Care Home: Fir Lodge

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What the care home does well The individuals we spoke with and those who responded by survey said they are able to choose how to spend their day and they are treated well by staff who listen to them and act on what they say. The relatives who responded by survey said the home does meet the needs of each individual and provides the care and support they expect. The staff we spoke with and those who responded by survey said they are well supported in their role, remain committed to providing a good service and enjoy working in the home. The home promotes a person centred approach and remains committed to improving this to ensure individuals are supported to determine their own service. The service works actively with external agencies and Health Care Professionals to develop and improve the support provided to people who live in the home. What has improved since the last inspection? The fire alarm system is now checked regularly and staff have received formal fire safety training. This helps to ensure effective fire safety for both the people who live in the home and the staff team. Most of the planned environmental improvements have now been completed. This ensures a homely and safe environment for each person to live in. The frequency of staff meetings has now been improved. This helps to ensure consistent support is provided to each person who lives in the home. What the care home could do better: Each current or prospective user of this service must be provided with up to date details of the services the home is able to provide. This would support individuals to decide if this is the right home for them to live in. Each care plan must continue to be regularly reviewed and a clear record of the review process must be maintained. This would ensure each person is provided with support which meets their current needs.Training in relation to challenging behaviour must be provided to staff. This will ensure they are suitably trained to support individuals in a safe and consistent manner. The recently appointed Manager must complete the registration process with us to ensure each person who lives in the home is provided with an accountable service. The home should consider noting how often each Risk Assessment should be reviewed. This would help to ensure each individual is provided with support which meets their current needs. The home should consider reviewing the administration of rescue medication. This would promote the welfare and safety of each person who lives in the home. Each individual should be provided with up to date information should they wish to make a complaint. The home should complete the redecoration of the toilet on the first floor and the staff sleeping-in room. This would provide a better living and working environment. CARE HOME ADULTS 18-65 Fir Lodge 91 Bloomfield Avenue Bath Bath & N E Somerset BA2 3AE Lead Inspector David Smith Key Unannounced Key Inspection 19th February 2008 09:30 Fir Lodge DS0000008180.V359840.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 Fir Lodge DS0000008180.V359840.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. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fir Lodge Address 91 Bloomfield Avenue Bath Bath & N E Somerset BA2 3AE 01225 421241 01225 786619 jason.darcy@new-dimensions.org.uk www.dimensions-uk.org Dimensions (UK) Ltd 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) Post Vacant Care Home 5 Category(ies) of Learning disability (3), Physical disability (2) registration, with number of places Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 bed home currently registered for 5 people with learning and physical disabilities. 8th June 2006 Date of last inspection Brief Description of the Service: Fir Lodge is operated by Dimensions (UK) Ltd, an independent voluntary organisation. The home is a spacious Victorian house situated in a quiet location and provides easy access to local shops. The city centre is also no more than a mile away. Accommodation is provided on three floors. There are six single bedrooms in total, one on the ground floor, which has en-suite facilities, and four on the first floor, one with en-suite facilities and another with a through floor lift, which was installed specifically for the person who occupies this bedroom. Staff members provide sleep-in cover and use the sixth bedroom, which is on the second floor. A communal lounge area, a dining room, kitchen and laundry area are located on the ground floor. There are two bathrooms with toilets, one on the first floor and one on the second floor. There is also an additional communal toilet on the ground floor. The home is set in its own grounds and there is a garden with a patio area, which can be accessed by wheelchair down a path, which runs along the side of the house. The home has its own mini-bus, which enables access to the wider community. Fir Lodge DS0000008180.V359840.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. This was an unannounced visit to the home as part of a Key Inspection of this service. The review of evidence and pre-inspection planning involved reviewing the report of the last Key Inspection carried out in June 2006 and the service history, which details all contact with the home including notifications of significant events which they have reported to us. We (the CSCI) provided the home with their Annual Quality Assurance Assessment (known as an AQAA, pronounced as ‘aqua’) and a range of survey forms for people who live in the home, their relatives, carers, advocates, health professionals and staff members, prior to our visit. The AQAA was completed and returned, together with fourteen surveys. We examined staff personnel records at the organisation’s Bath offices, where all personnel records are now stored. We gathered additional information during this visit through informal discussions with people who live in the home, the newly appointed Manager, Deputy Manager and other staff members. Interaction and communication between staff and individuals was also observed. Care plans and associated records were examined together with Risk Assessments, finances, complaints procedures, medication administration, menu plans, staff personnel and training records and health and safety records. We also viewed all communal areas of the home and some of the individual’s own rooms. The people who live in the home wish to be described as “people who live in the home”, or “individuals”, rather than service users. Dimensions (UK) Ltd uses the term “people we support”. This terminology has therefore been acknowledged and replaced the term “service user” in this report. