Inspection on 03/10/08 for Worstead Lodge

This inspection was carried out on 3rd October 2008.

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

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

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Worstead Lodge 106 Cromer Road North Walsham Norfolk NR28 0NB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Debra Allen     Date: 1 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Worstead Lodge 106 Cromer Road North Walsham Norfolk NR28 0NB 01692403865 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Rachel Tatchell Type of registration: Number of places registered: Independence with Care Ltd care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 15 The registered person may provide the following category 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 category: Learning Disability Code LD Date of last inspection Brief description of the care home 15 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This is the first key inspection since the service became re-registered with the Commission in May 2008, following the change of ownership to Independence With Care Ltd. Care Homes for Adults (18-65 years) Page 5 of 29 The inspection was carried out over two days, in conjunction with the Organisations other service, The Shires. During this time discussions were held with the new provider, service manager, members of staff and several people living at Worstead Lodge. A full tour of the premises was also carried out and a number of people were happy for their rooms to be seen. Care plans, staff files, health and safety information and other records required for regulation were also examined as part of the inspection process. Two requirements and one recommendation have been made as a result of this inspection. What the care home does well: What has improved since the last inspection? What they could do better: The communal toilet on the first floor needs to either have a hand washing basin installed or anti-bacterial hand wipes to be provided, for the purposes of infection control. A formal Quality Assurance system, that includes, and records, consultation with people living at the home, needs to be introduced. The front bedroom on the first floor should have the heating system checked and be improved if possible. Care Homes for Adults (18-65 years) Page 7 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users receive comprehensive information, in appropriate formats, to ensure they and their relatives know what support is offered by Worstead Lodge. People also have the opportunity to visit the home and a full needs assessment is carried out for each person before they move in, to help make sure that staff know what support they need. Evidence: Although this is the first key inspection since the service was re-registered with the Commission, following the change of ownership, the service is extremely well established and all the residents are very settled. The most recent admission was in 2006. All the care plans looked at provided evidence that a detailed assessment of peoples needs and suitability was made before anyone moved into Worstead Lodge and discussions with the new proprietor and the manager, together with other records Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: seen, confirmed that this assessment process will be ongoing. Meanwhile, all the care plans seen had new service agreements in respect of Independence with Care Ltd and contracts, which included NCC rate charges. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All the people living at Worstead Lodge continue to be able to make decisions about their lives and their assessed and changing needs and personal goals are reflected in their personal plans. Detailed risk assessments show how people are supported to take risks as part of an independent lifestyle. Evidence: Everybody living at Worstead Lodge has a very detailed and comprehensive care plan, each of which is currently in the process of being reviewed and updated. A combination of old and new style plans were seen during the inspection, as well as some that were being worked on. However, although the new style plans are also excellent, care should be taken to include as much of the pre-existing information as possible, as this will ensure people’s assessed and changing needs and personal goals continue to be fully reflected. Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: The general contents of the care plans included areas such as: Service User Contract, Service Agreement, Inventory, Application, Gift List, Support Plan (Including Review Details) and Risk Assessments. One person explained how they had helped to put their new care plan together, which included writing, pictures and symbols to make it easier to understand, and was happy to go through it during the inspection. The new care plans were seen to have the following information in the Support Plan section: Communication and Behaviour, Where I live and Who I Live With, My General and Mental Health, Personal Hygiene, Domestic Tasks, Preparing Meals and Cooking, Shopping, Using the Telephone, Safety Indoors and Outdoors, Family Members, Carers, Support Networks and Relations, Using Transport, Managing Money, Work, Learning and Leisure and Weekly Timetable. The last section also had What Im Good At and contained information such as: I am very good at helping in the garden, I am a kind, caring and considerate person and I am good at saving money and shopping. Another part had Hopes and Wishes for the Future which included things like: I would like to try horse riding in the future, I would like to go to the pub more often, I would like to continue helping in the garden, I would like to stay at Worstead Lodge and I would like to visit Banham Zoo. The people spoken to confirmed that they make decisions for themselves and as a group about their lives and about the home. House meetings are held regularly and notes were seen from one meeting, which were very clear and included each person. Observations of interactions between staff and residents during the inspection confirmed that staff continue to listen to what people want and work hard to enable them to achieve their aspirations. Risk assessments were seen to be clear, detailed and individual and covered all aspects of peoples daily lives such as: Communication and Behaviour, General and Mental Health, Personal Hygiene, Domestic Tasks, Preparation and Cooking, Shopping, Using Transport, Safety Indoors and Outdoors, Managing Money and Going to Work/While at Work. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: All the risk assessments seen confirmed that people are supported to take risks that help them become more independent, as safely as possible, rather than having things done for them. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Worstead Lodge continue to be able to pursue their own hobbies and interests and have work/day placements during the week. Regular contact with friends and family is maintained and each person continues to enjoy their meals, be involved in food shopping or preparation and deciding what they want to eat. Evidence: All the people seen and spoken to during the inspection said they were happy living at Worstead Lodge. Observations, records seen and discussions provided confirmation that each person has their own hobbies and interests such as gardening, listening to music, carpentry, needlework, walking, shopping and adding to personal collections such as posters or teddies etc. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Other activities noted included pub visits, social time with friends or family, various holidays and day trips. Several people were noted to have jobs at various companies or organisations, some paid and some voluntary work. Adult education classes and day services were also seen to be accessed. A number of people living at Worstead Lodge also continue to use local facilities and public transport as a matter of routine. Discussions with some of the people living at Worstead Lodge and individual records confirmed that people are supported to maintain their family and friendship networks. Some people said that they visit their families regularly and that their friends are able to come and visit. Observations, discussions and records also confirmed that individual personal relationships are very positively supported. Each person said that they enjoyed their food and observations confirmed that they were able to choose what they wanted to eat, with some people seen choosing and preparing their own breakfasts and lunches. Some examples from recent menus included: Chicken Curry and Rice - Ginger Pudding and Custard Fish, Mash and Broccolli - Cheesecake Roast Pork and Veg - Peaches and Cream Beef Stew and Dumplings - Rice Pudding Shepherds Pie - Trifle Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person living at Worstead Lodge receives personal care and support in the way they choose and their physical and emotional healthcare needs continue to be met. Medication is handled appropriately and these, together with medication records, are stored securely. Evidence: Each persons care plan was seen to contain clear descriptions with regard to how they like or need to be supported and records and discussions confirmed that personal routines were flexible and that people could make genuine choices with regard to things like bathing, what to wear and what time to go to bed or get up. Currently, everyone living at Worstead Lodge is capable of carrying out most of their own personal care needs and generally only require encouragement and prompting from support staff. Each person continues to be registered with the local doctor and dentist and visits to other healthcare professionals such as optician, chiropodist, dietician and psychiatrist Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: were also noted. The care plans were seen to be regularly updated and include information regarding all healthcare issues and appointments. Medication and the relevant records were seen to be stored securely, with no errors or omissions noted. Between the first and second visit to the home the medication folders were seen to be in the process of being reorganised, so that each person had a completely separate section, which contained all the information that was relevant to them. Meanwhile, evidence of staff training in medication and other health matters was seen and risk assessments in respect of self-medication were also seen. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Worstead Lodge feel safe and know who to talk to if they have any problems or concerns and they are protected from abuse, neglect and self-harm as much as is possible. Evidence: One formal complaint was seen to have been received by the home since the last inspection, which was responded to appropriately, in accordance with the homes complaints procedure. Some of the people spoken to said that they knew how to make a complaint and that they knew they would be listened to. Everyone spoken to said they were happy talking to the staff and would tell them if they had any problems. A number of compliments by way of cards and letters were seen to have been sent to Worstead Lodge by some of the people living there and their relatives. Staff files were seen to contain evidence of training for staff in areas of adult protection. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Worstead Lodge is a homely, comfortable and safe environment, which is clean and hygienic and people’s bedrooms suit their needs and lifestyles and promote their independence. Evidence: A tour of the premises was carried out as part of the inspection, guided by some of the people living there. Each person was seen to have their own bedroom and each room looked at was noted to be individual and had been personalised. Two lounges and a dining room were seen to provide a choice of communal areas and the whole environment was found to be comfortable, homely and very pleasantly decorated throughout. Overall, the home was found to be clean, hygienic and free from hazards. However, one of the bedrooms on the first floor felt quite cold and had a portable radiator, which was not totally ideal. A recommendation has been made for the heating system in this room to be checked and improved if possible. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: Also, it was noted that the communal toilet on the first floor landing had no hand basin/hand washing facilities or toilet paper, which puts people at risk of infection by having to return to their bedrooms or the bathroom before being able to wash their hands after using the toilet. A requirement has been made for this situation to be rectified, either by installing a hand basin or providing, and encouraging the use of, anti-bacterial hand wipes. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Worstead Lodge has a robust recruitment procedure and staff are trained, skilled and in sufficient numbers to support the people living there. Evidence: Three staff files were looked at during the inspection and these were found to contain relevant information such as personal details, contract, references, guide to staff practice and service, training certificates, supervision records, wages information and personal induction records. As part of the recruitment process, Independence with Care Ltd requires a full application form to be completed by prospective staff and states that two references are required (one from the most recent employer and must not be a relative). The personnel files also provided evidence that each member of staff had received clear, enhanced Criminal Records Bureau (CRB) disclosures, prior to starting work, therefore confirming that the home/organisation has robust recruitment procedures. It was evident from the records seen and discussions with the staff and manager that mandatory training continues to be provided and regularly updated. Training records Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: showed evidence of courses attended such as first aid, fire safety, food hygiene, safeguarding adults and medication. Evidence was also seen to show that staff received one-to-one support and supervision on a regular basis. Staff spoken to also confirmed this fact. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Worstead Lodge is a well run home, in which the service users views are taken into consideration and their overall health, safety and welfare is promoted and protected. Evidence: During the inspection a number of the people living at Worstead Lodge commented on how much they liked the new owner, the manager and all the staff. Observations showed them all to be approachable, supportive and professional. With regard to a structured and documented quality assurance system, a formal system still needs to be put in place to enable effective auditing and future planning of the service. However, it is recognised and acknowledged that the people living at Worstead Lodge, plus their friends and family, continue to be consulted properly and their views and feedback are taken seriously and acted upon accordingly. Meanwhile, the regulated checks for fire, environmental health, water and electric were found to be satisfactory and cleaning materials/hazardous chemicals were seen Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: to be stored appropriately. A full fire risk assessment was seen to have been completed in September 2007. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 23 It is required that The communal toilet on the first floor either has a hand washing basin installed or that anti-bacterial hand wipes are provided, for the purposes of infection control. People are at risk of infection by having to return to their bedrooms or the bathroom before being able to wash their hands after using the toilet. 31/01/2009 2 39 24 A Quality Assurance system that includes consultation with people living at the home must be introduced. To ensure that the home develops according to the needs and wishes of people living there. 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards Care Homes for Adults (18-65 years) Page 27 of 29 and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 25 It is recommended that the front bedroom on the first floor has the heating system checked and improved if possible. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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