Care Home: Ivy Lodge

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What the care home does well Before people come to live in the home their needs are appropriately assessed. This ensures that there is a suitable amount of information available about them on which to base their care. The home ensures that people`s needs and choices are respected, these being identified in support plans and followed through in practice. People are given opportunities to engage in activities that they enjoy, go on holiday, maintain contact with their families and lead ordinary lives. They receive personal care that meets their needs and people can be confident that the home will liaise well with health care professionals on their behalf to ensure that issues are followed up appropriately. People who use the service told us that they knew who to speak to if they were unhappy about their care and procedures are in place to respond to complaints and protect people from harm. Ivy Lodge provides a homely environment for people to live in and people are enabled to make their bedrooms their own. The provider has demonstrated an awareness of safe recruitment procedures to ensure that care workers are safe to work with residents and all staff benefit from training opportunities, including those for nationally-recognised qualifications, to ensure they have the underpinning knowledge to fulfil their role. The home has benefited from consistent leadership since its registration and this has enabled sound systems to be put in place, including those in relation to health and safety. This ensures that people are safe in the home. Several positive comments from relatives of people who use the service were received in surveys `A friendly, relaxed atmosphere and flexible where needed` `X is made to feel comfortable and secure` `I am happy with the way X is looked after. Members of staff are good, managers are very supportive` What has improved since the last inspection? There were no requirements made at the last inspection. Discussion with the registered provider indicated that recommendations are given consideration and practice is reviewed as a result. What the care home could do better: As a result of this inspection, four recommendations have been made. These are to promote good practice and should be given serious consideration. A recommendation for the provider to keep the door locking system under ongoing review has been made so that people who use the service can lock their bedroom doors from both sides.The home should improve the recording of individuals` food intake. Records should be comprehensive enough to demonstrate that people are eating a balanced diet that meets their nutritional needs. At present the majority of training that is delivered to care workers is undertaken in-house through videos and workbooks. While this is valid it is recommended that the home continues to explore the range of external training opportunities available to ensure that they are providing the best training to staff to meet people`s needs. The home has recently put in place a new system for quality assurance in the home. The home should now ensure this is fully implemented so that there is a clear annual development plan for the service based on the views and aspirations of people who live there. CARE HOME ADULTS 18-65 Ivy Lodge 212A Howeth Road Ensbury Park Bournemouth Dorset BH10 5NZ Lead Inspector Heidi Banks Key Unannounced Inspection 25th January 2008 09:25 Ivy Lodge DS0000062109.V359788.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 Ivy Lodge DS0000062109.V359788.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. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ivy Lodge Address 212A Howeth Road Ensbury Park Bournemouth Dorset BH10 5NZ 01202 593593 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) acornlodge.ltd@btinternet.com Acorn Lodge (Bournemouth) Ltd Mr Matthew Druce Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The first floor bedroom must only be occupied by an ambulant service user who is able to understand and react to emergency situations including evacuation. The home may accommodate up to six (6) service users where the care home address is their permanent place of residence. A seventh (7th) place is available for a service user who has a permanent place of residence which is not that of the care home and for whom short-term respite care is required. 14th June 2006 Date of last inspection Brief Description of the Service: Ivy Lodge is owned by Acorn Lodge (Bournemouth) Ltd and Mrs Angela Druce is the Responsible Individual. The home is registered to provide accommodation and personal care for a maximum of seven people. The registered provider also owns Acorn Lodge which provides accommodation and care for people with learning disabilities in the Bournemouth area. Ivy Lodge has been a registered care home since May 2004. Mr Matthew Druce is the registered manager with day-to-day responsibility for the running of Ivy Lodge. The home is a large detached chalet style bungalow set in pleasant grounds with ample off-road parking for visitors. The premises comprises two floors with most of the accommodation and communal living areas being situated on the ground floor except for one bedroom which is on the first floor. All bedrooms are for single occupancy and all have en suite facilities. There is a separate bathroom on the ground floor, a lounge/dining area and a fully fitted kitchen. The laundry room is sited in the grounds in a separate building adjacent to the home’s office space. Access to the property and rear garden is by a small flight of steps however these do not present any difficulties for the current group of residents living at Ivy Lodge. Ivy Lodge is on a main bus route to all parts of Bournemouth and a short walk away from a bus route to Poole. Staffing is provided in the home twenty-four hours a day. Fee levels charged by the service vary according to people’s individually assessed needs. From information obtained in February 2008 the basic fee level charged by the service is £650 per week. Further information on fees and fair terms of contracts can be found on the website of the Office of Fair Trading; www.oft.org.uk. Ivy Lodge DS0000062109.V359788.