Care Home: Cherry Lodge

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What the care home does well People who use the service told us they like the outings, holidays, having barbeques, the food, having residents meetings and the care. People say the staff are `friendly`. Other comments people made included `I`m happy living here` and `I`m settled`. Cherry Lodge provides a homely environment for the people who live there. People are involved in developing care plans, which are kept under review. People have access to the local community for education, social and leisure pursuits. What has improved since the last inspection? A structure has been put in place to ensure staff have regular supervision and monthly visits to look at the quality of the service are now taking place. These were issues raised at the last inspection. A new sofa has been purchased for the lounge, keeping the environment at a good standard for the people who live there. A staff supervision schedule is in place and staff have started to get regular support and supervision. A full time manager has been appointed, this will provide consistency of care for the people who live there, support for staff and ensure the required monitoring is completed. What the care home could do better: People who use the service said they would like `more outings`, for staff to `listen better` and to `go on holiday more often`. Old information in case files could be archived, to ensure staff have access to the most relevant up to date information. More opportunities could be found for activities for people who use the service, to provide them with more to do during the day. The recording of medication must include any that is left over, to ensure records are correct. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cherry Lodge 14 Lynton Road New Malden Surrey KT3 5EE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Emma Dove     Date: 1 6 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Cherry Lodge 14 Lynton Road New Malden Surrey KT3 5EE 02082969188 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Kay Jeetoo,Mr Younoos Jeetoo care home 9 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 9 The Registered Person may provide the following categories 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: Learning Disability - Code LD The maximum number of service users who can be accommodated is: 9 Date of last inspection Brief description of the care home Cherry Lodge is a registered care home for up to nine adults with learning disabilities. Eight people are currently living there. It is privately owned by a couple who own three other similar services in neighbouring towns. Cherry Lodge is located in New Malden and is a short, ten to twenty minute walk to local shops and bus or rail links. Information about the service is available in the Statement of Purpose and Service Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home User Guide. Current fees are in the range of £590.94 to £855.08 per week. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out over three and a half hours on the 15th June and six hours on the 16th June 2009. One regulation inspector visited, spoke with people who use the service, staff and the new manager and looked at records. Surveys were sent to people who use the service and their relatives or representatives. We received seven completed surveys, comments from these are included throughout this report. We received an annual quality assurance assessment (AQAA) from the temporary manager in April 2009, this contained some good information but not enough detail about how the service meets peoples needs. Care Homes for Adults (18-65 years) Page 6 of 27 Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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 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. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has developed a Statement of Purpose and Serivce Users Guide which helps prospective people decide whether the home is right for them. Assessments are completed before a decision is made about offering someone a place at the home. Evidence: There is a Statement of Purpose and Service Users Guide, which include the services and support provided. The manager told us they plan to review the information available. People told us they are happy living at Cherry Lodge. One person told us they had visited before moving in. Six people told us that they had been asked if they wanted to move in and had enough information to help them make that decision. The manager told us, in the self assessment, that they have a comprehensive assessment and probationary period for prospective and new people who use the service. We saw assessments completed before people moved in. These documents noted the support and assistance the individual needs and the reason for the placement. Care Homes for Adults (18-65 years) Page 10 of 27 Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this 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 who use the service are involved in developing and reviewing their care plans and making decisions about their future. Risk assessments are in place. Evidence: The new manager told us they have updated two care plans to be more person centred and are working to integrate daily recording into the process. We saw care plans detail the care, support and health needs of the individual. People who use the service told us they are involved in developing and reviewing their care plan. As a part of updating care plans, old information should be archived, to ensure staff only access relevant and up to date details. We saw one care plan include some clear goals to be achieved with short timescales. Care must be taken to break the goals down into achievable steps with details of how staff should support the individual and regular reviews, to ensure the timescales are met. We saw staff have detailed knowledge of peoples needs and how they should be met. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: We saw risk assessments around using the kitchen, independent travelling and accessing the community. People who use the service said they appreciate the risk assessments and understand why they are in place. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is committed to enabling people who use the service to maintain and develop their social, emotional and independent living skills. People are supported to keep in contact with relatives and friends. People are involved in a range of community activities. Evidence: The manager told us that most people who use the service attend meaningful education or occupation activities. People told us they go to day centres, to a local cafe, to a singing class and other activities of their choice. Six people told us in surveys that they do what they want during the day, evening and weekends. One person told us they would like to go to a day centre or somewhere similar during the day. The manager told us they could improve the opportunities and interests for people who are less motivated. More could be done to involve people who use the Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: service in community activities, clubs and groups, to fully meet their social and leisure needs. The manager told us they respect the cultural beliefs and wishes of the people who use the service. People confirmed that they celebrate Birthdays and festivals of their choice, in the way they wish. People who use the service told us they keep in contact with relatives and friends and can go and meet them, stay with them and have visitors to the home. One relative or advocate told us the service supports them to keep in touch. We saw a varied menu which takes into account peoples religious and medical dietary needs. People told us they like the food, enjoyed dinner and the food is usually good. We saw people involved in the preparation of meals and clearing away. People confirmed that being involved in the day to day running of the home is fair and they should do the cooking and cleaning. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. 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. This is what people staying in this care home experience: Judgement: People using this 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 who use the service need minimal support from staff with personal care tasks. Peoples healthcare needs are well met. Medication is generally well managed with some issues around recording. Evidence: People who use the service told us they dont need assistance from staff with personal care tasks. We saw case files include some detailed information about the individuals health care needs, although they were not all complete and signed. Case files contain good information about health appointments, with any actions needed or any changes to treatment plans clearly noted. People who use the service are registered with a GP and see other community health care professionals as required. People told us staff are available to attend health appointments if they need support. Medication is appropriately stored and labelled with Medication Administration Record Sheets signed by staff. Good systems are in place to check medication is administered. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: However the recording of medication received at the home needs to be improved to include any medication left over. The count of two medications showed too many tablets for one person and one tablet missing for one person. Care must also be taken when taking medication from packets that only one section is broken, preventing other tablets from being open to the air. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a clear complaints procedure which is accessible to the people who live there. Appropriate policies are in place for safeguarding, staff complete training and are aware of their responsibilities. Evidence: The manager told us they have an accessible complaints procedure in pictorial format. People who use the service confirmed that they are aware who to speak to and how to make a complaint. People feel the service responds to concerns and complaints and they feel listened to. The manager told us in the annual assessment there were three complaints that were upheld. We saw records of two complaints with clear actions taken. The manager told us staff complete training in safeguarding as a part of their on-going development. Staff are aware of their responsibilities around safeguarding. One safeguarding issue has been reported to the local social services department, who completed an investigation. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay 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. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriate to meet the needs of the people who live there. People have their own bedrooms, which are decorated and personalised as they choose. The home is well maintained and kept to a good standard. Evidence: People have access to a lounge/dining room, separate kitchen, laundry area and staff office on the ground floor. The dining area has doors to the garden. The manager told us they plan to make some changes to the environment by developing the office into a bedroom, building a small extension to make an office and making one of the bedrooms on the first floor smaller to make a separate quiet lounge. We saw people have personalised their rooms to their taste. People told us I like my room, Ive got all I need in my room, its comfy and Im happy here. There are sufficient bathrooms and toilets. All areas of the home were seen to be clean. Five people told us in surveys that the home is always and one person said usually clean and fresh. Care Homes for Adults (18-65 years) Page 19 of 27 Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this 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 who use the service have confidence in the staff who support them. Staff levels are sufficient to meet peoples needs. Staff recruitment is in line with regulations. Staff have access to training. Further work is required to ensure all staff receive regular supervision. Evidence: We saw enough staff to meet peoples needs, with two staff during the day and one staff asleep but on call at the home at night. The new manager has developed the staff rota, which is available a month in advance. We saw some good interactions between staff and people who use the service. Staff demonstrated a good knowledge of individuals and how to meet their needs. We looked at one staff recruitment file, the appropriate checks had been completed before the person started work. Staff told us they have access to relevant training to help them do their job and have completed training in food hygiene, first aid, health and safety, manual handling, mental health awareness, person centred care and care planning, medication Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: administration, infection control, challenging behaviour and the protection of vulnerable adults. Some staff are due to do refresher training in some areas during the next few months. The manager told us they need to improve the frequency of staff supervision. The new manager has devised a staff supervision programme where everyone is seen every other month. Staff told us they feel supported to carry out their job. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. 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. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A new manager has been appointed to the home, who needs to complete the probationary period and register with the Commission. Residents meetings are held every other month. Monthly visits to check the quality of the service now take place. Health and safety is well managed with checks up to date. Evidence: A new manager has been at the home for four weeks and has developed an action plan of improvements to be made. The Operations Director has started to complete monthly visits to the service, to check on the quality of care and support provided by speaking with people who use the service, staff and looking at some records. This is an improvement and will give people the opportunity to comment about the support they receive. Residents meetings are held every month, this provides people with the opportunity to make decisions about the day to day running of the home. Residents also meet to plan the menu for the foillowing week. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: We saw records of health and safety checks to be up to date, with the gas safety checked in Spetember 2008 and the Portable Electrical Appliances tested in July 2008. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Medication must be administered as per GP instructions with records kept up to date. To ensure peoples health needs are fully met. 14/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 Consideration should be given to providing the service users guide in a more accesssible format for people who use the service. Care should be taken to break individuals goals into achievable stages, with details of how staff should support the individual and regular reviews, to ensure the timescales are met Work on developing care plans should continue, to include all people who use the service and integration of daily recording. More could be done to involve people who use the service in community leisure and occupational activities, clubs and groups, to fully meet their social and leisure needs. 2 6 3 6 4 12 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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