Care Home: Cheddle Lodge

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What the care home does well The manager and staff acted in the best interests of residents at all times and, wherever possible, residents were supported to make their own decisions and choices in all aspects of their lives. Residents were supported to have as many experiences of life in general as possible taking into account capabilities, funding and staff availability. Holidays take place with the support and agreement of relatives and with the assistance of the staff team.Residents were also supported to visit skills centres, which enabled them to mix with others and learn skills, which would enhance their physical, mental and emotional wellbeing. Residents were also supported to visit places within the community, which enabled them to meet and see others without disabilities. However, the majority of meaningful relationships with others who did not have a disability were with relatives and staff teams. The health and overall welfare of residents was seen as a priority. Staff were trained and experienced in caring for and supporting those with complex needs and who required specialised care and attention. Medication records were correctly detailed and systems were in place to ensure medication was stored safely. The staff knew service users` favourite foods and specialised requirements. Food served was plentiful and appeared to be enjoyed by all service users. The managers and staff encouraged relatives to visit the home and take part an active part in the care of the resident. There was a relatives committee, which was run by the relatives with minutes taken and distributed to relevant personnel, including the Commission. The manager was asked to attend the meeting, which took place at Cheddle Lodge. One relative said that there were `High standards of care due to frequent and good quality training programmes much appreciated support levels to parents`. There had been a low staff turnover (one part time care worker had left) over the past 12 months. This meant that a stable and experienced staff team was caring for the residents. All the staff who completed a survey form or were spoke with said that the employer had carried out checks, such as CRB and references, before they had started work. Induction followed the Skills for Care induction standards and was conducted over a period of three months. Further mandatory training was provided by the organisation through a training organiser whose role and responsibility it was to ensure staff had all the training they required to fulfil their role. Training provided by the organisation was good with 26 of the 30 staff having completed a National Vocational Qualification. This was confirmed by the staff group who said that they were being given training which was relevant to their role; helped them understand and meet the individual needs of residents; kept them up to date with new ways of working. The senior management of the organisation was also stable, with the Chief Executive visiting the home regularly.Cheddle LodgeDS0000008546.V371004.R01.S.docVersion 5.2Page 8All parts of the home were clean and well cared for. A detailed regular inspection of all areas by a senior member of staff ensured that standards were maintained; a housekeeper was also employed. What has improved since the last inspection? Questionnaires for residents had been produced in a pictorial format. One form to seek the views and opinions of people who had attended for respite had been introduced. One had been completed with positive responses. The second questionnaire was distributed to find out what the residents would like to do for activities outside of their day care services. The manager was in process of analysing these and was introducing activities in the evenings for those who wished to take part. Improvements to the home continued with the completion of the sunroom and the refurbishment of bedrooms, which included decoration and carpets. A light tower had been donated for use in the sunroom. Tracking systems to support safe transfers of residents had been fitted in all bedrooms. The systems offered improved safety and comfort to service users whilst also aiding staff. The recent appointment of a new Health and Safety manager employed by the Society was to increase input to Cheddle Lodge and ensure that the home and staff complied with all current and future health and safety legislation. It was recommended at the previous inspection of November 2007 that a record of the food eaten by residents should be made in the individual`s file; this had been implemented. CARE HOME ADULTS 18-65 Cheddle Lodge 29 Ashfield Road Cheadle Stockport Cheshire SK8 1BB Lead Inspector Jackie Kelly Unannounced Inspection 2nd & 8th September 2008 12:30 Cheddle Lodge DS0000008546.V371004.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 Cheddle Lodge DS0000008546.V371004.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. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cheddle Lodge Address 29 Ashfield Road Cheadle Stockport Cheshire SK8 1BB 0161 428 5189 0161 428 5189 cheddle@ukonline.co.uk 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) Stockport East Cheshire & High Peak Cerebral Palsy Society Mr William Delaney Care Home 13 Category(ies) of Learning disability (13), Physical disability (13) registration, with number of places Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 13 LD and up to 13 PD. Date of last inspection 8th November 2006 Brief Description of the Service: Stockport, East Cheshire and High Peak Cerebral Palsy Society own Cheddle Lodge, which is situated in a quiet residential area of Cheadle. Cheddle Lodge is registered to provide long-term care for younger adults with cerebral palsy and a physical or learning disability. Accommodation is provided on one level and has 13 single bedrooms. One of the places is for supporting people from the community with respite care. The residents have the use of a combined lounge and dining room, enabling them and staff to interact openly. Families had formed an active group, which met regularly and was able to contribute to the development of the home. Family members were often on the premises and had become part of daily life at Cheddle Lodge. The fee structure for Cheddle Lodge varied according to the care/support required and funding arrangements through social services or health authority continuing care. Currently, the lowest fee is £980 and the highest £2079.00. The respite care service was based on a nightly fee and was, at this time, £157.84 per night. There was a service user guide available and people had access to the latest inspection reports. Cheddle Lodge DS0000008546.V371004.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 3 star. This means the people who use this service experience excellent quality outcomes. This was a key unannounced inspection, which included two site visits to the home. On the first day of the inspection six hours were spent on the premises. During this time, discussions took place with two of the senior staff team and the registered manager. Records were looked at such as the Essential Lifestyle Plans, Care Plans, staff files, medication records and complaints file. A tour of the home was undertaken. Staff were also observed carrying out their duties with those residents who were at home during the inspection. Due to the limited communication skills of residents, it was difficult to have a detailed discussion with them about their experiences. The second visit, a week later, consisted of talking with other staff and meeting one of the relatives. A number of weeks prior to the inspection date we asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. The form provided us with sufficient and good quality information, which helped us during the inspection process. We sent survey forms to a small sample of residents and care workers, asking for their views on the service they received. We also provided surveys for relatives to complete. People should be aware that the residents were not able to complete the surveys themselves and, as such, had received assistance from relatives. The results of the questionnaires were positive with the majority of people saying that they were happy with the care provided and had no complaints. They also felt and observations suggested that the residents’ privacy and dignity were respected. The residents said that they were all asked if they wanted to move into the home and all said that they had received enough information about the home before they moved in so they could decide if it was the right place for them. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 6 There was one negative comment received regarding being able to do what they wanted at weekends:- ‘Depends if there are enough staff to take me out. In the evenings and weekends the staff are too busy with other residents to spend much time with me or to organise activities for us to do’. This was something that the manager was aware of and had recently conducted a survey with the residents and was in the process of looking at ways activities could be organised. However, the majority of residents said that they could do what the wanted during the day and in the evenings. In answer to the question, did staff treat them well; three always and one said always/sometimes; one direct comment was received:- ‘Most of the time’. The relatives who completed a form or were spoken with said always/ usually they felt that the home met the different needs of residents and always the care staff supported the resident with the care agreed and had the right skills and experience. The following are a small number of answers and comments obtained through the questionnaires from the staff team:- the majority said that usually they felt they had the right support, experience and knowledge to meet the different needs of people who used services; they said that always they were given up to date information about the needs of the people; and that usually there were enough staff to meet the individual needs of all the people who used the service. The Commission had received no complaints or concerns. The manager reported in the AQAA that there had been two complaints/concerns recorded; the two incidents were well documented and had been resolved satisfactorily. All the residents and relatives who we had contacted said that they knew how to make a complaint and one relative said that the managers always responded appropriately if raised concerns. There had been no safeguarding adult referrals or investigations. What the service does well: The manager and staff acted in the best interests of residents at all times and, wherever possible, residents were supported to make their own decisions and choices in all aspects of their lives. Residents were supported to have as many experiences of life in general as possible taking into account capabilities, funding and staff availability. Holidays take place with the support and agreement of relatives and with the assistance of the staff team. