Care Home: Gladwyn Lodge

What the care home does well What has improved since the last inspection? What the care home could do better: CARE HOME ADULTS 18-65 Gladwyn Lodge 65-67 Harwich Road Colchester Essex CO4 3BU Lead Inspector Tim Thornton-Jones Key Unannounced Inspection 5th September 2006 09:30 Gladwyn Lodge DS0000017828.V310364.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 Gladwyn Lodge DS0000017828.V310364.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. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gladwyn Lodge Address 65-67 Harwich Road Colchester Essex CO4 3BU 01206 793207 N/A 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 Daramdeo Ramchurn Miss Anusha Ramchurn Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 8 persons) The registered manager must complete NVQ4 in care and management within 18 months from the date of this certificate 23rd March 2006 Date of last inspection Brief Description of the Service: Gladwyn Lodge is a residential service for adults with a learning disability. The service aims to provide supportive living, within a realistic domestic setting, for those persons who do not require complex care management. The home does not purport to accommodate those, for example, with challenging behaviour or who have associated complex physical care requirements such as acute continence management. The advised purpose of the service is to provide a homely environment, with care and support, to those who are unable or no longer wish to live with relatives, as part of a group home approach, with a view to enabling those accommodated to live as independent a life as possible. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home remains as a homely and comfortable environment. The presentation of the home environment continues to improve, with a replacement double glazed door and window to the side elevation of the home, providing alternative access to the rear garden rather than going via the kitchen patio door. The registered person will need to improve maintenance and decoration, particularly externally. Windows to the rear are in need of attention. Decoration that had been achieved at the time of the previous inspection was generally satisfactory. The tidiness and general organisation was satisfactory, although there were some areas noted that would benefit from a regular cleaning schedule. It was noted that as an improvement to the service users life skills, inclusion with domestic skills had been appropriately developed; although there remain a need for routine cleaning in high risk areas in addition to service user related and supported cleaning, particularly as the home does not employ separate staff to do this. The structure of the care management has continued to improve and is now achieving a good standard. The approach is more detailed and appropriate for the service user group accommodated. Staffing related practice is steadily improving. Turnover has not changed since the last inspection and staff remain committed and supportive of service users. Recruitment practice is sound and the manager continues to develop the supervisory approach. Training remains an area for improvement, although it is noted that four staff have now signed up for National Vocational Training (NVQ) at level 2 and are awaiting a start date. Service users spoken with (two) were confident and communicative and ‘at home’ with their surroundings. Access to the community and their involvement with social and leisure pursuits remain good. Healthcare arrangements are satisfactory although there are recommendations linked with medicines and monitoring of healthcare. Sampled policies, procedures and records were being maintained in a satisfactory way, although some are now in need of review to reflect current thinking and practice. The manager was not present at this inspection although continued steady progress with care management was evident. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 6 Quality assurance and monitoring needs further development to meet National Minimum Standards. This is an important management area since matters highlighted within this report that require improvement and development are all linked to the home’s ability to quality assure and monitor the service and thus make informed improvements to ensure positive outcomes for service users. The registered person will need to ensure that all financial records and budgetary arrangements are up to date and available for inspection upon request. Overall, this inspection concluded that good progress has been made in key areas although some work and development of the service is required. The outcome of the inspection concludes that service users are safe but would benefit from further improvement to the service in some areas. Within the eight outcome groups, four were rated as ‘good’ and four were rated as adequate. Based upon the ‘key’ national minimum standards the service has shown an improvement since the previous inspection from 50 to 59 compliance and is indicative of the service improving. There are, however, development needs, particularly within four of the outcome groups rated as adequate, and therefore the Registered Person will need to set out an improvement plan to ensure that progress is ongoing. What the service does well: What has improved since the last inspection? • • • • • Care plans are improved using a format that enables a person centred style and approach. Risk assessment has improved. Some aspects to the premises. Staff training has developed. Staff supervision. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Gladwyn Lodge DS0000017828.V310364.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 Gladwyn Lodge DS0000017828.V310364.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 • Service users who could be admitted to the home would benefit from the homes procedure for admission. This outcome is judged as ‘Good’ because it has more strengths than areas for improvement. There are no significant areas for improvement relating to the health and safety of people using the service or issues of poor management. The key NMS under this outcome heading are generally met but there are some areas of improvement that CSCI are confident that the provider can manage. EVIDENCE: All service users accommodated at the home have been resident since 1995 when the home was first registered. No further admissions have taken place and there are no current vacancies. The service does have an admission procedure and this broadly reflects satisfactory practice although it would benefit from further development to reflect all the requirements of National Minimum Standards since the policy has been in operation for some time. The Registered Person must advise all service users that the service can meet their needs, based upon the preadmission assessment process. Whilst no service users have been introduced to the home during the period that this has been a requirement, the need to do this must be integral to the admission policy and practice. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 10 On this basis existing service users who have been subject to reviews of their care will need to receive a letter of this sort to reassure them that the home is able to, and willing, to continue to meet their needs. The manager was not present at this inspection and therefore it was not possible to ascertain her underpinning knowledge and understanding. The senior staff member of duty was able to reflect all of the practice principles that would be expected should a referral be made to the service. Gladwyn Lodge DS0000017828.V310364.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 • • Service users mainly benefit from a developing care planning approach that includes improving consultation and decision making. Service users mainly benefit from the activities they undertake being assessed as to the presenting risk. This outcome group has been judged as ‘Good’ because it has more strengths than areas for improvement. There are no significant areas for improvement relating to the health and safety of people using the service or issues of poor management. The key NMS under this outcome heading are generally met but there are some areas of improvement that the Inspector is confident the provider can manage. EVIDENCE: The inspection highlighted that care plan format has been further revised since the last inspection to reflect a better person centred approach. The recording format provides for both needs and wishes, desired outcomes, method for achievement and comments from the service user that demonstrates appropriate consultation. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 12 The recording on a daily basis is sound in that within some of the ‘functional’ recording of the person’s day, there are entries that relate to the care outcome objectives. There is risk assessment activity on file and this relates to the care outcomes. The format is appropriate although the risk assessment activity would benefit from a wider approach that impact’s on all key areas of the person’s life within the home. Staff still tend to rely too heavily upon intuitive risk assessment. Whilst there will always be an element of professional judgement about appropriate and inappropriate risk taking, the existing approach, although developing, will need to fully and more comprehensively reflect a wider framework of assessment based upon full consultation with the service user and to show how the known risk will be managed, to enable the person to undertake tasks to achieve an agreed outcome. The two service users chosen by the inspector as examples for case tracking purposes were at home. Both service users were considered to not lack capacity to make decisions. The plan indicates a sensible balance between lifestyle choices and development needs. For example, from the sample taken a service user who chooses to drink alcohol at a nearby public house had been empowered to do so and the person’s independence is being encouraged by enabling the service user to enjoy the environment without the need for staff supervision, although support is provided in transporting the person to and from the public house to safeguard their welfare. The service user maintains their personal funds. A risk assessment needs to be developed in this context as mainly historical understanding of the individual’s needs indicates that an agreement about the amount of cash that should be taken with them has been reached. This particular aspect should, however, be better recorded within the plan of care although was demonstrably managed with consent of the service user. The inspection concluded that service users control their own money and access their accounts via cash machines much the same way as anyone else living in the community and this is positive in relation to the home ethos. Some service users are supported to do this and this inevitably requires staff to have access to security arrangements. In order to ensure that robust safeguards are in place the manager is advised to review the audit process to ensure service users’ rights are upheld and staff are protected from being exposed to potential allegation related to service users cash access. It should be emphasised that no such allegation has been received and no suggestion of impropriety is expressed or intended. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 13 The registered person maintains a receipt book for all payments made by service users regarding care home fees paid. It is recommended that a receipt book be maintained for each service user for ease of audit and confidentiality. The second case file reviewed was for a person who was less able to venture within the community unaided and required support from staff. The person confirmed that they felt well supported and had a very good relationship with staff. The service user gave examples of how the community was accessed and what interests were enjoyed. The plan of care reflected this. The structure of both plans was similar. The whole approach toward care planning was very flexible although service users are, to some extent, viewed by staff as somewhat of an ‘extended family’. Whilst this engenders an intrinsic and supportive/protective quality to the care provided, this approach can also present challenges to the notion of ‘independence’ and ‘self-determination’. This aspect to the home’s approach of care management has improved overall since the current manager introduced revised care planning tools and this continues to develop in a way that enables a more independent and objective quality to the process. Service users are actively being encouraged to take increased responsibility for example, their own rooms, personal decision making and perhaps to a lesser extent, their long term future and this should continue. The manager is advised to further develop the care planning approach and to maintain and develop the consultative and empowering approach that has started. The service users spoken with were confident and expressed satisfaction at their life within the home. The development is moving toward improved professional practice and with the planned emphasis on training of staff this should gain momentum. Staff achieve good outcomes for service users and the method of achieving this is evidently becoming increasingly as a result of planned, consultative objective setting rather than reliance of familiar, intuitive knowledge and understanding by association. This is a positive step. The inspection, based upon the case tracking process, indicated that service users were safe and that the management of care planning was developing in a structured and positive way. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 • • • • • Service users mainly benefit from opportunities to take part in appropriate activities. Service users benefit from access to and participation in the local community. Service users mainly benefit from the home’s approach to include family and friends within care planning. Service users mainly benefit from exercising their rights and responsibilities Service users benefit from a healthy diet. This outcome group has been judged as ‘Good’ because it has more strengths than areas for improvement. There are no significant areas for improvement relating to the health and safety of people using the service or issues of poor management. The key NMS under this outcome heading are generally met but there are some areas of improvement that the Inspector is confident the provider can manage. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 15 EVIDENCE: No service users are currently involved in external occupational work or work substitute. The inspector was advised that one service user recently attended a road safety and literacy course at the Colchester Institute and this had now been completed. Remaining service users attend a variety of social and leisure facilities within the locality. Whilst staff confirm that service users are provided with an opportunity to discuss what they want to do with their social and leisure time, it would be helpful, in terms of person centred planning, to review the options available and to possibly involve an advocate where appropriate. The two service users ‘case tracked’ on this occasion were spoken with regarding their interests. Both were mature adults, although not yet ‘retired’ and indicated they were not interested in education courses or attending day centres, for example. One person, as previously stated, uses a local public house and occasionally goes out accompanied by staff to Colchester town centre. The second service user stated she goes out locally supported by staff although the main stated pastime was watching TV ‘soaps’ of which the person appeared very knowledgeable. Neither of the two service users expressed a wish to attend places of worship or expressed any cultural wishes. Information regarding local events were not readily available and this is an area that would benefit the choices available to service users. One service users stated they wanted to telephone a relative and the Inspector enquired if this request had been made to a staff member, to which the person confirmed the request had not yet been made. The likely need for staff to be involved in this process is due to the hearing difficulty of the individual and the person was encouraged to speak with an appropriate staff member for assistance. The care planning for this individual should include aids and adaptations to assist the person to live as normal a life as possible, including a suitable telephone system. Consultation about these matters should be made with the service user. Where service users have relatives, the staff member confirmed they are made welcome although few service users appear to have relatives living close by. It was disappointing to note that CSCI have been unable to obtain a list of relatives contact details to forward questionnaires with a view to including their views and comments as part of the inspection process. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 16 The home had previously supported two service users who were within a consenting relationship, indicating a positive and supportive stance. It is recommended that this aspect of all service users life is included, as appropriate, within the person centred planning approach. During the inspection the two service users engaged in conversation with the Inspector, staff and between themselves, indicating a sense of openness and confidence. Service users have a degree of responsibility for the upkeep of their own personal space. The Inspector was invited to view one bedroom, which was adequately tidy to the preference of the service user. The manager will need to ensure, however, that a balance is achieved between empowering service users with an expectation of ‘ownership’ of their personal space and ensuring adequate levels of hygiene and cleanliness. No service users have any pets. Service users spoken with stated they had no interest in keeping any pet. The catering service remains very flexible and is designed to suit, as far as practicable, service users lifestyles. Food stocks were adequate and fruit was available within a bowl within the kitchen containing apples bananas and grapes. The record of food served has been revised and now provides comprehensive information individually on what service users have eaten and an indication of the quantity. No service users were following a ‘special’ dietary requirement. Both service users were actively encouraged to help themselves to drinks and snacks. