Care Home: Northam Lodge

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What the care home does well Feedback from people living at the home, their representatives and outside professionals indicate that Northam Lodge is a friendly and relaxed home. One person told us, "I like my new home", another commented, "I am well looked after & feel this is my home". One relative told us, "This is the best home in North Devon. They deserve a good report". Professionals were also positive about the service, one wrote, "They work well with others. Very practical & honest in their approach", another said, "This is a very impressive place. People here are well cared for". There are good arrangements in place to ensure admissions to the home are successful. People are welcome to visit Northam Lodge to ensure they like the home, and thorough assessments are completed to make sure the home can meet people`s needs. Care planning is generally good, providing detailed information for staff and ensuring people`s needs and preferences can be met. The home has a core of experienced staff who know the people living here extremely well, they understand their individual communication methods, and mostly provide assistance and care in a sensitive and supportive manner (see what they could do better). Staff provide people with the assistance and the communication support they need to make daily choices and risks appear to be well managed. People are supported to participate in a varied programme of community activities. The home has three vehicles which are used daily to get people out and about to their chosen activity. Several people attend local clubs and day centres which provide an opportunity for them to make friends outside of the home. Feedback from the majority of parents and family members was good. The home appears to communicate well with most relatives. The meals at the home take into account people`s likes and dislikes and is varied and on the whole healthy and balanced. People`s health needs are well monitored and they have access to a good variety of health professionals to ensure health needs are met. Health professionals contacted were happy with the care provided. One told us, "They are very quick to respond to clients ill health". Although many people would not be able to raise a complaint, there are systems in place to alert staff should someone be unhappy. Relatives know who to speak with should they have any concerns and the home will help people to access independent advocates if needed. People are protected from abuse by clear procedures and well trained staff who fully understand the procedures they must follow if they have any concerns. Everyone responding to our survey told us that staff treated them well and listened and acted on what they said. The environment is generally bright, homely and clean. It is furnished and decorated to a satisfactory standard in most areas. People`s bedrooms are personalised and reflect the individual`s personality and interests. Their are aids and adaptations to maximise people`s independence and comfort.We found that there are sufficient staff on duty most days to meet people`s needs and preferences. Recruitment checks have been carried out on new staff to ensure they are suitable to work at the home (see what they could do better). People living at the home are involved in the selection of new staff. A good range of induction and ongoing training has been provided to staff to ensure they work effectively and safely with people. Overall the home is well managed and there are systems in place to review the quality of the service (See what they could do better). What has improved since the last inspection? No requirements or recommendations were made at the last key inspection. The home tells us they have made improvements to the variety of activities and holidays as a result of listening to people. People living at the home have also been involved in the recruitment of new staff. Staff training is on-going and most staff have attended training about the Mental Capacity Act to ensure people`s rights are protected. The home reports a lower staff turn over since the last key inspection, which helps to provide consistency for people. What the care home could do better: One requirement has been made as a result of this inspection. While medication practices were generally safe, some aspects could be improved to ensure complete safety at all times. Northam Lodge does not have secure storage facilities for controlled medicines. Recommendations have been made to ensure that good practice is maintained. The home has been asked to ensure that important information such as the Statement of Purpose is available in formats, which suit people`s needs. Some additional information is needed to ensure that they have all of the information they need to make important decisions. The home has been asked to look at the monthly charges levied on people for using the home`s transport. It is recommended that a fair and equitable system of charging be introduced which reflects the extent to which people actually use the transport. In order to continue to promote people`s quality of life, care plans should reflect people`s aspirations and reviews should demonstrate that goals have been achieved. In order to protect people`s rights fully, the home has been asked to ensure that multidisciplinary decision making is in place regarding the use of covert medication or when other decisions are made on behalf of people who cannot consent or give their opinion.Mealtimes would be more relaxed and pleasant if staff sat with people who required assistance to eat. In order to promote people`s dignity staff should consult with them when delivering personal care. The home should provide appropriate screening in shared rooms in order to maintain people`s privacy and dignity. The home has been asked to ensure that people`s weight in monitored regularly so that the appropriate action can be taken to manage any weight loss. The home should monitor staffing levels and ensure that there are sufficient staff on duty at all