Inspection on 10/05/05 for Yew Tree Lodge

This inspection was carried out on 10th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Yew Tree Lodge 15/04/08

Yew Tree Lodge 13/11/06

Yew Tree Lodge 15/11/05

Yew Tree Lodge 04/11/04

Yew Tree Lodge 24/06/04

Similar services:

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

Ashley House

Ascot Nursing Home

Fountain View

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

CARE HOME ADULTS 18-65 YEW TREE LODGE 17 - 19 Redlands Road Reading Berkshire RG1 5HX Lead Inspector Sally Newman Unannounced 10 May 2005 @ 10:55am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Yew Tree Lodge Address 17 - 19 Redlands Road Reading Berkshire RG1 5HX 0118 931 3534 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care (UK) Mental Health Partnerships Limited Mr Derek Bouldin Care Home 16 Category(ies) of Mental Disorder (MD) registration, with number of places YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The home can provide a service to one named respite service user over the age of 65. Date of last inspection 04/11/04 Brief Description of the Service: Yew Tree Lodge is registered to provide care for adults (18-65yrs) with mental health issues. Accommodation is in single rooms with full en suite facilities and both male and female residents are eligible for admission to the home.Yew Tree Lodge provides personal care to residents to meet all identified needs as assessed. This means supporting individuals to do as much as they are willing and able to do for themselves and to provide help in those areas in which individuals have identified needs. Individual care is planned and delivered following a comprehensive assessment of need which involves the resident, their family/representative/advocate and other health professional who knows the individual. YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted over 3 ¾ hour period. Time was spent with the deputy manager discussing aspects of the home. 8 service users were spoken to of which 3 were seen in private. A small sample of care plans and records were seen. What the service does well: What has improved since the last inspection? What they could do better: By providing administrative support the home could ensure that record keeping was more up to date and accessible. YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 6 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. YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The needs of prospective service users are properly assessed. EVIDENCE: Evidence was provided from the sampling of care plans and from talking to the deputy Manager. A standard referral form is used to obtain initial information about a prospective service user. The service user is then visited by a member of the senior team or is invited to the home for a meeting where discussion and further information is obtained. Further documentation such as Care Programme Approach, risk assessments and background information is requested if available before a decision is made to offer a place to a service user. YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 8 Assessed and changing needs together with personal goals are appropriately recorded. Decision making by service users is encouraged and supported by staff. Some consultation occurs with service users through residents meetings. EVIDENCE: Care plans provided evidence that changes to needs are recorded and acted upon. There was evidence that personal goals are known with recording being seen in a range of care plans. The majority of evidence for this standard was taken from talking to service users. Those spoken to valued the key worker system which was described as supportive. It was acknowledged that some decisions are difficult but those service users spoken to felt that the relationship they enjoyed with their keyworker enabled them to explore all possibilities before making a final decision. YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 10 The home had implemented small residents meetings arranged by individual floors which had proved to be successful. These meetings were not held regularly for individuals. It is recommended that staff responsibility for coordinating these meetings is identified to enable a regular system of meetings to be implemented. YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 The food provided in the home is generally varied and provides a healthy diet. EVIDENCE: Evidence for this standard was primarily obtained by talking to service users. There was a general feeling that the food provided was of a good standard. Some individual views expressed included having less meat dishes and more vegetarian options and it was stated that there is no choice at mealtimes. Discussion with the deputy manager indicated that choice is available if an individual service user does not like what is on offer. Menu choices are a regular topic of discussion at residents meetings. YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 &19 Personal support is provided with individual needs and preferences at the forefront of thinking. The physical and emotional health needs of service users are met. EVIDENCE: Evidence was obtained from talking to service users and from perusal of care plans. Individual needs and preferences are well understood by staff. A change in the current keyworker allocation had caused some disruption with evidence that some service users do not know who their keyworkers are. Service users spoken to indicated that they would approach staff if they had any physical health care needs. Those service users who expressed an opinion stated that staff were supportive and approachable when they were feeling stressed or depressed and they felt happy talking to staff on these occasions. YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Complaints and concerns are taken seriously and are acted upon swiftly and appropriately. The systems for protecting service users from abuse, neglect and self-harm are robust. EVIDENCE: Complaints are recorded thoroughly with outcomes clearly stated. The home has two current complaints which are not yet resolved. The homes complaints record is not comprehensive and does not include all complaints made in the past. It will be required that the record of complaints is reviewed and updated to ensure that all complaints made are in chronological order to enable accurate auditing. All staff have received abuse awareness training and an ongoing system of updates is in place. The latest interagency procedures were available in the home. The proprietor organisation has circulated a handout on the potential for abuse which is kept in the staff room. There are procedures produced by the organisation which dovetail with the local interagency procedures. YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The home is comfortable and homely and provides a range of shared space for the service users. This home is clean, tidy and hygienic. EVIDENCE: All communal areas seen were clean and tidy. New lounge furniture had been purchased since the last inspection. An on going renewal and maintenance programme is in place. Some of the décor requires attention however, the deputy manager was fully aware of the areas requiring attention. Quotes had been obtained for replacing the roof which had been leaking rendering two bedrooms out of use. No timescale was yet known for the commencement of this work. YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) No standards under this heading were inspected on this occasion. EVIDENCE: YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) No standards under this heading were inspected on this occasion. EVIDENCE: YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 2 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x x x x x x 3 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 YEW TREE LODGE Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x x x H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 18 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 22 Regulation 22 (8) Requirement To ensure a comprehensive record of complaints is maintained. Timescale for action 30.6.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 8 Good Practice Recommendations To review system of residents meetings to ensure they occur on a regular basis. YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale Reading RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI YEW TREE LODGE H51-H01 11256 Yew Tree Lodge V217126 100505 Stage 4.doc Version 1.30 Page 20 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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