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 7 Residents were also supported to visit skills centres, which enabled them to mix with others and learn skills, which would enhance their physical, mental and emotional wellbeing. Residents were also supported to visit places within the community, which enabled them to meet and see others without disabilities. However, the majority of meaningful relationships with others who did not have a disability were with relatives and staff teams. The health and overall welfare of residents was seen as a priority. Staff were trained and experienced in caring for and supporting those with complex needs and who required specialised care and attention. Medication records were correctly detailed and systems were in place to ensure medication was stored safely. The staff knew service users’ favourite foods and specialised requirements. Food served was plentiful and appeared to be enjoyed by all service users. The managers and staff encouraged relatives to visit the home and take part an active part in the care of the resident. There was a relatives committee, which was run by the relatives with minutes taken and distributed to relevant personnel, including the Commission. The manager was asked to attend the meeting, which took place at Cheddle Lodge. One relative said that there were ‘High standards of care due to frequent and good quality training programmes much appreciated support levels to parents’. There had been a low staff turnover (one part time care worker had left) over the past 12 months. This meant that a stable and experienced staff team was caring for the residents. All the staff who completed a survey form or were spoke with said that the employer had carried out checks, such as CRB and references, before they had started work. Induction followed the Skills for Care induction standards and was conducted over a period of three months. Further mandatory training was provided by the organisation through a training organiser whose role and responsibility it was to ensure staff had all the training they required to fulfil their role. Training provided by the organisation was good with 26 of the 30 staff having completed a National Vocational Qualification. This was confirmed by the staff group who said that they were being given training which was relevant to their role; helped them understand and meet the individual needs of residents; kept them up to date with new ways of working. The senior management of the organisation was also stable, with the Chief Executive visiting the home regularly. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 8 All parts of the home were clean and well cared for. A detailed regular inspection of all areas by a senior member of staff ensured that standards were maintained; a housekeeper was also employed. What has improved since the last inspection? What they could do better: Overall, the home had no major issues of concern; the following are recommendations, which should assist the manager and staff to improve the service and record keeping further making life better and safer for the residents and staff. The service user guide needs to have the frequency of inspections and the address of the Commission amended to reflect the recent changes made by the Commission. The complaints procedure booklet also needs to be amended to include the Commission’s recent change of address and telephone number. This would ensure that people had the correct information to contact the Commission if they so wish. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 9 The Essential Lifestyle plans should contain a record of the personal wishes, dreams and aspirations, as well as physical and health care needs of the resident. The manager should look at the Essential Lifestyle plans with a view to setting attainable goals. The record should say how the staff will support the residents to achieve their goals, how the goals will be obtained, how people have progressed and where changes may be necessary. Setting obtainable goals should make the lives of the residents more meaningful. The manager should look at implementing a system whereby the staff record how and when the residents and relatives have been involved in the decisionmaking processes. This would be part of the Essential Lifestyle Plan. This would ensure that all relevant parities were aware of what had been agreed and would be a useful reference document for future meetings and discussions. The holistic record of daily activity of the residents made on the handover sheets was better than that written in the care plan. Therefore, it would be more appropriate for the more useful information to be included in the individual care plan. The bathrooms were in need of renovation, as they were now looking well worn. The refurbishment would also make them more hygienic, homely and pleasant for the residents to use. The application form, when asking for employment history, should add the statement ‘from leaving school or full time education and explain any gaps’. This would ensure that only suitable people were employed. The organisation should provide training in caring for people with Multiple Sclerosis if they are to continue offering care to people with this disease. Only one member of staff had received training in infection control; the organisation should look at this. As the manager recognised in the AQAA, the up to date recording of training and development of the staff team on staff files kept at Cheddle Lodge needs to be improved. The policies and procedures, which had not been reviewed for some time, should be looked at. This is to ensure that they meet with current legislation and practice. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 10 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. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 11 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 Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 12 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): Standard 2. Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. A comprehensive care needs assessment conducted by the manager ensured that the needs of prospective residents could be met. EVIDENCE: All the people we had contact with said that they either always or usually received sufficient information about the home to assist them in making decisions. The service user guide was printed in a user-friendly manner with text and pictures. However, the guide required amending to include the most up to date information regarding the frequency of inspections made by the Commission and the change of the Commission’s address and telephone number. Care needs assessments completed by Social Services or Health Care Services were submitted to the manager as part of the initial referral process. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 13 The registered manager and/or a member of the management team visited the prospective resident in his or her own home or current placement to complete the company’s own assessment documentation. The assessments formed part of the Essential Lifestyle Plan and Care Plan. Also, as part of the process, prospective residents and their relatives were encouraged to visit the home. If everyone was satisfied that the home was suitable and could meet the person’s needs, they were offered a trial visit for a day; gradually progressing for longer periods. The introduction process was designed around the needs and circumstances of the person. Many of the permanent residents had attended a number of times for short stays before they were offered a permanent place when one became available. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 14 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): Standard 6, 7, 9 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Residents are supported to make decisions, choices and take responsible risks within their capabilities. EVIDENCE: Essential lifestyle plans provided a record of the personal wishes, dreams and aspirations, as well as physical and health care needs of the resident. The Lifestyle plan should also include how staff are to support residents achieve their aspirations and maintain their health and personal care. However, whilst the plans were well organised and well presented, they were task orientated with little information about goals to be aimed for. The manager and staff need to look at the plans with a view to setting attainable goals. The records should contain information such as what equipment (if any) needs to be obtained, how the staff will support the residents to achieve their goals, how people have progressed or where changes may be necessary. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 15 The care files/care plans contained many of the documents that were in the Essential Lifestyle Plans. The care plans also contained information about the day-to-day needs of the residents and the care they received. Preferences for their daily living routines were recorded. Residents were involved as much as possible in decisions about their lives according to their capabilities. Wherever possible, they played a part in planning the care and support they received. Parents or other relatives were also very involved in the decision-making processes. However, there was little evidence of when and how residents and relatives were consulted. This was recognised by the manager in the AQAA as an area that required improvement. The decisions and choices discussed should be linked into the goals and aspirations of the resident and families, reviewed and updated as necessary and recorded in the Essential Lifestyle Plan. The activity required to carry out the decisions made would be transferred to the day-to-day care plan for staff to implement. The residents were allowed to take responsible risks. A record of risk assessments had been completed where necessary and were part of the care plans. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 – 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Staff assisted residents to make choices about their life and routines within the boundaries of health and physical care needs. EVIDENCE: Due to the physical and health care needs of the current group of residents, they were unable to take part in full time education or employment. However, wherever possible, residents were assisted to attend a day centre where they could meet other people and take part in an activity. The residents’ favourite leisure activities were recorded at the time of their admission and, whenever possible, they were assisted to take part. Residents also visited local shops in Cheadle village and Stockport town centre. Holidays were an annual event for some of the residents, however these very much depended on funds and the goodwill of the staff team. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 17 The manager had recently distributed a questionnaire regarding activities to families for them to complete with their relative. The manager was now to analyse the information and it was hoped a more structured activity programme could be introduced within the home. The beginnings of this were now displayed in the sunroom on the activities board, which included a ‘pat’ dog and someone to conduct ‘art therapy’ sessions. Family relationships were promoted and encouraged, as the residents were, for the most part, unable to form and maintain very few ‘outside’ friendships due to their physical and/or mental health. The staff ensured that residents were, as far as possible, supported to take control over their own routines. However, some routines were determined by the attendance at day centres, availability of transport, medical needs, and staff availability; weekends were more relaxed. The home had a four-week menu plan that incorporated a variety of dishes suitable for the needs of those who lived in the home and who were from a mixed age range. Residents’ favourite food was known and provided. Soft diets were prepared and food supplements were provided. number of residents were fed through a ‘PEG’ feed. A small Cheddle Lodge DS0000008546.V371004.