Inspection on 17/10/05 for Windmill Lodge

This inspection was carried out on 17th October 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Windmill Lodge 14/03/08

Windmill Lodge 26/07/06

Windmill Lodge 05/05/05

Windmill Lodge 30/11/04

Windmill Lodge 05/07/04

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

CARE HOME ADULTS 18-65 Windmill Lodge 26 Springhead Road Northfleet Gravesend Kent DA11 9QY Lead Inspector Eamonn Kelly Announced 17 October 2005 14:00 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. Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Windmill Lodge Address 26 Springhead Road Northfleet Gravesend Kent DA11 9QY 01474 354212 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) Mr Abdoollah Hosanee Mr Abdoollah Hosanee Care Home 8 Category(ies) of Learning disabiity (8) registration, with number of places Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 05 May 2005 Brief Description of the Service: Accommodation and care is provided for up to 8 people with learning and some physical disabilities. Twenty-four hour care is provided [a member of staff (asleep) is on duty at night]. All service users have single en-suite bedrooms. There is a garden at the rear and a patio area at 1st floor level. The premises are about 15-20 minutes walk from the centre of Gravesend and there is easy access to public transport and to a range of amenities. Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection comprised meeting with the owner/manager, members of staff (including a visiting agency support worker) and some service users. Parts of the premises were inspected. The report uses information provided by means of a questionnaire completed by the owner. CSCI “comment cards” (questionnaires) completed by service users and a number of GP’s were received. What the service does well: What has improved since the last inspection? In the previous inspection report (May 2005), there was a requirement that improvements be made to the pre-admission written information (available to service users and their supporters). There were recommendations relating to the effectiveness of service user care plans, the numbers of staff employed by the home, and communications problems in the home’s dealings with agencies where service users spent significant time during weekdays. Progress has been made on these issues and there have been benefits to service users and members of staff. Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 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. Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 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 Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 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 & 5 Prospective service users and their advocates are able to readily determine, from written information and other means during pre-admission assessment, if their needs will be effectively met. The needs of current service users have been identified and are being met. EVIDENCE: The service user’s guide (that includes a statement of purpose of the home), provides extensive information about the home’s services and facilities. New service users and their advocates are encouraged to visit, meet other service users and members of staff and get information about how their particular needs are likely to be met. Members of staff have an appropriate and extensive knowledge of service user’s disabilities and care requirements. These needs have been recently re-assessed, this process has included new and ongoing contact with day care providers to ensure that they are providing agreed support and intervention. Examples of the progress in this area were discussed. All service users are provided with a personal contract that details the general rights and responsibilities of both parties. Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 9 Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 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 & 9 Service users have a real say in how they spend their time and in deciding for example, which locations they visit. They are supported in taking some risks as part of an independent lifestyle. EVIDENCE: Since the previous inspection, new service user care plans have been put into place. In the examples seen (and cross referenced to meeting service users/discussion of their care needs), the revised system clearly identified predominant disabilities and how these were being addressed. During the previous inspection, service users were visiting at a number of day care locations. Some difficulties with these attachments were identified. For example, there were communications difficulties between some day care staff and home staff and day care venues were sometimes providing inappropriate care for service users. The home has endeavoured to resolve these issues and the benefit of closer connections with day centre staff were discussed on this occasion. This closer contact is now being maintained. Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 11 The examples of recorded risk assessments seen, corresponded to the circumstances witnessed during the inspection. Some service users have received assistance with using public transport alone and their continued safety is kept under review. There is a high emphasis on encouraging each service user to be as independent as possible and to maintain this independence when day-to-day occurrences sometimes affect service user’s confidence. This is a core objective of the home. Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 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, 13, 14, 16 & 17. The home provides a good range of opportunities for service users. There is a well researched “healthy eating” programme at the home. EVIDENCE: The pattern of activities of each service user was discussed and it was clear that opportunities commensurate with their assessed needs are identified. There was evidence that service users have a stable and planned set of routines. Some service users generally are under the supervision of persons outside the home during weekdays: 2 are retired and spend most of their time under the supervision of members of staff at home. One is independent and decides for himself how he wants to spend his day, often helping his friends outside the home, for which a written risk assessment has been produced. The premises are about 20 minutes walk from the centre of Gravesend. Each service user has ready access with staff supervision or, in some cases, unaccompanied to a range of community amenities. There is a record of Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 13 service users’ preferred locations and newer routines are added from time to time if they indicate new preferences that benefit their lifestyles and progress. Service users have the benefit of transport in the home’s minibus [supplemented if necessary by occasional use of cars owned by members of staff (insurance and MOT certificates are checked by the owner each year)]. Service users also experience an annual holiday away from the home. The home’s intention is to enable service users to maintain their network of personal and family friends. Circumstances were discussed which indicated that routines of the home should not take precedence over this aspect of personal development and that if there were relevant issues that required restrictions these are specifically shown in the service user’s plan. The home places a high emphasis on the provision of good food and meals. Two members of staff showed how this important standard is upheld. There is a well researched “healthy eating” programme at the home that has been developed over some years. In recent advances in communications with day care centres, instances where these centres were providing the types of food which adversely affected some service users were identified and specific arrangements were agreed. To rectify this and other potential problems with external daytime care providers, a communications book is brought to the centre each day to record events and assess the disposition of services users over the course of the day. Outcomes are used to inform the service user’s new care plan. Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 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 & 19 Good support is provided for service users in relation to healthcare and physical and emotional needs. EVIDENCE: There was evidence that service users received sensitive personal support. The home has procedures about the provision of personal care by male and female carers to male and female service users. Service users have ready access to a GP, dentist, optician and other healthcare specialists. A day centre representative described how the home had helped a service user change to clothes which were “more relevant and age-related” and how close liaison was helping to have consistent practices at the home and day centre. Since taking up residence, over the past 2 years it was noticeable that service users have developed routines that suits them. With the range of disabilities existing amongst the group of 8 service users, care is taken to provide sufficient pastoral and emotional support to meet individual needs and aspirations. Examples discussed of how changing mood swings and “challenging” behaviours are dealt with by staff, strongly indicated that service user’s needs are understood in some depth (such knowledge and skill deployed Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 15 in ways that alleviated service user’s potential concerns and prevented escalation of incidents). Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 16 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 & 23 The home takes steps to protect service users and it has a complaints procedure in place. EVIDENCE: The revised service user’s guide contains a clear complaints procedure and the name/address/phone number of the Commission is included. Recruitment processes are sufficient in that the steps necessary (eg. references, CRB checks, POVA arrangements) are in place and followed. The home has a copy of the Kent & Medway adult protection policy; members of staff met were aware of this procedure. Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 17 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 & 30 The premises are suitable for the needs of current service users. EVIDENCE: The premises were refurbished in 2004 (to meet National Minimum Standards) when the owner purchased it. The home is comfortable and safe for service users, staff and visitors (as far as can be reasonably determined). Each service user has a single bedroom with an en-suite facility that meets their current needs and lifestyles. Three bedrooms are on the ground floor. Bedrooms are comfortable and well furnished. Each bedroom contains many of the service users’ personal possessions. A bedroom has recently been newly furnished for a new service user. There are sufficient WC and bathroom facilities (with a staff WC on the ground floor). Service users and members of staff have the use of a kitchen, a 1st floor level patio area at the rear of the home, a dining area, lounge and rear garden. Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 18 On the day of the inspection the premises were clean, tidy and free from offensive odours. Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 19 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 & 35 Service users current needs are met by appropriately trained and experienced members of staff. However, the number of support workers available for duty has not reached the number required. EVIDENCE: The revised service user’s guide states that there are 6 support workers at the home. The owner stated that he has included himself in this figure; four support workers are actually employed. The owner stated that, as the home now has a full complement of service users, the staffing criteria would be met. The owner/manager has suitable qualifications in care and management. The assistant manager is undertaking NVQ Level 4 in Care. The senior support worker is close to completing NVQ Level 2 in Care. A support worker recently recruited already has an NVQ Level 2 in Care. Another member of staff is shortly beginning an NVQ Level 2. Two members of staff have full first aid certificates (one certificate has expired after 3 years and the refresher course to re-validate it is planned). All members of staff have undertaken training in medication administration, fire safety training and moving & handling training via external providers (but held within the home). Training in food hygiene, first aid health & safety and Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 20 adult protection procedures is planned (according to members of staff) to take place soon. New members of staff receive induction. The owner has been advised to assess these procedures in relation to revised TOPSS/Skills of Care procedures (that includes a logbook to be kept for the first 6 months). Separate meetings were held with 3 members of staff: each had a good understanding of the care needs of service users and how these were being met. Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 21 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) 37 & 42 Service users benefit from a well run home. The safety and welfare of service users is promoted as a matter of priority. EVIDENCE: The owner/manager is registered with NMC (Nursing & Midwifery Council) as a registered nurse (RNM & RNMH). He has a diploma in management studies, has achieved units in the Registered Manager’s Award and is undertaking a BSc in Health & Social Care. The assistant manager is completing NVQ Level 4 in Care (having already completed a Certificate in Health and Social Care Practice). In relation to the promotion of safety and welfare of service users, the preinspection questionnaire contained a declaration relating to maintenance and Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 22 associated records. The home has a file containing documentation relating to safety and maintenance standards (some of which were checked). The systems and procedures of the home place a high emphasis on safety within the premises and in ensuring that service users are safe at all times outside the premises subject to recorded and reviewed risk assessments. Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x 3 x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x x x 3 Standard No 11 12 13 14 15 16 17 3 x 3 3 x 3 4 Standard No 31 32 33 34 35 36 Score x x 2 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Windmill Lodge Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 3 x H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 24 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 33 Regulation 18 (1) (a) Requirement The registered person shall..ensure that..suitably qualified, competent persons are working at the care home in such numbers as are appropriate... As the home now has a full complement of service users, the required numbers of support staff should be available for the purpose of providing agreed levels of care and preparing realistic staffing rosters. Timescale for action 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Windmill Lodge H56-H06 S59514 Windmill Lodge V247536 171005 Stage 4.doc Version 1.40 Page 26 - 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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