Care Home: Harefield Lodge

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Harefield Lodge 6 Westwood Road Southampton Hampshire SO17 1DN two star good service The quality rating for this care home is: 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: Nick Morrison Date: 3 0 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Harefield Lodge 6 Westwood Road Southampton Hampshire SO17 1DN 02380555802 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): harefield@ilg.co.uk Rivers Reach Care Ltd Name of registered manager (if applicable) Ms Sonia Beverley Osborne Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 10 0 care home 10 learning disability Additional conditions: 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). The maximum number of service users to be accommodated is 10. Date of last inspection Brief Description Harefield Lodge provides care and support for up to 10 younger adults with learning disability and challenging behaviour. Help is given when required but service users are supported to live their lives as independently as possible. Harefield Lodge is a large detached house situated in a quiet residential road of Portswood. It is close to local amenities and Southampton Common is within walking distance. Accommodation is provided in single rooms over two floors. One room has its own ensuite facilities and separate lounge area. There is a lounge and separate dining room and a spacious enclosed garden. Harefield Lodge was purchased in March 2006 by ILIACE Limited, an organisation with a number of homes in the South of England. The home is managed by registered manager Ms Sonia Osborne. 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 How we did our inspection: This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 30th September 2008 and lasted six hours. During this time we toured the premises, looked at the files of four service users, met with two and observed the support they were receiving. We also met the Manager and two members of staff and observed interaction between staff and service users. All records and relevant documentation referred to in the report was seen on the day of the inspection visit. We also referred to service’s own self-assessment of the home. What the care home does well What has got better from the last inspection What the care home could do better There were no requirements or recommendations made as a result of this inspection. We did discuss some issues with the Manager which she has undertaken to address without delay. These were the fact that there were cigarette ends outside the back door, that one of the toilets was not flushing, that service users money should not be kept in the medication cupboard and that full records should be kept of all complaints including details of any investigation and a record of the outcome of the complaint. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 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 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 . Service users benefit from having their needs and aspirations assessed prior to moving into the home. Evidence: The home requires a full care management assessment for each person before they move into the home. In addition to this, the home does it’s own comprehensive assessment. Records showed that all assessments were in place prior to the person moving in and that service users and their families had been involved in the assessment. 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 . Service users benefit from having clear care plans and risk assessments in place and from being supported to make their own decisions. Evidence: Individual care plans were in place for each person living in the home and were clearly related to the initial assessment and the ongoing information the home had gathered on each person over time. Service users were involved in the care planning process and those spoken with said they understood their care plan. Care plans are reviewed on a monthly basis and are also updated in the meantime if necessary. All staff sign to say they have read and understood each persons care plan. There was a Keyworker system in place and they were responsible for ensuring the care plans for people were up to date and relevant. The Manager also reviewed care plans periodically. the home is in the process of introducing a person centered planning system and some very good work has already taken place on implementing this. Staff are beginning to record good information about the aspirations of service users in a person centered way and they are making good use of pictures to ensure that each persons plan is accessible to them. From observation during the inspection it was clear that people living in the home were supported to make their own decisions about their lives. This included day-to-day decisions about what they wanted to eat and what activities they took part in as well as what time they wanted to go to bed and get up. Staff spoken with and observed throughout the inspection demonstrated an understanding of the need to help people make decisions rather than make decisions Evidence: for them. Care plans were clear about how service users made decisions and about what things were important to them. Risk assessments were clearly written and reviewed on a regular basis. Staff spoken with were clear about risk assessments for each person and the importance of supporting people in line with the risk assessments. Risk assessments were used to promote independence and support people living in the home to be involved safely in the activities they wanted to do. Some people living in the home were able to go out without staff support and this was supported by risk assessments. Staff sign to say they have read and understood each persons risk assessments. 