Inspection on 07/08/08 for Wisteria Lodge

This inspection was carried out on 7th August 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

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Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOME ADULTS 18-65 Wisteria Lodge 24 Brookdene Avenue Oxhey Hertfordshire WD19 4LF Lead Inspector Pat House Unannounced Inspection 7th and 14 August 2008 11:00 th Wisteria Lodge DS0000071460.V367231.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 Wisteria Lodge DS0000071460.V367231.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. Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wisteria Lodge Address 24 Brookdene Avenue Oxhey Hertfordshire WD19 4LF 01923 465723 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) Tin Fah Chan Wan Fong Tin Fah Chan Wan Fong Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accommodated is 4 2. Date of last inspection Not Applicable Brief Description of the Service: The home has four bedrooms, all for single occupancy for those with a learning disability. One bedroom is situated on the ground floor and three are on the first floor. The house has two floors but no passenger lift and so three rooms would be unsuitable for those with a physical disability. The ground floor bedroom has en-suite facilities and all the first floor rooms have wash hand basins. There are steps to the front door of the house and ramped access via the rear of the property. The home has an open plan lounge/dining room and domestic style kitchen. There is a large garden to the rear of the house. The home is an adapted and extended house, situated on a main road in Oxhey, which is a residential area of Watford. There is a small driveway outside and there is unrestricted parking available in the road. There are local shops nearby and the town of Watford, with its extensive amenities, can easily be accessed by bus. There are train stations nearby in Bushey and Watford and several motorways within a short drive. Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1star. This means the people who use this service experience adequate quality outcomes. The information in this report is based on an unannounced visit to the home by one regulation inspector carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as ‘we’. The home was registered with the Commission in March this year. At the time of the inspection there was only one resident living in the home. The manager was not on duty at the time of the first visit and so an additional visit was made to examine the areas not available on the first occasion. We spoke with one staff member and with the current resident. We inspected all areas of the home briefly and examined a selection of records. The manager has completed and returned a self-assessment questionnaire, sent out by the Commission. This is the Annual Quality Assurance Assessment document, called the AQAA in this report. We have included information from this document in this report. Quality surveys have also been provided for the resident and staff at the home. Comments from any which are returned to the Commission will be included in the next inspection report. The home’s Statement of Purpose and Service User’s Guide are available from the office on request. Current fees for the home are £980 per week. What the service does well: The one resident in the home told us that they were very happy living in the home and that “this place has been perfect”. The resident has lived in other care settings and compared this home very favourably. The resident commented that they had all their care needs met and had had their diabetic food needs assessed for the first time since entering the home. We heard form the resident that care staff supported their independence in all ways and that the food provided was very good. The home has been decorated and furnished to a high standard and was extremely well presented. Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 6 The resident praised the manager and staff and said that their views were listened to and included in plans for running the home. 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 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. Wisteria Lodge DS0000071460.V367231.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 Wisteria Lodge DS0000071460.V367231.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): Standards 1, 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are given detailed information about the home and have their needs fully assessed before moving in, so that all parties can be sure the home is right for them. EVIDENCE: The home has a written Statement of Purpose and Service User’s Guide, which were examined during the Commission’s registration process. These documents give detailed information about the services provided and, in the AQAA, the manager states that all residents and prospective residents are provided with copies of these documents so that they can be sure the home is right for them. We checked the records for the one resident in the home and these contained copies of care summaries and assessments from the referring agency and from the care services, which had been involved previously. These assessments were very detailed and provided a full picture of the resident and their possible needs. Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 9 We spoke with the resident during the visit and they confirmed that they had visited the home before they became a resident and, as a result, had chosen to move in. The staff member we spoke with said that any prospective resident would be invited to visit the home and meet the present residents before a place was offered. This would be important in such a small home to ensure that current residents and prospective residents could live comfortably together. Wisteria Lodge DS0000071460.V367231.