times, including night time, to meet people`s needs and preferences. The home has been asked to strengthen its recruitment process in relation to obtaining verbal references. The home should try to find a way of including people`s views on how the home is run, they should also include outside stake holders views, such as relatives and professionals, to ensure the home is being run in the best interest of the people living there. The home should complete a risk assessment for the toilet window on the first floor of Northam Lodge to ensure it does not pose a risk to people living at the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Northam Lodge Rose Hill Heywood Road Northam Bideford Devon EX39 3PG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deirdre McEvoy     Date: 1 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Northam Lodge Heywood Road Rose Hill Northam Bideford Devon EX39 3PG 01237477238 01237422850 northamlodge@chessbroadband.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Northam Lodge Charity Name of registered manager (if applicable) Miss Joanne Alison Babb Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is 24. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD - maximum 21 places Learning disability - Code LD - maximum 21 places Physical disability aged 65 years and over on admission - Code PD(E)- maximum number of places 3 Learning disability aged 65 years and over on admission - Code LD(E) maximum number of places 3 Date of last inspection Brief description of the care home Northam Lodge comprises three separate residential units, registered to accommodate twenty four adults with learning disabilities and who may also have physical Care Homes for Adults (18-65 years) Page 4 of 36 care home 24 Over 65 3 3 21 21 Brief description of the care home disabilities. The units are set within their own well maintained garden. Northam Lodge has a separate administrative centre, located a short distance away at Rose hill, where there is also a day centre. Copies of reports of previous inspections are available at the home. Charges levied at Northam Lodge vary from 700 to 1,600 pounds per week depending on individual needs. Additional fees are levied for hairdressing, chiropody, certain toiletries, newspapers, magazines, activities and outings. There is an additional fee which is a contribution to vehicle running and mobility costs. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Several weeks before this inspection took place we sent an annual quality assurance assessment (AQAA) form to the home. The completed document was returned to the Commission and this has provided us with information about the home and the way it is run. We also sent out survey forms to people living at the home, health and social care professionals and staff. We received responses from 6 people living at the home. Surveys had been completed with assistance from parents, family members and key workers. 8 staff sent us responses and two health and social care professionals. The outcome from the surveys have been included in this report and helped us to make judgements about the service provided. This unannounced inspection was completed over a period of 10 hours. During our time Care Homes for Adults (18-65 years) Page 6 of 36 at the home we met with or saw most of the people living there. Some of the people living at the home have limited communication and were therefore unable to fully contribute verbally to the inspection process. Time was spent with people and observations were made throughout the inspection. We also spoke with nine members of staff, including care staff, catering staff, and members of the management team. We spoke at length with one relative and a visiting health professional. Following the inspection another relative contacted us to discuss their views. The views and comments of people have been reflected throughout this report. During this visit we looked at the care files for four people and all of the documents relating to their daily care, including medicine administration and accident reports. This helps us to judge how care is planned and delivered to people. We also looked around the home and inspected other records. These included, staff recruitment and training records, financial records and the complaints log. We completed an Annual Service Review of the home in June 2008, which did not involve a visit to the home but is a summary of information given to us or collected by us. This review indicated that the home was still providing a good service to people. Copies of this report can be obtained from CSCI. What the care home does well: Feedback from people living at the home, their representatives and outside professionals indicate that Northam Lodge is a friendly and relaxed home. One person told us, I like my new home, another commented, I am well looked after & feel this is my home. One relative told us, This is the best home in North Devon. They deserve a good report. Professionals were also positive about the service, one wrote, They work well with others. Very practical & honest in their approach, another said, This is a very impressive place. People here are well cared for. There are good arrangements in place to ensure admissions to the home are successful. People are welcome to visit Northam Lodge to ensure they like the home, and thorough assessments are completed to make sure the home can meet peoples needs. Care planning is generally good, providing detailed information for staff and ensuring peoples needs and preferences can be met. The home has a core of experienced staff who know the people living here extremely well, they understand their individual communication methods, and mostly provide assistance and care in a sensitive and supportive manner (see what they could do better). Staff provide people with the assistance and the communication support they need to make daily choices and risks appear to be well managed. People are supported to participate in a varied programme of community activities. The home has three vehicles which are used daily to get people out and about to