Care Home: Allswell Lodge

Similar services:

• Ashlong House
• Norbury Crescent (30)
• Edenvale
• Wadham Avenue
• Chatsworth Care - Dawson House
• Cowden Road, 52 - 54
• Chatsworth Care - Tudor Lodge
• Foxley Lane (121a)

What the care home does well Feedback received from a number of care managers who represent the majority of people placed at the home were very positive about the standard of care provided at Allswell Lodge. Typical comments included "the home is good at taking on board suggestions and advice", "the staff work well as a team, have a good attitude, and an holistic approach to providing care", and "the standard of appearance of both the home and the people who use the service is always very high". Significant time and effort is spent making admission to the home personal and well managed. All new service users receive a full comprehensive needs assessment before admission and information is always gathered from a range of sources including other relevant professionals. Before agreeing admissions the service carefully considers whether or not the home is capable of meeting a prospective service users and if they would be compatible with those already living in the home. Prospective people are always given the opportunity to spend time in the home before a decision to move in is taken. The proprietor has ensured that the physical environment of the home is noninstitutional and provides for the individual requirements of the people who use the service. The living environment is homely, comfortable, clean, and safe. People who use services are encouraged to see the home as their own. It is also a very well maintained, attractive home, with very good access to community facilities and services. As a result of the home`s effective recruitment and selection process and its commitment to training its diverse staff team has a balance of all the skills, knowledge, and experience to meet the needs of the people who use the service. There is also evidence that they demonstrate a thorough understanding of the particular needs of the service users, and can deliver highly effective person centred care. What has improved since the last inspection? We can confirm that as stated in the homes AQAA the management have responded well to the requirements identified in its last inspection report in a timely fashion. All the requirements addressed in the past six months are listed below: All the people using the service have now been supplied with an easy to read contracts that set out their terms and conditions of occupancy, which includes details about the fees, the home charges for services and facilities provided. The management have reviewed the way they report significant incidents to external bodies and staff seem very clear which type of events need to be shared with other professionals. Procedures for receiving prescribed medication into the home have been established and the latest version of the Royal Pharmaceutical Societies guidelines on handling medication in a residential care setting obtained. The people who use the service and their representatives now have access to easy to read versions of the homes complaints policy. Suitable arrangements for the auditing of the homes finances at regular intervals are now in place and the practice of allowing the manager to act as the appointee for people who use the service in exceptional circumstances has ceased. The homes washing machine has been replaced with a new model that has a sluicing programme that is capable of washing soiled laundry at appropriate temperatures.All staff that work at the home have recently received infection control training. Fire drills are now being undertaken approximately once a month thus ensuring all staff who work at the home are involved in at least one every quarter in line with good fire safety guidance. Dead locks fitted to outside gates, which are on fire escape routes have been replaced with more suitable devices that are far easier to open in the event of a fire. All the homes radiators have been assessed and those that present a risk to the people who use the service have been encased. What the care home could do better: All the positive comments made above notwithstanding their remains a number of areas of practice that the home must take urgent action to address in order to improve the lives of the people who use the service: All staff that assist people who use the service to eat their meals must be appropriately trained to perform this task as discreetly and sensitively as possible. Under no circumstances must staff assist people at mealtime`s whist standing up. This will ensure the dignity of the people who use the service is respected. When medication is administered to people who use the service it must be clearly recorded. Staff must be reminded of their medication recording responsibilities. This will ensure that people receive the correct levels of medication. Furthermore, the way in which the service monitors staff compliance with its medication handling procedures should be reviewed as a matter of urgency to minimise the risk of recording errors continually occurring. This will ensure the people who use the service receive the correct levels of medication. The way in which the home obtains the views of people who use the service and their representatives regarding aging and death should be reviewed in order that the death of a person who uses/used the service is handled as the individual would wish. The home should establish a staff expenses policy that clarifies whether or not staff are expected to contribute to their expenses when supporting people who use the service whilst out in the wider community and on holiday. The person in operational day-to-day control of the home should be registered with the Commission as soon as reasonably practicable. This will enable the Commission to determine whether or not the current acting manager is `fit` torun a residential care home for adults with learning disabilities. Furthermore, the role of the proprietor and the new acting manager regarding the day-today running of the service is unclear and should be clarified. A suitably qualified professional must test the homes water heating systems for legionella at regular intervals. This will ensure the safety of people using the service, their guests, and staff. CARE HOME ADULTS 18-65 Allswell Lodge 95 Gander Green Lane Sutton Surrey SM1 2EP Lead Inspector Lee Willis Unannounced Inspection 7th April 2008 11:15 Allswell Lodge DS0000069620.V361383.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 Allswell Lodge DS0000069620.V361383.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. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Allswell Lodge Address 95 Gander Green Lane Sutton Surrey SM1 2EP 020 8642 2896 020 8642 2896 allswell_lodge@btinternet.com 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) Allswell Care Services Ltd Vacant post Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 5 7th November 2007 Date of last inspection Brief Description of the Service: Allswell Lodge is a small property offering accommodation and personal support for five generally ‘middle aged’ adults with learning disabilities. The service currently supports four females and has one vacancy. Judith Conteh is the homes new acting manager having been appointed in January 2008 to replace the former registered manager who resigned in November 2007. The home is close to good transport links and is quite near Sutton town centre, with its good leisure and community facilities. The home also leases a bus and some staff are insured to drive their own vehicles to take people who use the service out - as and when required. This recently converted bungalow is well furnished and suitably adapted to maximise people’s independence. The property has five single occupancy bedrooms all with en-suite toilets and bathing facilities. Communal areas are all located on the ground floor and include a main lounge, separate relaxation room, an open plan kitchen/dinning area, large entrance hall, cloakroom, and laundry. There is also a small office and staff toilet/shower facilities on the first floor. The garden at the rear of the property is well maintained and has been paved over to make it wheelchair accessible. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 5 The home has developed clear information to help people who use the service and their representatives to understand what facilities and services are provided. The service currently charges £1,500 to £2,000 a week for each placement. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The new quality rating for this service is 2 stars. We therefore consider the people who live at Allswell Lodge to experience good quality outcomes. This is a significant improvement on its zero star rating given at its last Key inspection. From all the available evidence we gathered during this key (main) Inspection it was clear the service now has significantly more strengths than areas of weakness. Furthermore, where areas for improvement have emerged in the recent past the service has been particularly good at recognising this and establishing action plans to address shortfalls. We spent four hours at the home. During the visit we met all four of the people who currently reside at the home, the proprietor, the relatively new acting manager, and five support workers. We also looked at records and documents, including the care plans for two people who were chosen to have their cases tracked. The remainder of this site visit was spent touring the premises. We received six ‘have your say’ comment cards about the home. Three were completed by the people who use the service with help from their keyworkers, two by their care managers, and one by an advocate. As part of the inspection process the acting manager also completed and returned an Annual Quality Assurance Assessment (AQAA) to tell us about this service, how it makes sure of good outcomes for the people using it, and any future developments that are being planned. What the service does well: Feedback received from a number of care managers who represent the majority of people placed at the home were very positive about the standard of care provided at Allswell Lodge. Typical comments included “the home is good at taking on board suggestions and advice”, “the staff work well as a team, have a good attitude, and an holistic approach to providing care”, and ”the standard of appearance of both the home and the people who use the service is always very high”. Significant time and effort is spent making admission to the home personal and well managed. All new service users receive a full comprehensive needs assessment before admission and information is always gathered from a range of sources including other relevant professionals. Before agreeing admissions the service carefully considers whether or not the home is capable of meeting a prospective service users and if they would be compatible with those already living in the home. Prospective people are Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 7 always given the opportunity to spend time in the home before a decision to move in is taken. The proprietor has ensured that the physical environment of the home is noninstitutional and provides for the individual requirements of the people who use the service. The living environment is homely, comfortable, clean, and safe. People who use services are encouraged to see the home as their own. It is also a very well maintained, attractive home, with very good access to community facilities and services. As a result of the home’s effective recruitment and selection process and its commitment to training its diverse staff team has a balance of all the skills, knowledge, and experience to meet the needs of the people who use the service. There is also evidence that they demonstrate a thorough understanding of the particular needs of the service users, and can deliver highly effective person centred care. What has improved since the last inspection? We can confirm that as stated in the homes AQAA the management have responded well to the requirements identified in its last inspection report in a timely fashion. All the requirements addressed in the past six months are listed below: All the people using the service have now been supplied with an easy to read contracts that set out their terms and conditions of occupancy, which includes details about the fees, the home charges for services and facilities provided. The management have reviewed the way they report significant incidents to external bodies and staff seem very clear which type of events need to be shared with other professionals. Procedures for receiving prescribed medication into the home have been established and the latest version of the Royal Pharmaceutical Societies guidelines on handling medication in a residential care setting obtained. The people who use the service and their representatives now have access to easy to read versions of the homes complaints policy. Suitable arrangements for the auditing of the homes finances at regular intervals are now in place and the practice of allowing the manager to act as the appointee for people who use the service in exceptional circumstances has ceased. The homes washing machine has been replaced with a new model that has a sluicing programme that is capable of washing soiled laundry at appropriate temperatures. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 8 All staff that work at the home have recently received infection control training. Fire drills are now being undertaken approximately once a month thus ensuring all staff who work at the home are involved in at least one every quarter in line with good fire safety guidance. Dead locks fitted to outside gates, which are on fire escape routes have been replaced with more suitable devices that are far easier to open in the event of a fire. All the homes radiators have been assessed and those that present a risk to the people who use the service have been encased. What they could do better: All the positive comments made above notwithstanding their remains a number of areas of practice that the home must take urgent action to address in order to improve the lives of the people who use the service: All staff that assist people who use the service to eat their meals must be appropriately trained to perform this task as discreetly and sensitively as possible. Under no circumstances must staff assist people at mealtime’s whist standing up. This will ensure the dignity of the people who use the service is respected. When medication is administered to people who use the service it must be clearly recorded. Staff must be reminded of their medication recording responsibilities. This will ensure that people receive the correct levels of medication. Furthermore, the way in which the service monitors staff compliance with its medication handling procedures should be reviewed as a matter of urgency to minimise the risk of recording errors continually occurring. This will ensure the people who use the service receive the correct levels of medication. The way in which the home obtains the views of people who use the service and their representatives regarding aging and death should be reviewed in order that the death of a person who uses/used the service is handled as the individual would wish. The home should establish a staff expenses policy that clarifies whether or not staff are expected to contribute to their expenses when supporting people who use the service whilst out in the wider community and on holiday. The person in operational day-to-day control of the home should be registered with the Commission as soon as reasonably practicable. This will enable the Commission to determine whether or not the current acting manager is ‘fit’ to Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 9 run a residential care home for adults with learning disabilities. Furthermore, the role of the proprietor and the new acting manager regarding the day-today running of the service is unclear and should be clarified. A suitably qualified professional must test the homes water heating systems for legionella at regular intervals. This will ensure the safety of people using the service, their guests, and staff. 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. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 10 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 Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 11 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, 2, 4 & 5 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate, and up to date information. If they decide to stay in the home they and people close to them know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 12 EVIDENCE: The home has developed a comprehensive Statement of Purpose and Service User Guide. As required at the last inspection these documents have both been up dated in the past six months to include all the information people who use the service and their representatives need to know about the home, for example, the Guide now refers to its most recent CSCI inspection report and contains an easy to read complaints procedure. All this information is in a format suitable to the needs of the people who use the service, and their families, for example, appropriate language, colourful pictures, and symbols. The acting manager told us staff explain the Guide to people they keywork. The proprietor then told us the results of the satisfaction surveys she is in the process of distributing among the people who use the service and their representatives would be included in the Guide next time it is reviewed. The acting manager told us she intended to review these documents on an annual basis and up date them accordingly to reflect any changes in provision. The service is highly efficient in obtaining a summary of any assessment undertaken through care management arrangements, and insists on receiving a copy of the care plan before admission, which were made available on request for the two people who care was being case tracked. Furthermore, the home carries out its own needs assessment and it was evident from the information contained in these documents that prospective services users are actively encouraged to be involved in the referral process and their views taken into account. The acting manager told us before agreeing admission the service carefully considers whether or not the home has the capacity to meet the individuals needs and if they would be compatible with all the people currently residing at the home. We commend this new service for ensuring all four of the people currently residing at Allswells Lodge are well matched a process the new acting manager told us she is keen to continue. The acting manager told us the homes two most recent referrals were both given the opportunity to spend time in the home, including tea visits and over nights stays, before design whether or not to move in. As required at the homes last inspection all the people who use the service have now been supplied with written contract to that they and/or their representatives have agreed to and that gives clear information about fees and extra charges. This information is meaningful and is easy to read because the text is illustrated with a variety of coloured pictures and symbols. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 13 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, 7 & 9 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 14 EVIDENCE: It was evident from the two care plans selected for case tracking that they are person centred and are agreed with the individual. The plan is written in plain language, is easy to understand, and looks at all areas of the individual’s life. One support worker spoken with at length clearly had the skills and ability to support and encourage the individual they keyworked to be involved in the ongoing development of their plan. The key and Co-key worker system the home has in place allows staff to work closely with people who use the service on a one-to-one basis. Throughout the morning of the visit staff were observed having one to one sessions with a number of people who used the service to ascertain their views and ensure they were involved in making decisions about how their home was run. The care plan for the homes most recent admission had been reviewed within the first three months of the individuals arrival in accordance with this standard and involved the service user and their representatives, including their relatives, care manager and new keyworker. As required in the home last inspection both the care plans look at in detail contained a far more comprehensive set of risk assessments that covered every aspect of service users lives. These assessments are reviewed regularly. It was evident from the information included in the assessments that the acting manager has a positive approach to management identified risks ensuring people who use the service are able to take responsible risks in order to develop their independent living skills while addressing safety issues. Where limitations are in place, the rational behind such a decision are always recorded. Allswell Lodge DS0000069620.V361383.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): 12, 13, 14, 15, 16, & 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as an individual and the care home is responsive to peoples race, culture, religion, age, disability, and gender. People can take part in age appropriate activities in the local community and staff support them to follow their personal interests. People are able to keep in touch with family, friends, and representatives and the home supports them to have appropriate personal and family relationships. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally wellbalanced meals. However, staff that assist people at mealtimes are not always as discreet or sensitive as they could be and in doing so has compromised service users dignity. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 16 EVIDENCE: Two care managers who completed comment cards about the home told us they felt Allswell Lodge was particularly good at ‘supporting people who used the service to engage in social and leisure activities in the wider community’. 100 of people who completed surveys (with help from their keyworkers) said ‘always’ when asked if they could make decisions about what they did each day including, in the evening and at weekends. We saw a number of instances over the course of this inspection where people who used the service were supported by staff to go out as and when they requested. Staff also seemed to have time to talk and interact with the service users. It was evident from records sampled at random including, the staff duty rosters, care plans, and daily diary notes that staff roles, shift patterns, and weekly activity schedules all take the social needs and wishes of the individual into account (i.e. person centred) and are clearly not task based. During several tours of the building the main lounge area appeared to be the most popular place for people who use the service to congregate. A member of staff told us the people who use the service like to sit in the relaxation room in the evenings. Since the homes last inspection the proprietor has decided to contribute to the cost of annual holidays for people who use the service, which is now reflected in the services Guide and peoples individual terms and conditions of occupancy. The acting manager told us it was agreed at the last staff meeting that keyworkers should start supporting people who use the service to choose holiday destinations for this year. Care plans inspected contained detailed programmes designed to encourage people who used the service to maintain and develop their independent living skills. The acting manager told us all the people who used the service could now access public transport with staff support a skill many of them had never developed at previous placements. It was clear from comments made by staff met that they are committed to ensuring the people who use the service are actively encouraged to maintain and develop their independent living skills. The manager told us the home operates an open visitors policy without restrictions. People who use the service have the opportunity to develop and maintain important personal and family relationships. On arrival staff told us to sign the visitors book and were very security conscious. People who use the service take responsibility for menu planning making sure that they are able to enjoy the food they prefer and like. A pictorial version of the menu is conspicuously displayed on a notice board in the kitchen and staff use photographs to help people who use the service plan and choose the meals Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 17 they eat. A record of the food actually eaten showed people who use the service have the option to choose an alternative meal other than the one advertised on the published menu each day. The menu is varied and the lunchtime meal served on the day of this inspection was nutritionally well balanced and appeared to ‘go down well’ with the individuals using the service. All four service users sat together at lunchtime around a large table in the open plan kitchen/dinning area. The atmosphere was extremely congenial and relaxed. For those individuals who need support during mealtimes, staff in the main give appropriate assistance allowing individuals the time they need to finish their meals comfortably. However, a member of staff was observed standing up to assistant a service user eat their lunch. This practice was not particularly discrete and lacked sensitively with regards the feelings of the person they were helping and others sitting around the table at the time. Staff should be patient and remain seated when assisting people with their food. Allswell Lodge DS0000069620.V361383.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, 19, 20 & 21 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. People who take medicine cannot manage it themselves and the care home supports them with it in a ‘relatively’ safe way although there is significant room for improvement with regards the homes medication recording practices. This lack of staff understanding of safe medication recording practices and monitoring at regular intervals is placing the people who use service at risk of harm. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 19 EVIDENCE: All the service users met during this visit were suitably dressed in wellmaintained clothes that were appropriate for the season. A member of staff told us they actively encourage the people who use the service to choose what clothes they wear each day. Information contained in the two care plans being case tracked showed people’s personal healthcare needs are clearly identified and action plans are in place to meet them. Staff maintain records of all the appointments people who use the service attend with health care professionals, who included GP’s, community based nurses, dentists, opticians, and chiropodists. As required in the homes last inspection report the proprietor has developed a new procedure for the receipt of medication into the home and an up dated version of the Royal Pharmaceutical societies good practice guidelines for handling medication in a residential care setting have been obtained. The acting manager told us no systems are currently in place for suitably experienced and qualified staff to monitor and check the homes medication practices. Consequently, an unacceptable number of gaps were noted on medication administration records sampled at random where staff had failed to enter the correct information on these sheets as required. The current practice and lack of adequate recording puts people who use the service at risk. The wishes of individuals about terminal care and arrangements after death is not always recorded, but the proprietor assured us she is still in the process of obtaining this highly sensitive infiramtion from the relevant people and was also able to give a good account of what the arrangements would be for most of the people who currently reside at the home. The good practice recommendation made in the homes last report is repeated here and progress made to implement it will be assessed at the next inspection. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 20 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 & 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. People who use the service are also safeguarded because the home now follows much clearer financial and accounting procedures. EVIDENCE: The service has a complaints procedure that is clearly written and easy to understand. It is available on request in an easy to read format that is illustrated with coloured pictures and symbols to help anyone living at, or involved with, the service to complain or make suggestions for improvement. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the service. The acting manager told us she would keep a full record of any complaints made about the home, including details of the investigation and any actions taken. The home has not received any complaints about it operation since it opened in June 2007. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 21 The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. The relatively new acting manager and two staff spoken with during the inspection all knew when incidents need external input and who to refer it too. No significant incidents have occurred in the home in the past six months and none of the people using the service have been admitted to hospital in that time. The acting manager was able to demonstrate she understood the local authorities procedures for Safeguarding Adults and said she would always attend meetings or provide information to external agencies as and when requested. There are a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. Certificates of attendance were made available on request to show training of staff in the area of protection is regularly arranged by the Home. The residents are protected from financial abuse due to the financial procedures that have now been put in place. The balances recorded on financial sheets kept for the people using the service matched the amounts being held by the home on their behalves. All the outstanding requirements identified at the homes last inspection with regards management of service users monies have now been addressed including, reducing the amount of money kept on the premises, the instruction of folio numbers on receipts for ease of auditing purposes, and no longer allowing anyone who works at the home to act as a service users financial appointee or agent. Furthermore, the proprietor told us she audits the homes finances on a monthly basis, in addition to an independent quarterly audit undertaken by the owner’s accountant. Despite the good practice recommendation made in the homes last inspection report the proprietor did conceded that she had still not established a clear policy regarding whether or not staff should contribute to their own expenses when supporting people who use the service in the wider community. Staff spoken to about this issue remain confused about what their rights and responsibilities with regards spending services users money on staff drinks and food when supporting people on the wider community. The recommendations repeated in this report and should be implemented as soon as reasonably practicable to clarify this outstanding issue. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 22 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, 26, 27, 28, 29 & 30 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and well-maintained home that is homely, clean, comfortable, pleasant, and hygienic. People live in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable, and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. EVIDENCE: The living environment of the home is appropriate for the particular lifestyle and needs of the people who use the service and is homely, comfortable, and well maintained. The home is also very well lit, clean, and smells fresh. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 23 Since the homes last inspection a new ramp has been installed in the garden to ensure all the people who use the service can access the raised decking area demonstrating the service will go that ‘extra mile’ to provide an environment that fully meets the needs of all people using the service. The layout of the home ensures small group living where people who use services can enjoy maximum independence in a discrete non- institutional environment. The proprietor told us she employs a handy man to ensure this recently refurbished home continues to be very well maintained. It is fully accessible throughout to people with physical disabilities, adaptations and specialist equipment are designed to fit within the homely environment. The home has single bedrooms available for all the people who use the service. All the bedrooms are above average size and have en-suite facilities. The fixtures and fittings are of a high quality and well maintained. There is a selection of communal areas both inside and outside of the home, this means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The kitchen and laundry are designed to enable and promote the involvement of people who use services in domestic tasks and as part of developing or maintaining self-help skills. Records are appropriately maintained of the temperature of hot water emanating from all the homes water outlets on a weekly basis. The manager told us all the homes relatively new baths and showers had been fitted with fail-safe thermostatic mixer valves that prevented temperatures exceeding 43 degrees Celsius. The temperature of hot water emanating from an ensuite shower facilities located in a bedroom on the ground floor was noted to be a safe 40 degrees Celsius when tested at 13.30. The home has recently purchased a new washing machine that has a sluicing facility, which is capable of washing foul/soiled laundry at appropriate temperatures in accordance with environmental health standards. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 24 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): 32, 33, 34, 35 & 36 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. An effective staff team who understand and do what is expected of them support the people who use the service. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 25 EVIDENCE: Care managers who completed our surveys consistently reported that ‘clients’ they helped place at Allswell Lodge are having their needs met by suitably experienced and competent staff. Typical comments included “the staff have a good attitude” and “the staff work well as a team”. Staff spoken with as a group during handover also told us they felt they worked particularly well as a team. This was evident from the way all those present at handover interacted with one another and shared essential information about the early shift. The handover was also very service user specific and focused almost entirely on how events that morning had affected the people who used the service. It was also evident from practices observed throughout this four hour inspection that staff support each other and the more experienced members share their knowledge and skills with the younger relatively inexperienced members of staff. Staff duty rosters sampled at random and the numbers of staff noted to be working on both the early and late shifts during the day of this inspection seemed to be adequate to meet the needs, activities and aspirations of the people using the service in an individualised and person centred way. Staff spoken with at length told us a minimum of three staff are always employed throughout the day, including weekends and evenings, which was the level needed to run the home effectively. The acting manager told she believed the recruitment of good quality carers was the cornerstone of delivering good outcomes for the people who use the service. The service is highly selective, with the recruitment of the right person for the job being more important to the filling of a vacancy. Notes taken during an interview with a relatively new member of staff revealed the selection process is based upon identified criteria that are closely related to the job being advertised and supports the procedure. Staffs personal files sampled at random showed all elements of recruitment are accurately recorded and the required documentation is always received prior to the employee starting work. This includes a completed job application with details about previous employment; two written references on head paper where possible; up to date Criminal Records Bureau and Protection of Vulnerable Adults checks; a declaration of any offences committed; statement of health; photographic proof of identity; and any Home Office approved work permits/visas (where applicable). Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 26 The acting manager and proprietor demonstrated a good understanding of the checks that needed to be carried out on all new staff and the importance of asking appropriate questions at face-to-face interviews. The service sees induction and any probation as vital to the success of staff recruitment and retention. The content of the induction and probationary periods are seen to be very robust, detailed, and service specific. Staff spoken with told us they had received a thorough induction before being allowed to commence working at the home. Documentary evidence was produced on request to show the induction process is linked to Skills for care and covered safe working practices, worker role, and the needs of the people using the service. The service ensures that all staff within its organisation receives relevant training that is targeted and focused on improving outcomes for people who use services. The service. Staff have access to a very good programme of training. The manager has carried out a training needs and strengths assessment of his entire staff team, which revealed very few gaps in staffs’ knowledge and skills. Mandatory training is provided in a number of areas including fire safety, manual handling, first aid, food hygiene, safeguarding adults, medication handling training, and infection control. Additional workshops are provided on specialist areas including Makaton communication and there is a strong NVQ provision with staff able to study for both the Level 2 and 3 qualifications. It was positively noted that in line with National Minimum Standards 100 of the homes permanent staff team have either already achieved an NVQ Level 2 or above in care or were enrolled on suitable courses. Individual supervision sessions take place regularly and staff say that they find them useful for their development and can demonstrate practical outcomes. Both the homes most recent recruits had received one to one supervision sessions with a suitably qualified senior member of staff within the first six weeks of their probationary period of employment in accordance with recommended good practice. The proprietor told us arrangements were also in place for the overall performance of the homes staff team to appraised within the first twelve months of employment. Progress made by the home to achieve this aim will be assessed at its next inspection when the service will having been operating for well over a year. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 27 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, 38, 39 & 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is run and managed appropriately. This open approach makes people who use the service and their representatives feel valued and respected. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. In the main the environment is safe for people and staff because health and safety practices are carried out, although the way the home tests it waterheating systems needs to be improved. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 28 EVIDENCE: The new acting manager, Judith Conteh, has been in post for three months and in accordance with National Minimum Standard 37 has well over two years experience working in a residential care setting as a manager and has achieved an National Vocational Qualification Level 4 in both management and care. Consequently, the acting manager has considerable knowledge and experience of running care homes for adults with learning disabilities. Judith was also able to describe a clear vision for the home as well as sound understanding and application of ‘best practice’. It was clear from comments made by staff that they welcome the open approach of the relatively new manager. The acting manager is aware that her appointment is subject to a fit person interview with the Commission, which she must pass to be registered. Judith should submit an application to the Commissions Regional Registration Team as soon as reasonably practicable. We will closely monitor progress made on this. Feedback received from an independent source suggested a lack of clarity regarding the role of the proprietor and management in terms of the day to day running of the home continued to be a problem and had lead to the former registered manager resigning. Management roles should be made clearer. The home is commended for ensuring staff meetings are held on a monthly basis. This exceeds National Minimum Standards that requires homes to hold at least six a year. These meetings were always well attended by staff are cover a wide variety of topics including the changing needs of the people who use the service and their worker roles and responsibilities. The proprietor told us she was fully aware that a quality assurance audit of the home based on the views of the people who use the service and their representatives needs to be carried out at least once a year and the results of any satisfaction surveys used published. Progress made by the home to achieve this aim will be assessed at its next inspection. The acting manager was able to produce Regulation 26 reports on request to show monthly unannounced visits to the home continue to be carried out by the proprietors business partner. In addition to these reports the acting manager had also provided d the Commission with an Annual Quality Assurance Assessment. The homes fire records revealed that the fire alarm system continues to be tested on a weekly basis and that three fire drills had been undertaken in the past four months in line with good fire safety guidelines. Fire doors tested at random on the ground all closed flush into their frames when released. During a tour of the premises two well stocked first aid boxes were found located on the ground and first floors. Staff told us they test the call bell alarm system on Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 29 a weekly basis. Radiators assessed as placing people who use the service at risk have been covered. During a tour of the kitchen it was noted that all items of food were correctly stored in line with basic food hygiene standards. A set of multi-coloured chopping boards was also observed being used for the safe preparation of food. The proprietor told us the homes water tank had not been tested for legionella by a suitably qualified professional since the home opened. This health and safety shortfall will need to be rectified as soon a practicable. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 30 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 4 3 X 4 4 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 4 25 X 26 3 27 3 28 4 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 4 3 X X 2 X Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 31 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA17 Regulation 12(4)(a) Requirement All staff who assist people who use the service to eat their meals must be appropriately trained to perform this task as discreetly and sensitively as possible. Under no circumstances must staff assist people at mealtime’s whist standing up. This will ensure the dignity of the people who use the service is respected. When medication is administered to people who use the service it must be clearly recorded. Staff must be reminded of their medication recording responsibilities. This will ensure that people receive the correct levels of medication. Timescale for action 15/04/08 2. YA20 13(2) 15/04/08 3. YA42 13(4) A suitably qualified professional 01/06/08 must test the homes water tank for legionella at regular intervals. This will ensure the safety of people using the service, their guests, and staff. Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 32 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 YA20 Good Practice Recommendations The way in which the service monitors staff compliance with its medication handling procedures should be reviewed as a matter of urgency to minimise the risk of recording errors continually occurring. This will ensure the people who use the service receive the correct levels of medication. The way in which the home obtains the views of people who use the service and their representatives regarding aging and death should be reviewed in order that the death of a person who uses/used the service is handled as the individual would wish. This recommendation was made at the homes last key inspection, but was not implemented. The home should establish a staff expenses policy that clarifies whether or not staff are expected to contribute to their expenses when supporting people who use the service whilst out in the wider community or on holiday. This recommendation was made at the homes last key inspection, but was not implemented. The person in operational day-to-day control of the home should be registered with the Commission as soon as reasonably practicable. This will enable the Commission to determine whether or not the current acting manager is ‘fit’ to run a residential care home for adults with learning disabilities. The role of the proprietor and the manager regarding the day to day running of the service should be made clearer. 2. YA21 3. YA23 4. YA37 5. YA37 Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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. Extracts may not be used or reproduced without the express permission of CSCI Allswell Lodge DS0000069620.V361383.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!