Care Home: Forest Lodge

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What the care home does well The manager completes an assessment of the needs of any prospective new service users, which includes visits to the home before they decide to move in. All service users have a support plan in place which covers both health and social care needs. The home liaises well with health and social care professionals. Medication is stored appropriately and staff are trained in how to give medication. Service users choose how they spend their days and what they like to eat. Relationships with family are promoted by support staff. There is a complaints procedure in place and staff have received training in the safeguarding of adults. There is a programme of maintenance and re-decoration of the home and the home is kept clean. The home follows robust recruitment procedures when recruiting new staff. New staff undergo an induction period and there is an ongoing training programme in place. The manager is qualified and the home is well run. What has improved since the last inspection? The last inspection report did not identify any areas for improvement but the home continues to make improvements. What the care home could do better: This report does not identify any areas which the home must improve. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Forest Lodge Locksway Road Portsmouth Hampshire PO4 8LU     The quality rating for this care home is:   two star good 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: 2 8 0 4 2 0 0 9 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. that people have said are important to them: They reflect the things 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 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Forest Lodge Locksway Road Portsmouth Hampshire PO4 8LU 02392733421 F/P02392733421 d.snell@nhs.net www.hantspt.nhs.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hampshire Partnership NHS Foundation Trust care home 5 Type of registration: Number of places registered: 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 5. 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 Forest Lodge is a residential home providing care, support and accommodation for up to five younger adults (aged 18 to 65 years) with complex learning disabilities. The home has been in existence for some years but was registered under the Hampshire Partnership NHS Trust early in 2006. The building is a detached two-storey property surrounded by gardens and trees. It is Care Homes for Adults (18-65 years) Page 4 of 24 Over 65 0 5 Brief description of the care home located in a residential area of Portsmouth. Nearby facilities include shops, a post office, public houses and bus services. The home has five single rooms, one with an en-suite facility. One bedroom is on the ground floor and stairs access the rooms on the first floor. The large lounge/dining room and kitchen are situated on the ground floor. There is a good-sized garden at the rear. This is a safe, enclosed space with seating and a trampoline for use by the residents. There is ample parking space at the back of the home. The fees for this home are individually calculated and are dependent on the level of need of each service user. Care Homes for Adults (18-65 years) Page 5 of 24 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: two star good 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 the inspection we looked at the previous inspection report and the previous Annual Service Review. We also read the Annual Quality Assurance Assessment which had been completed by the manager. We received nine completed surveys from staff which were all positive about care at the home. One completed survey was received from a healthcare professional, which was also positive. During the inspection we looked around the home, observed staff working with service users, spoke with service users generally, the manager and a staff member. Care Homes for Adults (18-65 years) Page 6 of 24 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 24 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 8 of 24 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. The manager ensures that new service users have their needs assessed before they move into the home. Evidence: We spoke to the manager about the process which was followed when the home had a vacancy. She told us that she and the deputy manager visit the prospective service user where they are living. Visits continue and family visit the home. The prospective service user makes short visits to the home, staying for lunch and so on. Information to inform the assessment is gathered from the prospective service user, their family and professionals who work with them. The manager also said that she had provided a photo book of the home before the service user moved in. We saw an assessment which the manager had completed and this covered health and social care needs. Care Homes for Adults (18-65 years) Page 9 of 24 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. The home supports service users to make their own choices and meets needs on an individual basis. Evidence: We looked at one support plan in detail and another briefly. The support plan covered all areas of support needed, including activities, personal care, sleep patterns and eating. Daily records are kept for each plan which contribute to the regular review. Other information, such as a communication dictionary were also in the plans. This is a working document which was added to and amended as staff learnt more about the individual service users communication. Where there were restrictions on activities, this was clearly detailed in the plans, with a written rationale as to why there were such restrictions in place. The plans also referred to the involvement of health and social care professionals in the development of the plans. Staff told us that they found the support plans useful and that they referred to them regularly to see if there had been any changes. Care Homes for Adults (18-65 years) Page 10 of 24 Evidence: We saw that support plans included risk assessments for activities such as going out and swimming. Throughout the day we saw service users making choices and decisions, for example, going out to buy some lunch and spending time sitting in the garden. Care Homes for Adults (18-65 years) Page 11 of 24 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. Service users make choices in their everyday lives. Evidence: Each service user has an activities folder, which includes an activity schedule. Each is created with the service user so that it is individual and based on what the service user likes. Staff told us that the schedule is a guide and that if the service user does not want to do what is listed for that day, they do not have to. Staff look out for new ideas for activities and make suggestions to service users. Activities include going out for a drive, walking on the seafront, bowling, swimming, going for meals out and so on. One service user has their own trampoline and spa. Contact with families is promoted and staff support service users to visit family or go on holiday with them. On the day of the inspection two staff were picking up a service user from the family home which was a long way from Forest Lodge. Care Homes for Adults (18-65 years) Page 12 of 24 Evidence: On the day of the inspection we saw that service users had chosen what they wanted for lunch. We saw sample menus and found them to be varied, but the manager told us that a record of food actually eaten is not routinely recorded for everyone. We explained why this was important and she agreed to record food provided from now on. The menus showed where the recipe could be found, for example, in the cookbook. This is to ensure that the meal is cooked the same way each time, which is important for the service users. We saw evidence of staff responding well to diverse needs. Care Homes for Adults (18-65 years) Page 13 of 24 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 health and social care needs of service users are met in ways which suit them. Evidence: The health care needs of the service users are regularly assessed. All are registered with local GPs, who will undertake home visits if necessary. Good relationships are maintained with health and social care professionals. Records show that the service users all receive regular attention from a range of health and social care professionals such as the dentist, occupational therapist, speech and language therapist and chiropodist. Health care needs are recorded in the individual personal plans. A healthcare professional completed a survey and said