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 benefit from having their rights respected and from balanced and nutritious meals. They also benefit from having the opportunity to engage in a wide range of activities both inside and outside of the home. Evidence: People living in the home have busy and varied lifestyles. Activities are planned on an individual basis according to needs, aspirations and preferences. Service users make use of a wide variety of community facilities including the local leisure centre, the college and work opportunities. One person works at a local vehicle restoration centre and told us he really enjoyed this because he was very interested in cars and liked working with the people there. Staff in the home worked hard in liaising with local colleges so that people had access to educational opportunities appropriate to their needs and preferences. On the day of the inspection we observed the Manager negotiating with a local college to ensure that new courses would be available to two people living in the home. All service users spoken with on the day of the inspection visit said they felt they had a lot of activities to do and that staff supported them to be involved in those activities. People living in the home were supported to maintain contact with their friends and families. Records were kept of visits from families and of people going to stay with families. Visiting times in the home were from nine in the morning until eight at night according to the policy, but service users spoken with told us this was not rigid. People were also supported to maintain contact with their families over the telephone and Evidence: staff assisted them to make telephone calls if necessary. The home had a very positive approach to supporting peoples needs regarding relationships and records on peoples care plans demonstrated that appropriate support was given. Food in the home was of good quality and people spoken with during the inspection visit said they enjoyed their meals. There was a four weekly menu in place that had taken account of the known individual preferences of service users. The menu was also discussed at house meetings so that people had an opportunity to suggest different meals. Pictures were also used so that all service users could contribute ideas and understand what was on the menu. Service users were able to change their minds and deviate from the menu if they chose to. The feedback from service users about the food in the home was very positive. 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 . Service users benefit from having their healthcare needs met and are protected by the home’s medication policies and practices. Evidence: Care plans contained information on how people preferred to be supported with their personal care. The files of people living in the home demonstrated that healthcare needs were monitored and that people were supported to use healthcare services as necessary. There were comprehensive records relating to each person’s health. Each person’s healthcare needs were monitored and recorded on a regular basis. Where people had used healthcare services there were records detailing the time and date, the reason why they attended and any outcomes as a result of the consultation. Staff in the home liaised closely with healthcare professionals in the interests of people living in the home. Service users spoken with said staff always supported them to use healthcare services whenever necessary. The home also liaised closely with healthcare professionals regarding the psychological support needed by people living there. There were clear records demonstrating how advice was sought from professionals regarding peoples behavioural needs and how this advice was built into care plans and subsequently into the way staff worked with individual behaviours. On the day of the inspection visit we observed staff responding to a difficult situation with a service user. Their approach was calm and measured and fully reflected the approach outlined in the persons care plan. Staff had received good training and guidance in dealing with such situations and were able to resolve a difficult situation with little fuss. The system for administering medication in the home was clear and was stated in the Evidence: home’s policies. Staff who were involved in administering medication said they had received good training and demonstrated that they had a good understanding of medication issues. Medication records were clear and up-to-date and all medication was stored appropriately and safely. There was a comprehensive system in place for monitoring medication with regular checks and crosschecking to minimise the possibility of any errors occurring. Some service users money was kept in the medication cabinet and we discussed with the Manager the fact that this should be kept elsewhere. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Service users benefit from having their views listened to and are protected by the home’s policies and practices Evidence: The home has a complaints policy in place and service users spoken with said they were clear about how to complain if they wanted to, but had not felt the need to make formal complaints, as issues were resolved in house meetings or in conversation with the manager or their keyworker. The home had received some complaints and we discussed with the manager the need to ensure that records of complaints included details of any investigation and a record of the outcome of the complaint. The complaints procedure was available in a pictorial format and service users had their own copy. There were behavioural supports plans in place for people whose behaviour occasionally caused problems for other people in the home. The way the plans were written demonstrated a positive approach to such behaviour and that individual service users were involved in the plans put in place for them. Any incidents were recorded. The home has good policies and procedures in place for dealing with allegations or suspicions of abuse and had demonstrated in the past that they took issues seriously and knew how to report them within local procedures. They had liaised closely with the Social Services Department to ensure that any allegations or suspicions were responded to appropriately. Records demonstrated that all staff had received adult protection training and this was confirmed by the staff spoken with. 