Care Home: Lodge Hill (169)

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What the care home does well There is a welcoming and friendly atmosphere in the home, which is reflected in the experience and comments of other visitors to the home. The staff are good at helping the residents. There is good help provided by health care professionals such as psychology, GPs, dentist, and community nurse, and there are plans for involvement from chiropody and a speech and language specialists to improve the care provided. Citizen`s advocacy provides residents with help to speak up and make decisions. Relationships with family and friends are encouraged and one resident said that the staff help him to make friends and invite them to visit. Staff are enthusiastic about working at the home, and help residents to go out very regularly to shops, day centres and other activities. One resident is supported to do a part time job at a farm. He said that staff are very helpful and that the manager is always there to talk to about any problems. The staff support the residents to shop and cook meals that they like, and are very sensitive and helpful in the way the provide support. There are good written care plans and guidance for staff describing how to best support each resident, and staff show that they understand these.The home is warm and homely, the residents have been involved in decoration of their own rooms, which are well maintained. The home is clean and everything works well. What has improved since the last inspection? There is improved communication between the home and the staff that run the day centre, and some day centre staff are invited to attend planning review meetings. This helps them to provide the same care for residents, as they would receive in their home. The home now looks after resident`s medication so that creams and homely remedies are dated when they are opened. Dedication had collected every month now, which the manager and staff say is easier to manage. Paving around the home has been levelled out so that the residents have less risk of accidents. Trees have been cut back so that residents had better light in their home. The manager has now registered with CSCI and both residents and staff say that they are happy with the management of the home. Residents meetings now take place in the home so that they can discuss any problems are having, and the home has carried out surveys to find out what the residents and their families think about how the home is run so that improvement can be made. One resident said he is very happy with the staff and management and they always ask him for his ideas and opinions. What the care home could do better: The home needs to try to get social services more involved in care reviews for residents, so that they can be sure they are providing good care and support for the residents. A number of residents don`t have care assessments provided by social services and the home needs to ask for these so that they can be sure they are providing a good service. There are needs to be a clearer agreement about what residents pay towards the homes transport, and this should be done with residents, and social services. Advocacy may also be able to help to make any decisions. That staff should get more training about what it`s like to have dementia, and about things they might do to help one resident to be as active and involved as is possible. Some more training for staff in Person Centre Planning should be planned so that staff can fully understand how this will help residents to be fully able to say what they want to do, and to be better able to understand their care plans.The home needs to show residents what they have found from surveys they have carried out and have a system for checking that the home is providing a good service and that it is planning for making things better. CARE HOME ADULTS 18-65 Lodge Hill (169) 169 Lodge Hill Abbey Wood London SE2 0AS Lead Inspector Sean Healy Key Unannounced Inspection 3rd March 2008 10:00 Lodge Hill (169) DS0000036906.V350929.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 Lodge Hill (169) DS0000036906.V350929.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. Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lodge Hill (169) Address 169 Lodge Hill Abbey Wood London SE2 0AS 0208 316 4086 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) feizalglo@yahoo.co.uk Greenwich Council Rita Anne Fitton Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 6 16th November 2006 Date of last inspection Brief Description of the Service: 169 Lodge Hill is a modern chalet style building situated in the grounds of the former Goldie Leigh hospital close to the facilities of Welling and Bexleyheath. There are six single bedrooms providing accommodation for residents with moderate to severe learning difficulties and physical disability. There are currently no vacancies. Four rooms are located on the ground floor two of which are suited for two residents who use wheelchairs and have access to the downstairs bathroom and separate walk in shower. The lounge and kitchen diner area are also located on the ground floor. There is level access to the small garden and patio area from the kitchen diner. Upstairs are a further two residents bedrooms, a combined bathroom and toilet, and the staff sleep in room / office. The home is one of a number, managed by the London Borough of Greenwich within the Greenwich Living Options Scheme. A staff team of eight provide 24 hours cover, supported by a manager and deputy manager, with some additional cover of up to 32 hours weekly available. Residents attend local day centres during weekdays and are provided with personal care and support to live as independently as possible and to take part in activities both within the home and the community. Residents are encouraged to personalise their own room; meals, laundry and care support are provided by staff. Information about the services provided is made available to current and potential residents in the homes Statement of Purpose and