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 3 star. This means the people who use this service experience excellent quality outcomes. This was a key unannounced inspection of the service which took place over one day on 25th January 2008. The purpose of the inspection was to assess how well the service achieves positive outcomes for people who use the service and meets the regulations and national minimum standards. During the course of the inspection discussion took place with the registered provider, Mrs Angela Druce, and some staff who are employed by the service. We were able to meet several people who use the service during the inspection. Prior to the inspection the registered manager supplied a completed Annual Quality Assurance Assessment (AQAA) to the Commission. Surveys were distributed to some people who use the service, their relatives, care workers and health and social care professionals to obtain their views about the service. A total of fifteen completed surveys were received and information obtained from these sources is reflected throughout this report. A sample of records was examined including some policies and procedures, support plans, daily records, medication records, staff and training records. A total of twenty-two standards were assessed during this inspection. What the service does well: Before people come to live in the home their needs are appropriately assessed. This ensures that there is a suitable amount of information available about them on which to base their care. The home ensures that people’s needs and choices are respected, these being identified in support plans and followed through in practice. People are given opportunities to engage in activities that they enjoy, go on holiday, maintain contact with their families and lead ordinary lives. They receive personal care that meets their needs and people can be confident that the home will liaise well with health care professionals on their behalf to ensure that issues are followed up appropriately. People who use the service told us that they knew who to speak to if they were unhappy about their care and procedures are in place to respond to complaints and protect people from harm. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 6 Ivy Lodge provides a homely environment for people to live in and people are enabled to make their bedrooms their own. The provider has demonstrated an awareness of safe recruitment procedures to ensure that care workers are safe to work with residents and all staff benefit from training opportunities, including those for nationally-recognised qualifications, to ensure they have the underpinning knowledge to fulfil their role. The home has benefited from consistent leadership since its registration and this has enabled sound systems to be put in place, including those in relation to health and safety. This ensures that people are safe in the home. Several positive comments from relatives of people who use the service were received in surveys ‘A friendly, relaxed atmosphere and flexible where needed’ ‘X is made to feel comfortable and secure’ ‘I am happy with the way X is looked after. Members of staff are good, managers are very supportive’ What has improved since the last inspection? What they could do better: As a result of this inspection, four recommendations have been made. These are to promote good practice and should be given serious consideration. A recommendation for the provider to keep the door locking system under ongoing review has been made so that people who use the service can lock their bedroom doors from both sides. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 7 The home should improve the recording of individuals’ food intake. Records should be comprehensive enough to demonstrate that people are eating a balanced diet that meets their nutritional needs. At present the majority of training that is delivered to care workers is undertaken in-house through videos and workbooks. While this is valid it is recommended that the home continues to explore the range of external training opportunities available to ensure that they are providing the best training to staff to meet people’s needs. The home has recently put in place a new system for quality assurance in the home. The home should now ensure this is fully implemented so that there is a clear annual development plan for the service based on the views and aspirations of people who live there. 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. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Information on people’s needs and wishes is gathered as part of the admissions process to the home which ensures that they receive a service that meets their individual requirements. EVIDENCE: The deputy manager of the home told us at the inspection that there have been no new permanent admissions to the home since the last inspection of the service. This was confirmed in discussion with the registered provider. This standard was fully met at the last inspection of the service in June 2006 when it was found that assessment documentation was in place for a new service user and the person’s needs and goals had been well documented. The person concerned and their relative confirmed that they had been consulted during the process and the move had gone well. The home has told us in their Annual Quality Assurance Assessment that there are systems in place to promote smooth transitions for people which are based on a full assessment of each individual’s needs. They have told us that care management assessments are obtained and the views of people and their Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 10 relatives are sought through a pre-admission questionnaire. Two care managers who responded to the survey indicated that the home’s assessment arrangements ensured that accurate information is gathered and the right service is planned for individuals. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is responsive to people’s individual needs and choices on a daily basis which means that people are supported in a positive and respectful way. EVIDENCE: The home’s Annual Quality Assurance Assessment tells us that individual care plans have been written in consultation with people who use the service. A sample of service user plans was seen. These showed that information about each individual had been gathered to identify the person’s needs, likes and dislikes. Plans told us about people’s religious and cultural beliefs, their personal care, preferred leisure activities, relationships, behaviour, money management, mobility needs and participation in activities around the home. There was consideration given to people’s preferences, for example, ‘Likes to wear shoes, not trainers’, and what they can do for themselves and where support is needed; ‘X is able to get things ready (to make a hot drink), for Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 12 example, cups, spoon and milk. Staff to pour the hot water to minimise the risk of an accident’. Plans showed evidence of regular internal review and there was also evidence on file of annual reviews by the local authority. Efforts have been made to ensure plans are presented in an easy-read format that is accessible to people. Things that were important to the person, raised at reviews, had been followed up by the home. For example, where a service user liked pickle in his sandwiches there was evidence in menu records that this is being implemented. All staff responding to the survey told us they always had up-to-date information about people to be able to deliver their care. Out of two surveys received from care managers who have contact with people in the home, one indicated that the care service always responded to the different needs of individuals, the other indicating that this was usually the case. Half the relatives responding to the survey also told us that the home always meets the needs of their family member, the remaining half stating this usually happened. The home’s Annual Quality Assurance Assessment tells us that people who use the service are fully involved in the running of the home. The home is implementing a new quality assurance system, part of which is to obtain the views of people who use the service about the care they receive. Links are being established with a local advocacy organisation to look at ways in which people can be supported to express themselves. The deputy manager told us that regular service user meetings are held at the home although at the time of the inspection minutes of the most recent meeting were not available. It is recommended that the home ensures there is a clear record of discussions held with people who use the service to form an audit trail of individuals’ decisionmaking and how these are being followed up. Two people who use the service told us in surveys that they always made decisions about what they did each day, with one person telling us that they had been able to make a decision about their holiday. Service user plans showed that risks had been considered, for example, ‘To keep X safe and healthy we need to remind X not to open the front door and invite strangers into the home’. In addition, the level of support needed by individuals with specific areas of their life had been documented; ‘Staff need to assist X to cross the road at the correct places, for example, traffic lights / zebra crossings’. Observation of people living in the home showed that where individuals’ behaviour could potentially present risks this is well-managed with care workers continuing to promote the person’s independence at home and in the community. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 13 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, 15, 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service lead an ordinary lifestyle in their home and community which respects their rights and preferences. EVIDENCE: The home has told us in their Annual Quality Assurance Assessment that people who use the service are an integral part of their local community, visiting and using local shops, cinemas, libraries, pubs, banks and leisure centres. On the day of the inspection three people were attending various day services in the community while the remaining three were spending time at home, going to the supermarket and having lunch out. Individuals’ preferred activities had been identified in their support plans and from observing people in their home and what they told us in surveys there was evidence that they are given opportunities to pursue interests that are important to them. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 14 One person told us that they had recently been to an ice skating show with the home which they had enjoyed very much and they had also had opportunities to go to Mexico and Spain with their peers. This was confirmed by a relative who told us that the home ‘provides a great many activities, outings, holidays etc’. Mrs Druce told us that they distribute an annual newsletter to families and stakeholders reporting on activities that people are enjoying in the home and updating them on various events taking place. They also told us in their Annual Quality Assurance Assessment that the home supports people to keep in touch with their families. This was echoed by relatives in surveys with five out of six telling us that the home always helped their family member keep in touch with them and one relative stating that this was usually the case. One relative told us that staff always took their family member out to buy birthday and Christmas cards and presents for them. The home told us that they encourage and support people to be involved in the daily routines of their home and take some responsibility for their own bedroom, their laundry, shopping and meal preparation. The majority of relatives told us that the home did well in always supporting people to live the life they choose and care managers told us that this generally happened. Discussion with the provider and deputy manager indicated a respectful attitude towards individuals’ choices and needs and an appreciation of diversity issues and the implications of the Mental Capacity Act. Positive interaction between people who use the service and staff who support them was noted during the inspection. A recommendation was made at the last inspection that the home reviews locking systems on people’s bedroom doors. The system currently in place is ‘star locks’ which means that doors can be locked from the