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Inspection on 10/08/06 for West Court Lodge

Also see our care home review for West Court Lodge for more information

This inspection was carried out on 10th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

West Court Lodge continues to provide the service users with a relaxed and informal environment in which they are able to their lives at their own pace. The needs and abilities of the service users have been well assessed and have been linked in with their care plans thereby providing the staff with a good basis on which to build a quality service. The independence of the service users continues to be promoted and generally they are encouraged to make decisions for themselves. The staff have developed a good understanding of the service users` needs and treat them in mature and adult fashion. The care home has a competent and enthusiastic management team who have the needs of the service users at heart. The registered manager has a clear idea of what she would wish West Court Lodge to achieve in terms of service provided and is far from complacent with regard to the improvements already achieved.

What has improved since the last inspection?

The requirements and recommendations made during previous inspections have been addressed. The manager has largely been successful in motivating the staff and involving them in the decision making processes in the home. She has also provided the service users with a greater level of meaning to their lives primarily through increased contact with external agencies and the development of an internal social activities programme. The staff continue to be provided with an opportunity to participate in a range of training courses which consequently provides them with a greater level of knowledge of the service users` needs and how to address those needs. The communication between staff has also improved with full handovers taking place at the end of each shift. There is evidence that a programme of refurbishment and redecorating is underway with the majority of the service users` bedrooms being decorated to a good standard.

What the care home could do better:

Whilst it is acknowledged that the registered manager has commendable aims for the home, the achievement of these are, as she acknowledged, dependent upon the numbers and quality of the staff. The competence and enthusiasm of the staff has undoubtedly improved but the level of day staffing, particularly with regard to the Support Workers, limits the amount of time that staff have available to spend with service users on a one-to-one basis. In turn this has a direct effect on the ability of the staff to promote and develop the service users` life skills and their integration within the community. This situation was exacerbated during and subsequent to the inspection visit due to the exceptional level of staff sickness. Work also needs to be done to ensure that where the staff provide activities that they are directly linked with the service users` care plans. In a similar vein, whilst it is acknowledged that considerable improvement has been made in the physical standards of the home, this improvement has, however, been somewhat undermined by the poor state of the bedrooms of five service users. Whilst there were mitigating reasons for this, it is reiterated that the physical standards must no be allowed to fall below an acceptable minimum standard and internal financial budgets must take into account the needs of the service users and the above average wear and tear that the home is subjected to.

CARE HOME ADULTS 18-65 West Court Lodge 6 West Street Scarborough North Yorkshire YO11 2QL Lead Inspector Mr M. A. Tomlinson Key Unannounced Inspection 10th August 2006 09:30 West Court Lodge DS0000007829.V305379.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 West Court Lodge DS0000007829.V305379.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. West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Court Lodge Address 6 West Street Scarborough North Yorkshire YO11 2QL 01723 507256 01723 507256 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) Care UK Mental Health Partnership Limited (Arc Healthcare Limited) Mrs Catherine Rayner Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (16) West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Category MD(E) for current service users who reach the age of 65 years whilst resident in the home and whose needs can still be met by the home. 28th February 2006 Date of last inspection Brief Description of the Service: West Court Lodge is registered to provide residential social and personal care for 16 adults with mental health problems. Nursing care is not provided. Should such care be required on a temporary basis then it will be provided by the community healthcare services. The home is a detached Victorian property located in the south cliff area of Scarborough. It has five floors with the service users accommodation located on all floors. The main lounge is on the ground floor and the dining room on the lower ground floor. The home does not have a passenger lift and is therefore only considered suitable for service users who are fully ambulant. All of the bedrooms are for single occupancy. The home is conveniently situated for all main community facilities including the public transport network. The home does not have any grounds but is located adjacent to a public park. On-road parking is readily available for visitors. The registered provider is Care UK Mental Health Partnership Ltd. The registered manager is Mrs Catherine Rayner. The current scale of charges for service users range from £317 to £417 a week. This does not include additional charges made, for example, for hairdressing, private chiropody and some personal toiletries. West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was an integral part of the ‘key inspection’ process undertaken by the Commission for Social Care Inspection. Information contained in this report was obtained through discussions with the home’s management, the staff, service users, the relatives of one service user and telephone discussions with health and social care professionals. The report also reflects comments made in survey forms returned from service users and health and social care professionals and the information provided by the registered manager in the pre-inspection questionnaire. A number of statutory records were examined including five service users’ care records, medication records, three staff records and health and safety records. What the service does