Service Users Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 5 Guide. The recent CSCI report is currently referred to in the home’s Statement of Purpose, and a copy is kept in the manager’s office. This was last reviewed in December 2007. The manager agreed to make this available to residents in a more public area of the home. At 3rd March 2008, the homes fees for support are paid for by the local authority. The individual costs for support for each resident quoted in the homes Tenants Guide are £1,434.60 per week. Each individual resident pays a fee of £6.23 per week towards the cost of support, and an additional £36.76 per week for food costs. Residents have to pay for other personal expenses such as hairdressing, transport and personal shopping. The provider’s email address is: feizalglo@yahoo.co.uk Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality Rating for this service is 3 Star. This means that the people who use this service experience good quality outcomes. The inspection was unannounced and was conducted over one day period. The inspection ended on 13/3/08 following receipt of further information requested. It was facilitated by the registered care manager, who was efficient in providing all of the information needed for the inspection. The inspection included interviews with one resident, and observations of staff helping three other residents. Three support staff were also interviewed. The inspection also included a tour of the premises and examination of three residents’ files, three staff files, and recruitment records and maintenance records. What the service does well: There is a welcoming and friendly atmosphere in the home, which is reflected in the experience and comments of other visitors to the home. The staff are good at helping the residents. There is good help provided by health care professionals such as psychology, GPs, dentist, and community nurse, and there are plans for involvement from chiropody and a speech and language specialists to improve the care provided. Citizen’s advocacy provides residents with help to speak up and make decisions. Relationships with family and friends are encouraged and one resident said that the staff help him to make friends and invite them to visit. Staff are enthusiastic about working at the home, and help residents to go out very regularly to shops, day centres and other activities. One resident is supported to do a part time job at a farm. He said that staff are very helpful and that the manager is always there to talk to about any problems. The staff support the residents to shop and cook meals that they like, and are very sensitive and helpful in the way the provide support. There are good written care plans and guidance for staff describing how to best support each resident, and staff show that they understand these. Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 7 The home is warm and homely, the residents have been involved in decoration of their own rooms, which are well maintained. The home is clean and everything works well. What has improved since the last inspection? What they could do better: The home needs to try to get social services more involved in care reviews for residents, so that they can be sure they are providing good care and support for the residents. A number of residents don’t have care assessments provided by social services and the home needs to ask for these so that they can be sure they are providing a good service. There are needs to be a clearer agreement about what residents pay towards the homes transport, and this should be done with residents, and social services. Advocacy may also be able to help to make any decisions. That staff should get more training about what it’s like to have dementia, and about things they might do to help one resident to be as active and involved as is possible. Some more training for staff in Person Centre Planning should be planned so that staff can fully understand how this will help residents to be fully able to say what they want to do, and to be better able to understand their care plans. Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 8 The home needs to show residents what they have found from surveys they have carried out and have a system for checking that the home is providing a good service and that it is planning for making things 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. Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 9 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 Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 10 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 and 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. All of the information is available to help residents make a choice about whether to live at the home. Care and support needs are assessed and the residents have written contracts explaining their rights and the cost of the service provided. EVIDENCE: The home has produced a Statement of Purpose and a Service Users Guide, (called a Tenants Guide), which provide all the necessary information to help people decide whether they want to live there. These documents set out the aims, objectives and philosophy of the home. They are clearly written, and were reviewed in December 2007. The information includes the purpose of the home, the fees charged, the facilities, description of the accommodation, number of rooms, manager and staff qualifications, and the summary of the complaints procedure. The home facilitates introductory visits by prospective residents, and organises overnight visits to help residents decide whether they like the accommodation. These documents are clearly written and the section about how to make complaints is written using pictures so that it can be more easily understood. The Statement of Purpose states that the home provides support and accommodation for adults with learning disabilities and complex support needs, Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 11 who must be residents of the borough of Greenwich. It is managed by Greenwich local