Care Home: Devon Lodge

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What the care home does well New service users have their needs assessed before they move into the home. Service users can make their own decisions and can take part in activities with a level of risk. Each service user has a weekly plan for the activities they are going to undertake. Service users have their needs met in ways they prefer and healthcare professionals are involved when needed. There is a complaints procedure in place and service users use it. The home looks after money on behalf of service users and records were accurate. The environment was clean and homely. Staff have access to training and a high number of staff have achieved a qualification in care. The home is managed with regard to health and safety. What has improved since the last inspection? Care plans have been improved since the last inspection. Service users can rely on staff to provide medication as prescribed. Special diets are now better catered for. The provider is now giving the acting manager copies of monthly visit reports which means the acting manager is aware of any issues which need looking into. The acting manager has been given time to undertake management tasks. What the care home could do better: The home does not follow its own procedure when recruiting new staff and not all checks are in place before they start work. Therefore, the home cannot evidence that new staff are safe to work with service users. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Devon Lodge 23a Grange Road Hedge End Southampton Hampshire SO30 2FL     The quality rating for this care home is:   one star adequate 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: Beverley Rand     Date: 0 1 1 2 2 0 0 8 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. the things that people have said are important to them: They reflect 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 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Devon Lodge 23a Grange Road Hedge End Southampton Hampshire SO30 2FL 01489785177 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Matthews Type of registration: Number of places registered: Hazelwood Care Limited care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 14. The registered person may provide the following category/ies of service only: Care home only - (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 (LD). Date of last inspection Brief description of the care home Devon Lodge is a care home for up to fourteen adults with a learning disability. There is a communal lounge/dining room and a conservatory. All bedrooms are single. There is a garden with garden furniture. The current fees are arranged and paid for by the placing authority. 14 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 25 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: one star adequate 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 was an unannounced key inspection. Before we visited the home we looked at the last inspection report and other correspondence received from the provider, such as the improvement plan which was sent after the last inspection. During the inspection we looked around the home, spoke with service users generally, spoke with four staff and the acting manager. We also looked at records such as care plans and staff recruitment files. Care Homes for Adults (18-65 years) Page 5 of 25 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 6 of 25 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 7 of 25 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. Prospective service users have their needs assessed before they move into the home. Evidence: There have not been any new service users since the last inspection. However, we looked at this standard at the last inspection and found that assessments were in place and prospective service users were welcome to spend time in the home before deciding to move in. Care Homes for Adults (18-65 years) Page 8 of 25 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. Care planning and records have improved which has resulted in better outcomes for service users. Evidence: The new acting manager has spent time reviewing and improving the care plans and we found them to be more personalised and up to date. Information necessary for staff to meet individual needs was written as a narrative which made the information easier to read and the needs easier to understand. The information included preferences, personal backgrounds, behaviour, mental health capacity, risk assessments, health and safety, mobility and a night time support plan. We looked at another care plan which clearly stated that the person liked their bathing routine to be done in a certain way. Food preferences and individual needs, such as needing one to one support with food being cut up, were also detailed. We spoke with staff who were able to describe the individual ways they supported people. Care Homes for Adults (18-65 years) Page 9 of 25 Evidence: We saw evidence that service users make their own decisions about every day life and undertake responsible risks, for example, going for a walk. Care Homes for Adults (18-65 years) Page 10 of 25 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 acting manager has ensured that more attention is given to arranging activities to suit individual needs. Service users have their needs met with regard to needing support with eating and drinking and special diets are better presented. Evidence: The acting manager told us she has worked with individual service users about what they would like to do for leisure and entertainment. A weekly planner has been devised with activities chosen by service users. What was a notice board is now being used as an information board, which has flyers relating to local activities. Staff told us that service users attend a day centre and college, if they wish to. They also go out with staff, either for a walk or a drive to pick up other service users. Other activities included going dancing, using a hydropool and bingo. When we arrived on the day of the inspection a staff member was going out for a walk with a service user because the Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: assessed need was for the service user to walk as much as possible. Throughout the inspection we saw service users spending time as they wished, for example, completing puzzles. The home has pet guinea pigs which service users can help look after if they wish. Some service users have particular needs with regard to food, such as one to one support, eating smaller meals more frequently, or having food cut up. The acting manager has worked to ensure this area has improved since the last inspection. On the day of the inspection the main meal was quiche with mashed potatoes and broccoli. We asked how this was made suitable for a service user who needed the food pureed and were told that all food was pureed