that the home, treats people as individuals in a very person centered way, always treats people with respect and dignity and, excellent at communication - even with complex autism. Medication was stored in a locked cupboard and medication administration records were completed, with no gaps in the recording. However, the records were not detailed enough to easily identify the quantity of some tablets which should be in the home, because the carried over section of the record was not completed. This meant Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: that it would not be easy to see if there were any tablets missing. The manager agreed that this would be addressed straight away. There were thorough guidelines for staff regarding when to administer medication prescribed as, when needed. This included medication prescribed for epilepsy and agitation and records were kept regarding when the medication was given and why. The manager said that all medication is reviewed regularly with health care professionals including the psychologist. There has been a medication error since the last inspection but this was dealt with appropriately and action was taken to minimise the risk of it happening again. Staff undertake training in medication, which is of a days duration and is provided by the Hampshire Partnership Foundation Trust. Updates take place in the form of a questionnaire which is overseen by a senior staff member from the Trust, who is a nurse. We spoke with a staff member who told us the procedure they followed when administrating medication, which included signing the records after the service user had taken their medication. They also told us that they felt the medication training was appropriate to the work they did. Care Homes for Adults (18-65 years) Page 15 of 24 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. The home has a complaints procedure in place and staff have received training in safeguarding adults. Evidence: The home does have a complaints procedure but service users do not have their own copy. The manager said this was because of the current service users individual needs. However, the current service users are vocal and would bring any dissatisfaction to the managers attention. Family members have been provided with a copy of the procedure. All of the staff who completed our survey said that they knew what to do if a service user, relative or advocate had a concern about the home. The home has not received any complaints and neither have we. Staff have received training in safeguarding adults and we spoke to a staff member about the training course. They told us that they found it interesting and thought provoking. They also knew who to talk to should there ever be any suspicion or allegation of abuse. The home looks after money on behalf of the service users and records are kept along with receipts. We looked at the money held and records for two service users, finding that one was correct but one was 20p down. The home does have a system in place of double checking with two staff signing the records. The manager said the money would be replaced, as this was the policy where a miscalculation occurred. Care Homes for Adults (18-65 years) Page 16 of 24 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 well decorated home. Evidence: We looked around the communal areas and saw two bedrooms. The main communal area is both a lounge and dining room and has a large television with a range of videos and so on. The bedrooms we saw were newly decorated and the decor had been agreed with the service user whose room it was. The bathroom has been refurbished recently and therefore has not been given any homely touches yet. The bathroom has also been designed to meet the individual cultural needs of a service user. There are ongoing plans for re-decoration of the home. There is a garden where service users can sit or enjoy in other ways. There is space for the trampoline and spa which belongs to one of the service users. The support staff have responsibility for cleaning the home and they support service users to take part in keeping the home clean. We saw that the home was clean on the day of the inspection. Staff told us that they used protective gloves and aprons when undertaking personal care and that there was always a good supply in the home. They also follow procedures when dealing with soiled laundry. Care Homes for Adults (18-65 years) Page 17 of 24 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 good 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 trained and qualified staff who have been recruited using robust recruitment procedures. Evidence: There are sixteen support staff employed at the home. Eight of the staff have achieved a National Vocational Qualification in care, (NVQ) level 3, and one is currently studying for level 4. This is higher than the NVQ level 2 detailed in the National Minimum Standards and is therefore seen as good practice. We looked at the rota and spoke to the manager about the staffing levels. Five support staff are in the home for each shift and there are two staff awake at night. The manager told us that sometimes three staff will be in the home later, if someone is unwell or needs more support for another reason. The staff team remains stable and only one person has been employed since the last inspection. We looked at a recruitment file and found that references and other checks were in place before the person started work. The manager told us about the induction training undertaken by new staff. The programme includes a one week course provided by the Trust, working as a Care Homes for Adults (18-65 years) Page 18 of 24 Evidence: supernumerary staff member for as long as necessary and not working nights until more experienced. There is a training programme in place which includes mandatory training such as first aid, fire training, moving and handling, food hygiene, safeguarding, medication, health and safety and infection control. However, moving and handling training has not been updated in the last year and the manager told us that there has been a difficulty in booking the course. We discussed this further and were told that the current service users do not need any support with moving and handling. We were later advised that all staff have received theoretical training which is a one off course, and practical training would be provided if necessary. Other training includes courses about autism, epilepsy and challenging behaviour although these courses have only been undertaken by the manager, deputy manager and one support worker. The manager told us that what they learnt on courses was fed back to other staff in team meetings. Care Homes for Adults (18-65 years) Page 19 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run but service users may benefit from a more formal quality assurance system. Evidence: The manager has some twenty-four years experience of working with people with learning disabilities. She was appointed to the post at Forest Lodge in January 2006. The manager has achieved the Registered Managers Award since the last inspection and continues to update her training. We spoke to the manager about how the service seeks the views of service users. She told us that service user surveys are available from the trust but the current service users would not be able to answer the questions, even with support. We asked if there was another way views could be sought and the manager said that service users were able to speak up about issues which concerned them. No-one has an advocate at the moment but the manager is trying to access one for one of the service users. Family members also do not have access to a formal survey and the manager said that family are happy to offer their opinions, or can be asked verbally. Monthly, unannounced Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: visits are undertaken by an employee of the Trust and these visits look at the welfare of the service users and the environment. A report is written and a copy is provided to the manager. Ongoing and routine maintenance is undertaken by the estates department and we saw certificates for the maintenance of equipment within the home. The home is run with regard to the health and safety of the service users. The registration certificate was displayed in the office which is upstairs and often locked. We advised the manager that the certificate must be displayed in a conspicuous place and she agreed to move it to a better location. Care Homes for Adults (18-65 years) Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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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