well: What has improved since the last inspection? The requirements and recommendations made during previous inspections have been addressed. The manager has largely been successful in motivating the staff and involving them in the decision making processes in the home. She has also provided the service users with a greater level of meaning to their lives primarily through increased contact with external agencies and the development of an internal social activities programme. The staff continue to be provided with an opportunity to participate in a range of training courses which consequently provides them with a greater level of knowledge of the service users’ needs and how to address those needs. The communication between staff has also improved with full handovers taking place at the end of each shift. There is evidence that a programme of refurbishment and redecorating is underway with the majority of the service users’ bedrooms being decorated to a good standard. West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 5 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service”. Prospective service users are provided with adequate information to enable them to decide whether they wished to live at West Court Lodge. The preadmission assessments enabled the manager to make a considered decision regarding the appropriateness of a proposed placement and provided a sound basis on which the initial care plan for a service user could be developed. EVIDENCE: The registered manager had developed a comprehensive pre-admission assessment process for prospective service users. This was in addition to any assessment undertaken by a placement authority. The assessment was subdivided into various elements of needs and abilities and provided excellent holistic information on which a considered decision could be made as to the appropriateness of a proposed placement in the home. The records confirmed that the admission process directly involved the prospective service user and took into account the assessment and views of a range of health and social care professionals. Where practical the prospective service user had been encouraged to visit the home and talk to the staff and permanent service users before making a decision to be admitted. According to the manager the assessment process endeavoured to take into account the needs of all of the West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 9 service users and the compatibility of the service user group. The majority of the service users indicated in the survey form that they were provided with sufficient information before their admission into West Court Lodge so that they could decide whether they wished to live there. In the five care records examined there was a copy of the terms and conditions of residence and these had been signed in agreement by the service user concerned. The registered manager demonstrated a sound awareness of the limitations of the home and the need to stay within the registered categories. The admission processes in place demonstrated the home’s capacity to meet the assessed needs of prospective service users. During previous inspections the aims and objectives of the home had been questioned as to their accuracy. The registered manager had addressed this by reviewing the purpose of the home and by re-assessing the service users to look at ways of making their lives more meaningful. She said, “I want it (West Court Lodge) to be more than just a hostel. I want the service users to have the opportunity to develop their personal and social skills”. West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 10 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, 8 and 9 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service”. Whilst the service users’ care plans were detailed and comprehensive, there was, however, an indication that some staff were not keeping themselves up to date with the care plans and consequently were unable to readily advise the representative of a placement authority of any changes to a service user’s needs with any confidence. EVIDENCE: In addition to the care plans provided by the service users’ placing authority, the manager had developed ‘in-house’ care plans that were comprehensive and individualised. The development of the care plans directly involved the service users and from discussions with them it was evident that they were satisfied by the way that their care plans were developed and implemented. There was documentary evidence of regular reviews of the care plans and that action had been taken to amend them as necessary. The service users confirmed that they were at liberty, and encouraged, to attend their reviews although some declined to do so. The registered manager and/or the deputy West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 11 manager had undertaken the majority of the care plan reviews with input from the respective ‘key worker’ and others directly involved in the care of respective service user. The parents of one service user confirmed this. According to the registered manager the timing of service users’ reviews was flexible to take into account their changing needs but in any case they were held at least every six months. Whilst the majority of the surveys returned by representatives of a Placing Authority (care managers) indicated satisfaction with the care provided and the review of the service users’ care plans, two questioned whether the care plans were being followed by the home’s staff and were regularly reviewed. There was also an indication that these care managers had not been informed by the home of all significant events that affected their clients’ well-being. One of these care managers had particularly good contact with the staff of West Court Lodge, had provided them with training and had on occasions attended staff meetings. She was rather concerned that some of the staff indicated that they had no involvement in the review of the care plans even though they were ‘key workers’ for service users and when the care manager telephoned to enquire as to the progress of her clients the member of staff she spoke to replied “I don’t know – there appears to be no changes in the care plan”. The care manager stated that the Registered Manager and the deputy were ‘very good’ but when they were not around the staff ‘appeared lost’. She felt that although the staff were very caring and supportive of the service users but some did not understand how to encourage the service users to do things and that they did not plan ahead but made decisions regarding service users’ activities