transport facilities. The care home is a large detached property that offers 11 single and 2 double bedrooms to residents. Bedrooms, lounges, bathing and toilet facilities are situated on both floors of the house. There are patio doors leading from the lounge on the ground floor to the garden area. In July 2006 there were 2 residents accommodated in the home. Information about the fees charged may be obtained from the home, on request. Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 2 visits to the home. The first visit took place on a Thursday morning in June. It started at 9.15am and finished at 12.45pm. The second visit took place on the 19th July and started at 8.30 am and finished at 5pm. The Inspector would like to thank Ms Aylett, members of staff and residents for their assistance and comments during the inspection. What the service does well: What has improved since the last inspection? During the previous inspection 9 statutory requirements were identified. Five of these are now met. The residents’ agreement to restrictions on choice and freedoms within the context of their treatment programme is recorded as part of the assessment process. Care plans include how the health and welfare Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 6 needs of the residents are to be met. They also include the resident’s aspirations, aims and objectives, within the context of their treatment programme. Staff have undertaken an in house training session in respect of adult protection procedures. The cleaning schedules now include cleaning the ventilation units. The temperature of the water leaving the taps is at a safe level or there is a notice warning of hot water if it is likely to exceed 43 degrees Celsius. What they could do better: Staff must undertake medication training with an accredited trainer. All staff must undertake training in adult protection procedures with an accredited trainer. The alarm system ceiling pull cords, in residents’ bedrooms, need to be at a height where residents can use them, when necessary. If a resident asks for the ceiling pull cord to be tied up (and out of use) it may only be agreed as part of an individual risk assessment, which is kept under regular review. Staff need training, from an accredited trainer, in infection control procedures. Appropriate training for carers, to demonstrate their understanding of the philosophy of the 12 step programme, must be included in the training plan for the home. There must be a daily staff rota in place to indicate what staff are working in the care home over a 24-hour period. All staff files must contain proof of identity. All staff working with residents, including therapists and counsellors need an enhanced CRB disclosure. That the home needs to have a training plan, which supports the aims and objectives of the home, and which is informed by the development of individual staff training profiles. The induction training programme for new members of staff must be recorded and meet the Sector Skills Council’s standards. A Care Manager must be appointed to work in the care home. All fire doors need to close positively when left to swing shut. New members of staff need training in safe working practice topics i.e. manual handling, fire safety, first aid and food hygiene. Wellington Lodge DS0000065106.V291448.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. Wellington Lodge DS0000065106.V291448.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 Wellington Lodge DS0000065106.V291448.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment of the needs of the resident enables the home and the prospective resident to decide whether the resident is prepared to give their commitment to the treatment programme. A pre-admission visit to the home gives an opportunity to sample life in the home, prior to the home and the resident making their final decision on the placement. EVIDENCE: During the assessment process the home receives as much information as possible from the referral agency to ensure that the needs of the prospective resident can be met. Ms Aylett acknowledged that the amount of written information varied in respect of individual residents and said that this was supplemented by verbal information from the referral agency. In addition a member of the staff team meets the prospective resident and the Initial Assessment Form is completed. There was evidence of this on each case file. During the introductory visit the member of staff explains what the treatment programme entails so that the prospective resident is able to make an informed choice. A resident confirmed that an assessment had been carried out prior to their admission to the home. During the previous inspection a statutory requirement was identified that the resident’s agreement to accepting any restrictions on their choices or freedoms is recorded in the file. Two case files were examined. There was evidence of agreement to Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 10 restrictions on all documents in respect of admission and care planning. There was also evidence that the referral agency is aware of the restrictions that are necessary as part of the treatment programme. Residents are able to refer to a list of restrictions, which are within the context of the treatment plan. These are contained in a section of the resident’s handbook headed “house and treatment rules”, a copy of which is given to residents as part of the admission procedure. Ms Aylett said that it is preferable that the Initial Assessment Form is completed in Wellington Lodge so that the prospective resident has the opportunity to view the premises, see the room in which they would be accommodated, meet members of the staff team and other residents and see the treatment programme in operation. If it is not possible for the prospective resident to visit the home prior to admission someone from the referral agency has to visit the home. The prospective resident needs to make a positive choice to start the treatment programme. Residents confirmed that they had visited the home as part of the pre-admission procedure. One of the residents said that they had also visited another unit but they chose to move to Wellington Lodge. Wellington Lodge DS0000065106.V291448.