authority and Hyde Housing Association provides the housing. Only three of the current six residents have a full assessment of their needs provided to the home by social services. There is evidence to show that the home itself has put together good information about the residents needs, and has used this to develop well structured care plans. Care needs of residents include learning disability support needs, personal care support needs, communications support needs, dementia support needs, mobility support needs, some support with eating and a range of health care support needs. Reviews are carried out six monthly with the full care of you taking place for each resident annually. There is good written information to show that this is happening consistently for all residents. However the manager clarify that social services have not been involved in reviews on an annual basis. One resident’s support needs have increased substantially since they moved into the home, and now includes support with the management of dementia. A number of other residents have significant physical support needs, requiring the use of specialised equipment for mobility. The home must request in writing to social services care management to provide up-to-date care assessments for the residents who didn’t have them, and also request their involvement in annual care of reviews for all residents. (Refer to Requirement YA2) The home now provides written contracts for each resident, which outlined the service they are to be provided with, the room they will occupy, the fees to be paid, and a range of information relevant to the home. The individual costs for support for each resident quoted in the homes Tenants Guide are £1,434.60 per week. Each individual resident pays a fee of £6.23 per week towards the cost of support, and an additional £36.76 per week for food costs. Residents have to pay for other personal expenses such as hairdressing, transport and personal shopping. At that inspection these contracts were being updated and were to be given to residents for their agreement. Copies of these were forwarded to CSCI to show that this had been done. Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 12 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. This judgement has been made using available evidence including a visit to this service. The residents assessed needs are adequately reflected in individual care plans, and the residents are fully supported to make important decisions about their lives. Risk assessments do adequately protect residents and staff. EVIDENCE: The home has a good system for care planning which is linked to individual residents needs assessments. Care plans are being initially set up with each resident quickly after moving into the home, identifying objectives and review dates. I examined three residents’ care planning files and each was seen to have been very well written, typed and up to date. Care plans clearly described the support specifically needed by each resident, and show how best to support the resident with the use of risk assessments and written guidance for staff. They also show where residents are independent and should be allowed to do things for themselves. This enables the staff to provide support only where it is necessary and to help residents to Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 13 be more independent. Some residents care plans include a skills teaching plan which direct staff clearly in how to engage the resident and focus their attention in house activities. All of the residents have learning disability support needs, some of which are very complex and require a very good understanding of how the person communicates through non-verbal means. Comments received suggest that the home has planned well, and that this has enabled the residents to settle in well take part in a range of activities in and outside of the home, and to minimise risk from potentially difficult situations. Care plans include a personal profile which describes residents likes and dislikes, activities, personal care needs, behavioural issues, and the way in which they like to communicate. The home does not yet have a person centred planning approach or system for enabling planning to be more controlled by the residents, but the personal profile which is currently being used would form a good basis for person centred planning if some minor adjustments were made. It is recommended that the home include Person Centred Planning for staff in its training profile, and implement a system that enables residents to express specific issues that are important to them, and that these are written or recorded in a way that the resident can best understand. People other than staff, such as family or friends, should support this planning system if possible. It is understood that introducing such a system effectively will be done over time. (See Recommendation Standard YA35 of this report) One residents care plan provided information about how to support him in communications as verbal communication is limited. This persons care plan clearly identifies how he communicates, specifically what words or facial expressions are used, and whether the use of pictures objects are symbols will be beneficial. There is involvement from a speech and language therapist in developing communication approaches with this resident. Care plans are recorded in writing only and resident’s ability to read is limited. It is recommended that the home explore alternative means of recording key elements of care plans for residents who cannot read appropriate to their level of understanding such as use of picture book plans or cassette/video tapes. (Refer to Recommendation YA6) Each residents care plan include a weekly plan specifying activities such as cooking, doing puzzles, playing games, gardening, and social activities such as parties. The care plans were seen to be good, clearly recorded and plans in place for regular review. One resident is more independent and has an assessment, which is provided by social services. He