Care Home: Hope Lodge

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What the care home does well As there is currently only one person present in the service they are receiving very focused care. Staff are able to develop their skills and working relationships and attend training. People who move into the service are encouraged to do so at their own pace. The manager recognises that they cannot mix the two categories of people that the service is registered for and will develop the service accordingly. The service has some homely touches but as people move in they will be able to ensure that their home reflects their identities. The manager is working full time and is available to answer questions that the staff team may have. What has improved since the last inspection? This is the first inspection where people who use the service have moved in. Requirements made at the previous inspection in October 2007 to repair a bedroom window and provide bedroom chairs have been met. What the care home could do better: Because the service is not yet established it is difficult to determine how it can improve. The manager must ensure that staffing levels are adequate and they are not placed in a position where an unsafe amount of hours are worked. The manager should capitalise upon having time and staff available to complete documentation and training before the service reaches capacity. This will ensure a competent staff team who have received the same level of training and information are available. CARE HOME ADULTS 18-65 Hope Lodge 98 Farley Hill Luton Beds LU1 5NR Lead Inspector Angela Dalton Unannounced Inspection 11th November 2008 2:20pm Hope Lodge DS0000069703.V373037.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 Hope Lodge DS0000069703.V373037.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. Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hope Lodge Address 98 Farley Hill Luton Beds LU1 5NR 01582 457599 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) hopelodge@professionaltrainingcenter.co.uk Hope Lodge Limited Mr Taka Edingtone Chipango Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Hope Lodge DS0000069703.V373037.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: Mental disorder, excluding learning disability or dementia - Code MD Learning disability - Code LD The maximum number of service users who can be accommodated is: 3 31st October 2007 2. Date of last inspection Brief Description of the Service: Hope Lodge was initially registered with the Commission for Social Care Inspection in June 2007 as a service for up to 3 adults with Mental Disorder (MD) as their primary need and people with past or present drug or alcohol problem as their secondary need in the age range of 18 - 65 years. In June 2008 Hope Lodge updated its registration to enable the service to accommodate younger adults with a learning disability. Hope Lodge is situated at 98 Farley Hill Road Luton, LU1 5NR, close to local amenities, facilities, and transport. The home is a semi - detached house consisting of three individual bedrooms, lounge, dinning, shower cubicle with WC, separate bath room, utility room, kitchen, rear garden and parking to the front with a garage. Mr Taka Chipango is the Registered Manager. Hope Lodge DS0000069703.V373037.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 stars. This means the people who use this service experience good quality outcomes. One inspector conducted this unannounced site visit on 11th November 2008 between 2:20pm and 6.00pm. We waited for the manager and person who uses the service to return as they were out when we arrived. As only one person currently lives at hope Lodge we case tracked their information. We followed the care of people who use the service to ensure the care they receive is reflected in the care plan and meets their individual requirements. The case tracking process cross-references all the information gathered to confirm that what Inspectors are being told is actually happening and reflects the Statement of Purpose, which contains the aims and objectives for the service. It included meeting with the person who uses the service, staff members and the manager. We were present for dinner and observed some aspects of daily activity. What the service does well: What has improved since the last inspection? This is the first inspection where people who use the service have moved in. Requirements made at the previous inspection in October 2007 to repair a bedroom window and provide bedroom chairs have been met. Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 6 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. Hope Lodge DS0000069703.V373037.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 Hope Lodge DS0000069703.V373037.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 good. This judgement has been made using available evidence including a visit to this service. Prospective service users are able to visit the home and have the information needed to help them make an informed choice about moving into the home. EVIDENCE: The service had conducted a comprehensive assessment to ensure that the service was able to meet individual needs prior to admission. A copy of social service’s assessment also assisted in providing historical and cultural information. The assessment provides the basis for the care to ensure staff are equipped to meet individual needs. The home had a statement of purpose and a service user guide to inform people who wish to use the service about the aims and objectives. This enables them to see if they like what is available and make an informed choice. The service user guide is supported by pictures and is in a large print format to make it more user friendly. The manager is exploring alternatives to apply the same layout to the statement of purpose and other documentation accessed by people who use the service. When someone moves into the service the manager undertakes an assessment and where possible an advocate is involved in the process. A contract is issued to outline the service that will be provided. The advocacy service has just discharged the person they were working with but is available in future if required. The manager aims for the Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 9 moving in process to be designed to meet individual needs and is completed in phases- starting with mealtime visits and concluding in an overnight stay. The manager has previously visited people in their own placement to gather information and to discuss information about Hope Lodge. The manager stated that he would not admit any person to the home unless he and the staff felt that they would be able to meet their needs. It was also emphasised that they would not admit anyone to the home unless they were able to get on well with the other people living in home. The manager has made a commitment to only currently admit people with a learning disability to ensure that people with similar needs share their home. Hope Lodge DS0000069703.V373037.