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): Standards 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures followed by staff in the home ensure that residents are supported to make their own decisions and take appropriate risks. However currently written details in care plans are not sufficient and this could result in staff being unaware of procedures and in residents being put at risk. EVIDENCE: After speaking with the one resident in the home we checked their care planning records. The manager said that the current plan was an interim document and that care planning was being developed. However the wide range of care needs identified in the resident’s assessment from the referring agency were not adequately considered in the current care plan. This means that care staff could be unaware of some needs and some risks which might need addressing and this could have unwanted outcomes for the resident in question. In particular management plans are needed for cigarette and matches handling and for smoking, for challenging behaviour and for the selfmedication of insulin. A range of risks were identified in the care summary sent Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 11 to the home and detailed risk assessments must be completed to ensure the safety of residents and staff in the home. When we spoke with the resident we were told that the procedures followed when staff assist the resident to inject insulin to control their diabetes was thorough and that care staff had arranged for a doctor to alter the level of insulin prescribed when problems had arisen. The resident also confirmed that staff assist with checking their blood sugar levels. However there was insufficient detail recorded in the care records for new staff to follow this procedure and to demonstrate that the Health services were monitoring the assistance given. Similarly, the resident confirmed that, since moving into the home they had seen a dietician for the first time in order to ensure that the food provided supported their diabetic needs. This shows that staff at the home are following a thorough plan of care for this person but again the records we saw did not detail the diet plan so that inappropriate food could be provided at future times. The resident also told us that they had a mobile telephone in which staff had entered relevant and emergency numbers and that the resident rang the home when they were out on their own to confirm their safety. During the second visit the resident was out of the home and did ring the manager while we were there. This is an essential means of ensuring a risk is being controlled but again it needs documenting to ensure that all current and future staff are aware of procedures. The resident we spoke with said that they were supported to be as independent as they wanted and they made their own decisions about how they spent their days. They said that they handle their own finances and staff confirmed that the resident goes to the Post office independently to collect their allowance. Wisteria Lodge DS0000071460.V367231.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): Standards 12, 13, 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. Staff in the home support people who use the service to maintain family links and to use local facilities so that they remain part of the community. The meals provided are appropriate and enjoyable and support individual dietary needs, which helps maintain the residents’ good health. EVIDENCE: We spoke with the one resident who said that they went out independently and visited the shops when they needed to, using their mobile phone to keep in contact with care staff, as already described. The resident said that care staff also take them out in the home’s vehicle and that they could also come and go as they pleased. Staff have also supported the resident to apply for a bus pass to make travel easier. The resident said they have their own key to their room and to the front door of the house. We were also told that staff respected the residents’ privacy and always knocked and waited before entering their bedroom. Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 13 When we visited on the first occasion the resident was sitting in the garden of the home with a resident from a linked home. A member of staff from that second home was also present and both residents were enjoying the company and the social occasion. Care staff confirmed that it was the home’s policy to welcome the family and friends of all residents at all times. We saw examples of four-weekly menus, which had been planned by staff with the resident’s involvement. The meals looked well balanced and the resident told us that the food was very good at the home. Records were being kept of food, fridge and freezer temperatures and the kitchen was clean and fitted with all appropriate appliances. Wisteria Lodge DS0000071460.V367231.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): Standards 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service have their health needs met in the way they prefer by staff in the home but some procedures for dealing with medication need to be reviewed to ensure the safety of residents. EVIDENCE: We spoke with the current resident and were told that all the staff in the home provided support in the way they chose and that they had complete freedom to decide how they spent their days. As already noted the resident said that for the very first time they had had their dietary needs reviewed by the Health services at the instigation of staff at the home. Care staff also support the resident to administer their own diabetic medication, enabling the resident to maintain more of their independence. At the first visit the medication storage cupboard had not been secured to the wall as legally required for safety, but the cupboard had been fixed to the wall by our second visit. We checked the home’s written medication policy and this was fairly comprehensive but needed to include the home’s policy for dealing with non-prescribed and “homely” medication. The manager said that the Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 15 policy would be amended to include this guidance. The manager has ordered a record book for Controlled Drugs as now legally required although currently no controlled drugs are held in the home. The resident we spoke with confirmed that they wished the staff to look after their medication and were happy with the procedure followed for administering their insulin. Care staff currently draw up the correct amount of insulin for the resident to inject and some of the staff are registered nurses. However the written guidelines for the procedure for dealing with the insulin were inadequate to ensure the safety of this process and for ensuring that a health professional trained and monitored the care staff involved where they were not nurse trained. Because there was only one resident in the home at the time of the visit we were not able to fully assess the procedures for booking in medication, which might arrive with a new resident. The manager is aware however that two staff should sign any medication records, which are hand written and that amounts of medication must be noted and carried forward when new administration records are used. Wisteria Lodge DS0000071460.V367231.