Care Home: Cypress Lodge

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What the care home does well Individuals are supported to lead active lifestyles in the local community. Cypress Lodge supports individuals with complex care needs and challenging behaviour and enables them to live safely in the community. Individuals can be confident that staff receive regular training, ensuring they are competent to fulfil their roles. Individuals are encouraged to be as independent as possible. What the care home could do better: There is one outstanding requirement relating to the contracts. Individuals must be assured that they have a contract that includes the fees charged and any additional fees. This will ensure an open and transparent service is being provided. Where care needs have changed for one particular individual, then the plan of care must be amended ensuring a consistent and transparent service is being provided. Care plans must be signed by the member of staff compiling them and where possible the individual. Random inspection report Care homes for adults (18-65 years) Name: Address: Cypress Lodge The Witheys Whitchurch Bath & NE Somerset BS14 0QB one star adequate service 25/08/2009 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: Paula Cordell Date: 2 3 0 6 2 0 1 0 Information about the care home Name of care home: Address: Cypress Lodge The Witheys Whitchurch Bath & NE Somerset BS14 0QB 01275832012 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Kate Susannah Walker Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Neil Bradbury care home 10 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 10 May accommodate 3 named persons under the registration categories MD & LD (because of their mental health needs as well as their learning disability) May accommodate people age 18-64 May accommodate up to 4 people in the building known as Willow Cottage. May accommodate up to 6 people in the building known as Cypress Lodge. Date of last inspection Brief description of the care home Cypress Lodge is an establishment consisting of 2 properties, one named Willow Cottage and the other Cypress Lodge. Willow Cottage is registered to provide personal care for 4 people with learning Care Homes for Adults (18-65 years) Page 2 of 11 2 5 0 8 2 0 0 9 Brief description of the care home disabilities; Cypress Lodge is registered to provide personal care for 6 people with learning disabilities. Both properties are situated on the same site, in a small cul-desac in a residential area of Whitchurch. The houses are within walking distance of local shops and there are transport routes to other local amenities and facilities. To the front of the property there is a garden with a pond; the back door leads to a rear garden and patio area, and access to Willow Cottage. The current fee levels range from 1500 to 1750.00 pounds per week, depending on the support needs of each service user. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: This was an unannounced random visit. The purpose of the visit was to follow up the requirements from the key inspection which was conducted in August 2009 and to monitor the care provided to the individuals living at Cypress Lodge. There has been a change of manager since the last visit. Miss Kate Walker submitted an application and was successfully registered with the Care Quality Commission in June 2010, just prior to this visit. Miss Walker was previously the deputy manager for the home. The visit was planned using information that has been received since the last visit. This included correspondence, regulation 37 notices and the Annual Quality Assurance Assessment completed by the manager in September 2009 and the last inspection report. From reviewing the Annual Quality Assurance Assessment progress was being made towards meeting the requirements from the visit in August 2009. The visit was conducted over 3.5 hours. We examined care records for two people living in the home, the medication system and reviewed information relating to the recruitment, training and ongoing support for staff. An opportunity was taken to tour the communal areas of the home which gave an opportunity to speak with three individuals living in the home and three members of staff. The manager was present during the visit. At the time of the visit the home had full occupancy with no vacancies. There have been two admissions in the last 12 months. Good documentation was in place supporting the admission process of the individuals as seen at the last and this visit. Individuals had been supported to visit the home prior to making a decision on whether to move there. The staff in the home had worked with other professionals to ensure Cypress Lodge was suitable for the new person. This included the placing authority. Care plans seen incorporated the assessment completed by the home and that of the placing authority. One individual said they liked living in the home and had settled in well. A contracts was seen for one of the individuals that had recently moved to Cypress Lodge. It was noted that the contract had not been signed by a representative of the organisation, or the individual and did not include the fees or any additional costings for example the transport. This remains an outstanding requirement. Care plans were viewed for two individuals. The manager confirmed that a review had been completed of the confidential information to ensure that relevant information was recorded in the day to day file which was made available to staff. This was confirmed both in conversations with the manager and the documentation seen. Compliance had been achieved. However, it would be good practice for the placing authoritys assessment and care plan to be made available to