is good verbal communications and attends a gardening project four days a week and is voluntary work on a farm one day a week. He Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 14 told me that he really enjoys this and that is staff are very supportive and provide all the help that he needs. A number of the other residents have higher support needs with mobility, personal care, communications and in participating in activities. One resident who has been resident in the home for three years, has high mobility support needs and has developed some support needs in the area of dementia while living at home. They are good care plans in place and good risk assessments, and appropriate equipment such as bedroom and bathroom hoists, and a wheelchair are provided. This resident requires to staff to provide personal care support. However a number of staff said that they had sometimes provided to support by themselves, and they felt that it was necessary to do so, due to the lack of availability of extra staff. This was pointed out to the homes management, and the manager said that it has since been discussed with staff, and agreed that additional staff are available during the busy personal care period in the mornings. This resident did not have a social services and assessment available at the home, and social services have not been involved in annual care reviews. Given the significant increase in the care provided it is important that the home formally requests involvement from social services in providing and up-to-date assessment of care needs, and in participating in annual care reviews. (Refer to Requirement YA2) Two of the care plans examined showed that two residents have bedside rails used to minimised the risk of them falling out of bed. These residents have high physical support needs and there are risk assessments in place identifying a risk of falling if these aren’t used. However given their bedside rails may be perceived as a restraint, it is important that the home has on file formal agreement with social services and relevant others for their use. The home should raise this issue for agreement as part of the care review process for each of these residents. (Refer to Recommendation YA6) Staff communicate well with residents and include them in day-to-day decision-making. They were seen to be very respectful of residents in the way they spoke and in how they acted such as letting residents go first when going through doorways, and not entering residents bedrooms when they weren’t present. Advocacy services are now used by the home to help residents to make decisions. It is envisaged that advocacy will be maintained in future for important decision making when needed. The home provides new residents with information about how to get advocacy support. All six residents have learning disabilities and three residents have the finances looked after by the local council, who use this to pay for the cost of the care and provide money to the home for personal spending. One resident’s relatives are involved in managing their finances. Personal spending money is kept at the home and uses support residents to buy the day-to-day items that they Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 15 need. All expenditure is recorded and receipts are kept by the home. Three residents have their own building society accounts, and the home has provided two organizational appointees to act as signatories for these accounts. The home provides transport, which residents contribute to the cost of. There have been discussions and verbal agreements about how these charges are made, but there are no formal written agreements in place as yet. The home needs to ensure that written agreements are in place that have been agreed by residents or their representatives. (Refer to Requirement YA7) A number of residents need support in understanding in signing their contracts with the home and in participating in the home surveys. It is recommended that the home request advocacy support in providing this service. (Refer to Recommendation YA7) Examination at three residents files showed a range of good standard risk assessments being done on admission to the home, and plans are in place for these to be reviewed at least every six months, but more often in some cases. Risk assessments seen included: challenging behaviour, risk while going out in the community, mobility, self-neglect or harm, exploitation, and safety in and out of the home. Staff interviewed were able to show that they understood these assessments and written guidance for staff is also provided in how to deal with specific situations. Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents have opportunities for personal development, and are able to take part in age/peer and culturally appropriate activities. They are part of their local community, and are supported to have relationships. Resident’s rights are respected, and good meals are provided. EVIDENCE: Evidence was available from the care files of residents that opportunities are being made available for the personal development of residents. One of the residents has been able to participate in employment and further education. He attends a gardening project four days a week and has a job on a farm one day a week. He told me that he really enjoys this work and that he has learned a lot and that the staff have been very supportive and helpful in making sure he gets there each week. Four residents currently attend day centre places varying from two times to four times per week. At the last inspection the attendance of a new resident Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 17 had been reduced from five days to four to facilitate quality time spending a day with his key worker. The manager and staff said that this has been successful and has helped the resident to develop better activities more in tune with her personal choice, and has also helped the resident to develop a better relationship with staff. The manager said they hope to further reduce the use of day centres to