Care Home: Abbotts Lodge

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What the care home does well Prospective residents are being provided with the information they require, to make an informed choice, as to whether the home is likely to be suitable in meeting their needs. Prospective residents are being provided with the opportunity to visit the home, and stay overnight, before deciding whether the home is likely to meet their needs. Residents admitted to the home have been fully assessed and know that their individual needs will be met. Residents are having their health, personal and social care needs and goals set out in an individual plan of care, and are fully involved in the care planning process. Residents are enabled to participate fully in decisions that affect them and their day-to-day lives in the home. Residents are encouraged and supported to develop an independent lifestyle, with risk assessments being carried out for activities that involve responsible risk-taking. Residents are being assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. Residents are being enabled to participate fully, and to exercise choice and control, in their daily routines and activities. Residents are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Residents` rights and responsibilities are being respected and recognised in their day-to-day lives. Residents are being offered a healthy diet, in pleasant surroundings, and are able to exercise choice and flexibility with meal arrangements.The health, personal and social care needs of residents are being fully met, and their privacy respected. The home has an appropriate and well-publicised complaints policy and procedure in place. Residents and their relatives/friends are encouraged to raise any concerns that they may have. The home`s policies, procedures and practice indicate that residents are being protected from abuse and are living in a safe environment. Residents live in a safe, hygienic and well-maintained environment with access to appropriate and sufficient communal facilities. Residents` rooms are safe, comfortable and pleasantly decorated, being suited to their individual needs. Residents are living in a home that is generally being well managed and run in their best interests, and which provides an open, positive and inclusive atmosphere. The rights and best interests of residents are being safeguarded by the home`s record keeping policies and procedures. Generally, the health, safety and welfare of residents are being appropriately protected. However, some concerns were identified. What has improved since the last inspection? Issues relating to bereavement and loss are being handled with respect, and in accordance with individuals` wishes. Bereavement training has been provided for all staff. What the care home could do better: Generally, residents are being protected by the home`s medication policy and procedures, and by the provision of accredited medication training for all care staff. However, to prevent the possibility of any error from occurring, medication records for residents should include a front sheet that provides the name, date of birth and a photograph of the individual. Generally, residents are having their needs well met by an effective, appropriately trained and qualified staff group. However, a training programme needs to be drawn up for the next 12 months so as to evidence the training that is scheduled for each staff member. Generally, residents are being protected by the home`s recruitment policy and procedures. However, a health declaration form must be put in place so as to evidence the physical and mental health of each applicant. Generally, residents can be assured that their needs are being safeguarded, through staff being appropriately supported and supervised on a regular basis. However, annual staff appraisals must be completed with all staff who work at the home. The home is able to demonstrate that it is obtaining widespread feedback regarding the extent to which the home is supporting residents and meeting its aims and objectives. However, the Home needs to put a Development Plan in place so as to evidence the outcomes for residents and any actions required. CARE HOME ADULTS 18-65 Abbotts Lodge 56 Abbotts Road Cheam Surrey SM3 9TA Lead Inspector Peter Stanley Unannounced Inspection 16th May 2008 09:30 Abbotts Lodge DS0000007166.V363359.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 Abbotts Lodge DS0000007166.V363359.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. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbotts Lodge Address 56 Abbotts Road Cheam Surrey SM3 9TA 020 8395 9052 020 8286 4067 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) Mr Mohamad Hoozeer Mrs Bibi Mahazabine Hoozeer Mr Mohamad Hoozeer Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow one specified service user in the Learning Disabilty (LD) and Dementia (DE) categories to be accommodated until such time as the needs of the person can no longer be met or until such time as the placement ceases. No further admissions of service users outside of the Learning Disability (LD) category may be made. Care staff in the home must undertake training relating to the care and support needs of adults who have dementia. 17th May 2007 2. 3. Date of last inspection Brief Description of the Service: Abbotts Lodge is registered with the Commission For Social Care Inspection (CSCI) as a care home providing care for up to six adults with learning disabilities. The homes Statement of Purpose indicates that it is for adults between 20 and 60 years of age, and who have a degree of independence. The premises are situated off the Sutton/Cheam by-pass (A217). There are local shops and a bus route passes nearby. The home itself is a traditional, domestic family home converted to provide care home facilities. It remains a family home in appearance and given the small number of service users it retains a family atmosphere. There are four single and one double bedroom. One single room on the ground floor has an ensuite toilet and shower. There are the usual care home facilities, these being bathroom, toilets on each floor, a small kitchen, and small laundry area. There is a large store in the rear garden. The home has no office but for a small care home of this size the office arrangements are acceptable. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This key inspection was conducted over one day, and involved discussion with the registered provider and manager, Mr Mohamad Hoozeer. The inspector spoke individually with 2 residents and a staff member on duty. Completed questionnaires were received from 4 residents and 1 relative. There are presently 4 residents living in the home, one long-standing resident having transferred to another home following her family’s move away from the southeast. Information was available from the Annual Quality Assurance Assessment (AQAA). The home’s manager completed this prior to the inspection. The inspector had wide-ranging discussion regarding the home, and examined both staff and residents’ records. These included residents’ care plans, care reviews, risk assessments, health action plans and activity programmes. Staff records included staff rotas, supervision, appraisal and training records. Recruitment records and criminal records checks have been evidenced as satisfactory on previous inspections. However, a health declaration form needs to be put in place so as to evidence the physical and mental health of each applicant. No new staff have been recruited since the last inspection. The inspector examined documentation relating to the day-to-day running and management of the home. This included quality assurance questionnaires and records, policies and procedures and records relating to the logging of any accidents, incidents or complaints (none being recorded). The inspector carried out a full inspection of the premises and completed checks relating to health and safety. Documentation relating to health and safety including the home’s risk assessments, servicing and maintenance certification, were examined. All documentation examined was satisfactory and well maintained and in compliance with the national minimum care standards. This is a small closeknit home, which provides a very homely environment. Feedback from quality assurance surveys indicates that the home is generally well regarded by relatives and professionals. Views expressed by residents and relatives indicates that individuals feel settled and well supported in the home, and able to exercise a fair measure of choice and control in their daily lives. The home has access to a local day centre, and has developed varied opportunities for accessing local amenities and resources. There is evidence from feedback at reviews that residents’ rights are being respected, and that the home is providing an enabling and inclusive home environment. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 6 Of 10 requirements from the previous inspection 9 have now been met and 1 remains outstanding. From this inspection there are a further 7 requirements, (making 8 in total) and 4 recommendations The inspector would like to extend his thanks to the manager, Mr Hoozeer, and to staff and residents, for their assistance in helping to facilitate this inspection. What the service does well: Prospective residents are being provided with the information they require, to make an informed choice, as to whether the home is likely to be suitable in meeting their needs. Prospective residents are being provided with the opportunity to visit the home, and stay overnight, before deciding whether the home is likely to meet their needs. Residents admitted to the home have been fully assessed and know that their individual needs will be met. Residents are having their health, personal and social care needs and goals set out in an individual plan of care, and are fully involved in the care planning process. Residents are enabled to participate fully in decisions that affect them and their day-to-day lives in the home. Residents are encouraged and supported to develop an independent lifestyle, with risk assessments being carried out for activities that involve responsible risk-taking. Residents are being assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. Residents are being enabled to participate fully, and to exercise choice and control, in their daily routines and activities. Residents are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Residents’ rights and responsibilities are being respected and recognised in their day-to-day lives. Residents are being offered a healthy diet, in pleasant surroundings, and are able to exercise choice and flexibility with meal arrangements. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 7 The health, personal and social care needs of residents are being fully met, and their privacy respected. The home has an appropriate and well-publicised complaints policy and procedure in place. Residents and their relatives/friends are encouraged to raise any concerns that they may have. The home’s policies, procedures and practice indicate that residents are being protected from abuse and are living in a safe environment. Residents live in a safe, hygienic and well-maintained environment with access to appropriate and sufficient communal facilities. Residents’ rooms are safe, comfortable and pleasantly decorated, being suited to their individual needs. Residents are living in a home that is generally being well managed and run in their best interests, and which provides an open, positive and inclusive atmosphere. The rights and best interests of residents are being safeguarded by the home’s record keeping policies and procedures. Generally, the health, safety and welfare of residents are being appropriately protected. However, some concerns were identified. What has improved since the last inspection? What they could do better: Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 8 Generally, residents are being protected by the home’s medication policy and procedures, and by the provision of accredited medication training for all care staff. However, to prevent the possibility of any error from occurring, medication records for residents should include a front sheet that provides the name, date of birth and a photograph of the individual. Generally, residents are having their needs well met by an effective, appropriately trained and qualified staff group. However, a training programme needs to be drawn up for the next 12 months so as to evidence the training that is scheduled for each staff member. Generally, residents are being protected by the home’s recruitment policy and procedures. However, a health declaration form must be put in place so as to evidence the physical and mental health of each applicant. Generally, residents can be assured that their needs are being safeguarded, through staff being appropriately supported and supervised on a regular basis. However, annual staff appraisals must be completed with all staff who work at the home. The home is able to demonstrate that it is obtaining widespread feedback regarding the extent to which the home is supporting residents and meeting its aims and objectives. However, the Home needs to put a Development Plan in place so as to evidence the outcomes for residents and any actions required. