Inspection on 01/06/07 for York Lodge

This inspection was carried out on 1st June 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

York Lodge 26/01/06

York Lodge 21/06/05

York Lodge 04/10/04

York Lodge 16/06/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 York Lodge York Lodge 129 Balcombe Road Horley Surrey RH6 9BG Lead Inspector Chris Bowman Unannounced Inspection 1st June 2007 10:30 York Lodge DS0000013847.V338997.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 York Lodge DS0000013847.V338997.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. York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service York Lodge Address York Lodge 129 Balcombe Road Horley Surrey RH6 9BG 01293 785235 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) Welmede Housing Association Ltd Lee Alan Mather Care Home 8 Category(ies) of Learning disability (8) registration, with number of places York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be: 21 65 YEARS 26th January 2006 Date of last inspection Brief Description of the Service: York Lodge is a care home registered for provision of personal care and support for up to eight adults whose primary support need is a learning disability. Service users may have a secondary mental health disorder or sensory impairment. Registration conditions provide for either male or female service users, referred to as ‘service users’ in the report At the time of this inspection the user group was all male. The service aim is to enable ‘service users’ to lead as independent and fulfilled life as possible, providing support that maximises skills to the fullest potential. The property is a large, detached two storey building situated in a residential area. Horley town centre is within walking distance and community facilities and services are accessible. At the front of the building is a large garden and car parking facilities and an enclosed garden is available at the rear. Communal accommodation is arranged on the ground floor, comprising of a spacious lounge and smaller, second lounge. There is a large dining room, a well equipped kitchen, separate utility room and combined staff office/ sleeping - in facility also on this floor. Bedroom accommodation is arranged on the first and second floors, accessible by stairs only. All bedrooms are single occupancy and are situated near to toilet and bathing facilities. The Registered Provider, Welmede Housing Association specialises in care and support of adults with learning disabilities. York Lodge is part of a group of care homes operated in Surrey by this organisation. Hyde Housing Association owns this property and is responsible for its maintenance. Fees range from £650 to £1,000 per week. York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over six hours commencing at 10.30am and ending at 16.30pm and was undertaken by Ms Christine Bowman, regulation inspector. A decision had been made since the previous site visit that the people living in the home would no longer be known as ‘tenants’, but as ‘service users’. This term will therefore be used throughout the report when referring to the six young adults currently residing at the home. A floating support worker and one service user, who was about to leave to do voluntary work for a charity, were at home when the site visit commenced. One service was out in the community engaging in therapeutic work, another service user was on holiday in Cornwall, a third was in France taking a holiday with his family and two service users were taking an annual holiday at a holiday camp in Bognor Regis accompanied by two staff members. They returned in the afternoon looking happy and indicating they had, ‘had a good time.’ The registered manager, Mr Lee Mather, was interviewed in the afternoon and policies, procedures and records including two service user files containing their care plans were viewed. One service user kindly led a tour of the shared accommodation and allowed their room to be viewed before being collected by relatives to spend the rest of the day with them. Other service users and staff were observed and spoken with throughout the day and staff recruitment and training records were inspected. Five service users, two care managers, two relatives/carers and one General Practitioner completed comment cards and comments from these sources have been included throughout the report. Thanks are offered to the management, the staff and service users of York Lodge for their assistance and hospitality on the day of the site visit and to all those who completed comment cards for their contribution to this report. What the service does well: The service is very good at making sure the service users have person-centred plans covering all their assessed needs and which they are involved in drawing up. The person-centred plans were excellent, illustrated with photographs and described in words was a holistic plan of care for an individual whose likes and dislikes were thoroughly explored. Those things, which meant the most to the individual, were described in full in their own words and any support needed to bring those wishes to fruition was described. York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 6 Some of the comments service users made about the service included, ‘I like it at York Lodge, I like having more freedom over my own life,’ ‘I’m happy here,’ and, ‘ I’ve been at York Lodge for quite a long time and I like the freedom to go out on my own and that I can stay out late.’ The home had strong links with the local community and made good use of the facilities and resources available and the service users had a full programme of activities based on their individual needs and choices. The service was very good at supporting the service users to achieve their full potential, by enabling them to develop the life-skills necessary to become as independent as their individual potential would allow them to be. A service user, who was interviewed stated, ‘I am getting much more independent by living here, before I wasn’t able to take any risks. I really like learning to manage my own money, use public transport and do my own food shopping.’ The provision of training for the staff was good, ensuring they are well prepared for carrying out the caring role by providing a thorough induction programme, full mandatory and specialist training to meet the needs of the service users. A staff member spoken with stated that, ‘Wellmede were very good at providing training’. They stated that, ‘ they do not just provide the mandatory training, which all staff must complete, but also a wide variety of specialist training’. They stated that they had recently accessed a course on autism. Observations of the staff working with the service users confirmed they understood their needs well and treated them with respect and dignity. A health care professional stated in a comment card with respect to what the service does well, ‘the staff are extremely supportive and will ensure that where possible they meet the individuals needs.’ What has improved since the last inspection? The Licence Agreement drawn up for a service user, who had taken up residence at the home since the previous site visit, was in a ‘user friendly’ format. A record was kept of meals taken by service users. Independence with respect to taking responsibility for their own food was an important step service users are taking towards supported living and which empowers them. Adult education cookery classes had been introduced and advice and support with respect to meal planning, budgeting, and the constitution of a well-balanced and nutritious diet were always available from the staff, who were ready to intervene with respect to health issues should the need arise. Improvements had been made to the bathrooms by the installation of appropriate extractor fans had been to curb the condensation problems experienced at the previous site visit. The damaged bath panel had also been repaired making the bathrooms more pleasant for the service users. York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 7 Since the previous site visit, the new Common Induction Standards had been introduced and individual training files had been introduced for the staff to confirm they had received the appropriate introductory, foundation and specialist training required to support the service users. A manager, experienced in working with people with learning disabilities had been recruited from within the organisation and registered by the Commission for Social Care Inspection. Since the previous site visit he had obtained the Registered Manager’s Award to ensure he had the appropriate training to ensure the home was run in the best interests of the service users and to provide stability and leadership to the staff team. 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 York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 9 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 York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information available to current and prospective service users gave sufficient information for a decision to be made about the suitability of the home to meet their needs and sufficient information was collated prior to the acceptance of the agreement to ensure the home could meet those needs. Information with respect to fees and extra charges had not been clarified and made available to current and prospective service users in the service user guide. EVIDENCE: The home had a Statement of Purpose containing all the information a potential service user would need to make a decision about the suitability of the home to meet their needs. Information with respect to the Commission for Social Care Inspection had been amended as recommended at the previous site visit. Colour photographs of the interior of the house including the lounge, kitchen, dining room and an example of a bedroom were included. The garden was also well illustrated showing a large mature and attractive area laid to grass, shrubs and trees and at the rear was an outdoor eating space with tables, chairs and a bar-be-cue. The manager confirmed that the service users with mild to moderate learning disabilities would be able to access the language used in this document. The Service Users Guide had been created by York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 11 the current service users themselves and contained good illustrations, some copies of artwork produced by the service users, photographs, diagrams, pictures, symbols and short sentences to describe the important aspect of the home from their point of view. It was printed on brightly coloured paper. The recently reviewed complaints procedure, also produced by the service users, was in black and white with photographs and symbols, short sentences and gave clear guidance on the process. The information with respect to fees, brought into force in September 2006, had not yet been included in the Service User Guide to clarify the cost of the standard service offered and extra charges. Four of the five service users, who completed comment cards confirmed that they were asked if they wanted to move to the home and the fifth service user couldn’t remember. 100 of the service users stated they received enough information about the home before they moved in to decide if it was the right place for them. Comments included, ‘I had visits before moving in,’ and ‘I had a look round and stayed for two nights before I moved in.’ The initial assessment form required information with respect to ethnicity, religion and communication needs to promote equality and diversity and the referrals and selection guidelines were very clear about following the Wellmede equal opportunities policy and giving equal consideration to referrals regardless of sex, sexual orientation, colour, race, nationality, or ethnic or national origin, religion or appearance. Two service user files were inspected and both contained care management assessments and care plans. Standard 5 was not inspected, but a requirement had been made at the previous site visit for License Agreements to be updated to reflect the agreement between ‘service users’ and Welmede and reflect accurately any additional charges. The manager stated that this was under review and would be completed within the next twelve months together with a user-friendly version of the agreement. The manager confirmed that insurance cover for the service user’s furniture and other assets was included in the house contents insurance. A license agreement viewed on a service user’s file was symbolised for easy access by the service user and also signed to confirm involvement. York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 12 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 6,7,9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Excellent person-centred planning, regular reviews, consultation with the service users and their representatives and appropriate formats ensure the individual’s changing needs, goals and aspirations are set out in a way that is meaningful to them and achievable. Key worker support, house meetings and self-advocacy assist service users in making decisions about their lives. Service users are supported to develop independence skills and encouraged to become more self-sufficient and confident by balancing the positive value of taking risk with the potential risk of harm. EVIDENCE: The care plans of two service users were inspected. They were person-centred and signed to confirm the involvement of the service users and their representatives in the care planning process. Reviews involving the service user and their key workers had been recorded every three months to ensure their changing needs were reflected. The person-centred plans were excellent, illustrated with photographs and described in words was a holistic plan of care York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 13 for an individual whose likes and dislikes were thoroughly explored. Those things, which meant the most to the individual, were described in full in their own words and any support needed to bring those wishes to fruition was described. The service users’ rights to make their own decisions and choices were reflected in their person-centred plans. Regular house meetings, the minutes of which had been recorded, provided evidence of service users making choices and decisions with respect to the home. Five of the six service users, who returned comment cards confirmed they always made decisions about what they did each day and one service user thought they usually did apart from having a scheduled day for doing the housework. External meetings were arranged for service users to attend facilitated by an independent advocate. A service user interviewed stated that he liked to attend the self-advocacy group meetings organised by Wellmede. Risk assessments showed that high priority was given to the safe attainment of self-help and life skills supporting the service users to gain the independence required in some cases to move on to supported living. One service user was in the process of making this move. Another service user, who was interviewed stated, ‘I am getting much more independent by living here, before I wasn’t able to take any risks. I really like learning to manage my own money, use public transport and do my own food shopping.’ York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 14 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 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities are available for service users to participate in full and satisfying individual lifestyles, accessing the local community, maintaining important relationships and living ordinary lives. Daily routines of the home promote service user’s independence and their rights and responsibilities are respected. Independence with respect to taking responsibility for their own food is an important step service users are taking towards supported living and which empowers them. Advice and support with respect to meal planning, budgeting, and the constitution of a well-balanced and nutritious diet are always available from the staff, who intervene with respect to health issues should the need arise. EVIDENCE: Person Centred Plans confirmed that service users were involved in a wide variety of activities. One service user did voluntary work for a charitable organisation; another continued to work in paid employment, which they had been involved in prior to moving to the home and adult education was also York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 15 accessed. One service user attended pottery and cookery classes at an adult education centre. A variety of transport was used and service users spoke of using public transport, buses and trains (a railway station was nearby), taking a taxi and being transported by the staff. Some service users were eligible for free bus passes, the manager stated. The home did not have its own transport, but staff members were insured for business purposes to use their cars when necessary, the manager stated. Minutes of service user meetings confirmed that staff accompanied service users in the community, but when taking meals out, the service user was expected to pay for the staff meals from their allowances. This must be made clear in the service user guide and in the license agreement, however, as the staff are employed by Wellmede and not by the individual service users, accompanying service users, as part of their duties should not incur extra costs for the service users. Some of the leisure activities referred to in person-centred plans included attending football matches, being a member of a snooker club, attending sportability, self-advocacy group, spending time at the betting shop and planning and enjoying annual