Care Home: Harold Lodge

Similar services:

• Ashlong House
• Norbury Crescent (30)
• Edenvale
• Wadham Avenue
• Chatsworth Care - Dawson House
• Cowden Road, 52 - 54
• Chatsworth Care - Tudor Lodge
• Foxley Lane (121a)

What the care home does well The practice around assessing and admitting the 2 people currently living in the home has been of a very high standard. The home has been designed, decorated and equipped to a high standard and provides a safe, secure and very comfortable living environment. The people living in the home do not communicate in conventional ways and have independent advocates to support them. Staff have got to know the unique ways that the residents express themselves and the residents` opinions and decisions regarding their care are sought, together with those of their independent advocates and relatives. The home has made very good progress with getting to know the residents needs and in providing opportunities for leisure, education and activities in the local community. Observation of the residents indicated that the home provides a good standard of care to people. Care planning documents are very comprehensive and indicate that there is a good level of involvement with advocates and various professionals in care planning and review meetings and general day-to-day support. The management of the home is strong and the record keeping clear and well organised. Both advocates said that people had settled well and were getting a very good service, 1 said "I wish there were more homes like this in the Borough." What has improved since the last inspection? This was the first inspection of the home since it was registered. What the care home could do better: An area that can be developed further is with the written information that the people using the service have an involvement in, such as the service user guide, contracts, care plans, risk assessments and how to make a complaint. These can be made more accessible for people with learning disabilities and geared to each person`s method of communication by the use of pictures, large print and easy read or video formats. It is recommended that the risks associated with epilepsy be reflected in people`s individual risk assessments. The training plan for staff is developing well and it is recommended that the registered manager continue with developing this. CARE HOME ADULTS 18-65 Harold Lodge 6 Harold Road Leytonstone London E11 4QY Lead Inspector Caroline Mitchell Announced Inspection 15th April 2008 10:00 Harold Lodge DS0000070842.V362056.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 Harold Lodge DS0000070842.V362056.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. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harold Lodge Address 6 Harold Road Leytonstone London E11 4QY 020 8257 7094 TBC khanozgur@hotmail.co.uk 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) Clearwater Care (Hackney) Ltd Ozgur Khan Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 4 This is the first inspection, as it is a new service. Date of last inspection Brief Description of the Service: Harold Lodge is a residential care home registered with the Commission for Social Care Inspection to provide accommodation and support for up to 4 adults with learning disabilities (LD). Harold Lodge is an ordinary family home in a pleasant and quiet street off the main Leytonstone High Road and quite near to the train station. It is close to shops, other transport networks and local amenities, and is in keeping with other homes in the area. The home is owned and run by Clearwater Care, an organisation that runs several registered care home throughout Britain. There are 4 bedrooms for residents and each has en-suite facilities. There is a shared, open plan sitting room with a kitchen and dining area and an additional lounge on the first floor. Outside there is a private garden. The service user guide says that aim of the service is that “any person who comes to live in the home will have all their needs met on an individual basis.” The fees are normally between £1,500 - £1,900 for each placement per week, and the people who use the service are expected to pay separately for items such as hairdressing, outings and clothes. Following “Inspecting for Better Lives” the provider must make information available about the service, including inspection reports, to the people who use the services and other stakeholders. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was the first inspection of Harold Lodge as it is a relatively new service, registered in October 2007. This inspection was undertaken on an announced basis. The inspection was done in two visits, the first visit lasted a full day and a second, very brief, visit on the following Friday morning, to look at some more written records. We were able to meet and speak with the registered manager and a several support staff, all of whom were very helpful during the inspection process. At the time of the inspection there were 2 people living in the home. Because they don’t communicate in conventional ways, due to the nature of their learning disabilities, it was a challenge to gain their views about the quality of the service in the home. We spent time with them observing how they relate to the staff and shared lunch with them on the first day of the inspection. The written records that were reviewed as part of the inspection included the records the home keeps about the 2 residents, their care plans and risk assessments, contracts and pre-admission information, the personnel files for 3 staff, which showed the way that staff were recruited and the training they have had to help them work with the residents, the record of concerns and complaints, the arrangements around storage, administration and recording medication, health and safety safeguards and a number of written policies and procedures. We also spoke to the 2 independent advocates for the residents. What the service does well: The practice around assessing and admitting the 2 people currently living in the home has been of a very high standard. The home has been designed, decorated and equipped to a high standard and provides a safe, secure and very comfortable living environment. The people