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Abbotts Lodge DS0000007166.V363359.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 Abbotts Lodge DS0000007166.V363359.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): 1 to 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are being provided with the information they require, to make an informed choice, as to whether the home is likely to be suitable in meeting their needs. Prospective residents are being provided with the opportunity to visit the home, and stay overnight, before deciding whether the home is likely to meet their needs. Residents admitted to the home have been fully assessed and know that their individual needs will be met. EVIDENCE: Prospective residents are being provided with the information they need to make an informed choice. The home has a Statement of Purpose and a Service User Guide. These provide the information listed in the Regulations and National Minimum Standards. The Service Users Guide is produced in a pictorial format making it more comprehensible for service users. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 11 Both the Statement of Purpose and the Service Users Guide have been reviewed and updated, in March 2008. The CSCI contact details do, however, need to be amended to those for the CSCI London Regional Contact Team at Caledonia House. A requirement applies. Following referral, care management assessments, risk assessments and care plans are obtained from the referring agency. The home then completes its own detailed assessment (based on functional performance). The risk assessment format provides a generic assessment of risk and includes assessment of vulnerability, risk-taking, aggression and verbal abuse. This assessment document ensures that all aspects of prospective service users needs are assessed, including all those matters listed in the NMS No.2. The assessment documents are kept with the care plans and service user plans in the service user files. The registered provider/manager, Mr Hoozeer, has outlined the process for any individual who has been referred and assessed, and for whom there is the prospect of a possible placement. He/she is invited to visit the home, to meet residents and staff, and to spend some time looking round and getting the feel of the home. This can then be followed up with an overnight stay before a decision is made, involving consultation with the resident, their nearest relative, and the care manager. Should the admission proceed, then there is a two to three month trial period, prior to an initial review meeting, to decide whether the placement is meeting the person’s needs and is to become permanent. Assessment reports are obtained from psychiatrists and psychologists, with advice being sought as and when required. Feedback from relatives, care managers, and other professionals, from visits and reviews, indicates that there has been positive feedback regarding the home’s capacity to meet individuals’ assessed needs, and in helping to facilitate their independence and personal development. Each resident has a contract provided by the Local Authority. Each resident is also given the home’s own contract, which details conditions of residence and the services to be provided by the home. This has been produced in a pictorial form so as to aid service users’ understanding of its contents. Abbotts Lodge DS0000007166.V363359.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): 6 to 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are having their health, personal and social care needs and goals set out in an individual plan of care, and are fully involved in the care planning process. Residents are enabled to participate fully in decisions that affect them and their day-to-day lives in the home. Residents are encouraged and supported to develop an independent lifestyle, with risk assessments being carried out for activities that involve responsible risk-taking. Residents are being assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. EVIDENCE: Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 13 The home currently has four residents with mild to moderate learning difficulties, one of whom is autistic. One resident has recently transferred to another home following her family’s move away from the south-east. The inspector spoke individually with 2 residents and a staff member on duty. A third resident was present but did not respond verbally to attempts to engage him. He did, however, present as being settled and happy with his environment. Based on his observations, and the views expressed by residents and staff, the inspector was able to establish that the home is providing flexible and focussed support to residents, and to be meeting their individual and collective needs. The ethos in the home is an enabling one, with staff being observed to be encouraging and facilitative in their approach. The inspector examined a wide range of documentation. This included care plans, review minutes and activity programmes. The home has a very homely and caring atmosphere, this being reflected in the attitudes of residents and staff. Each resident who lives in the home has their care plan reviewed at least once every six months, these being updated to reflect any changing needs. This is in accordance with Standard 6.10. This provides a detailed breakdown of residents’ needs and goals and the actions required to meet these, and includes a list of clients’ likes and dislikes. These documents are checked frequently to ensure they remain up to date and relevant, and the manager ensures that each resident has been given a copy of these. The Plan is reviewed with each individual, his/her relative(s)/ representatives and any significant professionals including the care manager and day centre key worker. The inspector examined residents’ care plans and found that these had been reviewed most recently in September 2007 and March 2008. The home is aiming to move towards a more person-centred approach, the care plan format having recently been revised to make this more easily accessible for residents. The home is aiming to complete person-centred care plans for each resident within the next 12 months. A statutory 12 monthly care management review is arranged for each resident. The inspector examined residents’ files, and evidenced that statutory 12monthly care management reviews have now been completed for all four residents, thus meeting a requirement from the last inspection. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 14 The inspector spoke with two of the residents regarding their participation in day-to-day routines and activities. The two individuals attend a day centre and indicated that they have a choice of activities and that they are able to develop their interests. One resident has an interest in computers, which he is able to pursue at the centre, whilst the other resident said that she enjoys knitting and making jewellery. From the views expressed, individuals indicated that they are being well supported by staff and are able to exercise choice in their daily routines and activities. Each resident has an activity programme that is reviewed and updated periodically. Residents are encouraged to be as independent as possible in their day-to-day living and, with the support of their key workers, to be fully involved in making decisions relating to their daily recreation and activities. Care plans and review notes evidence that residents are able to make choices in their day-to-day routines and activities, and are consulted regarding decisions that affect them. Residents are consulted in a variety of ways during their stay in the home. This includes residents’ meetings, meetings with their key-worker, and care reviews. Residents’ views are also canvassed through questionnaires completed for quality assurance purposes. Residents’ meetings are held on a regular, monthly basis. Notes examined indicate that there is open discussion of issues relating to the home, and regarding issues that affect their welfare and interests. Residents are supported to take risks in developing independent skills and abilities. The home completes a wide range of risk assessments covering various aspects of risk and daily living. These are being updated in line with annual review, and more frequently if the need arises. Residents participate in a wide range of activities and are encouraged to access local recreational and shopping facilities. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 15 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): 11 to 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being enabled to participate fully, and to exercise choice and control, in their daily routines and activities. Residents are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Residents’ rights and responsibilities are being respected and recognised in their day-to-day lives. Residents are being offered a healthy diet, in pleasant surroundings, and are able to exercise choice and flexibility with meal arrangements. EVIDENCE: Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 16 The philosophy of the home, as indicated in the home’s Statement of Purpose, is to promote independence and enable residents to develop a wide range of social and independent living skills. Activity programmes and care plans evidence that residents are being provided with opportunities for personal and social development. This includes regular attendance, by 3 residents at a local day centre in Sutton, where there is a varied programme of activities. One resident, who enjoys gardening, works in a garden centre 4 days a week, while another resident is developing his interests in painting and computers. Another resident, who is interested in catering, helps out in the cafeteria at the day centre. The Local Authority provides classes for adults with special needs, which include arts and crafts, pottery, cookery, self-advocacy, and developing independent living skills. Residents also have the opportunity to attend a minigym and participate in physical activities at a local leisure centre. Two of the residents attend a local bowling centre in Sutton, and the home is planning to offer the opportunity for those residents, who are interested, to go swimming. Residents are being encouraged to attend independent living courses and work tester sessions with SCOLA (Sutton College of Learning for Adults), with the aim of obtaining paid employment. The home is aiming to develop its links with career advice, local job centres and employers with view to widening the employment opportunities available. Within the home residents are encouraged to participate and to develop domestic living skills, such as cleaning and keeping their room tidy, cooking (under supervision), setting table, and helping to maintain the garden. There are also opportunities for residents to participate in the local community, to go shopping, attend church and church events, and visit leisure centres. Three service users regularly attend the Gateway Club every Thursday evening where there is the opportunity for social contact with other users and activities including snooker, pool and other games. Occasional discos and other events are also arranged. Residents occasionally go to a local cinema or theatre, and other trips out are arranged. Residents maintain regular contact with residents at a small sister home, and participate in joint events and outings from time to time. A Christmas party was organised. There are occasional day outings, and an annual holiday at a coastal resort. A week’s holiday to Hastings is taking place towards the end of May. The home has its own transport that it uses for day trips and holidays. