Care Home: Narborough Lodge

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What the care home does well Service users are fully involved in life at the home. Any issues that arise are discussed and dealt with on a daily basis and service user meetings are held once a month. These meetings also provide the opportunity to remind all the service users of how to share a concern should they have one and what to do in the event of a fire.There is a relaxed and friendly atmosphere throughout the home and the support workers go about their daily work in a positive and lively manner. The registered manager and the support workers have a very good understanding of the service users current support needs and they provide this support in a respectful and sensitive way. Service users are able to choose what meals they would like. Each service user decides on and prepares there own breakfast and lunch, then picks one evening meal for all the service users to enjoy each week. Once the weekly menu is decided the service users are then supported to shop for the required groceries. Service users feel safe and are aware of whom to speak to if they have a concern of any kind. What has improved since the last inspection? Both the care plan documentation and risk assessment documentation is in the process of being updated and improved to enable the reader to get a clearer picture of the care and support needs of the service users. Service users and staff now have monthly meetings rather than two monthly meetings in order to discuss any issues and/or ideas. Management carries out regulation 26 visits in order to provide support and guidance to the registered manager. Staffing levels have increased to provide more one to one support for the service users. Policies and procedures have been reviewed since the last inspection. CARE HOME ADULTS 18-65 Narborough Lodge 504 Narborough Road Leicester LE3 2FU Lead Inspector Diane Butler Unannounced Inspection 4th September 2008 08:00 Narborough Lodge DS0000057109.V371726.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 Narborough Lodge DS0000057109.V371726.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. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Narborough Lodge Address 504 Narborough Road Leicester LE3 2FU 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) 0116 282 7337 Narborough Lodge Limited Alison Richardson Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (6) of places Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration condition Narborough Lodge Ltd is registered to only provide the service as outlined in their statement of Purpose/Service User Guide as agreed with the Commission for Social Care Inspection at the date of registration. 5th September 2006 Date of last inspection Brief Description of the Service: Narborough Lodge is a small care home for up to 6 adults who have learning disabilities and mental ill health. Everyone who lives in the home has his or her own bedroom. Bedrooms are on the first floor and ground floor of the house. All bedrooms are near bathrooms. The home is on Narborough Road, near to Fosse Park Shopping Centre. It takes about 30 minutes to go by bus to the city centre. There are some parking spaces in front of the home. The house has a big back garden. Basic fees for living in the home are from £350.00 to £455.00 Extra charges are made for hairdressing, chiropody, toiletries, and magazines and newspapers. A copy of the latest Inspection report is available at the home, or it can be accessed via the CSCI website: www.csci.org.uk. Further information about the home is available from the registered manager. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good outcomes. This was an unannounced visit, which took place over a 4.5 hour period in September 2008. When undertaking key inspections the Commission for Social Care Inspection (CSCI) focuses upon outcomes for service users and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting three service users and tracking the care they received through looking at their records, speaking with them and discussion with staff on duty at the time of the visit. A further three service users were also spoken with to gain their views of the home and the support they receive. Further planning for this visit included checking the service history of the home and the last Inspection report. Surveys were also sent to the service users currently living at the home and a selection of support workers to gain their views of Narborough Lodge. One support worker survey had been returned at the time of this visit-taking place. The AQAA document (Annual Quality Assurance Assessment) was also checked during the visit. The AQAA document is the main way that providers inform us of how well their service is delivering good outcomes for the people using it. Comments received during the visit include: “I think it’s a good place”. “The carers are very nice”. “Its really nice working here”. What the service does well: Service users are fully involved in life at the home. Any issues that arise are discussed and dealt with on a daily basis and service user meetings are held once a month. These meetings also provide the opportunity to remind all the service users of how to share a concern should they have one and what to do in the event of a fire. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 6 There is a relaxed and friendly atmosphere throughout the home and the support workers go about their daily work in a positive and lively manner. The registered manager and the support workers have a very good understanding of the service users current support needs and they provide this support in a respectful and sensitive way. Service users are able to choose what meals they would like. Each service user decides on and prepares there own breakfast and lunch, then picks one evening meal for all the service users to enjoy each week. Once the weekly menu is decided the service users are then supported to shop for the required groceries. Service users feel safe and are aware of whom to speak to if they have a concern of any kind. What has improved since the last inspection? What they could do better: Ensure that when assisting service users with their finances the required records including two signatures are obtained and the records are completed as soon as possible after the transaction is carried out. This will reduce the likelihood of mistakes being made. You should also ensure that the money held on behalf of the service user is the same as recorded on the record sheet; this will again reduce the likelihood of mistakes occurring. Ensure that the home is well maintained and appropriately decorated. Service users need to be provided with a homely, comfortable and safe environment. Ensure that once care plans have been reviewed that old paperwork is taken out of the working file to ensure no confusion arises around the delivery of care and support. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 7 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. Narborough Lodge DS0000057109.V371726.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 Narborough Lodge DS0000057109.V371726.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): 1,2,4,5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective service users are able to visit the home to see if it is the right place for them. EVIDENCE: A Statement of Purpose is in place. This document, which was reviewed in January of this year and is available in pictorial form, includes details of the services that can be provided and what is available in the home. A service user guide is also in place and a copy of this document is given to all service users when they arrive at the home. This document is also available in pictorial form and includes information on local amenities and the daily arrangements of the home. The registered manager explained that an assessment of need is obtained for all prospective service users, this is looked at carefully to ensure that the staff working at the home can meet the service users identified needs. On checking the paperwork belonging to three service users it was noted that the appropriate assessment paperwork was in place. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 10 All prospective service users are invited to visit the home to decide whether it is the right place for them. One service user explained “I came three days a week, just for the day, to see if I liked it”. All service users have a statement of terms and conditions of residency. This document includes details of what services will be provided and is signed by both the service user and a representative of the home. Narborough Lodge DS0000057109.V371726.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): 6,7,8,9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are supported to make decisions and take risks as part of an independent lifestyle. EVIDENCE: Care plans are in place. These are developed from the initial assessment information collected prior to the service user moving into Narborough Lodge and tell support workers how to meet the needs of the service users in their care. The registered manager explained that she was in the process of renewing all the care plans. Two of the three plans seen during this visit had been reviewed with new paperwork being used. It was noted that one had both the old style paperwork and the new style paperwork included which could be a little confusing for the reader. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 12 On checking another care plan it was noted that information including daily records prior to July this year had been archived and were inaccessible. Whilst the files were tidy because of the archiving not all relevant information was readily available, including support provided to the service user prior to July 2008. Care plans are reviewed once a month and service users spoken with confirmed that they were involved in this process. One service user explained, “We sit down and talk about the plan”. Support workers enable the service users to take responsible risks on a daily basis both in the home and in the local community. Risk assessments are carried out for activities undertaken and where a risk is identified measures are put into place to try to reduce the risk for the service user. Service users are fully involved in life at the home. Issues that arise are discussed on a daily basis and service user meetings are held every month. Minutes of the last meeting held on 31st August were seen. Service users are enabled to live an independent life style within the home and support workers support the service users to meet their individual goals. During the visit one service user paid a visit to the local cycle shop, whilst another was supported to visit the bank and shops. Narborough Lodge DS0000057109.V371726.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): 12,13,14,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Daily routines within the home promote service users independence and individual choices. EVIDENCE: Service users are supported to access local colleges, day services and appropriate community and leisure activities. These include shopping trips, attending the local swimming baths and visiting the pub for a drink. Daily routines within the home promote privacy, independence and choice. Service users can choose whether to be alone or join the other service users. All service users have keys to their bedroom doors and support workers ensure privacy by knocking and waiting to be invited in. Service users are encouraged and supported to clean and tidy their own rooms and do their own laundry and are assisted if needed to prepare their own meals. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 14 A healthy balanced diet is offered, choices are provided at every mealtime and the service users are supported to plan their own meals on a weekly basis. Mealtimes are relaxed, flexible and unrushed. Comments received included: “ Only on Sundays do the staff do the tea” “We make cakes” “We pick our meals on a Friday before we go shopping”. “I cook spaghetti Bolognese and Lasagne” “I can make my own breakfast”. Throughout the visit service users were seen preparing themselves drinks and choosing and preparing their own meals. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care and support is provided in a way that service users prefer. EVIDENCE: Service users are encouraged to be as independent as possible, for those less able to care for themselves, support and guidance is offered in a sensitive manner. Preferences regarding the care and support given are included in the care plan documentation and all service users spoken with confirmed that they were treated with respect and care and support was provided in a dignified manner. One service user explained, “The carers are very nice”. Service users are supported to access healthcare services when needed. These include GP’s, dentists and opticians. One service user explained, “I’m at Asda for my optician and I’m moving my dentist because its too far to go”. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 16 Medication records were checked. Medication had been appropriately signed into the home and medication had been signed for when given to the service users. All support workers have received training in administration of medication and medication was being appropriately stored. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are protected from harm. EVIDENCE: A complaints procedure is in place. This is available in pictorial form and is displayed on the notice board in the entrance hall. Details of how to make a complaint are also included in the statement of purpose, which is given to each service user and/or their relative on moving into the home to ensure that everyone is aware of how to raise a concern. How to make a complaint is also raised at every service user meeting to remind everyone living in Narborough Lodge of how to make a complaint and who to talk to if they are concerned about anything. All service users spoken with were aware of whom to talk to should they have any worries. One service user stated, “I would tell the staff, a second explained, “Id talk to Alison” [the registered manager]. The registered manager explained that no complaints had been received in the last twelve months. This was confirmed on checking the complaints book. Support workers attend training in the protection of vulnerable adults on an annual basis and the registered manager is aware of the procedures to follow to ensure that the service users in her care are protected. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 18 The support worker spoken with during the visit was also aware of the actions to take, should they suspect any form of abuse. Service users spoken with during the visit stated that they felt safe living in the home. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,28,30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The accommodation provided would benefit greatly from redecoration and refurbishment. EVIDENCE: Narborough Lodge has six single bedrooms each of which has its own sink. Communal facilities include a large lounge, dining room area and kitchen, and communal bathroom and toilet facilities are also available. On the day of the visit it was evident that some work was needed to improve the environment provided, both in the communal areas and in the service users own rooms. The carpet in the dining area was in need of cleaning/replacing and it was noted that many areas of the home would benefit from being redecorated. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 20 On checking one of the service users rooms it was noted that paint was peeling from the radiator and parts of the walls were without plaster where furniture had been knocked against them. In another room it was noted that the service users carpet was threadbare, the registered manager acknowledged this and explained that this was due to be replaced. The chairs in the dining area were somewhat worn and in one of the rooms shown it was noted that the chest of drawers were broken. The registered manager acknowledged the shortfalls and explained that steps were being taken to address the issues identified. There is a large garden and patio area at the rear of the home for the service users and their visitors to enjoy, it was noted that this area would benefit from tidying and further planting. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users living at Narborough Lodge are supported by competent and qualified staff. EVIDENCE: There are currently two support workers on anyone shift to provide care and support to the six service users currently living at the home and additional one to one support is also provided. An appropriate recruitment procedure is in place, application forms are completed, references are collected and a CRB (Criminal Records Bureau) and POVA 1st (Protection of Vulnerable Adults) check are obtained. On checking the files belonging to two support workers all the necessary checks were found to be in place. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 22 Induction training is provided for all new staff and a training register is in place to evidence what training has been provided in the last twelve months. This includes: Health and Safety Infection Control Food Hygiene First Aid Moving and Handling Safe handling of medicines Protection of Vulnerable Adults. All support workers have completed NVQ (National Vocational Qualification) level 2 and all bar two support workers are in the process of completing or have completed NVQ level 3. Staff meetings and supervision sessions are provided on a regular basis and the support worker spoken with during the visit stated that she felt well supported by the registered manager. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41,42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from the open and positive atmosphere, which is evident throughout the home. EVIDENCE: The registered manager has fifteen years experience in the care sector and has completed her NVQ level 4 and registered managers award. Policies and procedures for the health, safety and welfare of the service users are in place and all support workers are made aware of these during the induction process. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 24 Service user meetings are held on a monthly basis, this enables the service users to share their views on the service provided. Staff meetings are also held to enable the registered manager to gain the staffs view of the service they currently provide. Risk assessments were in place for safe working practices. Service users have full access to their records and are involved in reviewing care plans and risk assessments on a monthly basis. On checking the money held on behalf of two service users it was noted that one was not up to date, with a shopping trip which was carried out the day before the visit not being entered into the records. It was also noted that one had more money in it than it should have. The registered manager explained that this was possibly due to not having any change available when the transaction was carried out. It was also noted that although the registered manager stated that policy was to obtain two signatures for each transaction not all entries made included two signatures. It was evident during the visit that the service users benefit from the ethos and management that is provided by the registered manager and her team. There was a friendly atmosphere throughout the visit and the interactions between support workers and service users were relaxed and informal. Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 3 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 3 26 2 27 X 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 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 3 3 X Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations The registered person should ensure that once care plans have been reviewed that old paperwork is taken out of the working file to ensure no confusion arises around the delivery of care and support. The registered person should ensure that when assisting service users to access their finances records kept are up to date and accurate and relevant signatures are in place. The registered person should ensure that the areas of the home identified as in need of redecoration and cleaning and furnishings identified as needing replacing and cleaning are done so in a timely manner. 2 3 YA23 YA24 Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Narborough Lodge DS0000057109.V371726.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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