when they came on duty. Some activities were not, therefore, directly linked into a service user’s care plan. The care manager felt that on occasions the situation was exacerbated from the lack of staff (See Staffing). This care manager said that there were many ‘plus points’ to the home and that her two clients had made good progress and “had exceeded all expectations”. From an examination of the records and discussions with service users and staff it was apparent that the manager had endeavoured to make the service users more involved with the daily routines of the home. This included encouraging them to undertake domestic tasks on an agreed rota basis. Some of the service users were reluctant or unable to participate in this and their wishes had been respected (See Environment). This provided the service users with a degree of ownership over their environment and promoted their independence. The manager was also intending to introduce ‘Person Centred Planning’ for the service users so that the care and support is individualised and tailored specifically for the needs of an individual service user. She stated, “We’ve got to tailor our support for individuals and not the residents as a group”. Comprehensive risk assessments had been undertaken on all of the service users that took into account their daily routines both within and outside of the home. The registered manager acknowledged that in order to promote the service users’ independence, it was imperative that they took reasonable risks. West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 12 She provided examples of this including the fact that the majority of the service users were able to go out unsupervised. If restrictions were deemed necessary, such as the control of money or cigarettes, then they had been discussed and agreed with the service user concerned and included in their care plan. One service user stated, “People (outside of the home) take things off me – they took £5 from my wallet”. The manager was aware of this and following an internal investigation had concluded that whilst there was some truth in the statement the service user concerned will often give things away. This was recorded in the service user’s care plan and they had been provided with additional support and advice in order to address the problem. West Court Lodge DS0000007829.V305379.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): 11, 12, 13, 14, 15, 16 and 17. “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service”. A comprehensive of programme of social activities were in the process of being developed and implemented thereby providing the service users with the opportunity to develop their social skills. The meals provided a reasonable nutritional balance between ‘healthy eating’ and the service users preferences for convenience foods thereby ensuring that they receive a healthy and varied diet. EVIDENCE: The registered manager provided evidence that the service users had been provided with opportunities to participate in a range of activities both within and external of the home. All of the service users had at least one ‘planned’ activity each week that took into account their needs, ability and wishes. These included excursions to places of interest, quizzes, shopping and gardening. In the dining room there was a range of indoor games (including darts and a pool table) and exercise equipment. The service users’ West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 14 participation in these daily activities were recorded in the care records by the staff. Since the previous inspection the home had employed an Activity Organiser. In addition to planning formal activities she provided the service users with one-to-one support and endeavoured to get them involved in community activities along with the assistance of a care coordinator. For example some of the service users attended a local day centre. Four service users had independent advocates, although all of them had been offered the service, and on the day of the inspection visit one advocate had taken a service user out shopping. As previously mentioned in the report the service users were encouraged to take an active part in the daily routines of the home and assist with the domestic tasks such as cleaning their rooms. Five bedrooms were, however, below the expected standard (See Environment) having dirty carpets and stained paintwork. According to the manager these service users were reluctant to have their rooms cleaned and/or redecorated and had relatively low standards of personal hygiene. One concern of the manager was that some service users stayed in their rooms for long periods thereby leading to possible isolation and associated depression. Action had been taken to encourage these service users to come out of their rooms to at least take their meals in the dining room. Apathy amongst the service users had been, according to the manager, a major problem but action such as the introduction of programmed activities had been taken to address it. The majority of the service users presented as well motivated and communicative. It was apparent that the majority of the service users were relatively independent and could come and go from the home as they wished. They were, however, encouraged to keep the staff informed of their whereabouts for safety reasons. The records provided evidence that the service users had been encouraged to maintain contact with their families. The parents of one service user who had recently been admitted into the home said, “We’re kept informed about him (service user). He says he is quite happy here but he likes to stay in his room. We like to try and get him out. We don’t have any complaints or concerns about West Court at the moment”. Comments from the service users included: “The food’s great here. Sometimes I do things wrong and Catherine (registered manager) tells me that. I like it here; no-one shouts at you – it’s not like the other place (previous care home). I can use that (exercise) equipment”; “My relatives like to visit me here – they (staff) treat me well” and “I’m alright here – I can come and go as I like. The staff are OK”. From the information provided it was evident that the service users are able to lead reasonably active lives, at their own pace and regardless of disability. The menus indicated that the meals provided for the service users were varied and nutritious. The staff endeavoured to ensure that the meals were based on the wishes and preferences of the service users. They also endeavoured to balance the service users’ preferences with a