living in the home do not communicate in conventional ways and have independent advocates to support them. Staff have got to know the unique ways that the residents express themselves and the residents’ opinions and decisions regarding their care are sought, together with those of their independent advocates and relatives. The home has made very good progress with getting to know the residents needs and in providing opportunities for leisure, education and activities in the local community. Observation of the residents indicated that the home provides a good standard of care to people. Care planning documents are very comprehensive and indicate that there is a good level of involvement with advocates and various professionals in care planning and review meetings and general day-to-day support. The management of the home is strong and the record keeping clear and well organised. Both advocates said that people had settled well and were getting a very good service, 1 said “I wish there were more homes like this in the Borough.” Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Significant time and effort is spent in planning in order to make admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support. The home has developed a comprehensive statement of purpose and service user’s guide, which is specific to the resident group and considers the different styles of accommodation, support, treatment, philosophies and specialist services required to meet the needs of people who use the service. Whilst the information is in a reasonably good format, there is further room to make it more suitable for their and their families’ needs, using, for example, more appropriate language, pictures and large print. All new residents receive a comprehensive needs assessment before admission. The service is efficient in obtaining a summary of any assessment undertaken through care management arrangements before admission. People and their advocates are supported and encouraged to be involved in the assessment process. Information is gathered from a range of sources including other relevant professionals. Before agreeing admission the service carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. Prospective residents are given the opportunity to spend time in the home. All residents receive a contract. This information could be in a more accessible format. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 9 EVIDENCE: We reviewed the statement of purpose for the home, along with the service user guide. These were of a good standard and included a lot of information about the home, and is especially detailed about the staff working in the home, their experience and the training that they have done. The service user guide has some pictures to help people with learning disabilities understand what it says. It is already in reasonably clear language. However, there is room for further improvement as it would be made more accessible for the people living in the home, by being in plainer language and the use of more pictures and a larger print. A recommendation is made about this. The home is registered to care for 4 people and there were 2 people living in the home at the time of the inspection. We reviewed the written records for those 2 people. There was evidence that the home had been provided with lots of assessment information about people by the placing authority, to help them make a decision about whether the home would be able to meet their needs. This included personal information, needs assessments and healthcare assessments. There was evidence that managers from the home had undertaken very thorough pre-admission assessments, using these assessments to set out how the home would meet people’s identified needs in an initial care plan. The registered manager said that because the residents don’t communicate in conventional ways and the home that they were both moving from was closing there was lots of pre-admission planning. This included staff from Harold Lodge visiting the residents in their previous home. Staff from their previous home visited Harold Lodge with the residents for day visits and overnight stays and worked along side the staff from Harold Lodge to make sure that Harold Lodge had as much information as possible about how to work with each person, and people’s needs and preferences. There was a 4 week period where staff from both teams worked side by side. 1 staff member from the home where the 2 residents were previously living has subsequently joined the staff team at Harold Lodge. Both of the people living in the home have independent advocates and there was evidence that their families and their advocates were involved in the planning. The registered manager said that this also provided Harold Lodge staff with useful information about the residents. We noted that there were careful records kept on each person’s file reflecting this careful planning and admission process, and monitoring people’s welfare throughout the process. We noted that there were written contracts in place for each person. These set out the terms and conditions of people’s stay in the home and identified people’s bedrooms and included how much the service costs. Their independent advocates had signed them on people’s behalf. The contracts with the placing authority who were purchasing the service for each person were also included in people’s files. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service involves individuals in the planning of care that affects their lifestyle and quality of life. Staff understand the importance of residents being supported to take control of their own lives. Individuals are encouraged to make their own decisions and choices. The service records the preferred communication style of the individual. Care plans are person centred and are agreed with independent advocates. Plans look at all areas of the individual’s life. They include reference to equality and diversity and address any needs identified in a person centred way. A key worker system allows staff to work on a one-toone basis and contribute to the care plan for the individual. There also plans about each person’s health. The plans are kept up to date and focus on how people will develop their skills, and consider their future aspirations. The plans are working documents, and reviewed regularly involving the person and their representatives. Each care plan includes a comprehensive risk assessment, which is reviewed regularly. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. Where there are limitations, the decisions have been made with the agreement of the person or their representative and are accurately recorded. People have advocacy services for support. The plans would be improved by being available in an easy read format. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 11 EVIDENCE: The registered manager said that there is a key worker system in place and because there were only 2 residents living in the home, each per son had 2 key workers. We looked at the written records for both residents and noted that the care plan in place for each person were very detailed, informative and well set out. A number of people including the resident, their advocates and their family members had been involved in putting them together and they had been reviewed and updated regularly and continue to be developed as people have settled into the home. There was very much emphasis on what choices each person living in the home makes, and clear guidance around how to work with people to support them to make choices and to maintain and develop their independence. They provide a very good picture of each person, their personalities, needs and preferences. Although the plans have been developed in a person centred way, there is still room for them to be made more individualised and accessible to each person, by gearing them to people’s individual methods of communication, such as the use of easy read and video formats, pictures and large print. The registered manager said that she wishes to include photographs of the residents to illustrate the plans to make them more person centred. She said that 1 resident has a video care plan that was recorded in their previous home, showing how they are supported with their living skills and this is watched by the resident and staff at Harold Lodge. We observed that staff took opportunities to encourage people to make choices in areas such as what food they wanted, whether they wanted to be in the garden or inside and where they wanted to sit. We noted that any restrictions placed on people’s personal freedom were not excessive and are designed to be in the best interests of each individual. They were properly recorded and reviewed as part of the care plans and risk assessments. We spoke to the 2 advocates as part of the inspection and 1 said that they were always invited to reviews regarding the resident that they advocate for and that the resident was settling well in the home and talking more than they did previously. The care plans and risk assessments that were in place for each person were clear and well presented. As with the care plans, they have been put together with the input of a number of people involved in the residents’ lives. They deal with most of the risks relevant to each person, providing risk management guidance. They include any behaviour that people have that is difficult to live with. It was recorded that residents have histories of epilepsy and the registered manager said that the written information received at the time that they were admitted indicated that neither person has had a seizure for several years. However, it is recommended that the risks associated with epilepsy be included as part of each person’s risk assessment and health action plans and outline risk management strategies. The registered manager said that staff have had some training about epilepsy, in the form of a training video and 3 staff confirmed this to us in conversation. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a good commitment to enabling residents to develop and maintain their skills. People have the opportunity to develop and maintain important personal and family relationships. Staff practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make choices. The service respects peoples’ human rights with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. The staff team help with communication skills, to enable residents to fully participate in daily living activities and this is developing well, as they get to know the residents better. Residents are involved in meaningful daytime activities according to their individual interests, needs and capabilities. These opportunities are expanding, with staff finding new opportunities as they get to know people. The residents and their advocates have been fully involved in the planning of their lifestyle and quality of life. People attend specialist day services and enjoy the opportunities available in their local community. People are involved in the domestic routines of the home. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage people to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for peoples’ cultural and dietary needs. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 13 EVIDENCE: We noted that, despite not having lived in the home for very long, each person already has a good schedule of activities, both in the home and in the community. There was evidence that these continue to develop as people settle into the home, with further trips out and swimming being added recently. People attend specialist day services in the local area and are also encouraged to be involved in and develop their skills in day to day living by undertaking activities and chores in the home, with staff support. The registered manager said that she intends to provide more sensory equipment in 1 person’s bedroom and their relatives wish to be involved with this, along with the speech therapist involved, who has also offered to provide the staff in the home with training regarding working with people with autism. The daily records kept of what people do each day showed that people have good access to their local community and 1 person receives extra funding to facilitate 1-1, and sometime 2-1 staffing in certain circumstances, so that they can get out and about. People’s specific needs regarding going out are clearly set out in their care plans and risk