CARE HOME ADULTS 18-65
Wilson Lodge 16 Augusta Road East Moseley Birmingham B13 8AJ Lead Inspector
Kath Strong Unannounced 13th April 2005 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 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 Stationary 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. Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Wilson Lodge Address 16 Augusta Road East Moseley Birmingham West Midlands B13 8AJ 0121 449 1841 0121 449 2926 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Wilson Care Resources Ltd Mr Malcolm Wright Care Home for 36 Category(ies) of Mental disorder with learning disabilities for registration, with number adults of 18-65 years of age of places Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 24th August 2004 Brief Description of the Service: Wilson Lodge was purpose built in the 1970s and commenced operating as a residential home. The registration status changed later, the home currently provides nursing care for up to 36 adults with mental health problems. Residents may also have a learning disability but a mental health need is the primary reason for admission. The home is situated within a residential area, is close to the city centre and within walking distance of local shops and amenities. As well as the registered manager the home also employs a nurse manager. Accommodation is spread over the ground and first floors offering a mixture of single and shared rooms. Communal areas include two lounges, a dining room, a smoking room and two small gardens. There are dedicated on site kitchen and laundry facilities. The premises are located at the end of a cul-de-sac and does provide turning facilities for vehicles at the front of the building but no off road parking for visitors. Car parking is available for staff at the rear of the property. Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of the visit was to conduct an unannounced inspection; this took place over a period of 4.25 hours. The duration of the inspection included discussions with the registered manager, the nurse manager, five members of staff and four service users. Two care plans were inspected, this process included tracking of care and support provided by the home to residents. Some document reading was carried out and posters on display within the reception area were also examined. Information was provided regarding the recreational activities supplied by the home. During this visit the inspector did not have opportunity to speak with relatives and other professionals. The quality and presentation of the lunchtime meal and the menu were also reviewed. From previous visits the inspector had an in depth knowledge of the building therefore, on this occasion only a partial tour of the premises was carried out. What the service does well:
The home provides high standards of care including physical, mental and social care. The system, which is in place for monitoring the health, is comprehensive; which senior staff take responsibility for. The home has a group of staff who have worked at the home for a long period of time. They are well motivated and participate in the day-to-day operations of the home whilst maintaining a clear sense of direction. Positive relationships were noted between staff and residents even though some residents have severe communication difficulties. Residents spoken to expressed of their satisfaction with staff and the service provided. Emphasis is placed upon maintaining residents independence and socialising skills. Residents displayed their satisfaction with the increased in-house and external activities programme. A number of residents are encouraged and supported in going on holiday and are consulted regarding the location. Care plans and relevant documentation are comprehensive, regularly reviewed and up dated when changes occur. Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 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 standard(s) 1, 2, 3, 4, and 5. From the written information made available residents are encouraged to make an informed choice about living at the home. Comprehensive assessments are carried out prior to a placement being offered so that the home and resisdents know that the home is able to meet individuals needs. EVIDENCE: The registered manager confirmed that the statement of purpose had not been altered since the previous inspection when it was determined that the document was satisfactory. The service user guide had been reviewed and was sufficient in content to comply with the standard. Previously the home had encountered problems in respect of issuing of contracts to residents. The situation had recently been resolved and the home had commenced the process of issuing contracts and service user guides to residents. The home will need to complete the process in order to fully comply with the standard. Records revealed that the home has a comprehensive pre-admission assessment tool. The registered manager or the nurse manager carries out assessments; reports are also acquired from external professionals when a placement is being considered. Via documentation and discussion with senior staff it was evident that prospective residents and their relatives are
Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 9 encouraged and supported in making numerous visits to the home prior to an admission being offered. Following admission a trial period is provided and subsequent review before a placement is confirmed. Residents informed of their satisfaction with the provision of the service. Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 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 standard(s) 6, 7, and 9. Residents are consulted and involved with all aspects of planning and agreeing support needed. Care plans within the home were seen to be extensive including risk assessments and regular reviews. Staff actively encourage and support residents in their preferred daily activities of living and in maintaining their independence. EVIDENCE: Two care plans were examined. The contents included medical, psychiatric and social history and they provided valuable information in respect of identifying needs. Care plans were detailed and included sexuality, psychological and physical conditions, smoking, the level of support required and details regarding the person’s ability to manage their financial affairs. Risks had been identified, assessed and regularly reviewed. The involvement of service users with monthly reviews was well documented. Service users expressed their satisfaction with the standards of personal care provided; one person reported that she “wouldn’t want to live anywhere else”. There were several occasions when service users discussed with staff their intentions, access to the local community and future recreational plans. Staff
Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 11 were seen to be supportive and offered appropriate advice. The inspector participated in two animated discussions with service users regarding their autonomy and ability to make their own decisions. Care plans revealed that individual risk assessments in relation to mobilisation, smoking and activities both within the home and externally had been carried out and were being regularly reviewed. Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 12 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 standard(s) 11, 12, 13, 14, 16 and 17. The home actively encourages and supports individuals in developing social skills and in continuing their educational needs and preferences. Intergration within the community and pursuit of leisure activities are integral elements of the ethos of the home. Meals are both well managed, creative and provide daily variation so that residents have a healthy and varied diet of their liking. EVIDENCE: Routines within the home appeared to be flexible; service users were seen accessing all communal areas and the garden. Staff promotes individuals to adopt practical skills in respect of maintaining their own rooms and a number of people have tea-making facilities in their rooms. Some service users attend day centres where varied activities including computer studies are pursued. One person is undertaking a university course and computer studies. The inspector was informed that plans were in place for individuals to cast their vote in the imminent general election. A member of staff was taking the lead role in supporting residents in the process.
Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 13 Residents are supported in accessing the community as identified in their care plan and risk assessment. The home has recently employed a full time activities co-ordinator and a copy of the seven day programme of internal and external activities was supplied to the inspector. The programme included evening and weekend entertainments and was noted to be varied and interesting. A number of individuals had been to see Riverdance the previous evening. Regular parties are held within the home with relatives and friends being invited to attend. Residents displayed their enthusiasm and satisfaction with the range of leisure pursuits. The inspector was informed that three service users recently spent a week in Blackpool and three others had visited Ireland in November 2004. One resident advised that she “had been to Ireland again in an aeroplane”. Lunch is served in two sittings. The home employs dedicated cooks and kitchen assistants. The menu indicated that a varied and balanced diet is provided. Healthy eating is encouraged and fresh fruit is readily available. The menu and other documentation revealed that a number of options are offered and that cultural needs are catered for. Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 14 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 standard(s) 18 and 19. The privacy and dignity of residents was being upheld and protected by staff. There was a comprehensive and proactive approach towards ensuring that health needs were being met. The home is commended for the system it has in place. EVIDENCE: Care plans indicated the degree of assistance required, which varied from resident to resident. With the exception of attendance at day centres residents were able to rise and retire when they chose to. Clothing and hairstyles were noted to be age appropriate. The home maintains a separate file in respect of the input of external professionals. These were noted to consist of a multi-disciplinary group of professionals. The extensive assistance of external professionals was being utilised to support the process of monitoring the potential side effects of antipsychotic medications. The programme includes encouragement of healthy lifestyles. The practices were determined to be excellent in ensuring that an holistic approach to individual’s needs and health needs was being provided. Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 15 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 standard(s) 22 and 23. The complaints procedures in the home were acceptable to ensure that residents could make complaints and receive feedback. Arrangements for protecting residents were comprehensive, minimising risks as far as practically possible. EVIDENCE: Historically few complaints are made; none had been received by the home or CSCI since the last inspection of August 2004. The written procedure and means of recording complaints were noted to be satisfactory. Following the previous inspection some minor amendments had bee made to the extensive written policy on adult protection. The home also has an acceptable written procedure regarding missing persons. There was evidence to support that staff regularly receive training in this aspect of the service. Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 16 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 standard(s) 24, 25, 26 and 30. The home provides warm comfortable and safe accommodation. Improvements had been made regarding lounge and dining room furniture. Independence and personal choices were acknowledged and actioned. EVIDENCE: The home has two light and airy lounges, a separate dining room, a smoking room a small garden located at the side of a lounge and a further non smoking garden accessed via the front door of the home. All communal areas were domestic in design. New furniture had been installed in the lounges and the dining room. A variety of plants had been established in the gardens. Residents were observed using one of the gardens. Furniture, fixtures and fittings were of a good standard and well maintained. Communal space appeared to be adequate for the current resident group. The bedrooms viewed were clean and tidy and personalised to the extent of the occupant’s wishes. All rooms had suited locks and doors were painted in individual colours to encourage a sense of ownership. Residents expressed their satisfaction with their rooms and the personal possessions. One person
Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 17 advised that she does not wish staff to “adjust the layout of personal items” and staff appeared to respect such requests. The home was found to be clean, tidy and odour free. Hygienic working practices methods were noted to be being deployed for kitchen activities. There was a cleaning schedule in place, fridge/freezer temperatures were being recorded and all foods were appropriately stored. Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 36. Staffing levels were determined to be adequate to meet rersidents needs. Residents are supported by staff who are trainined and competant. EVIDENCE: The duty rota and discussions indicated that the home employs trained staff, care staff and ancillary staff in sufficient numbers to meet the needs of the current client group. A good proportion of the staff had worked at the home for many years and they demonstrated loyalty to the residents and senior management. The home does not utilise agency staff. Bank staff or permanent staff bridge identified gaps. With the exception of manual handling the home had provided all mandatory and refresher training. Other training requests are actioned, the home/residents will benefit from the knowledge/skills gained. The inspector was informed that a member of trained staff had recently completed a trainer’s course in manual handling and would shortly commence in-house training of all staff. Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 A quality assurance system was not in place. One requirement from the last inspection in respect of health and safety (manual handling training) remains outstanding. EVIDENCE: The registered manager was developing a quality assurance system, which had not yet been implemented. A more in depth examination of this aspect will be carried out at the next inspection when it is anticipated that the outstanding requirement will have been addressed. The home had carried out a risk assessment in respect of bathing facilities and staff had received Health and Safety training but not manual handling. The inspector was assured that the trained nurse who had recently successfully completed the trainer’s course would shortly address the issue with the provision of training for all staff. Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 2 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 x x x 3 Standard No 11 12 13 14 15
Wilson Lodge 3 3 3 4 x Standard No 31 32 33 34 35 36 Score x x 3 x 2 x
Version 1.20 Page 21 E54 S24909 Wilson Lodge V221448 130405 Stage4.doc 16 17 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 x x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 2 x Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 22 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 YA1 Regulation 5(2) Requirement The home must complete the process of providing each resident with a copy of the service user guide. This remains outstanding from the last inspection. The registered person must complete the process of supplying each service user with a contract/statement of terms and conditions. This remains outstanding from the last inspection. The home complete the development and implement an acceptable quality assurance system, which takes into account service users involvement. This remains outstanding from the last inspection. The registered person must ensure that a programme of training for all staff in respect of manual handling is completed. This remains outstanding from the last inspection. Timescale for action 30th June 2005 2. YA5 12(1) 30th June 2005 3. YA39 24 31st July 2005 4. YA42 13(6) 31st July 2005 Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 23 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 Good Practice Recommendations Wilson Lodge E54 S24909 Wilson Lodge V221448 130405 Stage4.doc Version 1.20 Page 24 Commission for Social Care Inspection 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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