their chosen activity. Several people attend local clubs and day centres which provide an opportunity for them to make friends outside of the home. Feedback from the majority of parents and family members was good. The home appears to communicate well with most relatives. The meals at the home take into account peoples likes and dislikes and is varied and on the whole healthy and balanced. Peoples health needs are well monitored and they have access to a good variety of health professionals to ensure health needs are met. Health professionals contacted were happy with the care provided. One told us, They are very quick to respond to clients ill health. Although many people would not be able to raise a complaint, there are systems in place to alert staff should someone be unhappy. Relatives know who to speak with should they have any concerns and the home will help people to access independent advocates if needed. People are protected from abuse by clear procedures and well trained staff who fully understand the procedures they must follow if they have any concerns. Everyone responding to our survey told us that staff treated them well and listened and acted on what they said. The environment is generally bright, homely and clean. It is furnished and decorated to a satisfactory standard in most areas. Peoples bedrooms are personalised and reflect the individuals personality and interests. Their are aids and adaptations to maximise peoples independence and comfort. Care Homes for Adults (18-65 years) Page 8 of 36 We found that there are sufficient staff on duty most days to meet peoples needs and preferences. Recruitment checks have been carried out on new staff to ensure they are suitable to work at the home (see what they could do better). People living at the home are involved in the selection of new staff. A good range of induction and ongoing training has been provided to staff to ensure they work effectively and safely with people. Overall the home is well managed and there are systems in place to review the quality of the service (See what they could do better). What has improved since the last inspection? What they could do better: One requirement has been made as a result of this inspection. While medication practices were generally safe, some aspects could be improved to ensure complete safety at all times. Northam Lodge does not have secure storage facilities for controlled medicines. Recommendations have been made to ensure that good practice is maintained. The home has been asked to ensure that important information such as the Statement of Purpose is available in formats, which suit peoples needs. Some additional information is needed to ensure that they have all of the information they need to make important decisions. The home has been asked to look at the monthly charges levied on people for using the homes transport. It is recommended that a fair and equitable system of charging be introduced which reflects the extent to which people actually use the transport. In order to continue to promote peoples quality of life, care plans should reflect peoples aspirations and reviews should demonstrate that goals have been achieved. In order to protect peoples rights fully, the home has been asked to ensure that multidisciplinary decision making is in place regarding the use of covert medication or when other decisions are made on behalf of people who cannot consent or give their opinion. Care Homes for Adults (18-65 years) Page 9 of 36 Mealtimes would be more relaxed and pleasant if staff sat with people who required assistance to eat. In order to promote peoples dignity staff should consult with them when delivering personal care. The home should provide appropriate screening in shared rooms in order to maintain peoples privacy and dignity. The home has been asked to ensure that peoples weight in monitored regularly so that the appropriate action can be taken to manage any weight loss. The home should monitor staffing levels and ensure that there are sufficient staff on duty at all times, including night time, to meet peoples needs and preferences. The home has been asked to strengthen its recruitment process in relation to obtaining verbal references. The home should try to find a way of including peoples views on how the home is run, they should also include outside stake holders views, such as relatives and professionals, to ensure the home is being run in the best interest of the people living there. The home should complete a risk assessment for the toilet window on the first floor of Northam Lodge to ensure it does not pose a risk to people living at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a good admissions process, which ensures that the home is able to meet individual needs. Information about services the home provides needs to be available in a format that people can understand. Evidence: People responding with surveys (assisted by parents and family members) told us they had been given enough information about the home to help them decide if it would be the right place to live. The home has a statement of purpose, which describes the services provided, however, currently important pieces of information, such as the Statement of Purpose and complaints procedure, are not available in a format to suit the needs of people using the service. We talked to the manager about making the documents more easily understood by the people living in the home. We appreciated that not many people living at the home would be unable to understand an easy read format but we were told that a number of people would benefit from having accessible Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: information. The AQAA tells us the home would like to produce a DVD/video about the service as an accessible format for people. This has been recommended. Information about additional cost, for things like hairdressing, chiropody, holidays, activities and outings, is not mentioned in the Statement of Purpose. One parent was concerned about additional charges not being clearly identified. The service takes care to ensure