staff to enable a review of the contractual care. Care plans detailed sufficient information for staff to provide a consistent approach. One person had a plan of care to support them with smoking and finances. However, the manager said this had changed in April 2010 after a review with the outreach services and the person was given more responsibility. The plan of care had not been updated to reflect the changes. The manager said they were waiting for the care plan from outreach Care Homes for Adults (18-65 years) Page 4 of 11 team before updating the homes plan of care. This must be updated to reflect the current support to avoid confusion ensuring an open and transparent service. Staff were aware of the changes. It was noted two individuals care plans had not been signed by the manager or the individuals. Good practice would be for the individual to sign the plan of care. There was no date on the back page of the care plan, however there was a date on the header. Good practice would be for the manager when signing the care plan, included a date when this was completed. The manager had identified this as an area for improvement in the Annual Quality Assurance Assessment. This had been a recommendation from the visit in August 2009. Consideration should be taken to review the present care planning model and look to use more service user friendly models which lends to supporting people with a learning disability and promotes more involvement for example Essential Lifestyle Planning, PATH or MAPS. The present care planning model may not be accessible to some of the individuals living in Cypress Lodge. The manager and the staff said there has been an improvement in organising activities for the individuals living in the home. The structured plans for people had been reviewed to ensure that it was still appropriate for the individual and that they continued to enjoy was being offered to them and there were sufficient staff on duty. Staff said that individuals regular go out into the local community, shopping or visits to the pub, places of interest, attendance at college courses, day centres and the farm. One member of staff said that one person goes swimming regular and if this is missed then it is arranged for the person to go on a weekend but they said this was very rarely missed. Records were being maintained of the activities people were participating in. Compliance had been demonstrated in relation to ensuring activities take place and adequate staff were available. Risk assessments were in place and had been expanded since the last visit to include areas identified at the last visit. This included falls, gender of staff supporting with personal care and relationships. These had been kept under review. Compliance has been achieved to a previous requirements. There was good health care monitoring in place with routine appointments being made to other professionals including the dentist, opticians and the GP. Other health care professionals included the local community Learning Disability Team, Consultant Psychiatrist and the Mental Health Outreach Team. It was recommended at the last visit that health action plans be introduced. The manager said they were obtaining information about this and in discussions with the Community Learning Disability Team. This remains outstanding. Good systems were in place in relation to the administration of medication, including storage, records, administration, policies and procedures and ongoing training for staff. The medication storage had been moved to the larger office. Staff confirmed that this has improved the administration of medication as it is quieter with less disruptions. There have three concerns raised since the last visit. These had been documented in the homes record of complaints. Documentation was in place to demonstrate that these had Care Homes for Adults (18-65 years) Page 5 of 11 been investigated and responded to appropriately. There has been two safeguarding referrals made to BANES, one related to a relationship between two individuals living in the home and the other the conduct of a member of staff. There were records to demonstrate that the service has worked closely with BANES and had taken appropriate action in minimising any further risks. A tour of the home was completed and a review in relation to the response to repairs. This included Cypress Lodge and Willow Cottage. Both homes are on the same site. The manager was able to demonstrate that the monitoring of repairs had improved since the last visit. All repairs noted at the last visit have been completed including replacement of the work surfaces and replacement of missing drawers in the kitchen at Willow Cottage and ensuring there were curtains in the lounge areas of Cypress Lodge. The maintenance person was working at Cypress Lodge on the day of the visit and confirmed an additional person had been employed to assist with the workload. The manager said that clearer records were being completed in respect of repairs required and the date of when they were actioned. This was confirmed in documentation seen. Regular reports were being forwarded to the provider so that this could be further monitored. One individual living in the home said they liked living at The Willows, they liked their bedroom and the staff that supported them. They said they would like to live more independently in the future. They said the staff were helping them to get the skills to be able to do this. They said they liked to go shopping and preparing their own meals. Another person said they had lived in the home for a long time and were happy, staff often take them out and they liked going to the farm. A further person said they were happy living at Cypress Lodge and the staff