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 benefit from living in a clean, comfortable and safe environment. Evidence: The house is very homely and comfortable. It is an old house that retains a lot of its original character but was well maintained and decorated throughout. The furniture in the communal areas was very modern and comfortable. Service users rooms were well equipped and they were able to bring their own possessions with them to the home. On the day of the inspection visit the kitchen and the laundry areas were in the process of being refurbished and there was a plan in place for the regular maintenance of the building. We discussed with the Manager the fact that one of the toilets was not flushing properly on the day of the inspection visit and that there were cigarette ends outside the back door. She told us she would deal with these issues without delay. The garden area was secluded and safe. There were different areas to the garden and it had been laid out and maintained so that it was an accessible and enjoyable place for people to spend time. Some service users rooms overlooked the garden and had privacy glass installed so that people in the garden could not see into their rooms. The home was clean throughout, while remaining comfortable and homely. There were cleaning rotas in place for each day of the week to ensure that cleanliness was maintained and clear records were kept of what cleaning had been done. Service users were supported to be involved in the cleaning of the house if they had identified this as something they had wanted to do. 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 benefit from being supported by adequate numbers of well-trained staff and are protected by the home’s recruitment policies and practices. Evidence: Examination of staff files during this inspection showed that all necessary preemployment checks were in place prior to people beginning to work in the home. There were three members of staff on duty throughout each part of the day and at night there was one person awake and one person sleeping-in. In addition the Manager was available during the daytime. Service users spoken with said there were sufficient staff available in the home to meet the needs of the people living there and to ensure that they could go out and use local facilities at specific times during the week. Staff also said they felt the staffing was sufficient to meet people’s needs. Staff training was well managed and good records were kept of the training that each member of staff had received, what training they still needed to do and when updates were required. Staff spoken with said the training was useful and relevant to their role and that access to training was good. Discussion with a member of staff on the day of the inspection visit, as well as reference to staff files, demonstrated that all staff received regular support and supervision sessions with the manager and that records were kept of these sessions. We were also told that the manager was always available for advice and support and that staff found her to be very supportive throughout their work. There were clear guidelines in place for staff so that they were aware of what was expected of them. These included Keyworker guidelines and a list of daily jobs that needed to be done. Staff interaction with people living in the home was very positive and demonstrated that they knew people well and had the skills and information to communicate with them effectively. We observed during the inspection visit that the Manager played a Evidence: crucial role in demonstrating good practice in interacting with service users in a positive and calm manner. 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 . Service users benefit from living in a well managed home that is safe and responsive to their needs. Evidence: The Manager is registered and has demonstrated that she has the skills, knowledge, experience and qualifications to manage the service well. Observation during the inspection visit confirmed that she is skilled in leading and directing staff and ensuring that the home is managed around the needs of the people who live there. She also keeps her training and knowledge up to date. Staff spoken with on the day of the inspection visit said that the Manager was available and supportive, ensured that staffing numbers were sufficient and ensured that care plans were in place and followed consistently. The quality assurance process in the home is focused on the needs and views of people living in the home and regular questionnaires are given to service users and their families to complete. Regular visits from the Provider focused on outcomes for people living in the home and good records were kept of each visit including actions needed and actions that had been addressed. There were monthly house meetings attended by people living in the home and good minutes were kept of these. Service users and visitors were also encouraged to use the suggestions box if they felt the need to. Examination of the fire logbook demonstrated that it was kept up-to-date. Each service user had their own fire evacuation plan in place and these were posted on the notice board in pictorial formats to make them easily accessible to people. There were effective systems in place for monitoring and managing health and safety issues in the Evidence: home. Good records were kept of all health and safety issues including fire, appliance servicing, substances hazardous to health, accidents and electrical testing. All staff received initial training in health and safety as part of their induction as well as regular updates. Regular checks and records were kept relating to health and safety aspects of the home. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 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 Description 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 Description 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 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. ------=ext_ - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!