outside but not from the inside. Discussion with Mrs Druce indicated that this system is in place due to safety reasons as they are concerned that, in the event of an emergency, people may lock themselves in their rooms and be at risk. The national minimum standards state that people should be offered a key to their own bedroom so that they can be locked from the inside and outside. This can be fitted with an override facility so that, in the event of an emergency, staff are able to gain access. The recommendation is repeated at this inspection. Inspection of the home’s kitchen showed evidence of a broad selection of groceries of various brands. Records were seen of meals chosen by individuals which showed evidence that people could make appropriate choices, for example which cereal they wanted at breakfast. One relative told us that they felt the home should pay more attention to offering a healthy diet including ‘five portions of fruit and vegetables each day’. Some references to meals in the records inspected were too general to give a full account of their nutritional content. For example, references to ‘pasta bake’ or ‘shepherds’ pie’ did not take account of vegetables offered with the meal and therefore it was not Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 15 possible to identify from the records that people were being offered them and are eating a balanced diet. A recommendation has been made for the home to ensure that records are comprehensive enough so that anyone reading them can judge whether meals are nutritionally balanced and meeting individuals’ needs. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 16 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 and 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People receive the personal care they require with good access to health care and medication procedures that are robust. This ensures that people’s needs are met effectively and safely. EVIDENCE: Support plans seen showed a suitable level of detail about people’s needs in personal care, for example ‘X can undertake all aspects of personal care independently but staff need to prompt him for this to take place’. Information about how to communicate with individuals was also included in the plan; ‘X has a hearing impairment making him speak a bit louder. Staff have to ensure that they speak clearly to X for him to understand’. Both service users responding to the survey told us that staff always treated them well. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 17 Feedback from relatives indicated that they were generally very satisfied with the personal care offered to their family member; ‘Ivy Lodge has always supported X and X is very happy living there. The residents are well-cared for, the home is clean and residents’ clothes are always washed and ironed’; ‘Our relative is very well-cared for and has a good relationship with other residents and staff’; ‘Attention needed for more regular shaving, tooth brushing, hair-brushing’. Support plans seen gave information about how individuals needed to be supported with their health care. Where people need assistance with making appointments this had been clearly documented and there was evidence that where family members wish to be involved in this process this is respected. Health records showed that people are supported to access doctors’ and hospital appointments as necessary and that where problems had been identified in relation to people’s health these were being followed up. This was echoed by a general medical practitioner who has contact with the home who indicated in a comment card that the home communicates clearly and works in partnership with them and that staff demonstrate a clear understanding of the care needs of service users. Discussion with the deputy manager indicated that one person was awaiting a visit from a physiotherapist and that there had been several telephone conversations between the physiotherapist and the home with regards to this. It is suggested that telephone contacts with professionals are also documented in people’s health records so that there is a clear and up-to-date account of events that are taking place and how the home is following up issues that arise. All six relatives responding to the survey told us that they were always kept up-to-date with important issues affecting their family member, one relative noting that staff did this ‘without being asked’. Another relative commented that the home presented as ‘very well-prepared and organised when liaising with health care professionals’. A care manager also reported that liaison with people’s families and others involved in their care was something the home did particularly well. The home has a medication policy that covers procedures for obtaining medication, receipt of medication, arrangements for respite and short-stay clients, medication administration, disposal, non-prescription medication and self-administration. Medication for all service users is stored in a lockable metal cabinet in a corner of the hallway of the home. Medication is supplied to the home by a local pharmacy, predominantly in the form of blister packs. Medication administration record (MAR) charts are also produced by the Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 18 pharmacy to record when medication is administered to each individual. A sample of blister packs were checked against records, these indicating that medication had been given to individuals as prescribed. Discussion with a member of staff indicated that an audit trail is in place to monitor that medication is being given appropriately and boxes of tablets for individuals showed dates of opening to enable checks to be completed effectively. A list of homely remedies were in place for each person which included instructions for use, dosage instructions and precautions. Lists had been signed by the individual’s general practitioner. The home’s Annual Quality Assurance Assessment tells us that all staff who are responsible for administering medication undertake comprehensive training including theoretical knowledge and practical assessment which is refreshed annually. A sample of staff training records were checked, all showing that staff had completed some training in medication administration. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 19 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 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s views are listened to and responded to by the home with procedures in place to protect people from harm. EVIDENCE: The complaints procedure for the home is on display in the main hallway of the home. This gives clear timescales and includes the contact details for the Commission for Social Care Inspection. The provider has told us in the Annual Quality Assurance Assessment that the procedure forms part of the home’s Service User Guide pack which people are given on admission. Both residents responding to the survey indicated that they knew who to speak to if they were unhappy, one stating that they would go to the manager. Both residents also told us that carers always listened to them and acted on what they said. Four out of six relatives, however, told us in their surveys that they either did not know how to make a complaint or could not remember. This was raised with the provider at the inspection who agreed that she would send out copies to all relatives to ensure they had this information to hand. Three relatives told us that when they had raised concerns in the past the home had always responded appropriately and this was echoed by care managers. One relative commented; ‘If X is upset the staff do their best to find out what the problem is and to put it right’ and another told us ‘They are ready to oblige if we make any request. They are friendly and helpful’. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 20 The home has told us in their Annual Quality Assurance Assessment that service users are ‘always free to raise concerns on an ad hoc basis’. Mrs Druce told us that they had not received any complaints about the service since the last inspection. The home could not recall any concerns being raised but it was suggested to them that they identify a clear system for recording any day-to-day concerns that may be raised by service users, their relatives or others and that the record is accessible to staff who may receive this information. The home’s Annual Quality Assurance Assessment indicates that a policy is in place on the disclosure of abuse and safeguarding adults which was last reviewed in April 2007. It goes on to say that staff training on abuse awareness is carried out through videos which are accompanied by questionnaires and workbooks to test people’s knowledge. Staff training records confirmed this. It is suggested that the home looks to secure some external training in this area in order to ensure that training is fully robust and updated in line with revised guidance and local procedures. The provider has told us that there have been no safeguarding adults referrals or investigations at the home since the last inspection. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 21 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 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a homely environment that meets their needs. Procedures are in place to manage infection that ensure people who live there are protected. EVIDENCE: Ivy Lodge is a bungalow situated in a residential area of Bournemouth with good public transport links to local towns. The property is in-keeping with others in the neighbourhood. A tour of the premises indicated that the home is homely, domestic in style and in an adequate state of repair, the home telling us in their Annual Quality Assurance Assessment that there is an ongoing cycle of redecoration throughout the home. Regular visits to the premises are made by the provider who uses this opportunity to look at aspects of the environment and arrange for any necessary repairs to be carried out. A relative told us in their survey Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 22 that they were pleased their family member was at Ivy Lodge; ‘It is more like home in being small and compact’. All residents have their own bedrooms and inspection of these showed that they have been personalised to suit individual tastes. The lounge / dining area was seen to be well-used by residents during the inspection. There is a key pad on the kitchen door but during the inspection the door was seen to be open to enable access. The home’s Annual Quality Assurance Assessment tells us that they have a policy on preventing infection and managing infection control which they have based on Department of Health guidance. They have also told us that all twelve care workers employed by the home have received training in this area. All staff take responsibility for keeping the environment clean and tidy. Of the two residents responding to surveys one told us that they always found the home to be fresh and clean, the other stating that this was ‘sometimes’ the case. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 23 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): 32, 34 and 35 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The provider is aware of safe recruitment processes and is committed to providing training for care workers. This helps promote people’s competence in their role and gives them the knowledge they need to work safely with people who use the service. EVIDENCE: Discussion with the provider indicated that no new staff have been employed in the home since the last inspection. Paperwork in relation to recruitment was reviewed at the last inspection of the service in June 2006, the national minimum standard being judged as met at this time. The home’s Annual Quality Assurance Assessment tells us that a system is in place to ensure that all necessary checks are carried out on prospective employees. The provider was reminded of the need to ensure that people give a full employment history before being appointed, including details of any other work they may be doing while being employed at the home. The provider told us that they were aware Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 24 that this was a regulatory requirement and have amended their application forms to ensure that this expectation is clearly stated in the future. Discussion with Mrs Druce indicated that she is fully aware of key issues in relation to staff training