Care Home: Colleton Lodge

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What the care home does well The home has good admission and assessment procedures in place for any new people who may be thinking of moving in. Good information is available to staff about each person`s support and care needs. People have been consulted over the contents of the care plan files, and regular reviews have been held to make sure the information is kept up to date. The home has liaised closely with relevant health and social care professionals to make sure each person has regular health checks, and to make sure all health needs have been met. The home has good procedures in place to make sure people can raise concerns or complaints and feel confident they will be listened to and acted upon correctly. In the last year a number of new staff have been recruited and the staffing levels are now satisfactory. Good induction and ongoing training programmes have been followed for all staff. The home is well managed. What the care home could do better: Improved staffing levels in the last year have resulted in some improvement in the support given to people to help them lead interesting and fulfilling lives, but there is still much room for improvement. Further efforts should be made to reduce or eliminate the risk of medication omissions or errors. A programme of redecoration and refurbishment should be drawn up to address those areas of the home that appear shabby, worn or stained. This relates particularly to the first floor landing, the smoking room, the bathrooms and toilets, and the hall and stair carpets. Recruitment procedures must be improved. The home must not allow new staff to work with vulnerable people unless they have obtained sufficient information to confirm that the person is entirely suitable for the work. This must include at least two satisfactory references, plus confirmation that the person has not been placed on a list barring them from working with vulnerable people. Random inspection report Care homes for adults (18-65 years) Name: Address: Colleton Lodge Colleton Crescent Exeter Devon EX2 4DG one star adequate service 18/06/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Vivien Stephens Date: 0 2 0 6 2 0 1 0 Information about the care home Name of care home: Address: Colleton Lodge Colleton Crescent Exeter Devon EX2 4DG 01392275456 Telephone number: Fax number: Email address: Provider web address: Colleton.Lodge@Guinness.org.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Amanda Joyce Hart Type of registration: Number of places registered: Conditions of registration: Category(ies) : Guinness Care and Support Ltd care home 10 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Conditions of registration: 10 The maximum number of service users who can be accommodated is 10. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Mental disorder (Code MD) Date of last inspection Brief description of the care home In October 2007 Devon Community Housing Society and Guinness Care and Support amalgamated with Guinness Care and Support being registered as the providers of this service in December 2007. 1 8 0 6 2 0 0 9 Care Homes for Adults (18-65 years) Page 2 of 12 Brief description of the care home The Home provides accommodation and support for up to 10 adults who have mental health problems. Colleton Lodge is an attractive, large detached building standing in its own grounds near the centre of Exeter. It has large gardens and its own small car park. The home has an airy entrance hall, with two lounges and a dining room. There are also three single bedrooms on the ground floor, and the homes main kitchen. The first floor includes seven single bedrooms with some WCs and two bathrooms. There is a WC and bath on a mezzanine landing between the ground and first floors. A basement area contains an office, food stores, the homes laundry and a smoking lounge. Among the stated aims of the home are to provide a safe, supportive and structured environment where individual needs of the service user will be met and optimum independence will be encouraged and supported. All places at this home are purchased under a block contract with Devon County Council at a set fee. Copies of the homes inspection reports are available in the entrance hall. Care Homes for Adults (18-65 years) Page 3 of 12 What we found: Several weeks before this inspection took place we asked the home to complete an Annual Quality Assurance Assessment (AQAA). We also sent some survey forms to the home to be distributed by them. We received 5 completed surveys from people who live in the home, and 4 from staff. Their responses were very useful and helped us to understand what it is like to live or work at Colleton Lodge. At the time of this inspection there were 8 people living in the home, and 2 vacancies. No new people have moved into Colleton Lodge for several years. We talked to the manager about the process they will use in the future for any new people who may be considering moving in. We were told that they would take time to get to know the person, invite them to visit, have a short stay if they want to, and they would gather as much information as possible from all relevant sources to make sure they will be able to meet the persons needs. They would also give the person written information about the home to help them decide if Colleton Lodge is the right place for them. We looked at the files held in the home for two people living there to find out how their support and care needs had been planned and delivered. The information was well laid out with indexed sections that made it easy to find relevant information quickly. Each person had been consulted about their care plan, and they were involved in the regular reviews. Risk assessments had been completed on all anticipated risks. Staff who completed a survey form before this inspection told us they were happy with the way information was shared with them about the people living in the home. One staff member said I think that all the patients details and information are stored very well and easy to understand and retrieve any information needed quickly and efficiently. We talked to five people who lived in the home to find out if the care plans accurately reflected the support they actually received. Three people said they were satisfied with the care plans and the way the support was delivered, while two people were less happy and said they wanted to return to live in their own home. We talked to the manager to make sure they had listened to these people and responded to their concerns. We were satisfied that the home had taken a range of actions and were working closely with health and social care professionals to make sure each person was well supported. Since the last inspection the way daily handover records have been recorded have been changed to make sure personal information is held in individual files to ensure confidentiality and allow people to read the information held about them if they wish. The home is situated close to Exeter city centre and the quay area. People can easily walk to local shops, clubs and other facilities. The home does not have transport facilities. We were told that everyone in the home has a bus pass enabling to get out and about easily if they do not want to walk. One person regularly rides a bicycle. Since the last inspection the staffing levels have improved and we heard that this has enabled staff to have more one-to-one time with people living in the home. They have gone out with people for shopping trips, or for coffee on Exeter Quay. Some people enjoy regular cooking sessions, and each person has been encouraged to help with household Care Homes for Adults (18-65 years) Page 4 of 12 routines such as food shopping, cleaning and washing. Activities organised recently have included art and music sessions. Every month the home holds a residents meeting where people can discuss the things that go on in the home, including group activities. We heard that group outings and activities have been discussed and agreed in the past but on the agreed day most people have decided they no longer want to go out. We were told that one of the major barriers to outside activities