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): Standard 18, 19, 20, 21 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. A staff team met the resident’s health and personal care needs with respect for the person’s privacy, dignity and personal preferences. EVIDENCE: Throughout the inspection residents were seen to be receiving the care and attention they required in a meaningful and respectful manner. Equipment was in place that ensured residents were moved as safely as possible and were comfortable both whilst relaxing in the communal areas or when in bed. There was a key worker system in place where a designated member of staff oversaw the care of a resident and, as far as possible, ensured that all their personal preferences were met. The care plan showed that access to medical services was obtained through visits to GP, consultants and, where applicable, the district nursing service. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 19 Trained competent staff administered medication. The current group of residents did not have the ability to administer their own medication. The administration records were looked at and found to be satisfactory. The colour coding system made them particularly easy to follow. The organisation had recently implemented training from ‘Respect’ for all staff to enable them to support residents through the grieving process. Bereavement counselling and support had been obtained for two residents who had lost parents in the last 12 months. Cheddle Lodge DS0000008546.V371004.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): Standard 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were protected and kept safe from abuse and had their complaints recognised and dealt with appropriately. EVIDENCE: The organisation had a complaints procedure booklet in place, which was simple and easy to read. However, the address and telephone number of the Commission needed updating to reflect the recent change to Preston. The complaints file was looked at. The two complaints received over the past 12 months had been recorded, investigated and resolved satisfactorily. There had been no safeguarding referrals. The manager said that all the staff team had received basic training in safeguarding adults during their induction with further training provided through National Vocational Qualifications (NVQ) and specific adult protection training. There were regular meetings between the relatives and the manager whereby people could voice their views and opinions if they had any concerns or issues. Minutes were taken at these meetings by one of the relatives and were distributed to all concerned. The Commission was also included in the distribution list. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 24, 30. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents had a safe, clean and comfortable home to live in, which was adapted to meet their needs. EVIDENCE: The home was set in its own grounds, had been built all on one level and was close to local amenities. Residents had a comfortable lounge and dining area with appropriate fixtures and fittings. The sunroom was now completed; everyone was pleased with it and said that it was a great asset. There was a sensory bubble tower in the room, which the residents really liked. The kitchen and laundry areas were well equipped and clean. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 22 Bedrooms were personalised according to residents’ individual tastes. A small number had been redecorated and carpeted since the previous inspection of November 2007. All the bedrooms now had overhead tracking to assist with moving and handling, which had helped both the residents and staff. The manager stated in the AQAA that a five-year rolling refurbishment programme was in place, which needed to be updated over the next 12 months. Regular inspection and servicing of the home’s equipment and replacement, if required, was in place. A recent appointment of a new Health and Safety manager employed by the Society was to increase input to Cheddle Lodge and ensure that the home and staff complied with all current and future health and safety legislation. All parts of the home were clean and well cared for. A detailed regular inspection of all areas by a senior member of staff ensured that standards were maintained; a housekeeper was also employed. Bathing and toileting areas were in need of renovation. The manager said that the five-year development programme had identified the refurbishment of at least one. However, both of the bathrooms need complete refurbishment to make them modern and appealing for residents to bathe in. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 32, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staff in sufficient numbers, who were trained and competent, supported the residents. EVIDENCE: The organisation employed staff in sufficient numbers to provide the care the residents required. Agency staff were rarely used as the company had their “own” bank staff. As there had only been one part-time employee leave Cheddle Lodge in the past 12 months, it meant that there was a stable team of experienced staff. Appropriate recruitment and selection procedures were in place. However, it was recommended that a statement be added to the application form asking for full employment history from leaving school or full time education and explain any gaps. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 24 Induction followed the Skills for Care induction standards and was conducted over a period of three months. Further mandatory training was provided by the organisation through a training organiser whose role and responsibility it was to ensure staff had all the training they required to fulfil their role. The AQAA stated that of the 30 members of staff; 26 had completed a National Vocational Qualification (NVQ). NVQ levels 3 and 4 were available to senior staff, as was the Registered Manager’s Award. The managers should look at providing specialist training in caring for people with Multiple Sclerosis if they are to expand their service in this area. Staff said that they received formal one to one supervision at an appropriate frequency. Regular meetings took place with the manager. However, the manager recognised in the AQAA that individual staff supervision and the recording of all staff training on their individual files at Cheddle Lodge was an area for improvement. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39, 40, 42 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Residents live in a home, which is well managed and run in their best interests providing for and meeting their health and personal care needs. EVIDENCE: Cheddle Lodge was a well run home. Residents were supported to live full lives and have everyday experiences, as far as their capabilities would allow. The registered manager had the relevant qualifications for managing a care home and was considered by the people who completed questionnaires and spoken with to be approachable and listened to people’s views and opinions. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 26 The manager had recently distributed pictorial questionnaires about activities. For those residents who needed assistance, the questionnaires had been given to relatives for them to support the resident. This was to ensure that they were able to give their views honestly and with confidentiality, if that is what they wished. A questionnaire (pictorial) was sent to a person using the service for the first time to seek out their views on the care they had received. The manager said that feedback was positive. The Chief Executive of the organisation visited the home at least monthly to monitor the care being provided. As part of this process, a report was completed with copies available on the premises. Policies and procedures were in place but some had not been reviewed for some time. This was an area that the organisation should look at to ensure that they are up to date with current legislation and practice. The daily report sheets that were completed by the seniors to use during the handover between shifts contained a holistic picture of the resident’s activities during the day and evening. This information should be kept on the care plan, as it was better than that which was currently being recorded. This was discussed with the manager. It was recommended that this information be transferred to each person’s individual file as the current system of having all the information on one sheet could present problems with Data Protection should there be a need to conduct any enquiry in the future. Equipment, as applicable, had been serviced or tested as recommended by the manufacturer or other regulatory body. There were written risk assessments on hazardous substances COSHH and moving and handling. There was a policy for preventing infection and managing infection control and the company had used the Department of Health guide ‘Essential Steps’ to assess current infection control management. However, only one member of staff had received training in infection control; the organisation should look at this. Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 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 4 x LIFESTYLES Standard No Score 11 x 12 4 13 3 14 x 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 4 4 x 3 3 3 3 x Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA1 YA6 Good Practice Recommendations The service user guide needs to be updated. This will ensure that people have the correct information in how to contact us if they wish to do so. The Essential Lifestyle plans should contain a record of the personal wishes, dreams and aspirations, as well as physical and health care needs of the resident. Setting obtainable goals should make the lives of the residents more meaningful. The manager should look at implementing a system whereby the staff record how and when the residents and relatives have been involved in the decision-making processes. This would be part of the Essential Lifestyle Plan. This would be a useful for future reference when care needs, etc., were being reviewed. The complaints procedure booklet needs to be updated to include the Commission’s recent change of address and telephone number for reasons as stated in standard 1. The bathrooms were in need of renovation, as they were now looking well worn, and to make them more homely and pleasant for the residents. The application form when asking for employment history should add the statement ‘from leaving school or full time education and explain any gaps.’ This would help to ensure that only suitable people were employed. The organisation should provide relevant training in caring for people with Multiple Sclerosis if they are to continue offering care to people with this type of disease. The policies and procedures, which had not been reviewed for some time, should be looked at. This is to ensure that they meet with current legislation and practice. The way in which the daily recordings are made should be assessed to ensure that they meet with data protection and the most useful information is included in the care plan. The staff team should receive training in infection control for the health and safety of the residents. 3 YA7 4 5 6 YA22 YA24 YA34 7 8 9 YA35 YA40 YA41 10 YA42 Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North West Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Cheddle Lodge DS0000008546.V371004.R01.S.doc Version 5.2 Page 31 - 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. 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