help other residents to benefit in the same way. The home does work hard to enable all residents to go out regularly in the local community, and to go on holiday each year. A range of outings take place each week including visits to pubs, cinemas, shops, parks, games, sightseeing and the resident interviewed spoke of how the home supports him in participating in shopping for the home and in keeping in contact with friends. He spoke about the holiday last year and said there are already talks happening with residents about planning a holiday for this year. Staff members actively support and encourage family contact for three of the residents who have family. One resident has an advocate from “Mencap” and the home has now agreed advocacy support for the other residents. As at the last inspection the residents meet other people by going out to the day centre and to other activities. However staff report that there are no relationships of significance for any of the residents. The home has decided with the residents to reduce the number of days at the day centre for residents and to avail of Direct Payments to fund other more meaningful activities for residents which may provide better opportunities to make friends and develop other relationships. This seems a good approach and fits nicely into the philosophy of person centred planning, and may provide residents with better opportunities for doing activities they prefer. Residents are supported to choose their clothes and to go on personal shopping trips accompanied by staff. Residents are also supported to choose colours for their bedrooms and for the home. The home provides residents with the opportunity to decide what food is bought and cooked and to participate in these activities. Weekly menus are drawn up and residents are able to choose different meals when they wish on a daily basis. Residents particular likes and dislikes are catered for, including special diets or allergies and alternative dishes are offered to suit their needs and taste. Cultural tastes and requirements are included and meal times are relaxed, unrushed and flexible to suit residents schedules. I examined the menus which showed a variety of meals being provided including salads for fruit and and meat dishes. Clear instructions are readily available on an individual basis for any special diets for residents. One resident sometimes refuses food and a risk assessment was in place advising staff members of alternatives such as ensure. Weight is regularly monitored at the day centre and communication is maintained with the day centre regarding monitoring of intake whilst he is Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 18 there over the lunch time period. Communications has improved between the home and the day centre since the last inspection and day centre representatives are now invited to care review meetings to discuss relevant health and support issues. Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 19 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 This judgement has been made using available evidence including a visit to this service. Personal care support for residents is provided in the way that they prefer and is in accordance with assessed needs. Respectful and sensitive support is provided for residents regarding health care and emotional needs, and they are supported to retain administration of their medication when appropriate. EVIDENCE: All residents have a comprehensive personal care plan, which has been completed following a personal care assessment when they first moved in to the home. Personal care needs are included as part of the homes assessment and review process, and is used to make a judgment as to whether the home can provide the personal care support needed. Three residents files showed that these plans include information for staff about how to maintain independence for residents, while allowing them to do things for themselves when possible. The residents need personal care support of varying levels; some need full support while one resident just needs some prompting. Personal care plans are very detailed and are supported by risk assessments and guidance for staff in how to provide personal care while maintaining residents independence. And number of residents have very high moving in Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 20 handling support needs and all staff are trained and experience in doing this. Providing the support includes using the specialised equipments such as hoists and tracking devices in bedrooms and bathrooms. All of the staff spoken to were clearly able to describe the guidance in how to provide support for two of these residents. A number of staff mentioned some difficulties from time to time in having enough staff to provide the two to one support required by one resident, when doing personal care in the morning. This was discussed with the homes management, who confirmed immediately following the inspection that they had spoken that staff, and put in place additional staff support for busy earlymorning personal care. Staff are also reminded that there is also support available from a nearby home and from on call management should the need arise. There was a know that the last inspection for the home to improve communications with the day centre especially regarding the dietary needs of residents. This has now been done and there is improved written communications between a day centre and the home, and day centre staff are invited to participate in the planning and review process in relevant areas. There are significant health care support needs for some residents, which include mobility support, dementia, epilepsy, eating support, and support with medication. There is for the involvement from a range of health care professionals, and an occupational therapist, physiotherapist, speech and language therapist, and district nurse, are involved in providing regular support within the home. All of the residents are registered with the local GP, and all are provided with dental care, and