is the lack of funding as people have to pay for the activities out of their own money. For those people in the home with limited income, and those who are heavy smokers, the cost of outings or outside activities is prohibitive. We discussed the importance of continuing to offer a wide range of activities, and to increase the level of meaningful and interesting occupation for each person. People told us that they had been consulted over the menus and they were always offered an alternative if they did not like the meals offered. Most people said they were happy with the meals provided. One person who completed a survey form said the variety of meals offered could be improved. We looked at the way medications have been stored and administered. The home uses a large national pharmacy to supply most of the medication on a 4 weekly basis. Most tablets are supplied in 4 weekly blister packs. These make it easier for staff to check the medicines have already been given. However, some medicines cannot be supplied in the blister packs and instead are supplied in bottles or boxes. Two medication errors have been made in recent months resulting in a person missing vital medication. We looked at some of the possible reasons why these errors may have occurred. We found that times of medication administration can vary from person to person according to the times they get up and go to bed. There was a list on the wall above the cupboard where the medications were kept showing the times each person needed medication. While we were completely satisfied that the home was following good practice by addressing individual needs, we saw that the varying times of administration may be problematic. We asked the manager to look at any other actions they can take to prevent staff forgetting to give medications in future. Records of medications that have been administered were generally good. However, they did not have an accounting system in place for those medicines not supplied in monthly blister packs. We advised the manager they should keep a record of the amounts held in the home and brought forward at the end of each 4 week period. The care plans held a list of medicines supplied to each person. While these lists were generally kept up to date we noted one person has been prescribed a cream that was not recorded. The manager assured us she would make sure all records were correct. All staff have received training on the safe administration of medicines and the home has carried out checks to make sure they are competent before allowing them to administer medicines. There have been two safeguarding incidents in the home in the last year. These were reported correctly to all relevant agencies and investigated thoroughly. Two staff were dismissed as a result of the investigations. Care Homes for Adults (18-65 years) Page 5 of 12 Since the last inspection the home has made sure each person has good access to the homes complaints procedure. They have been given copies of the procedure, and a copy has been displayed in the quiet lounge on the ground floor. Despite this, three out of the five people who completed a survey form said they did not know how to make a complaint. We looked around the communal areas in the home, and also looked in one bedroom that was unoccupied at the time of this inspection. The two lounges on the ground floor, the dining room, the entrance hallway and kitchen appeared bright, attractive and homely. These areas has been redecorated and refurbished in recent years. However, the carpet on the stairs was stained. The first floor landing and hallway had not been decorated for many years and appeared gloomy and in need of repainting. The smoking room on the lower ground floor was particularly gloomy and in need of redecoration. A cleaner is employed in the home and we heard that the carpets are regularly steam cleaned, and periodically a specialist company has been employed to clean the carpets. Despite this the carpets in some areas remain stained. The staff had attempted to decorated and brighten the bathrooms and toilets and this had made the rooms appear brighter and more attractive. However, the fittings were old and worn and in need of replacement. The manager said she hoped that the first floor hallway, the stair carpets and the bathrooms would be addressed in the next year depending on budget availability. Since the last inspection a number of new staff have been recruited. There were no unfilled vacancies, and this has resulted in a significant reduction in the use of agency staff. We were told that the new staff team were working well together and they were beginning to develop new ways of working, including new key working systems. On the day of this inspection there were sufficient staff on duty to meet the needs of the people living there. We looked at the recruitment files for four members of staff who had been employed in the last year. Guinness Care and Support have recently changed their recruitment process. The responsibility for obtaining checks and references has been passed to their local office. The records were no longer kept on the premises and therefore we asked for the files to be brought to the home for the inspection. Three of the files showed that safe recruitment procedures had been followed. For these members of staff at least two satisfactory references and the full Criminal Records Bureau (CRB) check had been received before the person began working in the home. However, for one member of staff an Independent Safeguarding Authority (ISA) check had been obtained before the person began working, but they had started work before the full CRB check had been completed. In addition, no references had been received. This showed that neither Guinness or the home had taken care to ensure they had sufficient information about the person to be certain that vulnerable people living at the home were safeguarded from the risk of harm or abuse. We were shown evidence that new staff have received thorough induction training at the start of their employment, following standards laid down by the national training organisation known as Skills for Care. All staff have received training and regular updates on all relevant health and safety topics. In addition the manager said she was in the Care Homes for Adults (18-65 years) Page 6 of 12 process of organising a range of specialist training for the staff team on topics relevant to the health and personal care needs of the people living at Colleton Lodge. In the last year Amanda Hart has been registered as the manager of the home. This means the Commission has been able to check her qualifications, experience and suitability and has considered that she is fit to manage the home. She told us she has recently completed a relevant nationally recognised qualification known as NVQ level 5. What the care home does well: 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 2. Care Homes for Adults (18-65 years) Page 7 of 12 Care Homes for Adults (18-65 years) Page 8 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 9 of 12 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, 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 34 19 New staff must not begin working directly with vulnerable people unless at least two satisfactory references have been obtained, and a check has been carried out to ensure the person has not been barred from working with vulnerable adults. This is to protect vulnerable people living in the home from the risk of abuse or harm. 11/06/2010 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 2 3 13 20 24 People should have more opportunities to meet their identified goals. Further action should be taken to eliminate or reduce the risk of medication errors or omissions. A programme of redecoration and refurbishment should be carried out to those areas of the home that appear shabby, Page 10 of 12 Care Homes for Adults (18-65 years) 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 worn, or stained. This relates especially to the first floor hallway, hall and stair carpets, and to bathrooms and toilets. Care Homes for Adults (18-65 years) Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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