degree of ‘healthy eating’. Examples of this included bowls of fruit being available to the service users in the dining room. The manager was intending to employ an additional cook in order to cover each day of the week and also lessen the need for Support West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 15 Workers to be involved in cooking meals thereby enabling them to spend more time with the service users. From discussions with the current cook it was evident that he had a good understanding of the service users’ dietary needs and well as their emotional needs. He was an integral part of the staff team and was included in staff meetings and shift handovers. Through this approach he was able to assess the dietary needs of the service users. There was a flexible approach to mealtimes to take into account the service users appointments and activities. For example, at the start of the inspection visit several of the service users were having breakfast. One stated, “We can have breakfast up until ten (10 a.m.)” and another, “The food’s great here – he (chef) always cooks nicely”. West Court Lodge DS0000007829.V305379.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 and 20 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service”. The service users’ health and personal care needs are met through good standards of monitoring by the staff and input from health and social care professionals. EVIDENCE: All of the service users, except one, primarily required social and emotional support. The one exception had been accommodated at the home for a considerable number of years and had deteriorated physically and required staff assistance with his physical needs such as bathing. He was still able to manage the stairs unaided. Several of the service users required assistance and guidance with regards their personal hygiene standards. The service users’ care records provided evidence that good support had been provided by social and health care professionals including a Community Psychiatric Nurse, an Occupational Therapist and several members of the Community Mental health Team. The manager provided evidence of referring service users for healthcare services. All of the service users had been registered with a local medical practice and had access to other health care services such as dentistry and chiropody. This established that the service users’ health care is West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 17 appropriately monitored and addressed. The registered manager had recently submitted a complaint to a local medical practice regarding a medical practitioner’s apparent refusal to visit the home to see a service user. The staff endeavoured to balance the wishes of the service users with their duty of care. For example, a number of the service users were reluctant to allow the staff to assist with their personal care such as bathing and wearing clean clothes. One service user hated any changes and refused to have a clean carpet or his room decorated and another did not want staff to touch anything in his room. These particular rooms consequently presented as being of a poor standard (See Environment). The majority of the service users were dressed in clean and appropriate clothing. They mainly bought their own clothing with, where necessary, the assistance of the staff, relatives and advocates. One had been out shopping for clothing on the day of the inspection visit. This provided them with a degree of independence and enabled them to make considered choices. The home continued to use a monitored dosage system for the administration of the service users’ medication. The medication was secured in a dedicated drugs cabinet, which was located in a locked room. Those staff who were identified as having responsibility for the administration of medication had undertaken an appropriate ‘distance learning package’ on the safe handling of medication. A dedicated refrigerator provided storage for specific medication. The medication records were complete and up to date and it was possible from these records to audit the medication process. A written medication policy and procedure was in place. From the description of the procedure given by a staff member, it was apparent that it appropriate and kept the chance of errors to a minimum. Specific procedures were in place for the administration and recording of Controlled Drugs. In general the service users were encouraged to come to the treatment room for the medication at the prescribed time. According to the staff this enabled the service users to take some responsibility for taking their medication. The administration process ensured that the service users received their medication at the correct time and at the recommended frequency. At the time of the inspection visit none of the service users were assessed as being capable of safely administering their own medication. West Court Lodge DS0000007829.V305379.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 and 23 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service”. A good network of internal and external support underpins the service users’ welfare and safety. The ability level of the service users enables them to bring any concerns directly to the notice of their placing authority or other statutory body. EVIDENCE: The home had an appropriate complaints procedure in place. This was displayed in the main entrance hall for the benefit of visitors and service users. The procedure was also displayed in the service users’ rooms. All of the service users had the ability to make a formal complaint if necessary although from discussions with some of them it was evident that they were able to discuss any complaints or concerns with the staff or the manager. This was observed during the inspection visit when the manager provided a service user with advice regarding their relationship with another service user. All of the service users had a named representative from their placing authority and were also able to discuss complaints and concerns with them. Without exception the service users indicated in the survey record that they knew the process for making a complaint. The staff had received training in adult protection procedures and demonstrated competence in reporting any instances of alleged abuse. They had also received training in challenging behaviour, restraint techniques and investigation into complaints. The manager had appropriately handled an allegation of verbal abuse that had occurred during the past year. The procedures in place ensured that any concerns regarding the welfare of a service user would be quickly identified West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 19 and acted upon. All of the service users, except one, had unrestricted access to their personal money. The one exception had an external ‘financial appointee’. Arrangements were in place for the safeguarding of the service users’ money if they wished. West Court Lodge DS0000007829.V305379.