chiropody support. One of the residents has developed increasing support needs regarding care of dementia, and the home has shown a commitment to helping this resident to remain at the home, while providing the necessary support needed. While the home has already provided some training for staff in how to provide the support, it is recommended that the home provide more training regarding the care of dementia for staff, to enable enhanced expertise among staff in this area. (Refer to Recommendation YA35) There was a requirement made at the last inspection for the home to implement a local medicines policy and procedure, and to clarify the description and quantities of tablets supplied for residents, and to ensure medicinal creams be dated when opened. This is now been done and there is a new medicines procedure for the home, which is clear and well written and includes all of these areas. There is a new medication sheet (MAR sheet) for recording medication and dosset boxes are used for storing and administering medication. The pharmacist who supplies the homes medication also inspects the storage and recording of medication every three months. The last inspection showed that no shortcomings were identified. Since the last CSCI inspection the re-ordering of medication has changed from weekly to monthly, which to staff and the manager say is easier to manage. There are no Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 21 controlled drugs being used in the home. Assessments are carried out regarding residents ability to self-administer medication, and none of the current residence self-administer medication. Staff are trained in special techniques for administering medication and ensuring residents who are immobile have exercise routines, and work closely with the district nurse and physiotherapist to help residents to stay healthy. Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 22 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 This judgement has been made using available evidence including a visit to this service. Residents feel their views are listened to and acted on appropriately, and that they are protected from abuse, neglect and self-harm. EVIDENCE: The home has a complaints policy in place, which was last reviewed in December 2007. This policy is clearly written, and shows responsibilities of the provider and the home staff in relation to dealing with complaints. This complaints policy is available in the home on the notice board, and is also clearly summarised in the homes Statement of Purpose. A section of this policy is provided in a user-friendly format, using pictures and symbols in order to residents might better understand what it says. There have been no complaints received since last inspection. There is the local authority adult protection policy available at the home, which was last reviewed in 2006. All of these staff interviewed were able to clearly say how they would deal with complaints and how they would report of the protection allegations should the need arise. There has been one referral to the adult protection team since last inspection, and this concerned inappropriate touching between two residents. This was responsibly reported and investigated and were sensitively handled by the home. There has been one staff referral to the POVA register as a result of an internal disciplinary concerning aggressive behaviour at work. This did not involve residents and they were not at risk or at all affected by this incident. Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 23 Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 24 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): 24,29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Residents live in a comfortable And safe home, with bedrooms, which suit their needs. Appropriate bathing facilities and specialist equipment are provided and the home is a safe clean and hygienic place to live. EVIDENCE: There were two requirements made very the last inspection asking that the home ensure that the pavement around the home its level to make it safe and usable for residents, and to ensure that the trees are cut back to enable better natural light for the residents bedrooms in the home. Both of these requirements were met. 169 Lodge Hill is a modern chalet style building situated in the grounds of the former Goldie Leigh hospital close to the facilities of Welling and Bexleyheath. There are six single bedrooms providing accommodation for residents with moderate to severe learning difficulties and physical disability. There are currently no vacancies. Four rooms are located on the ground floor two of Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 25 which are suited for two residents who use wheelchairs and have access to the downstairs bathroom and separate walk in shower. The lounge and kitchen diner area are also located on the ground floor. There is level access to the small garden and patio area from the kitchen diner. While the home is situated away from easy access to shops and high Street facilities, the staff and management are effective in ensuring that residents get out to use these facilities very regularly. And new bedroom was built onto the home in October 2006 with an ensuite adapted bathroom. This bathroom is fitted with hoist and seen tracking device which will initially required for this resident. However through good management staff are now able to support this resident with minimal use of this equipment. The home is a housing association owned home and they are responsible for the majority of the maintenance. Management of smells and odours within the home is very good. Carpets have been replaced throughout the ground floor to facilitate better mobility for some residents. One resident needs furniture to be replaced in his bedroom and this has already been agreed to be done in the new financial year. For residents rooms have been repainted and redecorated. The water, gas electrical and fire alarm systems in the home are well maintained and fully functional. The laundry room, which