holidays. ‘Wellmede have an amenity fund’, the manager stated, ‘and access to a yearly allowance is dependent upon the level of savings accrued by the service user. If the staff accompany service users on their annual holiday or trips, the service user is required to pay their expenses from this allowance’. This information should also be included in the Service User Guide and the license agreement. A service user, who was interviewed, stated that the best thing about living at the home was the freedom to choose what to do and where to go. He stated that the staff were supportive and helped him with budgeting, when food shopping, and to access public transport. At weekends he liked to go out for pub meals and in the summer months bar-b-cues were held at various Wellmede homes and the service users all socialised. One service user was waiting to be collected by his sister to visit his mother, which he said was a regular occurrence, and he enjoyed taking the dog out for a walk. He stated he was in regular contact with his family over the telephone and also had visits on Sundays. 100 of the service users who returned comment cards confirmed they could do what they wanted during the day, in the evening and at the weekends. Some of the comments added included, ‘I am able to decide what I want to do and the staff help me if I need it,’ ‘I can have friends over to visit me, usually at weekends,’ and ‘I like to do shopping at the weekends and see my friends in the evenings.’ Independence with respect to taking responsibility for their own food is an important step service users are taking towards supported living and which empowers them. Advice and support with respect to meal planning, budgeting, York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 16 and the constitution of a well-balanced and nutritious diet are always available from the staff, who intervene with respect to health issues should the need arise. Educational courses had been sought to support the service users in learning about healthy diet and balanced meals. A health care professional stated in a comment card, ‘York Lodge have been extremely supportive of activities my client wishes to do and also of his choice to move to supported living.’ York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 17 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 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are consulted with respect to the personal support they receive to maximise their independence. Health action planning ensures needs are regularly monitored and access to primary and specialist health care services are planned according to individual need. Service users are protected by safe medication procedures and risk assessed and supported to self medicate when this is appropriate for the individual. EVIDENCE: The service users were physically quite independent so did not require intimate personal support. Personal support recorded in Person-centred Plans included support with respect to budgeting, meal planning, holiday planning, keeping bedrooms clean and tidy, accessing health professionals and support with respect to self-medication. It was clear from the plans that they had been developed to ensure the individual had been consulted and their preferences recorded. The staff provided flexible support to maximise the service users independence and control over their own lives. All service users had a designated key worker. York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 18 Service user’s files inspected contained Health Action Plans showing what action needed to be taken to ensure the service users remained healthy. There was evidence of involvement of health professionals including General Practitioners, dentist, optician, community nurse, psychologist, chiropodist and physiotherapist. Check up dates were recorded and new dates entered when appointments had been attended. Comprehensive records were kept to inform the staff and enable them to provide the required support. A health care professional commented, ‘They provide support to arrange and attend relevant appointments.’ Medication was obtained from a local pharmacy in a monitored dosage system and was stored securely in a metal cabinet. Staff training logs viewed showed evidence of training in the administration of medication and policies and procedures were available to provide instruction to the staff. For service users, who were self-medicating, risk assessments were in place and regular tablet counts conducted and recorded as a check that instructions had been followed safely. Three notifications had been made to the Commission for Social Care Inspection since the previous site visit with respect to self-medication drug errors and the home had responded appropriately, seeking immediate medical advice and reviewing the risk assessment. A comment card from a health care professional stated, ‘York Lodge have supported my client to administer his own medication, however, when medication discrepancies have occurred, they have acted immediately and in an appropriate manner. York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 19 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 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The promotion of self-advocacy, a key worker system, service user meetings at the home and regionally and an accessible complaints procedure support the service users to make their views known and feedback confirms they feel their views are listened to and acted upon. Policies, procedures and training are in place to ensure the staff are wellinformed to protect the service users from abuse and neglect. EVIDENCE: The complaints procedure had been produced with the service users from the East Surrey Area group of Welmede homes. The procedure was illustrated with symbols and photographs and used large print and short sentences to facilitate understanding and accessibility by those with communication difficulties. It