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 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. Comprehensive care plans have been drawn up for each resident so that the service provided can meet the individual needs of the resident. The home is able to demonstrate that changes in the needs of residents are identified and addressed through a system of regular review meetings. The treatment programme gives residents the confidence and skills to make choices about their lifestyle both for the present and in the future. Responsible risk taking contributes towards the resident leading an independent lifestyle and reviewing these ensures that the changing needs of residents are identified and addressed. EVIDENCE: An initial care plan is completed on admission to the home and this is a brief, basic plan which is tailored to the need to “commit to and to concentrate on the treatment programme”. It lists the restrictions and agreements that are part of taking part in the treatment programme and the resident signs the form to record their acceptance. The referral agency is also aware of and accepts that the restrictions are part of and necessary to the successful Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 12 completion of the treatment A new updated Personal Development Questionnaire is introduced after the first few weeks of the resident’s programme and the resident records their expectations of the service. This is used in the development of the more comprehensive care plan. Care plans cover abstinence, aspirations, communication, culture, educational needs, emotional needs, employment, health, housing and resettlement, mobility, personal administration, personal care, religious needs and social interactions. There was evidence of the care planning process being followed on the case files and at each stage the involvement of the resident in this process was recorded. A resident confirmed that they had been involved in the care planning process. Another resident confirmed that they were familiar with their care plan and its goals and aims. They said that it was regularly reviewed i.e. every 3 weeks. Files contained a record of reviews. A statutory requirement had been identified during the previous inspection that care plans must include details of how residents’ health and welfare needs are to be met in Wellington Lodge and, in the context of their treatment programme, include their own agreed aspirations. There was evidence in the case files that the requirement was now met. However it was noted that within the aspirations section of one care plan it had been recorded that the resident did not have any comments. It is recommended that this section is reviewed at a later stage with the resident who may be clearer in their thoughts for their future as their treatment programme progresses. It is agreed by the resident that giving a commitment to their treatment programme entails some necessary restrictions on their choices and freedoms. However there are some elements of choice e.g. local fellowship meetings where attendance is recommended but not compulsory or on the menu. A resident spoke of how the programme made them realise that choices about their lifestyle had to be made while in the home and continued after their discharge. The office manager helps residents with benefit matters and a discharge information summary confirmed assistance with benefits and housing by listing appointments made on behalf of the resident and providing copies of letters sent on their behalf. However one of the sessions in the treatment programme covers personal administration where residents develop the confidence and skills to deal with housing and benefit matters after they complete their programme. Risk assessments have been drawn up to meet the individual needs of the residents and these were included on the case files examined. They included areas such as personal safety, self-harm and physical health. They included risk management strategies. There was evidence that these are kept under review. Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 13 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, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The treatment programme provides residents with the opportunity to make changes in their lifestyles and to prepare them for living independently in the community again. Residents are able to maintain contact with friends and family members who are supportive of the resident’s desire to change. Residents are offered a balanced diet to promote their physical health and well-being. EVIDENCE: There is a weekly programme that each resident is required to take part in as a condition of residence. A copy of this was available for inspection. The programme includes both group sessions and individual sessions. Most residents undertake a 12 week treatment programme and although residents leave the home to attend fellowship meetings or to go shopping etc their use of community resources and facilities is limited. Residents may go into the community on their own, but only towards the end of their Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 14 programme. A resident would not be physically prevented from leaving the home, although if this has not been agreed as part of their treatment programme, the placement could be terminated. A resident who had lived in the home for a few weeks confirmed that they had been out shopping with a member of staff. During the first visit to the home the shiatsu session and individual therapy sessions were taking place. Sessions take place throughout the day although activities/outings are programmed for a Wednesday afternoon. The carer said that this could be going out for a walk in the park or an arts and crafts session in the home. During the second visit a resident had been painting. There were 4 different step-by-step guides to copying an old master and the resident had selected a painting by Michelangelo. The resident said that they had enjoyed doing this although the instructions were quite complicated and she was not sure that the colours matched the guidelines. There were also opportunities to take part in gardening or cooking. Fellowship meetings, either compulsory in house meetings, or recommended external meetings take place each evening. Residents are able to maintain contact with their families, subject to information received during the assessment process. If the resident wishes to see a member of their family they complete a form and if approved, visits take place at the weekends in the afternoon. Although the visit can take place in the home residents and their relatives often prefer to go out for a walk or to a café. A resident confirmed that their parent visited them and that the members of staff on duty made their visitor welcome. Acceptance of restrictions is part of the early stages of the treatment programme although the promotion of independence, choice and freedom of movement is included in the later stages as preparation for leaving the home. A resident who had been recently admitted to the home said