separately. This was confirmed by the acting manager and is an improvement from the last inspection. For those service users who needed one to one support with eating, there is a support worker specifically allocated on the rota and we saw one to one support being provided. We spoke to staff who were aware of individual needs. The acting manager has created a picture menu to assist service users in making choices. However, we did see that the lunchtime medication round was started when service users were still eating their dinner. We asked staff as to how they decided the order of who was given their medication and were told it was in alphabetical order. This meant that service users were given medication half way through their meal. We spoke to the acting manager about whether this was appropriate or whether it would be nicer to be able to finish a meal before being given medication. She said that service users were offered medication and that they could theoretically say no, but accepted that they were unlikely to fully understand that they could say no. She agreed to look into this further. Care Homes for Adults (18-65 years) Page 12 of 25 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. The home was able to evidence that staff work with service users in ways they prefer and that healthcare professionals are involved. Medication systems have been improved and therefore outcomes for service users have been improved. Evidence: As detailed above, support plans were much improved and records showed ways that staff supported individual needs. Records also showed the level of social and healthcare professionals involvement. The acting manager told us about referrals which had been made in response to particular needs being identified or incidents occurring. The recording of medication administration has been improved since the last inspection. We looked at the Medication Administration Records, (MAR) for all service users and found only one gap in the recording. However, another, additional record showed that the service user did have the medication. We found detailed care plans in place regarding medication needed in certain circumstances, such as during epileptic Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: fits. These plans included pictures. We were told that only senior staff give out medication. Medication systems were found to be poor at the last inspection and the provider sent us an improvement plan in response. A pharmacy inspector visited the home on 28th July 2008 to undertake an inspection of medication. The resulting requirements were found to be met at this inspection. Additional records were put in place to provide a thorough audit of medication within the home, and we saw these systems in operation. Spot checks are also in place. Staff who give medication received training in October from a pharmacist which was tailored to the home and individual health needs, such as epilepsy. It is planned that all staff will receive training in February. All staff will be assessed as to their competence after the training. The home has a controlled drugs book, as well as a new cupboard fixed to a wall. The acting manager said that she had been told that the cupboard met the current regulations for the storage of controlled drugs. We looked at, and cross referenced, daily records with medication charts. For example, where a daily record showed a service user had had an incident which meant they should not have a certain medication, we looked to see whether they had the medication or not. We found that the records matched, which means the communication between staff worked and the healthcare needs of service users were met. The acting manager told us that when service users were prescribed medication such as anti-biotics, then these were got from the pharmacy and administered straight away and records confirmed this. Care Homes for Adults (18-65 years) Page 14 of 25 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. Service users feel able to complain and do so. Systems are in place to ensure safeguarding adults procedures are followed. Evidence: The home has a complaints procedure which is displayed in the hall and service users have a copy in their rooms. The procedure gives details of the timescales within which the home will respond if a complaint is made. The acting manager has created a new complaints form for service users which has pictures. The complaints log showed two complaints had been made but the home had responded within the timescales and sought to resolve the issues to the complainants satisfaction. The home has provided training regarding the protection of vulnerable adults to staff. The acting manager was aware of the procedure to follow should there be an allegation or suspicion of abuse. The home is currently subject to a Safeguarding Adults investigation by the local authority adult services. The local authority started these proceedings in response to information it received about service users before the last inspection. The provider has been involved with discussions about improving the home and improvements have been evidenced during this inspection. There have been no new referrals under safeguarding adults. Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: The home assists service users with managing their money. Care plans identified individual needs in this regard. We looked at the records and monies held for three service users and found that they matched. Care Homes for Adults (18-65 years) Page 16 of 25 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. Service users live in a clean and homely environment. Evidence: We looked around the communal areas of the home and saw that the home was clean. The acting manager told us that no redecoration had taken place since the last inspection and that she wanted to get a schedule in place. She also thought that service users should be involved, if they wished to be. An area of the lounge was previously set up as an office area but this has now been returned to domestic use. Service users can personalise their rooms. There is a maintenance logbook and staff confirmed that maintenance was completed quickly. The home has a laundry which is sited away from the kitchen. Staff told us there was plenty of protective clothing such as aprons and gloves. Care Homes for Adults (18-65 years) Page 17 of 25 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by staff who have access to training. Recruitment procedures are not robust and put service users at risk. Evidence: The improvement plan submitted by the provider on 2nd October, following the last inspection, stated that the, home ensures that all new employees have two references from previous employer/place of education...No employee is allowed to work unsupervised with vulnerable adults until a POVA check and references and CRB check have been received. It also stated that the Operations Manager was completing an audit on the staff files to