gave examples of some of the issues people had complained about and included the current details of the Commission for Social Care Inspection (CSCI) to enable anyone, who might wish to take a complaint further or address a new complaint via this route, to do so. 100 of the service users who returned comment cards confirmed they knew who to speak to if they were not happy and indicated they would speak to members of staff, key workers, the manager or the service manager. They also confirmed that they knew how to make a complaint. There were no recorded complaints since the previous site visit and the CSCI had not received any complaints with respect to this service. Systems, including the allocation of key workers to service users, frequent reviews attended by professional, service user meetings both in the home and regional and the promotion of self-advocacy provide many York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 20 opportunities for the service users to be listened to and have their views acted upon. The ‘Safeguarding Adults’ team had taken up no referrals, but the record of contact indicated that the manager had referred two situations for further investigation, one of which had involved the police. The manager stated that he had been trying to access the local authority ‘Safeguarding Adults’ training, but had not yet been successful. He stated that he would persist until a place was available. A copy of the local authority ‘Safeguarding Adults Procedures was held at the home to inform the staff with respect to making referrals. The staff whose training documentation was viewed had received training in the Protection of Vulnerable Adults. York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 21 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 24,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides suitable accommodation appropriate to the needs of the current service users. The service users are at risk of cross-infection by the communal use of towels in toilet areas. EVIDENCE: A partial tour of the home was undertaken and all the shared accommodation was viewed. The lounge was carpeted and well furnished with comfortable armchairs and sofas, occasional tables, display cabinets and large flat screen television and DVD and VCR. There was a second sitting room, which had been the smoking room, but since the home had become a no-smoking environment, service users who liked to smoke had to do so outside. The kitchen was well equipped, having two cookers, plenty of storage space both in cupboards and in refrigerators and freezers. Service users were allocated space and supplied with containers in which to store their food. Displayed on the wall was a poster illustrating the components of well-balanced meals pictorially to assist the service users in the planning of their own meals. There was a York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 22 spacious dining room with a large solid dining table. This room also had a television and some comfortable seating. There was an outdoor table and chairs and a bar-b-cue on the terrace and one service user stated that all the service users of the other Welmede homes come over in the summer and everyone socialises together. Standards 25,26,27 and 29 were not fully inspected, but the progress made on requirements from the previous site visit was followed up. The cracked bath panel observed at the previous site visit had been repaired and the condensation problems had been resolved by the installation of appropriate extractor fans. Service user bedrooms viewed were not clean and tidy, however, annual holidays were in progress and the staff confirmed that service users take responsibility for keeping their rooms clean and tidy but staff support is given once each week. ‘Service users keep the keys to their bedrooms and the staff only access them with permission’, a staff member stated. A service user was observed using his key to access his bedroom. Discussions with the manager had taken place at the previous site visit with respect to the need to review infection control risks in communal toilets and bathrooms. Specifically hand towels shared by ‘tenants’ for drying hands after hand washing following use of the toilet. Although paper towel holders were fitted in these areas provision was not made of paper towels. The situation had remained the same and the manager supported the decision by ascertaining that the hand towels provided a more domestic ambiance to the home. He was strongly advised to review the situation again with respect to infection control risks. The home had a dedicated laundry room equipped with washing machines and dryers and a service user confirmed they do their own washing. It had a door leading to the garden and a rotating washing line was also available. 100 of the service users who returned comment cards confirmed the home was always fresh and clean and one service user commented, ‘All of us take a turn to keep the house clean.’ York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 23 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 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Excellent preparation for the caring role and the provision of a full training programme supplies the staff with the skills to support the service users competently and effectively, but shortfalls in the recruitment processes leave them at risk. EVIDENCE: Staff personnel files confirmed the organisation was committed to professionalizing the workforce by ensuring the induction for newly recruited staff followed the ‘Skills to Care’ guidance and that all the mandatory training was accessed in induction. 