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 to 21. • • • • Service users benefit from a positive and supportive relationship with staff. Service users mainly benefit from the homes arrangements for arranging healthcare although could be developed further. Medicines taken by service users are managed well on a day to day basis but overall could be improved. Service users benefit from the homes practice relating to illness and end of life but would benefit from improved structure. This outcome group has been judged as ‘Good’ because it has more strengths than areas for improvement. There are no significant areas for improvement relating to the health and safety of people using the service or issues of poor management. The key NMS under this outcome heading are generally met but there are some areas of improvement that the Inspector is confident the provider can manage. EVIDENCE: All service users accommodated are ambulant and active. Of the two service users case tracked, one, as previously highlighted, has a hearing impairment. Records associated with this were examined and showed that the person attends an audiologist clinic of a periodic basis. With the exception of hearing Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 18 aids, which the person often refuses to wear, the plan of care does not explore alternatives, and this is recommended. The individual prefers for people to write down a question on paper, although this approach may hamper communication in some circumstances. The care plan has a recording sheet linked to all primary healthcare services and this provides an immediate overview of appointments attended or is due. It is recommended that within the recording tool the date of the appointment is entered to ensure that care staff are able to make a clear and easy link to the daily record that will provide further information about the referral and outcome of the relevant appointment. It is further recommended that a separate section be allocated within the care plan to ensure that all healthcare matters are identified and cross referenced to the daily recording, which at present is maintained in a chronological format. Whilst the records being maintained are specific to the individual, a separate recording format for healthcare, and for example social and leisure activities, would enable care staff to maintain a record that is more easily accessed for continuity. Service users were wearing clothes that reflected their age, gender and personality. A keyworker style approach is stated to be in operation although this could be more defined and developed. The Manager is recommended to ensure that care staff undertaking this role receive training to assist with their understanding. All service users are registered with a local GP and access other primary healthcare services including optician and dentist. Attendance and involvement with these services are made in community clinics in accordance with the ‘ordinary life’ principles the home reflects, unless, like most of us, a GP is required to attend the home. Some service users regularly take prescribed medicines although there are relatively few. The arrangements for the administration of the ‘bottle to mouth’ system and security of these are satisfactory. Staff who undertake support roles for this would benefit from ongoing training in addition to the support provided by the Registered Person who is a trained nurse. The information related to the purpose and side effects of medicines being taken are recommended to be included within the care plan or case file rather than separately held. There was no policy and procedure for the use and control of homely remedies. No evidence of service users’ consent for the home to maintain and administer medicines was available. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 19 A policy and practice procedure relating to serious illness and ‘end of life’ issues was not available for inspection. The manager will need to review the home’s approach to these matters and include them, as appropriate, within the ongoing reviews with service users. Historically the home has experienced the end of life of service users and these circumstances were managed respectfully and appropriately. It is important that the principles and practices associated with these experiences inform the homes stated practice. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 • • Service users have access to a complaint procedure. Service users mainly benefit from the homes arrangements regarding safeguarding adults although this could be improved. This outcome group has been judged as ‘Adequate’ because there are some strengths but also areas of particular weaknesses that may require improvement through an improvement plan monitored by the Commission. Most key NMS under this outcome heading are almost met. We judge that residents are safe in how the service delivers this outcome area, or if there are potential risks to residents these are being responded to by management. EVIDENCE: The home has a complaint procedure that is suitable for use by service users. Those spoken with as part of the case tracking process were able to give examples of what they would do if they had a concern. Both expressed that their first action would be to tell someone they trust which is a positive action. Each service user has a ‘Service Users Guide’ incorporating all of the necessary information. The manager stated at the previous inspection that she is looking at options of producing the information in alternative formats, including video and audio although no progress on this had been made. Current service users are relatively able and most can either read the documents or able to understand the main points. It would be encouraging if service users were enabled to speak about their life within the home and engage periodically within, for example, a forum approach. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 21 Staff confirmed that mealtimes are a good opportunity to engage service users in discussion and this is acknowledged. The service has received no complaints during the period between the last and current inspection. The CSCI have received no complaints about this service during the same period. The safeguarding adults protection pack produced by Essex Vulnerable Adult Protection Committee of Essex County Council, was available in the home. The service does have an additional policy procedure document, although this does not clearly link the home to the local authority policy and reporting guidance and, as such, the Manager is advised to make the necessary amendments. There have been no Safeguarding Adults issues raised in connection with this home during the period since the previous inspection. The home also is in possession of a staff training pack linked to protecting adults and the Inspector was advised that the Manager intends to introduce the learning pack to all staff. The inspector also advised that the training of staff in safeguarding adults was required, as none had been provided at the time of inspection. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 • • Service users mainly benefit from living within a homely comfortable and safe environment. Service users mainly benefit from a clean and hygienic home. This outcome group has been judged as ‘Adequate’ because there are some strengths but also areas of particular weaknesses that may require improvement through an improvement plan monitored by the Commission. Most key NMS under this outcome heading are almost met. We judge that residents are safe in how the service delivers this outcome area, or if there are potential risks to residents these are being responded to by management. EVIDENCE: The premises from the outside are similar to that of other adjacent properties and in keeping with the residential area. Repairs to the front elevation raised at the time of the last inspection have been completed. Repair and maintenance is required to the windows at the rear. It was noted that the Registered Person has replaced a door and window to the side elevation with double glazed units to improve access to the rear garden. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 23 The garden to the rear is adequately maintained although part of the to the east elevation is broken and requires replacement. The garage door is also broken and the content of the garage appears to be mainly discarded items. This was discussed at the previous inspection and was stated to require clearing to avoid a potential health and safety hazard. The facilities within the home met with the standards at the time the home transferred to the NCSC, and then to CSCI, under the care Standards Act 2000 in April 2002 and continue to provide the same level of accommodation. On this basis the home meets with National Minimum Standards. The service does not offer short stay or intermediate care facilities. Furniture, fittings and equipment are fit for purpose and some areas of the home have been redecorated during the last 6 months. However, some other areas, particularly the first floor looks in need of attention to the décor in parts. The bathrooms and toilets would benefit from refurbishment and improvement. The home was generally found to be clean although the Inspector did point out some minor areas on the first floor that were in need of attention. The laundry area is functional and seems adequate to maintain an appropriate cleaning service. The equipment is of domestic proportion and suitable for use by service users, with support, to encourage self help skills. The washing machine is capable of a high temperature wash to provide adequate disinfection. None of the present service users require assistance due to continence management. No sluicing facility is provided and is not considered necessary. Some improvements to the home have been noted, although the overall maintenance to the property has ‘slipped’ to the point that some work is now required to bring the environment to an improved level. It is acknowledged that the home accommodates eight active adults and the environment does reflect this. It is important that effective systems are in place to ensure that the maintenance, decoration, repair and cleaning of the environment is actively managed and a suitable system adopted to meet the inevitable demands and wear and tear the home absorbs. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 • • • • Service users do not fully benefit from a staff group who are demonstrably competent and qualified. Service users are supported by the home’s policy and procedure of staff recruitment. Service users do not yet benefit from a trained staff group. Service users mainly benefit from staff who receive structured supervision. This outcome group has been judged as ‘Adequate’ because there are some strengths but also areas of particular weaknesses that may require improvement through an improvement plan monitored by the Commission. Most key NMS under this outcome heading are almost met. We judge that residents are safe in how the service delivers this outcome area, or if there are potential risks to residents these are being responded to by management. EVIDENCE: It was not possible to fully assess the staff in terms of their attitudes and characteristics on the basis that only one staff member was present during the inspection. The service users spoken with and observed throughout the inspection stated they were happy with the staff and the support they receive. In observation it was apparent that a positive and genuine relationship existed between service users and the staff member. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 25 Staff have begun to receive training, mainly those areas of a ‘statutory’ nature such as food hygiene and fire training. Four staff are due to commence NVQ level 2 shortly and all staff have attended a training event around improved food risk/hazard reduction. This is a positive move since the previous inspection. There has been no recruitment since the previous inspection and therefore no staff have commenced the Skills for Care induction programme. The Manager is recommended, however, to consider introducing all staff to the non-service specific part of the induction process to offer a pre-learning opportunity toward NVQ2. Staff files were sampled in relation to the information required by regulation to be maintained. All the sample (3) met with requirements. It was noted that the Registered Person had voluntarily undertaken a further Criminal Record Bureau (CRB) check for all staff following a period of 3 years, which is commendable. The home does not meet the NMS of 50 of care staff holding an NVQ2 or equivalent certificate. No staff hold a current first aid certificate, although it is understood that some staff have received this training some time ago, more than 4 years. The Manager has undertaken some work on training and assessment profiles and this is a positive improvement. There is yet to be developed a training and development profile for the service as a whole. No staff have yet received Learning Disability Award Framework (LDAF) training, equal opportunities, care planning and assessment, epilepsy and other service user specific training and therefore more emphasis is required to ensure staff development is improved. There was no information available that indicates the home has a dedicated staff training budget or an annual training programme. Staff supervision has started and practice is now improved. It was not possible to ascertain the appropriate annual frequency of supervision yet and this will be again reviewed at the next Key Inspection but the evidence available was that a positive start has been made. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 and 43. • • • • Service users benefit from a manager who is improving standards and is competent to run the home. Service users do not yet benefit from the home’s quality assurance and quality monitoring approach. Service users mainly benefit from the home’s health, safety and welfare arrangements. Service users do not fully benefit from the home’s financial accountability of the home. This outcome group has been judged as ‘Adequate’ because there are some strengths but also areas of particular weaknesses that may require improvement through an improvement plan monitored by the Commission. Most key NMS under this outcome heading are almost met. We judge that residents are safe in how the service delivers this outcome area, or if there are potential risks to residents these are being responded to by management. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 27 EVIDENCE: The Registered Manager has demonstrated that improvements to the conduct of the home have been achieved since the previous inspection. The manager was not present at the inspection and therefore it was not possible to ascertain the progress being made to achieve the Registered Managers Award, which CSCI has been advised is being worked toward. A condition to the home’s registration certificate shows that the award is required to have been obtained within 12 months from the date the Manager was registered. On this basis the progress will continue to be monitored. The Quality Assurance and Monitoring process has not significantly developed since the previous inspection and therefore work is needed to meet this requirement. The Manager will need to ensure that the system is capable of identifying the views of service users and other stakeholders in testing key aspects of the homes operation to drive development and improvement of the service. There will need to be at least and annual audit and an annual development plan for the home. Results of surveys are required to be published and made available to service users. Policies, practices and procedures need to be reviewed to reflect changing legislation and good practice. This inspection concludes that service users are safe although improvements and service developments are required. Aspects to health and safety were considered and reference to these has been made within this report. Fire safety and emergency lighting systems, portable appliance testing and electrical and gas safety checks were noted to be satisfactory although it was considered that the information was not readily to hand, being rather disorganised. The manager must ensure that all statutory information be available for inspection. Other than the matters raised within this report, there were no other obvious health and safety matters of concern noted. The Registered Person will need to ensure that appropriate financial and business control methods are made available for inspection. These would typically include accounts for main expenditure such as running costs, food, heating, staff costs etc. The Senior Carer confirmed that such records do exist. It is accepted that this information is confidential and the Manager was not present on the day of inspection. However, the Registered Person will need to ensure that this information is maintained and kept up to date and available for inspection upon request. Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 28 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 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 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 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 2 3 X 2 X X 2 2 Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 29 YES Are there any outstanding requirements from the last inspection? 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 YA23 Regulation 18, 13(6) Timescale for action The Registered Person must 31/12/06 ensure that all staff working with vulnerable adults are adequately trained to understand current good practice concerning the Protection of Vulnerable Adults. This is a repeat requirement previously 30.06.06. The Registered Person must 31/10/06 ensure that the premises are clean and in a good condition of repair. The Registered Person must 31/12/06 ensure that competent and qualified staff supports service users. This is a repeat requirement previously 30.06.06. The Registered Person must 31/10/06 ensure that the service has an effective staff development programme. This is a repeat requirement previously 30.06.06. The Registered Person must 31/12/06 ensure that a quality assurance and quality monitoring system is DS0000017828.V310364.R01.S.doc Version 5.2 Page 30 Requirement 2 YA24 YA42 23(2)(b) (d)(o) 3 YA32 18 4 YA35 18 5 YA39 24 Gladwyn Lodge in place. This is a repeat requirement previously 30.06.06. 6 YA43 25 The Registered Person must 31/10/06 ensure that the overall management of the service ensures the effectiveness, financial viability and accountability of the home. This is a repeat requirement previously 30.06.06. 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 2 3 4 5 Refer to Standard YA36 YA23 YA20 YA30 YA39 Good Practice Recommendations The Registered Manager is recommended to maintain the content and frequency of staff supervision to demonstrate the compliance with National Minimum Standards. The Registered Person is recommended to engage with the Essex Vulnerable Adults Committee training facility regarding POVA training. The Registered Manager is recommended to include information about side effects and types of medicines being taken within the plan of care or care file. The Registered Person is recommended to ensure that maintenance and cleaning of high risk areas is maintained on a systematic basis. The Registered Person is recommended, as part of quality assurance, to include a review of financial procedures regarding service users’ personal money, in particular the issuing of receipts. The Registered Person is recommended to ensure that the care plan process has regard for the relationship and sexual needs of service users, as appropriate. The Registered Person is recommended to develop the review process to include illness and end of life issues, as appropriate. The Registered Manager is recommended to include existing staff onto the Skills For Care Induction Programme, specifically the non-service specific sections. DS0000017828.V310364.R01.S.doc Version 5.2 Page 31 6 7 8 YA15 YA21 YA32 Gladwyn Lodge Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 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 Gladwyn Lodge DS0000017828.V310364.R01.S.doc Version 5.2 Page 32 - 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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