assessments. The home is within walking distance from a number of community facilities the registered manager has identified that a car would help people go further a field, so she intends to support the residents to get their own transport. The registered manager said that 1 person had recently got in touch with family members that they had not seen for a long time and regular contact is being established. There were photographs displayed in the home of the residents with relatives who had attended parties in the home. As previously mentioned, the registered manager said that the input from relatives has been helpful in forming a picture of people’s backgrounds. Both residents have independent advocates who visit them and we asked them their views of the home as part of the inspection. People’s needs have been carefully considered and recorded with an emphasis on making sure their rights are protected. Because people don’t communicate in conventional ways, staff are creative in the ways in which they impart information and involve people in the decision making process. Each person has a 1-1 session regularly with staff, where they sit down and review their care plan, and talk about the things that are important and relevant in people’s lives. There was a lot of emphasis on people having a balanced diet. Information and guidance about people’s dietary needs and preferences was recorded in their care plans, risk assessments and health action plans. The home also keeps clear monitoring records of what people actually eat. There is a good menu in place and we noted that people are given lots of oportunity to choose within that. The registered manager said that the menu is changing and developing as staff are getting to know people’s preferences. Both residents Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 14 focus a lot on particular foods and the staff team have to be quite creative and present food in ways that are attractive to them to make sure they are getting a balanced diet. The home keeps a monitoring record of people’s weight, which was reasonably stable and there were no concerns arising from this. When sitting down for lunch, observing and chatting with residents and staff we noted that people enjoyed their meal, which was presented in a relaxed and pleasant atmosphere. The meal was very well presented, and included fresh fruit and salad. The staff were aware of the food that the residents like and were trying to make sure people had some variety in their diet. The kitchen cupboards and fridge were well stocked and a resident had been baking with staff in the morning. The result was a very nice chocolate cake. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The knowledge and guidance for staff regarding peoples’ personal care needs is developing well as staff get to know people’ better. Healthcare needs including specialist health and dietary requirements are clearly recorded in each person’s health action plan. They give a good overview of peoples’ health needs, act as an indicator of change in health requirements and are developing well as people settle into the home. The delivery of personal care is individual and is flexible, consistent, reliable, and person centred. People are supported and helped to be as independent as they can in their personal care. Staff observe, listen and take account of what is important to people. Staff make sure that people have regular appointments and visit local health care services. Staff have had access to some training in relevant health care matters, such as epilepsy and there are plans to provide training in autism. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. Regular management checks are recorded to monitor compliance. Thought has been given to providing safe but sensitive facilities for keeping medication. Staff have completed an appropriate medication course. To improve practice in this area an assessment should be carried out to ensure each member of staff is competent to handle, record and administer medication properly. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 16 EVIDENCE: There is clear written guidance in place about supporting people with their personal care needs as part of their care plans. These paint a carefully built picture of their personal care needs and help staff to be consistent in their approach to supporting people to be as independent as possible whilst maintaining their safety and dignity. The plans indicate that people require hands on care, prompting and supervision and set out their preferences and needs. Each person has a health action plan and peoples’ sexual health needs are considered in a sensitive way as part of these. The good, well laid out records of medical appointments and input from health care services help with monitoring peoples’ health and make it easy for issues to be followed through. These reflect that people have had good access to all necessary health services such as GPs, psychiatrists, dentists and chiropodists. The arrangements regarding the storage, administration and records for peoples’ medication was looked at as part of the inspection. The home uses a monitored dosage system and we noted that the medication was stored securely and appropriately. The home keeps written information about each type of medication each person is prescribed, which says what the medication is for and what the possible side effects are. Where people are prescribed as and when medication (PRN) there was written guidance in place. There was evidence that the appropriate health care professionals review people’s medication regularly. There were good records of the medication coming in and going out of the home. 2 staff sign when medication is administered and there was a record of staff signatures, so that it was easy to identify who had signed as administering medication. There was evidence that medication is checked at the beginning and end of shifts to make sure that the correct quantities are handed over. There was evidence that staff have received training about medication. The registered manager keeps a comprehensive medication refresher training pack, provided by a recognised national pharmacy company, so that refresher training can be provided to staff regularly. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents advocates say that the residents are happy with the service provided, are safe and well supported by the home. The service has a complaints procedure that is reasonably clearly written and easy to understand. It would be improved by being available in an easy read format. The complaints procedure is supplied to everyone living at the home and is displayed in home. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff working at the service know when incidents need external input and who to refer the incident to. There is a clear system for staff to report concerns about colleagues and managers. The home understands the procedures for safeguarding adults and has attended meetings and provided information to external agencies when requested. The outcomes from a recent referral were managed well and issues resolved to the satisfaction of all involved. Staff training in safeguarding adults is arranged by the home. Other training around dealing with physical and verbal aggression is to be made available to staff. Staff understand what restraint is and alternatives to its use in any form are looked for. Equipment that may be used to restrain people, such as keypads, is only used when necessary for peoples’ best interests. Residents and their advocates are involved in the decision making process about any limitations to their choice and individual assessments are completed, which also involve their relatives and any other professionals where relevant. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 18 EVIDENCE: How to complain is included in the statement of purpose, the service user guide and a written procedure is in place. It is already com[prehensive and quite clear. However, as with some other written materials, this would be made more accessible by use of pictures, larger print and easy read format and a recommendation is made about this. The registered manager said that no complaints had been received from residents, their relatives or their advocates. Records reflected that a complaint had been received from a neighbour about noise and this had been resolved. The registered manager said that 1 person can be noisy in the way they communicate, but this is not excessive in either noise or frequency, and does not really have a particularly detrimental effect on other in the home. Clearwater have found ways to resolve the issue and the complainant has sent a letter of apology to the home about the way that the complaint was made. The registered manager had been involved in the local authority safeguarding procedure, which was invoked as a result of the way this complaint was made. No particular concerns were identified regarding the care of the people in the home. Records reflect that staff have had training regarding safeguarding people and the registered manager said that she intends to send some staff on further external training as part of the training plan for this year. There is a clear procedure for safeguarding people in place in in the home. We noted that there are very few restrictions are placed on peoples’ freedom of movement around the home, such as locked doors or cupboards. The cupboards that contain hazzardous substances (COSHH) such as cleaning materials are locked, and the front door is opened by a key pad. People are assessed as being at risk when out in the community, and are always accompanied when going out. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service goes that ‘extra mile’ to provide an environment that meets the needs of the residents. Residents are encouraged to see the home as their own. It is a very well maintained, attractive home and has good access to community facilities and services. The management has a proactive infection control policy to ensure that infections are minimised. The home has single rooms available for all residents. The rooms are a good size, well designed and have en-suite facilities. The fixtures and fittings are of high quality and well maintained. People personalise their rooms and can use their own furniture if they wish. There is a selection of communal areas both inside and outside of the home, this means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The kitchen and laundry are designed to enable and promote the involvement of people in domestic tasks and as part of developing or maintaining independence. Where there are concerns about the health and safety of anyone using the kitchen and laundry arrangements are fully risk assessed with the involvement of the person. Access is only limited when the completed assessment indicates such a need. There are sufficient toilets to enable immediate access. The home is very well lit, clean and tidy and smells fresh. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 20 EVIDENCE: During the tour of the home we noted that it has been adapted, decorated and equipped to a high standard. People have their own bedrooms and these have en-suite facilities. The home is relatively newly opened and there is little evidence of wear and tear. The décor is light, modern and very homely and there are framed pictures of residents on the walls. The sitting area is well furnished and equipped with a television with extra channels and a music centre. There is an extra lounge on the first floor, which provides quiet space for people and can be used when they have visitors. The staff office is compact, but well organised and is on the first floor. Peoples’ bedrooms are being personalised as they settle in and are beginning to reflect their individual interests and personalities. There are sufficient bathrooms and toilets, which were nicely equipped and well presented. The room where staff can do sleepin duty has en-suite facilities with a shower. There is a nice garden with a paved area. The home was very clean and well presented at the time of the inspection. The laundry room is on the first floor and is equipped with a washing machine and dryer. The residents’ schedules of activities include being involved in household tasks, with support from staff, such as doing their washing. The kitchen is equipped with a dishwasher. Infection control is included in the induction training for staff. There was also evidence that it is covered in the NVQ training that the staff have received and it is included as an item on the homes training plan. The registered manager said that is to be arranged for May of this year. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. The representatives of the residents say that staff are skilled in their role and are consistently able to meet peoples’ needs. There are consistently enough staff, with more being available at peak times of activity. The staffing structure is based around delivering outcomes for residents and is not led by staff requirements. Staff have received some relevant training and this is focussed on delivering improved outcomes for residents. The home puts a high level of importance on training and staff report that they are supported through training to meet the needs of people in a person centred way. There is some training still to be planned and delivered as the residents’ settle in and their needs become better known, and the management team is proactive in ensuring that this training is provided. There is a clear and thorough recruitment procedure that clearly defines the process and is followed in practice. People who use the service have some involvement in the recruitment process. The home is clear about what is involved at all stages of recruitment and is robust in following its procedure. There are clear contingency plans for cover for vacancies and sickness and there is little, if any, use of any agency or temporary staff. Staff meetings take place regularly. Supervision sessions are regular and staff find them helpful with a focus on improving outcomes for people using the service. Notes and action points are taken of meetings and sessions, and progress is regularly reviewed. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 22 EVIDENCE: It was noted that were good levels of staff on duty at the time of the inspection, and evidence that this is a consistent feature of the service from the planned rota. This enables the people living in the home to benefit from 11 support where necessary, both at home and when getting out into the community. The registered manager explained that there is particular funding in place to provide 1-1, and sometimes 2-1, support for 1 resident. She said that there were no vacant posts at the time of the inspection. She explained that there is waking night staff cover, along with the facility for staff to sleep-in to provide back-up, should the need arise. This had not been necessary since the residents are now settled in the home. However, this was provided for the first few nights, when the residents first moved in. The personnel files for 3 staff were reviewed as part of the inspection. There was evidence that the home operated a robust recruitment process and undertook the necessary pre-employment checks for staff before employing them in the home. Each staff members’ file included a written application, a health declaration, Criminal Records Bureau check (CRB) details and 2 written references, verified by company stamps or headed notepaper. Where a reference had been provided by e-mail the registered manager had obtained a signature from the referee, by post. It was noted that people’s files also contained the notes of the interview process. The registered manager uses a system of points scoring against the criteria for employment to help make sure the process was fair and equitable. It was noted that some staff personnel file included a recent photograph and some didn’t. This was addressed by the registered manager, during the course of the inspection, making sure that they were in place for all staff. The registered manager said that, applicants are invited to the home for interview so that they are given the opportunity to meet the residents in an informal setting. There was evidence that a good quality and thorough induction process is in place for new staff and a clear monitoring system showing when formal 1-1 staff supervision was planned and undertaken. We saw the job descriptions and staff handbook that are in place and these were clear so that they help staff to be clear about their role and responsibilities. The registered manager said that NVQ training was being facilitated in the home and a 2 hour session was being held every 2 weeks, for those staff undertaking NVQ level 2, and 2 hours for those undertaking NVQ level 3. 1 staff member said that they had recently completed their NVQ training. The home had a written training schedule, which included all of the necessary core training and a number of specialist areas of training that are relevant to the needs of the residents. Although there are still some dates to be planned and confirmed, this is a good tool and is developing well as the home becomes more established. The plan includes a number of training sessions that are to be arranged for 2008/9, such as risk assessment, non-violent crisis intervention and person centred planning. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The registered manager is able to describe a clear vision of the home based on Clearwater Care’s values and priorities. She communicates a clear sense of direction, is able to evidence a sound understanding and application of ‘best practice’, particularly in relation to continuous improvement, customer satisfaction, and quality assurance, and equal opportunities. The registered manager provides an excellent role model for other employees. The registered manager undertakes regular training and understands and value opportunities for her continuing professional development. The ethos of the home is open and transparent. The views of people who use the service, their representatives and staff are listened to, and valued. The home has as appropriate, effective and regular support through a named line manager and, as required, access to professional accountancy and business advice. There are clear lines of accountability. Record keeping is of a consistently high standard. The home has a comprehensive range of policies and procedures to promote and protect residents’ and employees’ health and safety. Staff are trained, understand, and consistently follow these. The home proactively monitors its health and safety performance and consults other experts and specialist agencies about Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 24 health and safety issues as required. Health and safety systems are regularly reviewed and updated and are developed on the basis of experience in the home, outcomes for people using the service and learning from external developments. The registered manager ensures that staff are trained in health and safety matters and training records reflect this and regular updates are planned ahead. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) is an assessment that is done by the home and sent to the Commission to tell us how well outcomes are being met for people living in the home. There were no residents living in the home at the time the AQAA was completed so there was limited information available. We took the information provided by the registered person in the AQAA into consideration during the inspection and found that the aims and systems described in the AQAA to be reflected in the actual day-today running and reflected in the practice in the home. The manager has been registered by the Commission in October 2007, at the time that Harold Lodge was registered. She is also registered to manage another small home for Clearwater Care, next door to Harold Lodge. During the inspection she came across as committed and determined to provide a person centred, high-performing service, and seeking feedback and ideas to support her in this. She has completed training at level NVQ 4, the Registered Managers Award, further certified management training and has a background of managing care. The records kept in the home about all aspects of the resident’s lives and the running of the home were notably well presented and organised, providing clear evidence of the planning and development of the service so far. The registered manager said that as the team gets to know the needs of the 2 people living in the home and others move in, the written material that is for and about the people using the service will be made more accessible to suit their needs, by the use of larger pint, easy read formats pictures and photographs. As stated in other standards of this report, a recommendation is made about this. 39) Quality We spoke to the advocates as part of the inspection and the feedback that they gave was positive about what the home has achieved with the residents so far. They are consulted and their opinions taken seriously and acted upon. The home has asked people’s views about the quality of the service by using a questionnaire. We looked at the written feedback that the home received from advocates and relatives. Again, this was very positive. The staff said that there are regular staff meetings and that this is part of an open culture, providing them with a platform for discussion about issues relevant to the residents and the home. There was a lot of evidence of the systems of quality Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 25 monitoring that are in place and evidence that these are actively used by the registered manager to make sure that there is a good quality and continuously improving service. The registered manager said that the menu and activities are changing and improving as a result of feedback from the residents. There are regular visits and audits undertaken by more senior managers on behalf of Clearwater. The registered manager also said that she is soon to be involved in a quality exercise where the managers in the organisation visit other Clearwater homes to monitor quality, and that this will help in sharing ideas about best practice. The registered manager said that the residents’ money is still being sorted out after their move to Harold Lodge. Each person came in to the home with £150 and the home is loaning them money until things are sorted out, so they are not suffering as a consequence of the delay. People need high levels of support in dealing with their finances and the registered manager said that the intention was for the LA to be appointee for each person. There were clear and well-organised records of peoples’ expenditure and receipts were kept. There was evidence that Clearwater audits the accounts kept of residents’ expenditure on a regular basis. We looked at the records of health and safety checks undertaken to keep the home and the equipment safe. As the electrical goods were all new when the home opened, they don’t need to be tested for safety for the first year. The registered manager had set a date for when this to be done. All checks, such as the electrical and gas safety certificates were in place and a contractor had tested the fire alarm. Staff in the home also keep a record of the regular tests that they do of the fire alarm, door closures, emergency lights, fire alarm and fire fighting equipment. There were good quality environmental and Care of Substances Hazardous to Health (COSHH) risk assessments in place, although the fire risk assessment was not completed. This was addressed by the registered manager during the course of the inspection, and was properly completed and in place by the end of the inspection. Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 3 4 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 3 27 3 28 4 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 4 4 X 4 3 X Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 27 N/A 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 YA5 YA6 YA9 YA22 YA9 Good Practice Recommendations It is recommended that all written information that the people using the service have an involvement in, such as the service user guide, contracts, care plans, risk assessments and how to make a complaint, are made more accessible for people with learning disabilities by the use of pictures, larger print and easy read language. It is recommended that the risks associated with epilepsy be reflected in people’s individual risk assessments and health action plans. It is recommended that the registered manager continue to develop the staff training plan. 2. 3. YA35 Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Harold Lodge DS0000070842.V362056.R01.S.doc Version 5.2 Page 29 - 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!