Care Home: Elstow Lodge

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What the care home does well Elstow Lodge provides residents with a good standard of care in a comfortable and homely environment. The care staff are committed to giving residents a friendly and professional service. Comments received from residents, staff and relatives were positive about the care and support provided. There are clear guidelines recorded in care plans to ensure that care staff are able to provide appropriate care and support. Resident`s bedrooms are decorated and personalised to meet individual tastes and preferences. What has improved since the last inspection? A number of improvements have been made to the environment since the last inspection. Two bedrooms have been redecorated and two bathrooms have had new flooring. A new shower unit has also been fitted. A new carpet has been fitted in the lounge along with new lounge chairs. The dining room has been redecorated and new flooring has been laid. All windows are in the process of being replaced and redecorated. A new electrical fuse system has been installed and a fridge has been replaced in the kitchen. Supervision has improved since the last inspection and evidence of recorded sessions were seen in staff files. What the care home could do better: The home must ensure that prescribed medication is given at the stated times unless otherwise directed by a medical practitioner.The home must ensure that staff receive a detailed and recorded induction to ensure that they are aware of their responsibilities and all aspects of the home. Training regarding `Safeguarding Adults` must be in place for staff to ensure safe and up to date practice. It is recommended that the home use a range of pictorial aids to assist residents with communication difficulties when choosing food or other items. CARE HOME ADULTS 18-65 Elstow Lodge Wilstead Road Elstow Bedfordshire MK42 9YD Lead Inspector Andy Green Unannounced Inspection 13th February 2008 10:30 Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elstow Lodge Address Wilstead Road Elstow Bedfordshire MK42 9YD 01234 405021 01234 214664 pauljuliestokes@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (If applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr R M Sabey Mrs J Stokes Care Home 11 Category(ies) of Learning disability (11), Physical disability (1) registration, with number of places Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 2006 Brief Description of the Service: Elstow Lodge is a large detached house standing in well-maintained gardens. The home is situated in the village of Elstow near to local facilities including a post office, church, and two public houses. There is a bus route to Bedford from Elstow. This family run home is registered to provide residential accommodation for 11 adults with learning disabilities, and for 1 adult with physical disabilities. There is one bedroom on the ground floor, along with two lounges, the dining room, kitchen, and small laundry area. The remaining bedrooms, two of which are shared, are situated on the first floor. Residents are able to use the large garden, patio, and barbeque facilities provided. The fees range from £400 to £800 per week. Copies of CSCI reports are available to residents and their relatives on request from the home’s office. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. CSCI carried out this unannounced key inspection on 13th February 2008. The home completed an AQAA (Annual Quality Assurance Assessment). We met with the manager, care staff, residents and a relative to gather views regarding the services that are provided in the home. A number of records were inspected including care plans, training records, staff files, menus, staff rotas, medication records, fire testing records and health & safety records. A tour of the building and grounds was also undertaken. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that prescribed medication is given at the stated times unless otherwise directed by a medical practitioner. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 6 The home must ensure that staff receive a detailed and recorded induction to ensure that they are aware of their responsibilities and all aspects of the home. Training regarding ‘Safeguarding Adults’ must be in place for staff to ensure safe and up to date practice. It is recommended that the home use a range of pictorial aids to assist residents with communication difficulties when choosing food or other items. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are in place to ensure that the care and support needs of residents can be met. EVIDENCE: The home receives detailed assessment information from the local authority and a copy of the care plan. The manager and senior worker carry out a needs assessment using the home’s own assessment form. Reports are received from other healthcare professionals, where required, including speech & language therapists and psychologists. There have been two admissions to the home since the last inspection. Prospective residents and their family/relatives are encouraged to visit the home as part the assessment process to ensure that the residents need’s can be fully assessed. A relative spoken to during the day confirmed this to be the case. There have been no significant changes to the assessment process since the last inspection. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive appropriate health and personal care to meet their assessed needs. EVIDENCE: Three of the resident’s care files were seen. Detailed information and guidelines are recorded for the delivery of care and support required so that assessed needs can be safely met. Daily care notes are also detailed and accurately recorded. Changes in care are clearly documented with evidence that reviews are carried out on a regular basis. Where there have been significant changes a new updated sheet is inserted to ensure that the care plan remains current and up to date. It was recommended that the home uses a range of pictorial aids in care plans and other aspects of the home to assist residents with communication difficulties to make choices about their lives eg, food, activities and daytrips/holidays. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 10 Risk assessments are in place to ensure that residents are protected from potential harm. Examples seen included challenging behaviour guidelines and using electrical equipment. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff provide appropriate support to ensure that residents can engage in activities appropriate to their needs. EVIDENCE: The majority of residents have a structured daytime programme of activities including day centres and colleges. Two residents currently prefer to stay at home and receive support from care staff. In house activities include arts and crafts, cookery and exercise sessions. One of the residents continues to have a part time job with a local children’s activity centre. Regular shopping and daytrips are organised with visits to local towns and pubs. Holidays to Butlins and breaks via Mencap have also been organised during the last twelve months. Residents are fully involved in the choices of food in the home and a weekly menu is organised. Choices are clearly offered and snacks and drinks are Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 12 available throughout the day. Healthy eating is promoted and this has had particular benefit for one of the residents, which was confirmed by her relative. Residents are supported and encouraged to be involved in cleaning their rooms and other domestic chores including laundry, food preparation and washing up. Families and friends are encouraged to visit. One relative spoken to said that the staff were always welcoming and that she could visit at any time. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are treated with dignity and respect and receive personal care to meet their assessed needs. EVIDENCE: Residents are in regular contact with a variety of healthcare professionals including psychiatrists, speech and language therapists, chiropodist, dentists, optician, CPN’s and GPs from the local surgery. All healthcare visits and appointments are recorded in individual resident’s care plans. This was evidenced in the care plans seen during the inspection. One relative visiting the home confirmed that she felt that the care and support provided in the home was of a good standard and that she was kept informed of any changes in health or any other significant events concerning her relative. She stated that the staff were caring and. She also felt that the food, accommodation and cleanliness were always of a good standard. Medication records are generally recorded accurately. However the use of prescribed cream for one resident must be clarified with the GP as to whether it should be PRN or used three times per day. The manager stated that she would confirm this as soon as possible. Quality in this outcome area is good. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 14 Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure to make sure that residents have their complaints or concerns listened to and acted upon properly. EVIDENCE: The home has a clear complaints procedure to ensure that any concerns are dealt with and actioned appropriately. The home has not received any complaints since the last inspection. CSCI has also not received any complaints regarding the home. A relative confirmed that she would not hesitate in contacting the manager or senior staff if she had any concerns. The home has a policy statement regarding safeguarding adults. Conversations with members of staff clearly evidenced that they would have no hesitation in reporting any incidents of abuse or neglect to the manager or senior staff member on shift. However training in Safeguarding Adults needs to be updated for staff. It was noted during the inspection that care staff spoke to residents in a friendly, social and respectful manner. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides appropriate premises and accommodation to meet the resident’s needs. EVIDENCE: The home is well presented and free from unpleasant odours. An ongoing programme of maintenance ensures that the home remains in a good decorative condition and repairs are carried out in a timely manner. Residents and a relative confirmed that the accommodation provided was comfortable, homely and met their individual needs. Residents are encouraged to personalise their bedrooms with additional furniture, televisions, photographs and personal possessions. This was evidenced in bedrooms viewed during a tour of the premises. The manager stated that she is planning to refurbish one of the courtyard buildings to provide further communal/activity space for residents. Since the last inspection two bedrooms have been redecorated and two bathrooms have had new flooring. A new shower unit has also been fitted. A Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 17 new carpet has been fitted in the lounge along with new lounge chairs. The dining room has been redecorated and new flooring has been laid. All windows are in the process of being replaced and redecorated. A new electrical fuse system has been installed and a fridge has been replaced in the kitchen. Water temperatures tests are kept and recorded monthly. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s recruitment and training processes ensure that residents are protected from harm. However improvements to induction training needs to be made. EVIDENCE: Evidence of individual training were seen. Three members of care staff were interviewed and they confirmed that they received training throughout the year. Examples of training included; moving & handling, diabetes, autism, medication, infection control, fire safety, first aid, and health & safety. NVQ training is in place at level 2 and 3. However, training in Safeguarding Adults must to be organised to ensure that all staff have clear guidelines regarding the protection of residents from potential abuse. Although there is a basic induction there needs to be a formal recorded process in place. The home must ensure that staff receive a detailed and recorded induction to ensure that they are aware of their responsibilities and all aspects of the home. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 19 Supervision has improved since the last inspection and evidence of recorded sessions were seen in staff files. Care staff confirmed that they were regularly supervised. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed to ensure that residents receive a good and safe standard of care. EVIDENCE: The manager is experienced and skilled and provides a clear and supportive style of management. She has achieved NVQ level 4 and the Registered Managers Award. Staff members spoken to confirmed that they were well supported by the manager and senior care staff in the home and that they were able to freely raise any concerns or issues. Residents and relatives also confirmed that they found the management in the home to be responsive to any issues or queries that they have raised. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 21 It was noted during the inspection that one of the residents, who has lived in the home for many years, is now aged 66. An application for a variation to the homes registration must be submitted to CSCI regarding this resident as the home is registered for residents aged 18 to 65 years. The fire alarm records were satisfactory but it was noted that the monthly emergency lighting testing must be improved. Contracts for the servicing of equipment and fire safety appliances are in place and evidence of up to date checks were seen. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement The home must ensure that prescribed medication is given at the stated times unless otherwise directed by a medical practitioner. The home must ensure that staff receive a detailed and recorded induction to ensure that they are aware of their responsibilities and all aspects of the home. Arrangements for training, regarding ‘Safeguarding Adults’ must be in place for staff to ensure safe and up to date practice. An application for a variation to the homes registration must be submitted to the Commission in respect of a resident who is now aged over 65. Timescale for action 31/03/08 2 YA31 18 (1) (a) 30/04/08 3 YA34 18 (1) (c) (i) 30/04/08 4 YA37 14(2) (b) 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 24 No. 1. Refer to Standard YA7 Good Practice Recommendations It is recommended that the home uses a range of pictorial aids to assist residents with communication difficulties when choosing food or other items. Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elstow Lodge DS0000014899.V360086.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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