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, 25, 26, 27, 28, 29 and 30 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service”. Overall the premises were decorated and furnished to a good standard but the poor standard of the décor in five of the bedrooms and the state of some of the stairway carpets, even though there were mitigating reasons, undermined this overall standard. EVIDENCE: The external paintwork of the building was discoloured and flaking thereby giving a visitor a poor initial impression of the home. The manager provided assurance that this issue was being addressed in the near future as it was planned for the exterior front facade of the building to be redecorated. For security reasons the home had a CCTV directed at the main entrance door so that staff could monitor who was coming into the building. The monitor for this camera was located in the lower ground floor corridor. The main entrance hall was clean and reasonably welcoming. There was evidence that some internal redecorating had taken place since the previous inspection and that an effort had been made by the staff to ensure that the entrance hall carpet West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 21 remained clean. The service users had been involved in the choice of colour scheme. It was apparent from the stains and marks on the stair carpets, however, that the home is subjected to a high level of wear and tear. The registered manager provided assurance that replacement carpets were on order and there plans in place to have the main lounge redecorated. There was a marked reduction in the smell of cigarette smoke with the service users having been requested to solely use the main lounge for smoking or an out doors area. Good use had been made of small area leading from the rear entrance door. It had been converted into a patio area for both service users and staff with plants and appropriate seating available. This area provided reasonable privacy particularly for those service users who smoked cigarettes. The kitchen had been refurbished and for reasons of safety the service users only had access if supervised. There were facilities for making hot drinks and snacks in the dining room. The dining room also doubled as an activities room and in addition to indoor games also had fitness equipment available. All of the service users were accommodated in single rooms and had been provided with a key in order to lock their rooms if they wished. This gave them some ownership over their private space. The majority of the rooms were furnished to a good standard and had been furnished by the occupants with their personal belongings. In five rooms, however, the carpets were dirty and the walls and furniture stained. In mitigation the manager stated that the occupants of these rooms did not like change and were reluctant for the staff to enter their rooms and clean them. Two had refused to have a new carpet fitted. The manager said that it was intended to have these rooms refurbished and redecorated but this had been put on hold until the next financial year which starts in October. It was emphasised, however, that the physical standards of these rooms must not be allowed to fall below the accepted minimum otherwise it becomes degrading for the occupants of the rooms by default. The home did not have a passenger lift and consequently was only considered suitable for service users who were fully ambulant. Improvements to the facilities included the provision of ‘in-bath air operated hoists’ and the refurbishment of the shower units. A number of the kitchenettes had been decommissioned as they were not used and were considered to be a risk to some of the service users. Overall the home presented as an informal and domestic environment, enhanced by having flowers and plants in the hallways and pictures on the walls. From discussions with the service users it was apparent that they were satisfied with the standard of their accommodation. West Court Lodge DS0000007829.V305379.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 and 36 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service”. The level of the day staffing limited the amount of ‘quality time’ that staff could spend with service users on a one-to-one basis thereby undermining the quality of the service provided. EVIDENCE: One of the problem areas faced by the manager was the level of day staffing. Whilst she had endeavoured to provide the service users with improved standards of care and more ‘quality time’ with staff, it had been limited by the availability of staff. The number of staff off sick had exacerbated this situation and whilst the home had access to ‘bank staff’ this did not fully satisfy the situation. For example, subsequent to the inspection during the week beginning 28th August there was, according to the deputy manager, only two support staff on duty including him. From the information submitted by the registered manager prior to the inspection visit, it was apparent that the total number of ‘contracted’ Support Staff hours was 202 a week. It is acknowledged that these hours did not include those of the registered manager, the ancillary staff or the night staff. A simple calculation indicated that there was generally only two Support Staff on duty during the week for West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 23 sixteen service users, which, as previously stated, limited the amount of time a member of staff could spend with a service user on a one-to-one basis. This was also reflected in the comments of a care manager who felt that the Support Staff could not be pro-active in their daily planning but planned social activities, for example, on an ad-hoc basis depending upon the availability of staff. In essence the level of staffing had a direct effect on the quality of the service provided. The staff records confirmed that they had been provided with a range of training courses over the last year. These included training on statutory as well as professional subjects. Ten of the Support Staff had obtained a National Vocational Qualification at level two or above and consequently the home satisfied the recommended level of trained staff. Other training