is adjacent to the kitchen, is in need of refurbishment, and the door to odours room is often left open, leaving it visible to residents when using the kitchen. It is recommended that the laundry room be updated and the door be kept closed as much as is possible especially when residents are using the kitchen. (Refer to Recommendation YA24) A number of residents have significant mobility support needs and the home has fully involved relevant health care professionals such as an occupational therapist and physiotherapist in putting in place the required hoists and wheelchairs, to help residents to be as mobile as possible supported safely by staff. There are weekly health and safety checks carried out by the management in the home, and there is very good management of continence, so that there are no unwanted odours. A sluice washing machine is used for washing soiled materials, and staff have a daily checklist for ensuring that cleaning has been done. The home is maintained to a good level of hygiene and cleanliness. Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 26 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): 32,33,34,35 and 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are supported by competent and qualified staff, but further training is needed for staff to meet the specific support needs of residents. Residents are protected by the homes recruitment policy and practices and staff are well supervised and supported by the homes management. EVIDENCE: The staff team consists of a manager, a deputy manager and eight others support workers who are very experienced and well trained in working with people with people with learning disabilities. All of the care staff are qualified to NVQ level 2/3, and the deputy manager has an NVQ4 qualification in care and management. There are at least two staff on each shift during the daytime with one night waking staff and a sleep staff providing support at night. There are normally three staff available in the afternoon and evening. As a result of concerns raised by a number of staff that they needed more help during the busy personal care time in the mornings the manager discussed this with staff and agreed to an increase in the support provided during this busy time. The manager confirmed this in writing following the inspection. Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 27 There is also a separate management on call support system to provide backup support if needed, and emergency support is also available from a nearby home also managed by the registered manager. At the time of the inspection there was one staff vacancy, which was being kept open to provide flexible support for annual leave and staff training. The staff and the manager were very knowledgeable about the individual needs of residents, and work sensitively in communicating with residents some of whom have limited verbal communications skills. One resident said that the staff and a manager are very approachable, and very flexible when asked to provide help. The resident said that the staff do listen, and that he has settled in well with their help. The home’s induction and training programme is comprehensive and meets the requirements of Skills for Care and the learning disabilities quality framework. All of the staff I spoke to said they had been fully inducted and that they receive very good opportunities for training. The information in staff files supported this. It was my observation from the care plans, and from how staff relate to residents, that they are able to work well to meet their care needs. Examination of three staff files showed that excellent recruitment processes are in place and are being consistently applied. Very good records are being kept about staff recruitment including health and police checks, references, and checks on gaps in employment history. These are well organised, enabling the management of the home to make sure that everything is in place properly before staff begin employment. All staff undergo comprehensive induction and there are excellent records maintained of this induction, which are signed by the supervisees. Three staff files examined and discussion with three staff showed that all of these staff had undergone a detailed induction provided by the organisation and the homes manager, and other experienced staff. Care staff said that they found the induction to be very good, and they also felt they had been fairly interviewed. There is a good standard of training offered to staff, and the registered provider coordinates training. More specialised training such as medication, health and safety, fire safety, first aid, and moving in handling are contracted in from trained professionals. Training needs of staff are identified at annual appraisal and through supervision. Staff induction training includes: learning disability support, medication, moving and handling, fire prevention, protection of vulnerable adults, first aid, food hygiene, health and safety, death dying and bereavement, and the organisations policies and procedures. It is recommended that the home include Person Centred Planning and more in-depth vascular dementia training in the home’s team-training plan. (See Standard 6 and Standard 19 of this report for further information) Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 28 (Refer to Recommendation YA35) The homes manager provides formal supervision for staff, and examination of three care staff files showed that staff are receiving consistent formal supervision regarding their work, residents care and support needs, training and development, and employment issues. The staff interviewed commented that they find supervision to be very consistent and very beneficial to their work. The manager is present in the home approximately five days a week and provides immediate support and advice for staff when they need it. Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 29 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 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well managed by a qualified manager who receives good support from the registered provider. Resident’s views are included in the homes system for quality assurance and planning. The home and registered provider promotes the health and safety of residents and staff. EVIDENCE: The manager has been in post at the home since 2006. She has previous experience in working for the same registered provider. The manager is now registered with CSCI, meeting a requirement from the last inspection to do so, and is qualified to NVQ level 4 in care and management. She has also acquired an RMA and CMS qualification. She is very experienced in the field of learning disability support and management, having worked in this area of management for more than 18 years. Discussion with the manager and staff, and examination all of the homes many systems for a support for staff and Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 30 residents, showed that the manager has good management and organisational skills, and communicates well with staff and residents to give good direction and support. Staff members interviewed stated that she is approachable and supportive and would not hesitate to discuss any concerns about the home or the welfare of service users with her. Communication within the home is good with team meetings held regularly. There was a requirement made at the last inspection for the home to ensure that residents meetings are reinstated. This has now been done, and these meetings started again in March 2007. There was a period since then where these meetings lapsed again. The manager explained that this was due to some difficulty in engaging residents in the meetings appropriately. Some work has been done with residents and communications, and these meetings have started again in January 2008. One resident said that he enjoys attending these meetings, and feels he is able to say things that he would like to be improved in the home. The home now carries out annual surveys of residents, staff, and professionals views on how the home is managed. The last of these was done in August 2007, but the results of these surveys are not being published for residents and their families. So it is difficult for them to fully understand the meaning of the surveys or to know what the outcome and action will be. The home must published the results of the residents surveys results in a format that is understandable to residents, and ensure that they are given feedback in a way that they best understand. (Refer to Requirement YA39) The home does not currently have an annual audit system or a formal development plan as is required by the standard. The home must develop and implement an annual audit system and development plan. (Refer to Requirement YA 39) The home takes the management of health and safety very seriously and is able to show that there is a high standard of checks and balances in place for making the home safe. There is a health and safety policy in place including a fire safety risk assessment, which was reviewed in May 2007. The fire alarm is tested weekly and records are consistently kept. Fire evacuation drills are done quarterly on there is a clear understanding of how to support residents including where to take them to within the building during the course of a fire drill. Three staff interviewed were able to clearly describe the arrangements for supporting people during a fire evacuation drill. The home’s gas, and electrical, and hoist maintenance certificates are up-to-date. The kitchen is well maintained and kept very clean. Manual Handling, fire, infection control and food hygiene training is provided for all staff. Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 31 Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 32 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 2 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 33 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 &2 Requirement The registered provider and manager must request in writing for social services care management to provide up-todate care assessments for the residents who didn’t have them, and also request their involvement in annual care of reviews for all residents. The registered provider and manager must ensure that written agreements are in place regarding resident’s contributions to the cost of the homes transport, and that these have been agreed by residents or their representatives. The registered provider and manager must publish the results of the residents surveys, in a format that is understandable to residents, and ensure that they are given feedback in a way that they best understand. The registered provider and manager must develop and implement an annual quality audit system and development plan for the home. DS0000036906.V350929.R01.S.doc Timescale for action 31/07/08 2 YA7 12.1a & 12.2 30/10/08 3 YA39 24.2 30/10/08 4 YA39 24.1 & 24.3 30/10/08 Lodge Hill (169) Version 5.2 Page 34 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 It is recommended that the home explore alternative means of recording key elements of care plans for residents who cannot read, appropriate to their level of understanding, such as use of picture book plans or cassette/video tapes. The home should raise the issue of the use of bedside rails for agreement as part of the care review process for each of the residents who use them. It is recommended that the home request advocacy support in providing residents with support to understand and agree their support contracts with the home. It is recommended that the laundry room be updated and the door be kept closed as much as is possible especially when residents are using the kitchen. It is recommended that the home include Person Centred Planning and more in-depth vascular dementia training in the home’s team-training plan. 2 3 4 5 YA6 YA7 YA24 YA35 Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Lodge Hill (169) DS0000036906.V350929.R01.S.doc Version 5.2 Page 36 - 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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