Inspection on 24/04/07 for Winston Lodge

This inspection was carried out on 24th April 2007.

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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Winston Lodge 18/04/06

Winston Lodge 11/11/05

Winston Lodge 01/07/05

Winston Lodge 07/01/05

Winston Lodge 15/10/04

Winston Lodge 06/04/04

Winston Lodge 29/09/03

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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 Winston Lodge 362 London Road Waterlooville Hampshire PO7 7SR Lead Inspector Ms J Hartley Unannounced Inspection 24th April 2007 11:30 Winston Lodge DS0000011672.V334428.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 Winston Lodge DS0000011672.V334428.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. Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winston Lodge Address 362 London Road Waterlooville Hampshire PO7 7SR 023 9264 7895 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) www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) To Be Confirmed Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th December 2002 Brief Description of the Service: Winston Lodge is a care home registered to accommodate up to thirteen people in the category of learning disability. The home is owned by the Care Management Group who are based in Wimbledon. The group owns two other houses close to Winston Lodge. The home is situated within walking distance of Waterlooville town centre and is close to a range of amenities. The Responsible Individual for the home is Mr Michael Buckingham. The manager of the home is applying for registration with the commission. The current fees range from £500 to £1200 per week. Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit for this key unannounced inspection took place over five hours. The acting manager was present throughout the inspection and provided the information required. The inspector examined information held on the CSCI service file since the last inspection in April 2006, and read the previous two inspection reports, the Service User Guide and the Statement of Purpose. Evidence was also gathered from the pre-inspection questionnaire completed by the acting manager and the results of surveys, completed prior to the inspection by eleven residents (or their advocates) and five relatives. A Random Inspection took place in September 2006, evidence from that is also contained within this report. During the visit the inspector spoke to two of the residents, and two members of staff. The inspector undertook a tour of the premises and looked at four care plans and three staff files. Various record books, policies and procedures were also examined. What the service does well: What has improved since the last inspection? Many improvements have been made since the last inspection in April 2006. The Service User Guide has been updated to include details of extra costs that are not included in the fees. Care plans, needs assessments and risk assessments have been updated and improved. They are all now being reviewed regularly. The ground floor bathroom has been changed to a “wet room” with a walk in shower which residents are happy about. Grab rails have been fitted to the ground floor corridor to aid residents with mobility difficulties. Staff have now all received fire safety training and take part in fire drills. The menu has been improved to include healthier food options. Winston Lodge DS0000011672.V334428.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. The summary of this inspection report can be made available in other formats on request. Winston Lodge DS0000011672.V334428.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 Winston Lodge DS0000011672.V334428.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Potential residents are provided with all the information they need in order to make an informed choice about whether to move into the home. Their needs are assessed prior to admission and the assessment forms the basis for the initial care plan. EVIDENCE: The manager stated that information about additional costs to residents over and above the weekly fee for the provision of accommodation and personal care was included in a new/amended Service Users. All of the residents’ files that were case tracked contained a pre-admission assessment giving details of individual residents’ needs. Any restrictions to choice were documented and risk assessments were in place. The manager said that prospective residents are able to visit the home prior to admission. The manager said that when a referral is made the assessment team at CMG, (the company that owns the home), request an assessment from the referring authority. If they think the home is able to meet the Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 Page 9 persons needs the manager or deputy from the home visits the prospective resident for a further assessment. This information is then used to draw up an individual care plan. The prospective resident is then able to visit the home. Winston Lodge DS0000011672.V334428.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments reflect the current needs of residents and set out how these needs will be met by the home. They are both reviewed regularly. Residents are supported in making decisions about their lives and to be involved with the running of the home. EVIDENCE: At the random inspection that took place in September 2006 and the site visit of 24th April 2007 it was found that residents’ files included assessments of the needs of the individuals concerned, and plans that described the support that they needed.. There was evidence that they were reviewed every month and that formal comprehensive reviews took place at regular intervals. The contract/terms and conditions issued to every resident stated: - Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 Page 11 “The needs of the service user will be reassessed from time to time at least 6 monthly and annually with all professionals that are required to input into the plan”. Residents spoken with confirmed that they received the support that was set out in the care plans and staff spoken to were able to describe the needs and the likes and dislikes of the individuals whose care plans were examined. An audit of risk assessments had been completed and consequently there were up to date and new risk assessments in the files. There