included topics on Diversity, Mental Health and Person Centred Planning. Overall the staff had been provided with an excellent programme of training that assisted them to understand the needs of the service users and potentially provide a good quality service. The deputy manager stated, “ I’ve completed my NVQ 3 and I’m now doing the Registered Manager’s Award. I’ve been given excellent support by the manager and the organisation. They believe a lot in staff training”. The records confirmed that staff had been provided with regular supervision and the minutes of the staff meetings indicated that they were able to openly discuss issues. The home had a satisfactory staff recruitment and selection policy and procedure that ensured that all prospective staff were fully vetted before taking up employment in the home. From an examination of the staff records it was evident that a minimum of two personal references that could be properly validated had been obtained on prospective staff. This meant that appropriate action had been taken to ensure the employment of competent and enthusiastic staff. A number of staff have left West Court Lodge in the past year but according to the records all for legitimate and understandable reasons. The manager said that she aims to establish a settled staff team in order to provide consistency for the service users. Formal staff supervision had taken place on a regular basis. It was observed that the staff had established a good relationship with the service users; they demonstrated a reasonable understanding of their needs and of the actions required to provide them with a meaningful life style. They provided examples on how they promoted independence and choice for the service users. One long-term member of staff felt that ‘the home had moved on’ in terms of the service provided. West Court Lodge DS0000007829.V305379.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, 38, 39, 41 and 42 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service”. The service users and staff are provided with excellent standards of management support thereby ensuring that the service meets the stated aims of the home. This standard could, it is argued, be undermined by the level of day staffing (See Staffing). EVIDENCE: The registered manager is appropriately qualified and has considerable management experience in the provision of care to a diverse range of service users. She is also a Registered General Nurse and it was apparent that she uses her nursing experience to good effect particularly when liaising with health care professionals. It was apparent that since her appointment at West Court Lodge she had introduced a number of important changes that had provided the service users with a more meaningful lifestyle. She had also West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 25 improved the motivation and commitment of the staff particularly through the development of a comprehensive training programme and good standards of leadership. It was observed that she had established an open and honest relationship with the service users that enabled them to discuss any concerns or problems they had without fear of recrimination. She spoke to the service users in an adult manner, was honest with them particularly regarding any behavioural issues and explained the rationale behind her reasoning. The staff commended the support they had received from the registered manager. A healthcare professional who had regular contact with the home also felt that the manager and her deputy were doing a good job. The registered manager was acquainted with the forthcoming ‘Mental Capacity Act’ and understood its possible affect on the service users. The home had a comprehensive Quality Assurance monitoring process in place that had been developed by the parent company. It was apparent from the records that all of the home’s procedures had been regularly audited and had been the subject of an annual ‘clinical governance audit’ undertaken by a representative of the company. The home had also received monthly visits from the responsible individual and the manager had been provided with a written report of this visit. A detailed report of these formal audits, including comments contained in questionnaires completed by the service users, their relatives and health and social care professionals, clearly identified any shortfalls in the service along with the actions to be taken in order to address them. A number of statutory records were examined including care, medication, fire and accident records. These were maintained to a good standard and were readily accessible. They indicated that relevant information was being maintained to ensure the welfare and safety of the service users. From and examination of the records and an inspection of the premises, it was apparent that the registered manager had taken appropriate action, including the development of risk assessments, to ensure a safe environment for the service users and the staff. A member of staff had been delegated the responsibility for maintenance issues, fire system checks and checking of the hot water temperatures. The staff training records indicated that they had received training on health and safety related subjects. West Court Lodge DS0000007829.V305379.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 4 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 4 3 X 3 3 X West Court Lodge DS0000007829.V305379.R01.S.doc Version 5.2 Page 27 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 YA30 Regulation 23 Requirement The carpets in the identified bedrooms and stairways must be cleaned or replaced. The décor and furnishings in the identified bedrooms must be clean and hygienic. The level of the day staffing must be reviewed and if necessary revised to ensure that it is adequate to meet all of the assessed needs of the service users. Timescale for action 01/11/06 2. YA33 18 01/11/06 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 YA6 Good Practice Recommendations Action should be taken to ensure that all Support Staff refer to service users’ care plans when having discussions with representatives of placing authorities and ensure that satisfactory answers are provided to specific questions. Care should also be taken to ensure that where possible planned activities link in with aims contained a service user’s care plans. DS0000007829.V305379.R01.S.doc Version 5.2 Page 28 West Court Lodge Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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. 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