Care Home: Laglin Lodge

What the care home does well People who use the service say that they like living there and are able to make decisions about what they do each day. They also say that the staff treat them well and that they liked the relaxed atmosphere at the service. What has improved since the last inspection? At the last inspection there were three areas that the home had to improve upon. Action has been taken on these areas, which represents positive improvements to the service, particularly in the management of medication. What the care home could do better: Areas where the home could be doing better are highlighted in the report and were discussed with the manager during the inspection. This includes improvements to the environment and assessment process for new people prior to their moving to the service. The service also needs to improve the training provided to staff to ensure that they are giving support that is in line with current best practice, and that they are trained for the work they are expected to do. CARE HOME ADULTS 18-65 Laglin Lodge 7 Eardley Road Streatham London SW16 6DA Lead Inspector Louise Phillips Key Unannounced Inspection 2nd April 2009 09:45a Laglin Lodge DS0000035525.V374614.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 Laglin Lodge DS0000035525.V374614.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. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laglin Lodge Address 7 Eardley Road Streatham London SW16 6DA 020 8769 8655 020 8265 8340 laglinlodge@tiscali.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) Mrs Patricia Elizabeth Modile Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Laglin Lodge DS0000035525.V374614.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 (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 6 30th April 2008 Date of last inspection Brief Description of the Service: Laglin lodge is a registered care home for up to six adults with mental health needs. The home is a three-storey house and each person has single room accommodation and there are spacious modern communal areas consisting of a lounge, conservatory and kitchen/ dining area. There is a small car parking area to the front and a large garden to the rear of the house that has a patio and lawn. The home is close to bus and rail links that provide access to the shopping areas of Streatham, Tooting and Mitcham. Laglin Lodge DS0000035525.V374614.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 two stars – good service. This means the people who use this service experience good quality outcomes. This inspection took place over one day and included a visit to the service by us. When we visited we spoke to people who live and work at the home and the manager. We also looked at records, observed what was going on and looked at the environment. Surveys were received back from one person who lives at the service and two staff, and the responses are referred to in the report. What the service does well: 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. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 6 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 Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 7 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 Quality in this outcome area is adequate. Improvements need to be made to ensure that the service obtains all relevant information during the assessment of new people to the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who use the service are assessed by the manager prior to them being offered accommodation at the home. This information is then used to develop the care plans to ensure the person gets relevant support whilst living at Laglin Lodge. However, referral information must also be obtained from the care manager to ensure relevant information about the persons history, and also evidence of the involvement of care management, should be gained to inform the homes assessment of the person wanting to use the service, to ensure that they can meet all needs appropriately. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 8 Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is good. Care plans are in place for people who use the service to ensure they get the right support and risks are minimised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the care files for two people who use the service. Each person has care planned around their individual needs, and these detail support for areas such as support with personal care, budgeting, activities, cultural needs, mental health and maintaining positive relationships with family and friends. The care plans provide appropriate detail to demonstrate the care and support provided, and staff say that these provide up-to-date information about the needs of people who use the service. The care plans are reviewed every six months, or more frequently where needs have changed. The manager said that the people who use the service are involved in the development and reviewing of their care plans. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 10 Areas of risk identified for each person are included within the care plans as risk factors, around any challenging behaviours, alcohol misuse or self-neglect. The current format of care planning is that all care plans are on one sheet of paper, or several pages where there are a number of needs. We found this format confusing at times, when trying to identify people’s different care needs, and consideration should be given to re-formatting the care plans so that each area of need is identified on a new sheet of paper, which can also enable easier reviewing and amending of care plans. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 11 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 and 17 Quality in this outcome area is good. People who use the service are able to make decisions about what they do each day and are supported to spend each day as they wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection we observed people who use the service coming and going from the home, going about their daily lives. We spoke to one person who uses the service and one person responded to our survey, where they both said that they are supported to do what they want, when they want, throughout the day. The care files detail that people who use the service are encouraged to pursue family and significant relationships and are supported to attend church, day centres or the gym, as they wish. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 12 Some people are given money by the service to purchase their own food and do their own cooking, whilst others are provided meals by the home. The menu on display at the service states different meals that are provided, and staff said that people who use the service choose the meals during the monthly community meeting, and their choices are developed into the menu. Once a week people are able to order a takeaway meal. There was observed to be a variety of fresh, frozen and tinned foods for the consumption of people who use the service. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. People who use the service are able to have their physical, emotional and medical needs met through the service. Positive improvements have been made to the medication system at the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A record is maintained in each persons’ care files of appointments that they have with doctors, dentists and relevant health professionals, etc. Most people who use the service are independent in their personal, with staff supporting by prompting only. We looked at the medication system in use and found that positive improvements had been made to the monitoring of this with the implementation of a weekly audit to check that medication prescribed matches that listed on the MAR (medication administration record). Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 14 The manager said that this has led to any discrepancies being managed promptly and without harm to the person using the service. We checked the medication held for all the people who use the service, and these were seen to correspond with that listed on the MAR chart. However, we also identified that the PRN (as required) medication listed for one person had labels on the medication packet stating that they are to be given as regular medication. This was highlighted to the manager during the inspection who said that this would be addressed as a matter of urgency. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. The service has appropriate procedures for addressing complaints and concerns. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an appropriate complaints policy, which details the procedure and timescales for investigating complaints. People who use the service said that they would know who to talk to if they were unhappy about something, and that they know how to raise a complaint. The manager said that no complaints have been received by the service during the past year, and the Commission have received no complaints about Laglin Lodge during this period. There are is a policy in place for managing any allegation of abuse, though the service needs to obtain a copy of the most up-to-date safeguarding procedures for Wandsworth local authority to ensure that they have the most relevant information of procedures to follow. Staff records indicate that they have done training in safeguarding vulnerable adults (SOVA), though for some this had been last done over a year ago, and the service must ensure that all staff have up-to-date training in this. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 16 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, 27 and 30 Quality in this outcome area is good. The environment is welcoming and homely for the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person who uses the service has their own room that they clean themselves, with the support of staff if needed. People who use the service say that they like the environment and that it is kept clean. We observed that the home was fresh, clean and in good decorative order. The manager described improvements that have been made since we last visited the service, including repainting of some areas and the carpets being cleaned throughout the service. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 17 It was observed that there is some exposed pipe-work in the bathroom next to bedroom six, and in the WC next to bedroom three. These are a safety risk and must be boxed in to ensure risks to people who use the service are minimised. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is adequate. Risks to people who use the service are minimised through appropriate recruitment checks. However, improvements are needed to ensure all staff have appropriate, up-to-date training for their role. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff team comprises of people who have worked at the home for a number of years and staff who are newer to the service and their role. Staff say that they feel there is good teamwork at the service, and good support given to people who use the service. Staff said that they feel there are enough staff on duty to meet the needs of people who use the service. People who use the service say that the staff treat them well, and that staff generally listen to and act upon what they say. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 19 We looked at the recruitment files for three staff. These contain information to demonstrate that appropriate recruitment checks are carried out on staff prior to their starting work at the home. New staff receive an induction to the service that includes orientation to the policies and procedures around health and safety and working with people who use the service. Staff said that they feel the induction covered everything they needed to know when they first started working at the home. Some staff have completed relevant National Vocational Qualifications (NVQ) for their role. The training records indicate that some staff have been trained in areas such as first aid, fire safety and basic food hygiene, yet some of these were seen to have been done some years ago and need updating. An example of this was for one staff member who’s training records indicate that they last had medication training in 2007, moving and handling training in 2006 and life support training in 2003. There is no evidence to indicate that staff had done recent training in fire safety, moving and handling, medication administration, food hygiene, first aid or health and safety. Training in these areas must be provided to ensure that people using the service receive the most up-to-date support, and that staff are appropriately trained for their work. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 20 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 and 42 Quality in this outcome area is good. The manager is competent and has a good understanding of improvements needed to develop the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of Laglin Lodge is also one of the owners of the home. He is knowledgeable about the needs of the people who use the service and areas where the service can improve. People who use the service, and the staff said that they like the manager and feel that he is approachable and able to manage any issues they raise. The service carries out an annual survey and holds monthly community meetings to seek the views of people who use the service. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 21 The service holds certificates to demonstrate that relevant health and safety checks are carried out on the fire system, fire equipment, electrical systems and gas safety. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 22 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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 3 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 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 23 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 YA2 Regulation 14(1) Requirement The service must obtain a copy of the care management assessment prior to admitting new people to the service. This is so that the service has all the information to ensure it can meet the needs of people who live there. 2. YA23 13(4) All staff must receive up-to-date SOVA training. To ensure that people who use the service are appropriately protected. 3. YA23 13(4) The service must obtain a copy of Wandsworth local authority SOVA procedures. To ensure that appropriate procedures are in place at the service. 4. YA24 23(2) Exposed pipe-work at the service must be boxed in. To ensure risks to people who use the service are minimised. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 24 Timescale for action 30/04/09 31/05/09 31/05/09 31/05/09 5. YA35 18 Staff must be provided with training for the work they are expected to perform, including: fire safety, moving and handling, medication administration, food hygiene, first aid and health and safety training. This is to ensure that people who use the service receive support from appropriately trained staff. 31/10/09 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 YA6 Good Practice Recommendations Consideration should be given to re-formatting the care plans so that each area of need is identified on a new sheet of paper. Laglin Lodge DS0000035525.V374614.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection London Region Citygate Gallowgate Tyne And Wear NE2 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 Laglin Lodge DS0000035525.V374614.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. 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. 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