that they were aware of the rules and accepted the need for these. On return to the home from unsupervised visits a bag search will take place. If there are any changes to the resident’s behaviour a random drug or alcohol test may be carried out. A counsellor asks the resident to provide a urine sample or breath sample. The counsellor is the same gender as the resident to respect the dignity of the resident. A carer discussed the affects that drug abuse had on the body and the need to encourage residents to adopt a pattern of healthy eating. The carer was aware that residents leaving the home receive benefits and would need to carefully budget their money. Residents are shown how to prepare relatively simple meals that are cheaper than buying ready prepared meals. The importance of balance, variety and vitamins are covered in the nutrition and well-being session and the use of fresh fruit and vegetables are encouraged. A resident referred to the substance misuse awareness session and how it had made them realise what the consequences were. He said that he had made changes Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 15 to his diet and that thanks to the carer, he appreciated healthy eating. He said that his ambition was to cook a simple meal for his parent after he left the home. The other resident said that the carer was a brilliant cook. A carer on duty confirmed that residents were offered a choice of meals and there are lists of alternative meals that are available each day at lunch or in the evening. Menus were seen and the meals were varied and nutritious. Residents are encouraged to eat 3 meals a day and this was one of the agreements contained in a resident’s initial care plan. One of the residents confirmed that he had put weight on during his time in the home and said that he felt much fitter. Meals are listed at set times, due to the commitments of the treatment programme and residents are expected to dine together rather than in their room. There is a dining area in the home, which can accommodate a group of residents at one sitting but not the number for which the home is registered. Ms Aylett said that as treatment programmes have individual elements it is unlikely that all of the residents, if there were no vacancies in the home, would be sitting down for a meal at the same time. Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 16 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 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to develop the skills to take control of their lives through the support of a team of staff. Residents’ health care needs are met through access to health care services in the community. Residents’ general health and well-being is promoted by staff that assist the residents to take prescribed medication although staff need to be appropriately trained to carry out this task. EVIDENCE: The weekly programme sets out times for getting up in the morning and going to bed at night because there are meetings and sessions listed throughout the day (including the evening). Sessions include anger management, relapse prevention and step sessions. Residents are also expected to prepare for some of these sessions or to do some follow up work. The treatment programme includes therapy sessions to help both mind and body. A resident spoke about their sessions with a counsellor and about how they were able to discuss their personal circumstances in a way that they were comfortable with. The resident said that the counsellor asked them “let me help you to help yourself”. Residents attend to their own personal care needs although care staff may give some prompting. Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 17 There is evidence in the case files that residents have access to health care services in the community. A resident confirmed that they had “lots of health care appointments, even in one week”, as they began the process to improve their general health. The resident was pleased with the support given by a carer who accompanied them on their hospital appointments. When the resident completes their programme a package of care, involving appointments with health care professionals, has already been put into place by the home. The discharge information summary, copy seen, lists the support that has been arranged for the resident, after they complete their treatment programme. One summary included appointments at the hospital, with the GP, the physiotherapist and the dentist. There is a medication policy in place in the home. During the site inspection it was noted that the storage of medication was safe and secure. The administration of medication was inspected and was satisfactory. Records were up to date and complete. At present staff have received in house training in respect of medication. Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 18 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 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are aware of their right to complain if the care that they receive is not satisfactory. An adult protection policy and protection of vulnerable adults training for staff contribute towards the safety of residents. However all staff need to attend training with an accredited trainer. EVIDENCE: A complaints procedure is in place in the home. A copy of the procedure is contained in the resident’s handbook, a copy of which is given to each new resident. The procedure includes each stage of the process and the timescale for responding under each stage is noted. It is stated that all complaints are responded to within 28 days. The procedure also refers to other agencies that the complainant may wish to refer to i.e. the Commission for Social Care Inspection and gives contact details for the local office. No complaints from residents have been recorded since the last inspection. Both residents said that if there was something that concerned them they could speak to Ciara or to other people working in the home (therapists and carers) that they named. A resident said that they were listened to. They had asked to change from the room that they first occupied and they now had another room, which they were satisfied with. A protection of vulnerable adults procedure is in place. No incidents or allegations of abuse have been recorded since the last inspection. The treatment programme includes anger management sessions and residents have 1 to 1 sessions with counsellors and therapists. A statutory requirement was identified during the previous inspection that training must be provided for Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 19 all people working in the home. Ms Aylett said that an in house training course had taken place and that some staff had also attended an external training course. Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 20 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, 29, 30 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home, which is comfortably furnished and provides a pleasing environment for residents to relax and enjoy. Tying alarm pull cords so that they are out of reach compromises the safety of residents, in an emergency. Adaptations have been made to the home to assist a resident’s mobility. Residents live in a home where overall standards of cleanliness are good although staff lack training in infection control procedures. EVIDENCE: A partial tour of the building was undertaken as there were many bedrooms that were not being occupied. It was noted that the premises were comfortably and smartly furnished and provided residents with a homely environment. The premises are suitable for their purpose and are in a state of good repair. A statutory requirement was identified during the previous inspection that the alarm system ceiling pull cords are at a height where residents can use them when needed. This had not been met. Ms Aylett said that the cords had been tied as residents had found them to be in the way when they were getting in and out of bed etc. Two more statutory Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 21 requirements were identified during the previous inspection and there has been compliance. The cleaning schedules now include the cleaning of the ventilation units. The temperature of the water leaving the taps is at a safe level or there is a notice warning of hot water if it is likely to exceed 43 degrees Celsius. Both residents said that they were satisfied with their bedrooms and with the facilities in the home. A resident that has physical disabilities said that he had visited the home prior to admission and decided that he wanted to come to Wellington Lodge. The home carried out some adaptations prior to his admission to assist his mobility within the building. The resident is accommodated in a ground floor bedroom but wished to take part in some of the sessions that are held in rooms on the first floor. A second handrail was installed on part of the staircase so that the resident had extra support coming down the stairs. A grab rail was installed in the bathroom so that the resident could steady himself getting into and out of the bath. It is recommended that an OT assessment of the ground floor facilities be carried out. It was noted during the inspection that all areas viewed were clean and tidy and free from offensive odours. A resident said that the home was “spotless”. Laundry facilities are situated in an area where washing does not have to be taken through areas where food is stored, prepared, served or eaten. Staff have not received training in infection control procedures. Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 22 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, 33, 34, 35 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Training enhances the general skills and knowledge of carers. The home needs to include training on the “12 steps” treatment programme, in its training plan. As the home lacks a rota it is unable to demonstrate that there are always sufficient staff on duty to support the residents or that the managerial support for the home is sufficient to supervise staff and to monitor the standard of care. Recruitment practices, which include checks and references, protect the welfare and safety of residents and the home needs to ensure that an enhanced CRB disclosure, naming the company as the employer, and proof of identity is obtained for each member of staff. The home lacks a training plan, which is linked to the aims of the home. EVIDENCE: A resident commented about the people working in the home and said that they were very professional and put the residents first. The resident said that they were good quality staff. A range of staff support the residents including therapists and carers and Ms Aylett said that they were accredited within their own specialities. The Inspector spoke to 2 of the carers and one of the therapists during the inspection. One of the carers had previous experience of supporting this client group. Carers lack training to demonstrate that they Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 23 understand the treatment programme in operation i.e. the 12 steps. This requirement is outstanding from the previous inspection. During each unannounced inspection visit there were therapists and 2 carers on duty in the home, in addition to the Ms Aylett and to the office manager. However, there was no rota, although Ms Aylett said that the names of each person working in the home were entered in the diary that she used for the home. This requirement is outstanding from the previous inspection. The staff files of 2 members of staff employed since the last inspection were examined. It was noted that one staff file did not contain evidence that the home had verified the identity of the applicant. The other file was in respect of a recently appointed member of staff where there was evidence that an enhanced CRB disclosure had been applied. A pova first check was on file and Ms Aylett said that the new carer would be working under supervision until the return of the CRB. Ms Aylett confirmed that not all therapists and counsellors working in the home have enhanced CRB disclosures although some of their sessions are conducted on an individual basis, in private. Ms Aylett said that the therapists and counsellors working in the home are accredited within their own specialities. One of the 2 staff files examined belonged to a member of staff who had a counselling qualification and a copy of their certificate was on file. The office manager said that she was currently undertaking an NVQ level 4 training course in care and management. The home needs to produce a training plan that benefits from the development of individual training profiles for members of staff. Ms Aylett said that new staff undertake induction training and the home needs to demonstrate that the content of the induction training programme is recorded and meets Sector Skills Council’s standards. Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 24 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 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The interim arrangements in place to cover the duties of the vacant post of registered manager are satisfactory. However, as it is the registered manager’s role to ensure the success of the treatment programme in operation it is essential that an appointment be made. Service satisfaction questionnaires help to monitor the quality of the service provided and contribute towards the development of the service. They need to be given to the referral agency and to the resident. Training in safe working practice topics enables members of staff to safeguard the health, safety and welfare of the residents and this must be extended to all members of staff. Regular servicing and checking of equipment and systems used in the home ensures that items are in working order and safe to use. EVIDENCE: Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 25 The registered manager’s post has been vacant since the beginning of the year. Ms Aylett said that the post has been advertised during this time. A statutory requirement was identified during the previous inspection that a manager be appointed and that they forward an application for registration to the CSCI. The timescale for compliance has expired. The responsible individual, acting on behalf of the company, and the Office Manger have both commenced the Registered Manager’s Award training and Ms Aylett has assumed the duties of the manager of the home. Residents gave their opinions on the quality of the service offered by the home. One resident said that the treatment programme was well thought out and thorough. They were comfortable with the “12 step” approach to rehabilitation. They felt that in other units they had been part of a group but here they were respected as a person. The other resident said that it had helped them to make changes in their lifestyle and that they were aware of the pitfalls facing them in the future but felt that they could now overcome these. The treatment programme includes house council meetings and residents’ meetings and a resident confirmed that these were an opportunity to give feedback. Ms Aylett said that they ask for feedback from the referral agency after the placement has ended and from any after care teams that the resident may have contact with. She said that the home is developing a feedback questionnaire for residents to complete at the end of the placement. A resident said that the admission process included a health and safety induction. During the tour of the building it was noted that a door marked “fire door” on the first floor did not close positively when left to swing shut and this was brought to the attention of Ms Aylett. There was a fire risk assessment on file dated December 2005 and a fire precautions checklist had been completed in December 2005. There was evidence that the fire alarms were tested on a weekly basis and that fire drills took place. The Landlords Gas Safety Record was dated June 06. The fire extinguishers had been tested in December 2005. Although core staff have received training in manual handling, fire safety, food hygiene and first aid newer staff that have been recruited have yet to attend courses. Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 26 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 3 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 2 25 X 26 X 27 X 28 X 29 3 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 X Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 27 YES 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 YA20 Regulation 13.2 &18.1 Requirement That staff receive medication training from an accredited trainer. That the training includes a basic knowledge of how medicines are used, possible side effects that could develop and the home’s policy on handling/administering and recording medication. That all staff receive training in adult protection procedures from an accredited trainer. Ensure that the alarm system ceiling pull cords are at a height where residents can use them when needed. (Previous timescale of 24th March 2006 not met). That if a resident requests that the ceiling pull cord is tied up (and out of use) it may only be agreed as part of an individual risk assessment, which is kept under regular review. That staff receive training in infection control procedures from an accredited trainer. Appropriate training for carers, to demonstrate their understanding of the philosophy DS0000065106.V291448.R01.S.doc Timescale for action 01/01/07 2 3 YA23 YA24 13.6 13.4 01/01/07 01/11/06 4 YA24 13.4 01/11/06 5 6 YA30 YA32 13.3 18.1 01/01/07 01/04/07 Wellington Lodge Version 5.2 Page 28 of the 12 step programme, must be included in the training plan for the home. (Previous timescale of 24th May 2006 not met) 7 YA33 17.2S4.7 There must be a daily staff rota in place to indicate what staff are working in the care home over a 24-hour period. (Previous timescale of 24th March 2006 not met) That all staff files contain proof of ID e.g. passport details. That all staff working with residents, including therapists and counsellors have an enhanced CRB disclosure. That the home has a training plan, which supports the aims and objectives of the home, and which is informed by the development of individual staff training profiles. That the induction training programme for new members of staff is recorded and that the home can demonstrate that it meets the Sector Skills Council’s standards. A Care Manager must be appointed to work in the care home. They must submit an application for registration to the Commission for Social Care Inspection. (Previous timescale of 24th June 2006 not met). That all fire doors close positively when left to swing shut. That all staff undertake training in safe working practice topics i.e. manual handling, fire safety, first aid and food hygiene. 01/11/06 8 9 YA34 YA34 19.1 19.1 01/11/06 01/01/07 10 YA35 18.1 01/01/07 11 YA35 18.1 01/01/07 12 YA37 8.1 01/01/07 13 14 YA42 YA42 23.4 18.1 01/11/06 01/04/07 Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 29 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 Refer to Standard YA2 Good Practice Recommendations That all verbal information received during the preadmission process is recorded and that a copy of the information is sent to the referral agency so that they can agree the accuracy of the record and return to the home. That when parts of the main care plan are not completed the resident has the opportunity to review this at a later stage in their treatment programme. That an OT carries out an assessment of the ground floor facilities. That the questionnaire for residents to complete at the end of their placement becomes part of the discharge procedure. 2 3 4 YA6 YA29 YA39 Wellington Lodge DS0000065106.V291448.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Wellington Lodge DS0000065106.V291448.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. 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