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): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that their concerns will be listened to and that procedures followed in the home will protect them from abuse. EVIDENCE: The home has written policies covering Complaints, Whistle Blowing and Adult Safeguarding. We saw these during the inspection and, in the AQAA, the manager has confirmed that all policies are up to date. We spoke with the support worker on duty during the first visit and they were clear about Safeguarding procedures and understood the implications of Whistle Blowing. When we spoke with the resident they confirmed that care staff had “gone through” the procedures for making a complaint and said that they would not hesitate to tell a member of staff if they had any concerns. Wisteria Lodge DS0000071460.V367231.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): Standards 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is kept clean and well maintained and well furnished so that people who use the service can live in comfortable and hygienic surroundings. EVIDENCE: We visited all parts of the home and garden during the visits and all rooms were clean and well furnished and decorated to a high standard. The garden is accessible and tidy and is being planted gradually and is appropriate for the use of residents. There is a covered smoking area to the side of the house for the use of residents and staff. The resident we spoke with said that all areas of the home were cleaned daily and that there was always a good supply of hot water for their use. The bathrooms and toilets are fitted with soft paper towels and liquid soap as recommended in guidelines for infection control. Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that they will be supported by well trained staff and that procedures followed for staff recruitment will help to protect them from risk of harm. EVIDENCE: The resident we spoke with said that there was always someone on duty in the home who was available to support their needs. Currently some staff work at both this home and a sister home and the manager said that staff numbers would vary according to the numbers of people who would eventually be resident in the home. We checked the recruitment and training file of the member of staff we spoke with and this contained evidence that they had completed a wide range of training courses. The manager sad that a training course for the care of those with diabetes had been booked for all staff members and that further training courses were planned. In the AQAA the manager indicated that professional training for staff would be promoted and that a comprehensive induction training plan, which includes Safeguarding, Equality and Diversity and Medication Administration will be provided for all new staff. Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 19 We saw evidence that all appropriate checks had been in place before the staff member we spoke with had started work at the home. The manager is currently updating the home’s staff application form to ensure that a full work history is recorded so that this and other employment checks can help to protect all residents from risk of harm. Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 20 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): Standards 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the home is well run and with procedures in place to ensure their safety and that their views are included in any planning for the home. EVIDENCE: The home’s manager is a registered Learning Disability nurse with extensive experience in this field as well as appropriate management experience. The manager has achieved the NVQ level 4, Registered Manager’s Award and has been registered with the Commission. Both the staff member and the resident we spoke with praised the manager and said that he was always approachable and included their views in all day to day planning. During the Commission’s registration process, certificates which evidence compliance with fire safety were seen and confirmation was received that fire Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 21 risk assessments had been completed. It was also confirmed at registration that the home has a fire alarm system which, to ensure the safety of residents and staff, includes emergency lighting and automatic door closures which are activated if the fire alarm sounds. The home has not fitted window restrictors in bedrooms but the manager has confirmed that individual risk assessments will indicate if these are necessary for each new resident. Similarly the manager has stated that all rooms have thermostatically controlled radiators and that individual risk assessments would determine if these needed to be covered or not. We saw the home’s accident recording book, which is compliant with data protection requirements. The home has a thorough written policy on Quality Assurance and the procedures listed will be put into operation later in the year when there are more residents in the home. These procedures will evidence that care standards are maintained and that people using the service have their views reflected in the running of the home. Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 22 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 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 YA6 Regulation Requirement Timescale for action 01/10/08 2 YA9 3 YA20 15(1)&12(1)(a) The current service user’s plan must include management plans for dealing with the risks identified in the initial care assessments and must include planning for challenging behaviour, smoking and keeping matches and for food requirements. 13(4)(b)&(c) Risk assessments must be 01/10/08 completed for the risks identified about the current service user and must include smoking and holding matches, handling insulin injections, challenging behaviour and going out alone. 13(2) A management plan must be 01/10/08 completed for the procedures to be followed when staff handle the current resident’s insulin. The plan must evidence appropriate staff training and monitoring by a Health professional. Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 24 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 Wisteria Lodge DS0000071460.V367231.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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