ensure the home was complying with all the requirement. Further, the manager and deputy manager were to be, monitoring the Robust checks closely at all times. We asked the provider to clarify the situation regarding not allowing employees to work, unsupervised before the POVA check was received. We received clarification that employees were not allowed to work until checks were returned and would be supervised thereafter to enable shadowing and induction. We looked at the recruitment files for five new staff, recruited since the last inspection. None of the files showed the start date and this had to be found through other records. Only one of the files showed all the checks to be in place before the person started Care Homes for Adults (18-65 years) Page 18 of 25 Evidence: work. The files for two new staff employed in October showed that they did not work a shift until after the Protection of Vulnerable Adults check, (POVA) and two references had been received. However, they had started their induction programme within the home. The acting manager said the new staff stayed in the office and were always supervised. The induction covered various topics and included fire training and looking at care plans. We explained our concern to the acting manager that whilst the staff did not work directly with the service users, they did read confidential information about them. If the checks had indicated that the person should not be employed, they would already have sensitive information about vulnerable service users. Additionally, the office can only be accessed through the house. The other two staff were employed in July and the POVA check was received before they started work. However,one has no references at all, the other has one reference, but it was not clear whether this reference had been provided in response to a request from the company or whether the staff member had bought it with them. The acting manager was responsible for the whole recruitment process with regard to the staff member whose file was complete before they started work. Of the other four, two had been recruited about the same time as she was employed and the other two since she has been employed. The acting manager explained the recruitment procedure was for the responsible individual and the operations manager conduct the interviews. Staff were not interviewed at the home so were not able to meet service users. Therefore, service users were not involved in the recruitment process at all. Neither was the acting manager. She told us that she was on leave and staff took a phone call to say two new staff were starting at the home the next day and would be living in the grounds. She therefore decided to start their induction. The home has a training programme in place which includes health and safety; infection control; moving and handling; first aid; food hygiene and dispensing medication. New staff undertake induction training and some staff have also completed the Learning Disability Award Framework which is specific to the service users who live at the home. We spoke with staff who told us that the induction included policies, how to care, confidentiality, dignity, using protective clothing, promoting independence, fire safety, bathing and water temperatures. Staff have had training in specific areas such as diabetes, epilepsy awareness and stoma care. The acting manager is planning to offer training in autism awareness and to involve a service user. Some dementia training was also seen to be a good idea. Out of fourteen staff, nine have achieved the National Vocational Qualification in care, level 2 or above and the rest are currently studying for the qualification. Care Homes for Adults (18-65 years) Page 19 of 25 Care Homes for Adults (18-65 years) Page 20 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The outcomes have improved overall for service users, but recruitment procedures put them at risk. Evidence: The new acting manager is not yet registered in respect of Devon Lodge but was previously the registered manager of another service. She has been working in social care of nearly nine years and was a registered manager for four of those years. She has achieved the Registered Managers Award and continues to update her training. She is currently studying for the National Vocational Qualification level 4 in Health and Social Care. Since the last inspection, the outcomes have improved for service users. The provider has enabled the acting manager to spend time on management tasks rather than working as a support worker. However, the ongoing lack of robust recruitment procedures has continued to put vulnerable service users at risk. A requirement in this regard has not been met since the last inspection. Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: The provider is now giving the acting manager copies of the reports completed under Regulation 26 of the Care Homes Regulations. We looked at these and found they covered areas such as talking with service users, visitors and staff; environment; medication; meals; care plans; complaints and action required. Issues were identified and followed through, thus demonstrating commitment to quality assurance. The acting manager said she had not yet undertaken any quality assurance work but was looking at finding a pictorial format for service users surveys. This standard was met at the last inspection. The home is run with regard to health and safety. We were told that cleaning fluids were locked away and that there were information leaflets about them. Risk assessments were in place for window restrictors and hot water temperatures. The portable electrical equipment was tested earlier in the year. Fire equipment has been tested regularly and updated as necessary. Care Homes for Adults (18-65 years) Page 22 of 25 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, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 34 19 Persons must not be 24/06/2008 employed to work at the care home unless they are fit to do so. The information and documents specified in Schedule 2 must be obtained before a person is allowed to work in the care home so that service users can be protected Care Homes for Adults (18-65 years) Page 23 of 25 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 1 34 19 Persons must not be 19/12/2008 employed to work at the care home unless they are fit to do so. The information and documents specified in Schedule 2 must be obtained before a person is allowed to work in the care home. To protect service users from staff who may not be safe to work in the home. 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 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 Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: 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 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 © (2008) 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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