and has done well to keep up-to-date with current changes in this field. Mrs Druce has established links with a local workforce development group and is a member of a ‘learning hub’ to ensure that she continues to keep abreast of developments. In addition, the home is registered as a centre to provide training and assessment of staff for City and Guilds qualifications in health and social care. According to the home’s Annual Quality Assurance Assessment, nine care workers out of twelve have a National Vocational Qualification (NVQ) in Care at Level 2 or above with one person currently working towards this qualification. Training records showed that when staff commence in post they are given a structured induction programme and ongoing training is provided to promote their competence in their role. This was confirmed by all four care workers who responded to the survey. Training provided includes mandatory health and safety training, training in diet and nutrition and dealing with aggression. Half of the relatives who responded to surveys said that staff always had the necessary skills and experience to look after people properly, ‘The staff that are at Ivy Lodge at the moment seem supportive and kind’; ‘They do make the effort’. Both care managers who returned a survey told us that in their view staff and managers sometimes had the right skills and experience to support individuals’ social and health needs. At the time of the inspection, the majority of training that is carried out is in-house and it is recommended that the home explores other sources of training to ensure that they are accessing the most appropriate courses to meet people’s needs. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 25 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 and 42 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well-run with consistent leadership and robust health and safety procedures. This ensures that people are safe and can have confidence that the home is managed effectively. EVIDENCE: The registered manager of Ivy Lodge is Matthew Druce. Mr Druce holds a NVQ Level 4 in Care and the Registered Managers’ Award. The deputy manager of the home holds the same qualifications. The manager of the home is directly accountable to the registered provider. The home has benefited from consistent management since it was registered as a care home in May 2004. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 26 Discussion with the provider, Mrs Angela Druce, demonstrated that she is actively involved in the running of the home. It was clear from discussion that she has a sound knowledge of the regulations and national minimum standards and previous inspection reports have noted that, where shortfalls have been identified, she has reviewed the home’s practices promptly with positive effect. Staff told us in surveys that systems of communication between themselves and the manager work well. The home has told us in their Annual Quality Assurance Assessment that they have replaced their previous quality assurance methodology with a new system based on outcome areas identified in the government White Paper ‘Valuing People’. A dedicated file has been set up for this purpose at the home. The provider told us that they plan to monitor service provision through surveying people who live in the home and those who have contact with them, through the outcomes of statutory inspections and contract management meetings, residents’ meetings and the provider’s own monitoring visits to the home when various systems are audited. The home has told us in their Annual Quality Assurance Assessment that outcomes from these areas will contribute to their plans for improvement in the next twelve months. The home has a fire risk assessment which was completed in February 2007. Individual support plans for residents were seen to give some information about their needs in relation to fire safety; ‘X can recognise the fire alarm and is aware it means to evacuate. X can evacuate independently but needs to be advised of where to go’. All documentation in relation to fire checks was up-to-date. Fire drill records had been completed fully and indicated that practice evacuations take place at various times of day including those times when night staff are on duty. Records for staff training showed that fire awareness training is arranged every three months with staff signing to indicate their attendance. Quizzes are completed as part of the training sessions to test people’s knowledge of safe procedures, documentation in relation to which was seen on file. A sample of staff training records showed that all staff undertake training in emergency first aid, health and safety, food hygiene and moving and handling. This was confirmed in the home’s Annual Quality Assurance Assessment and staff surveys. The content of training was discussed with the provider at the inspection, Mrs Druce telling us that, where appropriate, training includes a practical as well as a theoretical component. Records of fridge and freezer temperatures seen at inspection had been completed twice daily and water temperatures are checked at each outlet on a regular basis. The most recent checks indicated that the temperatures were within a safe range. Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 28 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. 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 YA16 Good Practice Recommendations Service users should be able to lock their bedroom doors from the inside and outside. The locks should be fitted with an override facility. The provider should ensure that there are comprehensive records in place to detail individuals’ food intake so that any person reading the record can determine whether their diet is nutritionally balanced. The provider should continue to explore various sources of external training to ensure that care workers benefit from a range of training opportunities that reflect people’s needs. The home’s quality assurance process should be fully implemented with aims and objectives set as part of an annual development plan. 2. YA17 3. YA35 4. YA39 Ivy Lodge DS0000062109.V359788.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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