were assessments of the potential harm to residents arising from activities involved with every day living and health and personal care needs e.g. use of wash hand-basin and toiletries; self harm and choking and eating disorder. It was noted that all the files examined included a list of everyday domestic equipment e.g. kettle, toaster, television, that was available in the home and an indication of whether the person concerned could use them independently, or required staff support. There were also assessments of risks associated with staff working practices e.g. working at night; use of shower/wet-room. The manager and senior carers are in the process of updating all the care plans. The manager said that she has invited parents and relatives of residents to meet with her for one to one sessions to enable them to be involved in the care planning process. Residents are able to make decisions about their lives. One resident wants to move to be nearer her family. The home has arranged for the resident to visit the area she wants to move back to so she can re-familiarise herself with the area. Visits have also been made to the home she will be moving to. A resident told the inspector that she goes to bed when she wants and is supported by staff to go shopping to choose her own clothes. Residents said they are involved with the running of the home and supported with independent living skills such as cleaning their own rooms. The minutes of the weekly residents meeting showed that residents are consulted on menus, activities and are asked what they have liked and not liked about the previous week. Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, and 17. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents have opportunities for personal development and take part in appropriate activities. However lack of staff can affect the choice and frequency of activities available to the residents. Visitors to the home are made welcome. Residents are offered a choice of menu and enjoy the food provided by the home. EVIDENCE: Evidence from daily records and residents’ surveys show that residents attend services at local churches and attend a social gathering at a church group in the week. The manager said that currently there were no service users from different ethnic groups living at the home but that every effort would be made to ensure their cultural needs were met should someone from an ethnic minority reside at the home in the future. Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 Page 13 Residents are encouraged and supported to develop independent life skills. One resident said that she is now blow-drying her own hair, which she was pleased about. Another resident said that she attends cookery classes. Daily records and residents’ surveys show that residents are able to participate in the local community and attend college and training courses. They attend local discos, go shopping, visit local pubs and restaurants and go swimming amongst other activities. A relative said that some activities have been cancelled due to lack of staff and two residents said that they are not always able to do what they want to do due to staffing levels. The manager said that an extra member of staff is coming to the home some evenings to take residents to activities. Residents are assisted with claiming appropriate benefits. The manager said she has reviewed peoples’ current benefits and has assisted with applying for Disability Living Allowance, which has resulted in some residents’ benefits being increased. During the visit the manager had a meeting regarding a DLA application for a resident. Relatives who responded to the survey said that the home always helps their relative keep in touch with them. One relative commented that they are “always made welcome” when they visit Winston Lodge and that “telephone access is always available”. Staff at Winston Lodge were seen knocking on residents’ doors prior to entering their bedrooms. Staff interacted positively with residents and listened to what they were saying. Residents are able to have their own keys to their rooms if they wish. At present only one resident has taken up this opportunity. Residents spoken with during the visit said that they enjoy the food provided for them. The manager said that the menu has recently been changed to provide healthier food options. Residents are able to choose the weeks’ menu at residents’ meetings. Some residents who were overweight have been assisted in losing weight through healthier eating and exercise. Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Inadequate staffing levels at busy periods of the day mean that the staff team need the manager to assist to meet the needs of residents. Residents’ health care needs are met and they are able to administer their own medication if appropriate. EVIDENCE: A comment received by a relative said that the standard of personal care provided for residents is sometimes lacking due to not enough staff being on duty. This was discussed with the manager and staff on duty at the time of the visit. The manager said that it can appear that staff are not providing the same levels of personal care due to residents being encouraged and supported to be more independent. For example, one resident is now doing her own hair in the mornings and it may not look as neat and tidy as when staff have done it for her, however the resident is pleased that she is now able to do this for herself. The manager also said that in the mornings when several residents are getting ready for college and activities at the same time it is very busy and Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 Page 15 she sometimes comes in early to assist the staff team. Staff also said that they feel that there is not enough staff on duty at busy periods of the day. The files examined by the inspector held clear records of health appointments including specialist services provided such as dementia assessment, referral to an incontinence service and physiotherapy. At the time of the site visit handrails were being fitted in a downstairs corridor to provide a more safe environment for a resident with mobility problems. Medication records were examined and found to be clearly recorded with no gaps in recording. The medication cabinet contained clearly labelled medicines and there was no evidence of overstocking. Medication policies and procedures provide clear guidance for staff who administer medication. No resident self-medicates at present, however a risk assessment and policy is in place for future use. Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents feel their views are listened to and acted upon and are protected as far as possible from neglect by the home’s policies, procedures and training. EVIDENCE: The home has a complaints procedure in place that indicates who will investigate the complaint and gives timescales for the process. Residents said that they know who to talk to if they are unhappy and they know how to make a complaint. The complaints log was seen during the visit. All recorded complaints were responded to within the agreed timescales. Records seen showed that all staff have received training in abuse awareness. Two staff members spoken with confirmed this. Residents have separate bank accounts. Small amounts of money are kept for residents in the home and receipts are kept for all transactions. Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The homes premises are suitable for its’ stated purpose and are kept safe, clean and hygienic. EVIDENCE: The inspector looked round the home during the visit and found it to be suitable for its stated purpose. The home was well maintained throughout, clean, tidy and free from offensive odours. Furniture and fittings were of good quality and in good condition. Evidence of appropriate health and safety checks in the home were seen. The ground floor bathroom had been refurbished and the bath removed. It was described as a wet room. Its walls were tiled from floor to ceiling and it was equipped with a level access shower, a shower chair, grab rails and a curtain to provide privacy. It was clean and bright. Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 Page 18 The home has clear policies and procedures in place regarding the control of infection. The laundry facility is sited away from food preparation and storage areas. Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Relatives, residents and staff feel that here are not always sufficient staff on duty during busy periods of the day to meet all the needs of the residents. Staff recruitment procedures and training help, as far as possible, to protect the residents. EVIDENCE: The home’s manager said that staff training needs are identified through individual supervision meetings. Staff training records were examined and staff on duty were spoken to about the training that they have received. It was apparent from this that that there is a commitment to providing necessary training within the financial resources allocated to the home, and the availability of places on the training courses organised by the company. All staff had or were due to attend training in moving and handling and food hygiene and a number had attended recent training in key working. Some staff have also received training in areas relevant to the needs of the residents Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 Page 20 including person centred planning and autism. The home has not yet met the target of having fifty per cent of care staff holding an NVQ level 2 qualification. Residents, relatives and staff feel that there are not always enough staff on duty to meet all the needs of residents. One relative commented, “They always try but are often short staffed so are not able to give the time necessary to always give the care service necessary.” Staff said that it is difficult to find enough time to complete paperwork. The manager said that on some days she works “on the floor” to assist staff at busy periods. It was noted from the rota that the manager also does some sleep in duties. Support staff are also responsible for housework and cooking. The home needs to ensure that there are enough staff on duty to meet the needs of the residents. Although relatives commented about the shortage of staff they were positive about the commitment of the staff team. Comments included; “All staff and management are caring and are very approachable. Always try to sort out any problems a resident might have. Always stop to listen if you need to ask questions..” “They are all brilliant, they look after my brother very well.” Recruitment records were seen for three staff members. Two of the files contained all the information required however the third file only contained one reference. The manager said she would ensure that another reference was obtained. Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is no registered manager in post at the home. There is an effective quality assurance system in place and the health, safety and welfare of residents is promoted and protected. EVIDENCE: At present there is no registered manager in post at Winston Lodge. The acting manager said that the post has been advertised. The home has a quality monitoring and assurance system in place that includes obtaining the views of residents, relatives and other stakeholders through meeting and questionnaires. The last survey undertaken by the home Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 Page 22 was seen on file. The inspector saw the homes quarterly development plan that sets out goals and ways to improve the home, how they are going to be achieved and by when. Training records show that the home provides compulsory training for staff in safe working practices, including moving and handling, First Aid, Fire Safety, Food Hygiene and Infection Control. The company that owns the home provides comprehensive fire safety training and all staff attend this annually. This is supplemented by regular in house fire training sessions including fire drills. Evidence was seen that safety checks of electrical equipment, fire alarm systems and water temperatures are carried out on a regular basis. Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 X 29 X 30 3 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 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA33 Regulation 18 (1) (a) Requirement The registered person must ensure that there are sufficient numbers of staff on duty to meet the assessed needs of service users. Timescale for action 24/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Winston Lodge DS0000011672.V334428.R01.S.doc Version 5.2 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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