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 17 The home encourages residents to maintain their family links and friendships both inside and outside of the home. Residents are able to see visitors in the privacy of their own rooms, or to go out and stay with family for day or weekend visits. One resident, who met with the inspector, was about to go home to spend the weekend with his family. Photos of family and pets in his room evidence the close relationships that he has been able to sustain. Feedback from CSCI questionnaires, the home’s surveys and review notes indicate that the home is positively regarded and that friends and relatives are consulted and encouraged to maintain their contact. Views expressed by residents indicated that staff are supportive and caring, and encouraging in their attitudes. The philosophy of the home comes across as being a positive and enabling one, with a person-centred approach being evidenced in the development of residents’ care plans and activity programmes, and in the regular consultation that takes place between the manager, staff and residents. Generally, the evidence indicates that residents are able to exercise a fair degree of choice in their day-to-day lives, and that there is sufficient flexibility in their daily routines with which to develop their interests and social contacts. Views expressed by residents indicate that the food provided is generally good and varied. There is consultation with residents regarding individual preferences and choices, both individually and within residents’ meetings. Individuals are encouraged, if they wish, to assist with preparing sandwiches and light snacks, and to help with laying the table. Residents are encouraged to identify their food and drink preferences, these being noted in their files. Meals can be taken at flexible times to fit in with residents’ individual preferences and their social/recreational commitments. Meals are eaten in an attractive dining area in the conservatory extension. The menus planned over a four-week period offer a balanced, nutritious and varied range of food. Salad, fresh vegetables and fruit are included in the diet. One resident, who is a vegetarian, is provided with vegetarian or fish options. The kitchen area presented as clean and homely, with staff having undertaken training in food hygiene. Regular checks on fridge/freezer and oven temperatures are being maintained. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 to 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of residents are being fully met, and their privacy respected. Generally, residents are being protected by the home’s medication policy and procedures, and by the provision of accredited medication training for all care staff. However, to prevent the possibility of any error from occurring, medication records for residents should include a front sheet that provides the name, date of birth and a photograph of the individual. EVIDENCE: Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 19 The home has a friendly, homely feel with a small staff team, which works in shifts of two with the five residents. Staff observed on the inspection presented as caring and supportive towards the service users, and to be interacting in a positive way. The key worker system provides the opportunity for 1 to 1 support. As detailed in residents’ assessments and care plans, there is a varied range of personal support needs that are being presented. The support offered is provided according to individuals’ needs, wishes and goals. Inspection of care plans, together with observation and feedback provided from reviews, indicates that staff are enabling in promoting independence and are meeting individuals’ wishes and needs. Residents are encouraged to maintain responsibility for their own personal care, hygiene and appearance, with encouragement, prompting or assistance being given where this is required. The healthcare needs of residents are being met in this home. Records indicate that there is regular contact with health care professionals, four residents being registered with a local GP practice. One resident has retained his own GP in accordance with his wishes. There are occasional visits from a Psychiatrist, and periodic 3-monthly contact from a chiropodist. There are also annual dental checks and optician visits to test residents’ eyesight every two years. There is monitoring of residents’ weight, with weight charts being maintained, and, where appropriate, residents are assisted to manage their weight through a “healthy eating” program. The home has an appropriate medication policy and procedures in place. The home uses the Monitored Dosage System for administering medication. All staff have undertaken accredited medication training. A separate record is being maintained for all receipts and disposals of medication. The home’s medication policy has been reviewed and updated, and a section on homely remedies included, meeting a requirement from the last inspection. The inspector examined medication records for the two residents who are presently taking medication. None have been assessed as being able to selfadminister. The home maintains MAR sheets for administering medication. These were checked and found to be in order. The home has received an annual pharmacy inspection, no concerns being recorded. A recommendation from the previous inspection has not been acted upon. Given the need to ensure safe practice with the administration of medication, this is made a requirement. To prevent the possibility of any error from occurring, medication records for residents should include a front sheet that provides the name, date of birth and a photograph of the individual. Whilst there have been no deaths since the home was opened in 1996 a number of family members close to residents have died. All staff have now Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 20 received training in loss and bereavement, this having taken place with LB Sutton on 12 June 2007. This has provided the opportunity for staff to support residents in their understanding of serious illness and death. The wishes of each resident regarding the eventuality of their terminal illness or death does, however, need to be recorded. This should ideally involve the nearest relative, or an advocate. A recommendation applies. A recommendation from the last inspection remains to be implemented. The wishes of each resident, regarding the eventuality of their terminal illness or death, should be recorded on their file. This should involve the nearest relative or representative, or an advocate. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an appropriate and well-publicised complaints policy and procedure in place. Residents and their relatives/friends are encouraged to raise any concerns that they may have. The home’s policies, procedures and practice indicate that residents are being protected from abuse and are living in a safe environment. EVIDENCE: Any complaints or concerns are detailed in a complaints log. No complaints have been recorded since the last inspection on 17/05/07. The complaints procedures and information given to residents and their relatives is up to date, and comprehensive, providing details as to how, and to whom they should complain. Residents are assisted to understand the complaints procedure, with access to their care manager being arranged should grounds for making a complaint against the home arise. Independent advocacy, and/or support with communication, can be arranged if this is required. No allegations of abuse have been recorded since the last inspection. The home has a whistle-blowing policy, and a copy of the Local Authority’s Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 22 Protection from Abuse policy, which has been integrated into the home’s procedures manual. All staff are expected to be familiar with these policies, a copy of the policy and procedures being kept in the staff room. The registered manager has confirmed that all staff are being provided with a summary of the home’s procedures for the protection of vulnerable adults, and that all staff members (including one new staff member) have completed Sutton’s multiagency Safeguarding Adults training. As part of the inspection, a thematic probe on safeguarding issues was carried out. This involved gaining information about the Home’s safeguarding procedures, and the implementation of these in practice. The inspector asked a number of questions of the registered manager (and provider), Mr Hoozeer, regarding the safeguarding adults policy and procedures, how these are translated into practice, and the training made available for staff. On the basis of the responses received, the inspector was satisfied that the manager demonstrated the necessary knowledge, awareness and understanding of safeguarding issues. The inspector also spoke with a staff member recruited within the last 12 months. She was able to evidence relevant knowledge and training, and an understanding of the procedures to follow should an incident of abuse become apparent. The inspector also spoke with two residents who both indicated that they felt safe and secure living in the home, and would know who to speak to should any anxieties or concerns arise. The inspector spoke to residents regarding their day-to-day lives in the home, and noted that residents feel settled and safe, and that they have trusting relationships with staff. The inspector observed that staff are caring and respectful towards residents, and that the home has a good family atmosphere. No concerns were identified. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 to 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, hygienic and well-maintained environment with access to appropriate and sufficient communal facilities. Residents’ rooms are safe, comfortable and pleasantly decorated, being suited to their individual needs. EVIDENCE: This is a small home is an ordinary domestic dwelling that has been enlarged to provide care for up to six residents. The home is generally well maintained, and is in a good decorative state, with residents having access to safe and comfortable facilities. Double-glazing has been fitted to the bathroom, toilet and landing windows, helping to create a quieter environment. The lounge and adjoining conservatory have had light coloured wooden flooring laid down, and a new roof, creating an extended dining and living area. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 24 The inspector completed a tour of the premises, no health and safety concerns being identified. The home presents as clean, hygienic and comfortable throughout, and to be meeting the needs of the home’s residents. Residents presented as settled and comfortable in their surroundings, and the environment was observed to have a very ‘homely’ feel. The residents in this home are younger adults between 25 and 55 years of age and are reasonably mobile. The inspector engaged with residents and found them to be happy and settled in their environment. Individuals indicated that they are happy with their rooms and with the facilities provided. One resident showed the inspector her new room, which has been re-decorated and personalised with her photos and cuddly toys. Residents assist in various ways with practical domestic tasks, helping to keep their rooms clean and tidy, and in helping to look after their home. There are four single bedrooms, and one double bedroom, which has been rearranged and refurnished to create a single bedroom and living area. Each bedroom is decorated according to the individual’s choice and includes the required furniture and fittings. Rooms are pleasantly decorated and arranged, and reflect residents’ individual identities. The quality of décor, furnishings and facilities throughout the home is generally of a high standard, and is homely in character. The home has two toilets for residents, plus a toilet for the use of kitchen staff. There is a shower and a bathroom, while one single room has ensuite facilities. All these facilities have suitable locks and afford service users privacy. The home’s bathroom and toilet facilities appear to be meeting the current service users needs. The home has a small laundry that is adequate for the purpose. The home presents as safe and well adapted to the needs of the current residents, all of whom are able to mobilise freely around the home. The home has a risk assessment in place, and each resident is risk assessed on admission. Apart from emergency call systems, bath seats and rails, the current residents do not require any specialist adaptations or aids, and are able to move freely around the premises, including the ground and first floors, and the front and rear gardens. There is a small, pleasant garden to the rear of the house that residents can easily access from the dining area, and a patio with garden furniture where residents can sit and enjoy the garden. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 25 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): 31 to 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally, residents are having their needs well met by an effective, appropriately trained and qualified staff group. However, a training programme needs to be drawn up for the next 12 months so as to evidence the training that is scheduled for each staff member. Generally, residents are being protected by the home’s recruitment policy and procedures. However, a health declaration form must be put in place so as to evidence the physical and mental health of each applicant. Generally, residents can be assured that their needs are being safeguarded, through staff being appropriately supported and supervised on a regular basis. However, annual staff appraisals must be completed with all staff who work at the home. EVIDENCE: The home has an induction programme in place, which new staff members must complete over their first six weeks of working in the home. An induction Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 26 checklist to evidence the induction training that each new staff member undertakes has been put in place. The inspector spoke with a recently recruited staff member and evidenced that she had completed the induction programme. Staff are encouraged to obtain their NVQ qualifications. 70 of the staff have obtained their NVQ Level 2, while one staff member has an NVQ Level 3. Staff undertake ongoing training and staff development, with evidence on staff files of relevant staff having obtained the necessary qualifications, skills and experience with which to deliver the services and care that the home aims to provide. There is a programme of training for staff that includes safeguarding adults training and recent courses in epilepsy awareness and bereavement & loss. Refresher courses have been held in fire safety, food hygiene, medication, and health & safety. Training has also been held in Person Centred Planning. Previous courses attended include learning disabilities, autism and challenging behaviour. The inspector recommends that a training programme is drawn up for the next 12 months so as to evidence the training that is required for each staff member and the training and dates that have been scheduled. The inspector spoke with a staff member on duty. This indicated that the staff member (who has been working in the home for about a year) felt that she had been well supported in her role, and that she had been provided with the necessary induction and training opportunities for developing her knowledge and skills. Having come from a hospital-based nursing background, she found the transition to a more enabling and person-centred approach to have been rewarding, and felt that she had been positively assisted by the training, supervision and support that she has received. Staff are observed to be caring and enabling in their interaction with residents, and demonstrate good communication and inter-personal skills. Interactions observed between staff and residents on this, and previous inspections, have been generally very positive, with individual residents indicating that they feel well supported and enabled by staff to develop their daily living skills. The home has satisfactory recruitment policy and procedures in place. These are based upon sound equal opportunity principles, and with the safety and well being of residents in mind. No new staff members have been recruited since the last inspection on 17.5.07. However, a health declaration form must be put in place so as to evidence the physical and mental health of each applicant. A requirement applies. The inspector examined a sample of staff supervision files. This evidenced that staff are receiving regular two-monthly one-to-one supervision. The Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 27 supervision format has been revised so as to provide a fuller record of the issues raised and actions/decisions agreed. There are two requirements in regard to appraisals, one of which is unmet from the previous inspection. Whilst there is an appraisal process, the inspector found that appraisals had not been completed for three out of four staff whose files were inspected. An appraisal must be completed every 12 months for each staff member. A requirement applies. The appraisal must review a staff member’s performance against their job description, and agree development and learning objectives for the year ahead. An appraisal preparation form, for each staff member to self-evaluate their own performance and training/development needs has yet to be developed. This is an outstanding requirement from the last inspection. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 to 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are living in a home that is generally being well managed and run in their best interests, and which provides an open, positive and inclusive atmosphere. The home is able to demonstrate that it is obtaining widespread feedback regarding the extent to which the home is supporting residents and meeting its aims and objectives. However, the Home needs to put a Development Plan in place so as to evidence the outcomes for residents and any actions required. The rights and best interests of residents are being safeguarded by the home’s record keeping policies and procedures. Generally, the health, safety and welfare of residents are being appropriately protected. However, some concerns were identified. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 29 EVIDENCE: The registered provider and manager, Mr Hoozeer, has had 14 years experience in caring for adults with learning difficulties including several years at senior level. He has a Nursing qualification, and has a level 4 NVQ Management qualification. The home has been registered in his name since 1996. The evidence from this inspection indicates that the home is being managed in a caring, competent and professional way. The atmosphere in this small group home is evidenced as being open, positive and inclusive. Views expressed by residents indicates that they like the home, that it is being managed in a way that meets their needs, and that they are consulted and involved in making decisions that affect their day-to-day living and routines. Staff have said that they like working in the home, that they feel supported in carrying out their duties, and that they are being provided with relevant induction, training and supervision. No concerns were expressed. The home has been developing its quality assurance processes and has canvassed the views of residents, relatives/friends, and staff, though no responses have been received from care managers or health professionals. The questionnaire for residents has been designed using pictures and symbols to assist communication. Responses from the surveys have been collated and analysis sheets completed. However, a Development Plan for 2007-08 could not be evidenced and needs to be put in place. The plan must include the results of surveys with residents, relatives and other stakeholders, and assess the extent to which the aims and objectives of the home are being met. Actions to address any shortfalls or deficiencies must be identified. As detailed in Regulation 24(2), the Development Plan must be published and made available to service users, their relatives and representatives, and other interested parties including the CSCI. A requirement applies. The rights and best interests of residents are being safeguarded by the home’s record keeping, with generally comprehensive, up to date and accurate records being maintained. Staff and residents’ files were found to be generally satisfactory and well maintained. The home has a comprehensive range of policies and procedures. These were last reviewed in October 2007, a requirement from the previous inspection having been met. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 30 The inspector completed health and safety checks with updated certification having been provided for fire inspection, and the emergency call system (4/08), gas (4/08), (3-yearly) electrical installation (11/06) and portable electrical appliances (11/07), and environmental health (5-yearly, last completed 12/03). Test of the water supply for legionella was completed in July 2007, meeting a requirement from the last inspection. The inspector checked logs and evidenced that fire alarm checks are being completed on a weekly basis, with monthly checks of emergency lighting and call systems. Fire drills are being carried out a monthly basis. The inspector recommends that there is at least one fire drill in the evening or at night every 6 months. Risk assessments for Fire Safety were last updated in February 2008. However, the Health & Safety risk assessment has not been reviewed since 2 May 2007 and is overdue for review. A requirement applies. The home has completed a Business Plan for 2008. However, audited accounts for the year 2006-07 need to be evidenced. The registered provider and manager advised that these have been completed. A requirement applies. Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 31 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 2 2 3 3 3 4 3 5 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 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 2 3 3 3 2 3 3 2 2 Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes 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 6(a) & (b) Requirement Information The CSCI contact details included in the Statement of Purpose, Service user Guide, the complaints procedure, adult protection procedures and all other documentation, needs to be amended to those for the CSCI London Regional Contact Team at Caledonia House. 2 YA20 12(1)(a), 13(2) Medication records. To prevent the possibility of any error from occurring, medication records for residents should include a front sheet that provides the name, date of birth and a photograph of the individual. 3 YA34 19(1)(b), 19(4)4), 19(5)(c & d) Schedule 2, No. 6 Recruitment checks A health declaration form must be put in place so as Version 5.2 Page 33 Timescale for action 31/07/08 31/07/08 31/07/08 Abbotts Lodge DS0000007166.V363359.R01.S.doc to evidence the physical and mental health of each applicant. 4 YA36 12(1)(a)(b), 18(2) Staff appraisal Staff appraisals must provide full information regarding personal, training and development objectives for the year ahead. A pre-appraisal preparation form must be developed, and completed by the appraisee prior to the appraisal meeting. This should enable the appraisee to identify his/her strengths and weaknesses, and those areas where he/she feels that support and training are required. Requirement not met from previous inspection. Timescale extended. 5 YA36 18(1) & (2) Staff appraisal An appraisal of each staff member must be completed at least once every 12 months. Appraisals must be completed for 2007-08, and thereupon at least every 12 months. 6 YA39 24(2) Quality assurance. The registered manager must put a Development Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 34 31/07/08 31/07/08 31/07/08 Plan in place for 2007-08. The plan must include the results of results of surveys with service users, relatives and other stakeholders, and assess the extent to which the aims and objectives of the home are being met. Actions to address any shortfalls or deficiencies must be identified. The Development Plan must be published and made available to service users, their relatives and representatives, and other interested parties including the CSCI. 7 YA42 13(4)(a) & (c) Health and safety. The Health & Safety risk assessment has not been reviewed since 2 May 2007 and is overdue for review. 8 YA43 28(2)(a) Financial viability. A set of audited accounts for the year 2006-07 needs to be evidenced. 31/07/08 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 35 1 YA6 Person-centred care plans. The home is aiming to move towards a more personcentred approach, and needs to complete person-centred care plans with each resident. 2 YA21 The wish of each resident regarding the eventuality of their terminal illness or death needs to be recorded. This should ideally involve the nearest relative, or an advocate. The inspector recommends that a training programme is drawn up for the next 12 months so as to evidence the training that is required for each staff member and the training and dates that have been scheduled. The inspector recommends that there is at least one fire drill in the evening (or at night) every 6 months. 3 YA21 4 YA42 Abbotts Lodge DS0000007166.V363359.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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