100 of the staff had achieved National Vocational Qualifications at least at level 2 and others at level 3. The organisation had a system of Floating Support, which meant that a number of experienced staff could be deployed to supply targeted one-to-one support to service users in a number of homes, in addition to the home’s permanent staff. The floating support staff member was working alone at the time of the site visit due to holidays being taken at the time, and was well-informed with respect to the running of the home and the needs of the service users. York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 24 100 of the service users who returned comment cards confirmed they thought the staff always treated them well and that they always listened to them and acted on what they had to say. ‘In the last twelve months’, the manager stated, ‘a service user was on the interview panel for a senior support worker and there are plans to encourage more involvement although service users have not been very enthusiastic’. The recruitment of two staff members was inspected. ‘Some documents were held at the regional office’, the manager stated, ‘the equal opportunities monitoring forms completed by new recruits and the interview notes were amongst them.’ Records showed that one staff member had taken up employment prior to the receipt of the enhanced Criminal Records Bureau disclosure and there was no evidence of a Protection of Vulnerable Adults First having been carried out. The second reference had also been received three weeks after the date the member of staff had taken up employment. The manager explained that the staff member would have been completing an induction over those three weeks and would not have had contact with the service users. Good records were kept of induction following the ‘Common Induction Standards’, including two units of the Learning Disability Award Framework and the staff member and supervisor had also signed off the organisation’s own induction. Certificates were held on the staff training files for mandatory training including fire awareness, food hygiene, moving and handling, First Aid, Health and Safety, the Protection of Vulnerable Adults, Medication administration and infection control. Other certificates included Person-centred Planning, Dealing with Aggression, Mental Health Awareness, Equal Opportunities, Non Abusive Psychological and Physical Care Skills Intervention, Risk Assessment Theory and NVQ at level one and two. A staff member spoken with stated that Wellmede were very good at providing training. They stated that, ‘ they do not just provide the mandatory training, which all staff must complete, but also a wide variety of specialist training’. She stated that she had recently accessed a course on autism. York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 25 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 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good leadership and teamwork, quality assurance checks including consultation with service users, and excellent systems in place with respect to health and safety ensure this home is run in the best interests of the service users. EVIDENCE: The manager had completed the Registered Manager’s Award since the previous site visit and observation confirmed his management approach was open and inclusive. ‘Regular meetings were arranged by the organisation for the managers to share experiences and obtain peer support’, the manager stated, ‘and the service manager also provided support.’ One service user stated, ‘the staff are a very good team and the manager is good. They take me to work on Fridays.’ York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 26 Recorded service user meetings and annual quality assurance questionnaires completed by both service users and their relatives provided feedback and were used to improve the service. Statutory monthly visits on behalf of the provider were also carried out and copies of these reports were available in the home. The home was due to commence the implementation of a new Quality Audit self-assessment tool later in the month, the manager stated. Excellent systems were in place with respect to health and safety. Daily, weekly, monthly and annual recorded checks were in place, which were undertaken by the staff on duty to ensure the safe running of the home. Mandatory training with respect to health and safety had been accessed by the staff whose records were viewed, including, fire awareness and safety, risk assessment, food hygiene, moving and handling, First Aid and infection control. Certificates confirming the servicing of electrical and gas appliances had taken place in a timely fashion were sampled. York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 27 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 X 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 4 33 X 34 2 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 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 3 X 3 X X 3 X York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5(1)(bb)(bc)(bd) Requirement The service user guide must clarify the fee for the standard provision of services and any extra costs. For POVA/First checks to be carried out on staff taking up post prior to receipt of CRB Disclosures and for evidence of these checks to be held on personnel files in the home. This requirement had not been complied with within the timescale of 29/01/06 For compliance with CRB policy regarding recording, storage and disposal of CRB Disclosures. This requirement had not been complied with within the timescale of 29/02/06 DS0000013847.V338997.R01.S.doc Timescale for action 27/07/07 2. YA34 19(1)(a)Sch2.2 27/07/07 3. YA34 19 Sch 2.2 27/07/07 York Lodge Version 5.2 Page 29 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 YA30 Good Practice Recommendations Paper towels had not been provided in toilets for hand drying purposes and the manager was strongly advised to review the situation again with respect to infection control risks. York Lodge DS0000013847.V338997.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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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