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. Information is available to ensure that the person who uses the service’s needs are met. EVIDENCE: The person who uses the service moved in four weeks ago. A comprehensive care plan based on the assessment was in place and the manager told us it will be reviewed every three months to ensure it is still appropriate. It had identified risks and provided information about how they are to be monitored and managed. The manager is placing staff on relevant training courses to enable staff to meet identified needs. He plans to ensure staff are equipped to deal with challenging behaviour and can use sign language by enrolling upon a Makaton course. He is also devising a missing person form to ensure a description is available should a person who use the service go missing. The service has a level of staff that will enable staff to support individuals to explore the area and participate in activities where they will not be exposed to Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 11 risk. The manager is exploring alternative formats to enable the care plan t be more user friendly. Staff are forging a relationship by ensuring the person who uses the service by following their lead and pace. As stated earlier, the manager has utilised an advocacy service and is working with members of the multi disciplinary team. This will assist in continuity of care and familiar people involved in the person who uses the service’s life. The manager plans to hold regular house meetings when more people have moved in and are settled. Hope Lodge DS0000069703.V373037.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): 12,13,14, 15,16 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service are provided with the opportunity to continue with familiar activities. EVIDENCE: Due to the early part of the transition process having taken place the manager is continuing to provide familiar activities. The service has recently bought a designated people carrier, which provides choice and flexibility as reliance upon public transport and taxis can prove difficult for people with complex needs. Current activities consist of attending daycare and Snoezelen with outings to large open spaces. The manager is exploring other activities to pursue in future but does not wish to overwhelm with a variety of choices. Family contact is encouraged and the manager has worked closely with family members of the person who uses the service to involve them in the moving in Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 13 process. Weekly menus are displayed and staff do the shopping, involving the person who uses the service where possible. Weights are recorded to ensure that people who use the service remain healthy. The manager is researching a way to make menu information available in a user friendly format. The kitchen has a latched door fitted, which enables people who use the service to observe what is happening without placing themselves at risk. Entrance can be gained into the kitchen by two doors (one being the one with a latch fitted). Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 14 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): 18,19,20,21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at this service are assured of individualised care. EVIDENCE: Staff are still in the process of developing their relationship with the one person who currently uses the service and are mindful of their change in circumstances. Personal preferences form part of the care plan and information gathered by other agencies has enabled staff to be equipped with information to enable them to meet individual needs. The services of the local GP have been retained to ensure that the person who uses the service has to undergo fewer changes in people whom they are familiar with. Staff who have commenced working at Hope Lodge are experienced in care work and all have had training in their previous roles. The manager plans to implement a training programme to ensure that staff are consistent in their care delivery. Medication training was taking place in the week following the inspection. Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 15 We inspected medication and found it to be kept safely. Records reflected that it was being safely administered and dispensed. The manager plans to review storage facilities once more people move into the service. There is currently no designated fridge for storing medication but this is not a resource that is currently required. The manager is aware of the need to develop records for peoples wishes to be respected at the end of their life and will commence work once people living at Hope Lodge become more settled. Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 16 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. A complaints policy is in place but the recording system does not reflect action taken. EVIDENCE: Although the home has a complaints policy complaints have been recorded as an incident. There was no record of the action taken but the issue had been addressed and we saw a letter to verify this. The manager is devising a way to record complaints, concerns or compliments and the action that has been taken. This would assist staff to deal with any concerns that are identified and prevent them form escalating into complaints. The service has received one complaint that has been satisfactorily dealt with. The manager has not yet completed a complaints policy in a user friendly format but plans to have implemented one by the end of the year. A complaints policy is included in the service users’ guide and is displayed in the hall. The size of the service facilitates ongoing communication between people who use the service and staff. House meetings are planned when the service accommodates more people and the manager stated that minutes will be recorded. Staff are aware of the local safeguarding policy and the manager will be taking receipt of the local policy as it has been ordered. Financial records were checked during the inspection and found to be in good order. Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 17 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): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides a homely environment, which meets the needs of people who use the service. EVIDENCE: The service was clean and tidy and odour free. Because it has only recently accommodated people it is still developing its identity. As part of the settling in process people who move in will be encouraged to personalise their home. Some homely touches were evident such as artificial flowers and pictures but there is available space for people who move into Hope Lodge to add their own belongings and demonstrate their preferences. Each bedroom has a chair as they were on order at the previous inspection. The windowpane that was broken in a bedroom has also been repaired. The manager aims to review the laundry provision to ensure that it will meet the needs of people who use the service as it will currently accommodate domestic laundry but may not cope if an individual developed further health needs. Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 18 Protective clothing in the form of gloves and plastic aprons is available to staff. Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. The rota does not accurately reflect the level of hours worked and potentially compromises the health and safety of people who use the service and staff. EVIDENCE: All eight staff, with the exception of the manager, work part time. We were informed that seven staff hold an NVQ qualification: 1 at level 2 and 6 at level 3. The manager is a qualified mental health nurse with degree in care management. He is currently working to complete a Masters Degree in Public Health. Staff have not yet received supervision as they have only recently started work. The rota that was displayed did not accurately reflect hours worked and no record was being kept. The rota reflected that the manager had worked from 08.30am until 15.30 and then 22.30 until 08.30 on the day previous and into the day of the inspection, and then 9am until 3pm on the day of inspection. Although the manager stated he had left the previous day at 10am he had still worked from 10.30pm on 10th November until the inspection ended. Night staff remain awake. The manager stated that he had been unable to find alternative cover from the staff team and did not have a contract with an agency. He also Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 20 stated it had not happened before. The manager potentially put himself and the person using the service at risk by remaining awake and working independently for over 16 hours, whilst supervising and driving a person who uses the service. He stated that this would not be repeated nor would he expect staff to work in that way. We inspected 3 recruitment files for new members of staff. All required documentation had been received to ensure that staff were competent and people who use the service were protected. Staff have completed an induction and a record had been kept to demonstrate knowledge of the running of the home and policies and procedures. The manager is planning to introduce an induction recognised by the Learning Disability Award Frame work accredited training (LDAF) which would equip staff to wok with people with specialist needs. Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 21 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): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of people who use the service are fulfilled and formal systems are being developed to measure that the aims and objectives of the service are successfully met EVIDENCE: As the service has been occupied for one month the person who currently uses the service has been the focus of the staff team. An adequate level of staff has been employed but the previous chapter identifies that sufficient staff employed does not always guarantee availability. The member of staff we spoke to confirmed that the service was run in the best interests of people who use the service. They felt supported and able to approach the manager with any concerns that they may have. Once the service has been occupied for longer the manager plans to conduct a quality assurance review but will seek feedback informally in the meantime. Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 22 Health and safety risk assessments are in place for environmental risks within the home and water temperatures are noted. Staff cover health and safety as part of their induction. The manager is planning to expand the fire plan by utilising the local fire service’s assessment. As yet no fire drill or emergency light checks have been conducted but systems are in place to ensure that they can be recorded. Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 23 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 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 2 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 X 12 3 13 3 14 3 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X X 3 X Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA33 Regulation 18(1)(a) Requirement The staffing levels must be sufficient to ensure staff work a safe level of continuous hours with adequate breaks in between shifts. This must be illustrated in an accurate rota displaying actual hours worked. This will ensure the health and safety of people who use the service and staff are not compromised. Timescale for action 30/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA22 Good Practice Recommendations The service should have a designated place to record complaints. This will enable the manager to demonstrate that complaints are dealt with in accordance with the complaints policy and illustrate the outcome. Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Hope Lodge DS0000069703.V373037.R01.S.doc Version 5.2 Page 26 - 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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