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Each current or prospective user of this service must be provided with up to date details of the services the home is able to provide. This would support individuals to decide if this is the right home for them to live in. Each care plan must continue to be regularly reviewed and a clear record of the review process must be maintained. This would ensure each person is provided with support which meets their current needs. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 7 Training in relation to challenging behaviour must be provided to staff. This will ensure they are suitably trained to support individuals in a safe and consistent manner. The recently appointed Manager must complete the registration process with us to ensure each person who lives in the home is provided with an accountable service. The home should consider noting how often each Risk Assessment should be reviewed. This would help to ensure each individual is provided with support which meets their current needs. The home should consider reviewing the administration of rescue medication. This would promote the welfare and safety of each person who lives in the home. Each individual should be provided with up to date information should they wish to make a complaint. The home should complete the redecoration of the toilet on the first floor and the staff sleeping-in room. This would provide a better living and working environment. 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. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 8 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 Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 9 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): 1 and 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not currently provide up to date information to assist people in making an informed choice of whether the service is suitable for them. Each individual knows their needs and aspirations will be assessed and met by the home. EVIDENCE: The home has both a Statement of Purpose and Service Users Guide, however these are both out of date despite us saying these must be updated following our last inspection. Both documents still refer to New Era, which has recently become Dimensions (UK) Ltd, the National Care Standards Commission, which is now the Commission for Social Care Inspection and to staff who no longer work in the home or for the Dimensions organisation. One individual’s Service User Guide we examined still contains three separate documents explaining how to complain and a copy of an inspection report dated December 2002. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 10 These issues were discussed with the Manager who agreed that new documents need to be developed, which accurately describe the current service and then be provided to each person who lives in the home. Any individual interested in the service would be subject to a comprehensive assessment process operated by the home. However, there have been no new admissions to the home since 2002, so there are no recent assessments to examine. The introduction to the home is tailored to the individual who moves in, however people do generally visit or have short stays at the home prior to moving in permanently. The individuals who currently live in the home said they were asked if they wanted to move into the home and did receive enough information to decide if it was the right place for them to live. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 11 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 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home ensures that the service provided to each individual takes into account their changing needs and personal goals, supported by both written information in care plans and risk assessments which are subject to ongoing review. EVIDENCE: The care records of two people who live in the home were examined during this visit. Each plan is written in an individual way and covers key areas of support individuals require, such as personal care, healthcare, eating and drinking and how they wish to spend their leisure time. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 12 Individuals spoken with and those who responded by survey said they did make decisions about what they would like to do each day and felt that they generally do the things they choose. One relative who responded by survey said the home “provides my (relative) with a small, caring environment in which they can express themselves”. The home has not held formal reviews with individual’s Funding Authorities for some time. The Manager explained that two placement reviews had been conducted recently but there was no evidence available in the home to show how these reviews had been carried out or what the outcomes were. Staff continue to use a form which they sign to say that care plans are being reviewed in-house. It is not clear how these reviews are conducted or what information is used as there are no other records of the review process except this one sheet staff sign. No other evidence or information was presented to us to explain this process further. The home continues to operate a key-working system through which each individual is allocated a named member of staff who plays a central role in coordinating the service they receive. Staff spoken with display a good understanding of their roles and responsibilities in this respect and it was apparent that this system works well within the home. The home may therefore wish to develop a system for keyworkers to follow to show how care plans are reviewed and what information is used in this process. I did discuss this with the Manager who felt this would be useful and relatively easy to implement. Due to the nature of the disabilities of some of the people who live in the home it can be difficult for them to clearly communicate choices or wishes. Staff explained that they use a number of methods to ensure people are supported to make choices and decisions. For example staff use observation of body language, behaviours or gestures of individuals as indicators of choice as well as individuals being able to express themselves verbally or through sign language. During our visit staff appeared confident in communicating with people who live in the home, either through speech, the use of signs or by interpreting vocal sounds or gestures. Staff did provide choices, but let each person make their own decisions. There are person centred Risk Assessments in place, which support individuals to take risks as part of an independent lifestyle. These form part of each persons support plan and although they did appear to be in date, many did not state when they should be reviewed despite this being asked for on each assessment. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each individual has opportunities and appropriate support to develop, access leisure and educational facilities both locally and in the wider community including day trips and visits to family and friends. Each person’s rights and responsibilities are recognised in their daily lives. A healthy and balanced diet for each individual is promoted. EVIDENCE: The home has a person centred approach in supporting each person to develop. The records maintained within the home are designed to enable each person’s progress to be assessed and the support provided adapted accordingly. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 14 Each person has their own timetable of activities. This includes regular access to local community facilities such as shops, cinema, pubs, social groups as well as Local Authority Day Services. On the day of our visit some individuals were attending day services. Other people remained in the home and were supported by staff to choose how they wanted to spend their day. Individuals spoken with and those who responded by survey said they were able to choose how to spend their time and generally were able to do the things they wished to do. It was clear from discussions with staff that some people who live in the home have been supported in their personal development. One individual has now returned to using day services following several years of not attending. It is hoped one other person may also be able to re-establish their attendance shortly. One relative said “staff always encourage my (relative) to maximise their abilities, attend courses, holidays and activities they enjoy”. Observation during our visit and discussion with both people who live in the home and staff members show that each person is treated with respect and dignity. Each is seen as an individual and treated as such. Each person is encouraged to maintain contact with family and friends. Visitors to the home are welcomed and staff work hard to ensure individuals are able to visit their relatives when they wish. One person was recently supported to visit their family in Birmingham and it is hoped this will become a regular event. Relatives who responded by survey said the home does help their relative keep in touch and they are kept up to date regarding important issues. One family said they are “very happy” with the care and support provided by the home and felt “everything is excellent”. The menus show a wide range of food, which provide both a healthy and balanced diet. Whilst there is no formal menu planning as such, each person chooses what they would like to eat each day and this is respected. Individuals generally eat their meals in the dining room, which overlooks the front garden. If people wish to eat their meals in the privacy of their own room, this is respected. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 15 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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person is supported in their preferred manner and their personal and healthcare support needs are well met. The policy and procedures relating to administration of medication ensures individuals’ welfare and safety. EVIDENCE: The care documentation in place provides clear guidance for staff on how they should support those living at the home with their personal care. The care plans we examined show that individuals are registered with a local GP, dentist, optician and chiropodist. Other specialist services are accessed when an identified need arises. These are provided by Bridges Community Learning Disability Team (known as ‘CLDT’), such as Occupational Therapists, Physiotherapists and specialists in challenging behaviour. Contact with each professional is recorded and forms part of each persons ‘Health Action File’. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 16 Although there have been some changes in the staff team since our last visit, a core of experienced staff remain who have a good knowledge of individuals’ healthcare needs. Any changes, which may cause staff concern, are noted and acted upon. It remains evident that the management and staff spoken with are sensitive to the personal, healthcare and emotional needs of those living in the home. Each individual also has a Health Action Plan, which notes when each person last visited the dentist, optician, had vaccinations (such as tetanus) or blood tests. These have not been developed since our last inspection, although this remains an aim of the home. The home uses a Monitored Dosage System of medicine administration and this system is well managed. Medication is stored securely in a locked cabinet on the ground floor of the home. The care plans explain what medication each person takes and how this is to be administered. The medication records contain the home’s medication policy, details of medication, the times of administration and a list of staff signatures together with a sample of the initials they use on these records. Two staff are generally required to sign medication records and each individual’s record was correctly completed, signed by staff with no gaps evident. Each person has their own supply of medication which is used as and when required, such as painkillers and ‘rescue medication’ for people who suffer from epilepsy. We discussed this ‘rescue’ medication with the Manager and would recommend that the home obtain a copy of the ‘Joint Epilepsy Council’ guidelines, which relate to this. The home may then wish to review the existing guidelines, storage facilities and Risk Assessments to ensure they are in line with the JEC guidance. The records we examined show that staff have had formal medication administration training, completing either the Boots or Aset course. All staff members are also assessed ‘in-house’ each year. Training was provided in the use of epilepsy ‘rescue’ medication in September 2007. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 17 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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each individual is supported to communicate their views and they can be confident that they will be listened to and their views acted on if necessary. Clear policies and procedures are in place in order to protect individuals from the likelihood of abuse, neglect and self-harm. EVIDENCE: The home has a formal Complaints Policy, an Adult Protection Policy and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. There have been no complaints since our last visit and we have not had any concerns or complaints direct regarding Fir Lodge. Individuals we spoke with and those who responded by survey said they knew who to speak to if they were unhappy, felt safe living at the home and that staff listen to them and act on what they say. Some individuals did not know how to formally complain or how this process works. The number of documents relating to complaints in the ‘Service Users Guide’ may also make this more difficult for people to understand. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 18 The AQAA completed by the Manager confirms they intend to develop a more ‘user friendly’ complaints procedure for the people who live in the home, which would better suit their needs. All staff are provided with training in relation to the Protection of Vulnerable Adults and are subject to ‘enhanced’ Criminal Record Bureau disclosures (known as ‘CRB’s) before they start work in the home. Some people who live in the home may become distressed or present behaviours which may be perceived as challenging the service provided. These individual’s care plan have details of known trigger points and the appropriate defusing techniques. The staff we spoke with said they felt that the staff team responded consistently to this type of behaviour and it is generally easy to help defuse. These behaviours include not wishing to leave the house or becoming focused on future events, as well as occasional hitting out or kicking people or objects. Although some staff have attended training in this area, others have not despite us saying they had to following our last inspection. All staff must be provided with challenging behaviour training to ensure they are equipped with the knowledge and skills to support individuals who present such behaviours in a safe, effective and controlled way. The Manager has chosen an appropriate course and will ensure staff are trained on the next available date. Individuals are supported by staff to manage their money. Each person has their own account and any money withdrawn is stored securely in the home’s safe, which has a combination lock. Two individual’s finances were checked and found to be securely stored, clear records maintained and all cash balances were correct. The home maintains clear records of all accidents and incidents and notifies us of any significant event which occurs. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 19 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, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Fir Lodge is a homely, comfortable and safe environment for people to live in. EVIDENCE: Fir Lodge is a spacious Victorian house situated in a quiet location, and provides easy access to local shops. The centre of Bath is no more than a mile away. Accommodation is provided on three floors. There are six single bedrooms in total, one on the ground floor, which has en-suite facilities, and four on the first floor, one with en-suite facilities and another with a through floor lift, which was installed specifically for the person who occupies this bedroom. Staff members provide sleep-in cover and use the sixth bedroom, which is on the second floor, where there is also a bathroom and the home’s office. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 20 A communal lounge area, a dining room, kitchen and laundry area are located on the ground floor. There are two bathrooms with toilets, one on the first floor and one on the second floor. There is also an additional communal toilet on the ground floor. The home is set in its own grounds and there is a garden with a patio area, which can be accessed by wheelchair down a path, which runs along the side of the house. We viewed all of the communal areas, along with some of the individual’s own rooms. All areas of the home were very clean and tidy and furnishings and fittings are of a good quality. There have been a number of improvements since our last inspection; the carpets have been replaced, the lounge has been refurbished and each person who lives in the home has had their bedroom redecorated and chosen their own soft furnishings. There were lots or personal effects, pictures and photographs which added to the homely feel. The areas which still need to be improved are the toilet on the first floor and the staff sleeping-in room. These are in the process of being done and will be completed shortly. All areas of the home were clean and tidy when we visited. Individuals who responded by survey said the home is ‘always’ kept ‘fresh and clean’. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 21 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): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The clarity of staff roles and responsibilities along with staff training and supervision are designed to provide a consistent approach to the support of staff and service users. The home’s recruitment policy promotes both service users’ rights and their safety. EVIDENCE: There have been some changes within the staff team, although a core of experienced staff remain who are skilled and experienced to meet the needs of those living in the home. The home is currently recruiting staff, as there are vacancies for two full time staff and one part time. These hours are being covered by existing staff working extra hours, by the organisations’ Bank Staff and recently the home has also had to use Agency Staff. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 22 Staff members spoken with said that the staff team remains open, honest and supportive. They felt well supported by the manager and are able to discuss issues in an open and honest way. Staff were observed interacting with the people who live in the home and those spoken with demonstrated a good understanding of their support needs. Individuals appeared happy and relaxed in the company of staff. Individuals spoken with said they liked the staff team and were well supported by them. Each person who responded by survey said they are treated well by staff that listen to them and act on what they say. Relatives who responded by survey spoke highly of the staff team. One family said the staff are “excellent” and another said they provide “good all round standards of care”. The staff team now meets regularly. Staff spoken with said they find these meetings useful and are able to discuss any issues they wish as these can be added to the agenda. If staff are not able to attend, they read the minutes to ensure they remain up to date. The home operates a robust recruitment process and the records we examined included a photograph of each member of staff, application forms, health declarations, two satisfactory references, documents confirming proof of identity and Enhanced Criminal Record Bureau Disclosures. Staff are provided with a variety of training opportunities. The records we examined show that staff have had training in First Aid, Adult Protection, Food Hygiene, Health and Safety and how to move people safely. Staff are also provided with more specialist training to enable them to meet the current and changing needs of the people who live in the home. This training includes Epilepsy, Mental Health, Intensive Interaction and the organisations approach to supporting people. The home supports staff to attain a National Vocational Qualification (known as an ‘NVQ’). The home’s AQAA confirms that six members of staff currently hold this award and two staff are currently working towards this. Each member of staff is provided with regular, formal supervision. These meetings are held every six weeks and a clear record of each one is kept which both the supervisor and supervisee sign. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 23 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, 38, 39, 40, 41, 42 and 43. 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-run and individuals benefit from the ethos, leadership and management approach of the home. Each person’s views are sought in relation to the monitoring and review of the service provided by the home. Each person’s rights and best interests are promoted by the home’s record keeping and the organisations’ policies and procedures. The health, safety and welfare of people living in the home is promoted and protected. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 24 EVIDENCE: There have been a number of changes in the management of the home since our last inspection. The previous Registered Manager has now left the home to pursue a new role within the Dimensions organisation. The home was run by another manager for a short period of time and is now managed by Mr.D’arcy, who was previously the Deputy Manager. He has acted as the manager since September 2007, confirmed permanently in post in December and is now commencing the registration process with us. Through my discussions with Mr.D’arcy it is clear the management approach is open and positive, with a clear sense of direction and leadership. The AQAA he completed and our discussions also confirmed the commitment to the development and improvement of the service, where this is possible. The Management team now consists of the Manager and one Deputy, who is also relatively new to their role, having been promoted from a Support Worker. The staff spoken with said they felt the changes had been easy to adjust to, as the new management team are staff who already worked at Fir Lodge. They do not feel that the people who live in the home have been affected as it has been a reasonably seamless change. The views of the people who live in the home are sought as much as possible. Their views are seen as central to the ‘person centred’ approaches used in the home and the monitoring and development of the service. House meetings, person centred planning meetings and reviews are all designed to help gain these views. Fir Lodge has a current development plan, a copy of which is displayed prominently in the office. This has been completed using a person centred planning method known as a ‘path’. It is clear that each goal is focused upon improving the service and facilities available for the people who live in the home. This method of planning and review is used as an important part of the home’s quality assurance system. There are efficient management systems and structures in place to ensure the home runs effectively. The quality of record keeping in the home is generally good, with all records required during this visit easy to access and stored securely when not in use. The organisation has a number of policies and procedures, which are designed to ensure it complies with the law and remains aware of good practice guidelines. Full details of each policy were provided by the Manager as part of the AQAA he completed for us as part of this Key Inspection process. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 25 The registered provider’s representative makes regular visits to the home, and produces a comprehensive report of his findings, which continues to be sent to us each month. The systems to support health and safety in the home are being used consistently. The home’s fire log was examined which shows that the alarm system is tested each week, the emergency lighting is checked regularly and that fire drills are conducted, the last one being held on 18/02/08. There are regular checks on the temperature of hot water, the fridge and freezer temperatures and visual checks on electrical equipment used in the home. The home’s AQAA confirms that the safety tests on portable electrical appliances, hazardous substances used within the home, the home’s heating system and its electrical wiring are all up to date. Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 X 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 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 3 3 3 3 3 Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 YA1 Regulation 4 5 6 Sch 1 Requirement People who currently live in the home, or those who may wish to, must be provided with accurate information regarding the services the home can provide. (This requirement is repeated from our last inspection report). Timescale for action 19/05/08 2. YA6 15(2) To ensure individuals who live in the home receive a safe and responsive service, the reviewing and updating of care plans must be completed and a clear record of all review processes must be 19/02/08 maintained. To ensure individuals who live in the home receive a safe, consistent and responsive service, each member of staff must be provided with training in relation to responding to challenging behaviour. 3. YA23 13(6) 13(7) 18(1)(c) 19/05/08 Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 28 (This requirement is repeated from our last inspection report). 4. YA37 9(1) 9(2) The Manager must complete the registration process with us to ensure the people who live in the home are provided with an accountable service. 19/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA9 Good Practice Recommendations The home should consider noting how often each Risk Assessment should be reviewed to ensure each individual is provided with support which meets their current needs. The home should consider reviewing the administration of epilepsy ‘rescue’ medication to promote individual’s welfare and safety. Each individual should be provided with clearer information should they wish to make a complaint. The home should complete the redecoration of the toilet on the first floor and the staff sleeping-in room. This would provide a better living and working environment. 2. YA20 3. 4. YA22 YA24 Fir Lodge DS0000008180.V359840.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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