were ok as was the food. Two staff records were looked at, in respect of recruitment, training and ongoing support. There were clear records to demonstrate that a thorough recruitment process had been completed. There was a comprehensive application, two references and a criminal record disclosure. Since the last visit the service has developed a risk assessment/protocol where staff may have a positive disclosure on their criminal record. The manager said that a full risk assessment would be completed to determine if the applicant was suitable to work with vulnerable adults. Compliance has been demonstrated to a previous requirement. Staff complete an in house induction and the Learning Disability Qualification. As confirmed in staff records. The manager said staff complete a four month probationary period where at the end they are assessed on whether they are suitable to continue to work in the home. Staff confirmed that they had completed a comprehensive induction and for the first two weeks of employment were supernumerary. The manager said that some staff were still in the process of completing the Learning Disability Qualification. Once this was completed then they would be proceeding to complete a National Vocational Qualification at Level 2 in care. The manager said two staff had completed an NVQ in care. A further two staff were in the process of completing an NVQ 2 and one member of staff completing an NVQ 3 in care, out of a team of 10. The manager was in the process of completing an NVQ 4 in care and then she would be proceeding to complete the Leadership and Management Qualification previously known Care Homes for Adults (18-65 years) Page 6 of 11 as the Registered Managers Award. From talking with the manager she was aware of the need to ensure that at least 50 of the workforce have a National Vocational Qualification in care with a plan being developed. The manager was able to demonstrate that staff have a robust training plan in place. The plan included core training which included health and safety, fire, first aid and manual handling training. These were being updated at periodic intervals. Other training included mental health, safeguarding, supporting individuals that challenge, autism, epilepsy, relationships to name a few. It was advised that staff in addition to the attending the training on safeguarding with the organisation attend the local authoritys alerter course. Monthly meetings were taken place with minutes being maintained. Staff were receiving one to one supervision every six weeks as evidenced in staff records and the supervision planner. Feedback from staff was much more positive than on the last visit. Staff said that there is good communication from the manager with clearer direction. Staff confirmed that there has been an improvement in communication, response to repairs and activities that individuals can participate in. One member of staff said there is lots of training and that they like working with the individuals living in the home. Three staff were consulted with during the visit they demonstrated a good understanding of the needs of the individuals. From talking with the staff at times the home could be very busy especially if individuals were anxious or not happy. Staff described in a positive manner how they supported individuals during times when they were angry or upset and gave examples where additional staff were employed to assist with individuals when they were unsettled. The home was adequately staffed on the day of the visit. There was three staff and the manager. The minimum staffing levels for the home is three members of staff working during the day and the evenings and two members of staff at night, one member of staff providing sleeping cover and the other a waking night. An external Health and Safety Adviser was visiting Cypress Lodge making an assessment on the premises and the health and safety policies and procedures. This had been instigated by the provider. They said that a report would be compiled and sent to the provider with any actions that may be required. What the care home does well: What they could do better: Care Homes for Adults (18-65 years) Page 7 of 11 There is one outstanding requirement relating to the contracts. Individuals must be assured that they have a contract that includes the fees charged and any additional fees. This will ensure an open and transparent service is being provided. Where care needs have changed for one particular individual, then the plan of care must be amended ensuring a consistent and transparent service is being provided. Care plans must be signed by the member of staff compiling them and where possible the individual. 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 8 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 5 5A For individuals to have a 19/11/2009 contract of care that specifies what is and not included in the fees. Where individuals contribute towards transport cost this must be recorded in the homes contract. Ensuring an open and transparent service is being provided. Care Homes for Adults (18-65 years) Page 9 of 11 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 6 15 Ensure that care plans are amended where care needs change. Ensuring a consistent and transparent service is provided. 29/07/2010 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 6 18 For care plans to be dated and signed by the member of staff compiling them and where possible the individual. For health action plans to be developed for each individual in accordance with the governments white paper Valuing People. Care Homes for Adults (18-65 years) Page 10 of 11 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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