that admissions to the home are managed well. Information is gathered from referring professionals, from parents, and health care professionals. The manager and other senior staff will visit people (including visits out of the county) to get to know them, tell them about the home and complete their own assessment. People also have opportunities to visit the home, including overnight stays if possible, to get an idea of what it is like before they decide to move in. One person told us, Staff were very welcoming. I went for tea, then for a weekend. Another told us, I came to stay for trail weekends before coming full time. One parent told us, It was the best home we visited, not the poshest but a fun feel. We looked at the assessments for two people recently admitted to the home. Good information was available to help staff understand individual needs and plan the care required. Following admission the placement is reviewed and reassessed to ensure that the home is offering the appropriate support. One social care professional told us that the assessment arrangements at the home always ensure accurate information is gathered about peoples needs and that the right service is planned and given. Everyone living at the home contributes to the cost of transport and this is clearly stated in individual contract/ terms and conditions. However, as noted at the last key inspection, the same monthly charges are levied on everyone living at the home irrespective of how often they use the transport. It is recommended that a fairer and more equitable system of charging be introduced which reflects the extent to which those charged use the facility. Care Homes for Adults (18-65 years) Page 13 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide staff with some good information to help them meet peoples needs. Overall people are supported to make choices about their daily life. Involving representatives and relevant professionals when making decisions on behalf of people will ensure decisions are made in their best interest. Evidence: We looked at four care plans to see how care is planned and delivered. Where possible people living at the home, their family and relevant professionals are involved in the development of care plans and reviews. The care plans set out individual needs, preferences and any associated risks. The care plans have specific headings to address health, personal and social care needs, including individual and diverse needs. Good information is available about peoples abilities, how they communicate, their preferences and emotional and psychological needs. Care plans show the home has Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: sought guidance from relevant health and social care professionals when planning or reviewing peoples care. Although information about peoples needs is detailed in care plans, there is less information about peoples aspirations and how to achieve their goals. This could mean that people are not given an opportunity to develop their potential fully. One parent felt that activities planned were not entirely person centred. They told us, in their opinion their daughter would enjoy more diverse activities. This had been discussed with the home and the relative felt the home were slow to act to enable this person to fulfil this goal. The majority of staff (6 of 8) told us they are always given up to date information about peoples needs, two staff felt this was usually the case. Staff told us, Staff always informed of care plans and asked to sign when read, and We have good care plans, the communication book and daily handover to make sure we are aware of any changing needs. A newly appointed staff member told us, Care plans tell you exactly what you need to know about peoples abilities, communication needs etc. They are very useful. Surveys show that people living here are always or usually able to make decisions about their daily life. However many people living at the home are unable to express their wishes and choices verbally. Care plans contain information to guide staff about how to assist people to make decisions and choices. This includes information about peoples preferences, how to recognise non-verbal clues and objects of reference. The AQAA tell us that a number of people living at the home have been assisted to access advocacy services, which provides an independent support for people. Staff told us how some people let them know about their needs, and likes and dislikes through behaviour, facial expressions, noises and body language, which are reflected in the care plans for staff to understand and follow. Staff also told us they sometimes use objects of reference and choice indicators to help them communicate with people and ensure that individuals can make simple choices. One visiting professional told us, The interaction between staff and service users is very good. People are given choice, for example what to wear. Another health professional told us the home, Try to provide a very individual care approach which usually supports the individual to live as they choose. Another professional told us the home always supports the individual to live as they choose. We saw people making simple decisions about their daily lives, such as what activity they engaged with, where to spend their time and what they wanted to eat at mealtimes. Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: One relative was concerned about the way the home manages their relatives money. They were concerned that they had not been informed of additional costs and not been consulted about how their relatives money was spent. Care plans did not contain information about how people are assisted to manage their money, or who should be involved in the decision to spend money. It would be useful to have this information agreed and recorded to ensure that misunderstandings are avoided. Some medication is given covertly in food (refer to standard 20), the home has been asked to ensure this decision is discussed and agreed with other professionals and peoples representatives. This will help to ensure that decisions made are in peoples best interest. Risks to people are identified and guidelines for reducing and managing risks associated with behaviour, situations or the environment are available to staff. This ensures staff have the information they require to keep people safe. Risk assessments enable people living at the home to be involved in activities they enjoy such as swimming. Care Homes for Adults (18-65 years) Page 16 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy regular and varied activities and links with family, friends and the local community are good. People benefit from a varied and balanced diet, which takes their needs and likes and dislikes into account. Evidence: The AQAA tells us that people lead an active and fulfilled life by going on a variety of holidays, and accessing the local community, for example, libraries, pubs, places of worship and other places of interest. Several people at the home enjoy swimming and the home is in discussion with the local pool to improve facilities and access for people. The home is currently recruiting for an activities coordinator so that activities can be improved further. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: The home appears to have developed a good relationship with the local community and have local volunteers visiting. The home has taken part in the local carnival for the past two years, and fetes and other fund raising events at the home are well attended by the local community. Records showed that people visit local shops, cafes, clubs, beaches and other facilities. The home has three vehicles to enable people to take part in activities outside of the home. Northam Lodge provide day services for the local community in a facility nearby. Several people living at the home attend weekly art and craft and cooking sessions, as well as sensory and music sessions. This gives people an opportunity to met new people and make friends outside of the home. People told us (via surveys), I go to the clubs and day activities. If there is enough staff I do cooking and go swimming and I am getting busy with things to do during the day. I go to two clubs in the evening, and I have had a holiday. Another person told us, I would always be asked whether I wanted to do something. Opportunities to do some things depend upon staffing being available to help me (refer to standard 33). During our visit we saw people engaged in a variety of activities. A number of people were taking part in a musical session and appeared to enjoy banging and shaking different instruments. Another small group of people played a lively game of throw and catch. Staff spent one to one time with people talking or reading with people. In the afternoon several people went out to the shops or for tea. During our visit we saw that visitors were welcome. The home recognises the value of social networks and care plans inform staff about peoples close relationships with family and friends. One relative told us, There is always a friendly welcome and a cup of tea and I am free to visit when I wanted to. Relatives and other visitors are also offered lunch or tea. One relative commented, Its a home from home. Several relatives helped people complete the CSCI surveys and all comments were positive. Care plans contain information about peoples preferred routine and staff told us, where possible, peoples preferences are met. There was a relaxed atmosphere within all three of the units. We sat with people in Christopher Lodge over lunchtime. Two people told us they liked the food, others were unable to verbally express their opinion but seemed to enjoy the meals prepared during our visit. The meal was well presented, including the pureed meals. Care plans have details of peoples likes and dislikes and dietary needs. The Chef told Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: us he was always informed of peoples preferences and needs and that the four week menu reflected this. Some people need help at mealtimes. We saw staff standing over and behind two people when assisting them with lunch. This did not promote a dignified, relaxed or pleasant mealtime for some. Staff did not engage with the people they assisted, and for various periods of time engaged in conversations with other staff. We discussed this practice with the manager. She explained that a new dining table had been ordered which would improve this and enable staff to sit beside people when assisting them at mealtimes. Care Homes for Adults (18-65 years) Page 19 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home works in partnership with other professionals to ensure peoples health care needs are met. Peoples dignity could be better supported at times. Medication practices are generally safe, but some practice and storage arrangements do not fully protect peoples health and welfare. Evidence: On the whole staff were respectful and friendly when assisting people. Everyone responding with a survey told us staff always treat them well. Comments included, Attention paid all the time, As her Mum I have no concerns yet and I am well looked after and feel this is my home. One parent told us, I go home happy knowing she is loved and cared for. Visiting professionals also told us peoples privacy and dignity was respected by staff at the home. One wrote, Good standards and respectful to service users. On two occasions we saw practice which did not promote peoples dignity. After breakfast a carer approached one person, wiped their face and put a clean apron on. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: The carer did not speak to the person, explaining what they were about to do or make eye contact with them. On another occasion a carer moved a person using a wheelchair without explanation or consultation. The person said, Where I am going? Staff need to be mindful of this practice. We visited one shared room, the room was large and bright and had been personalised by the people living there. The manager told us people sharing rooms were happy to do so and the arrangements had been agreed. There was no screening or curtain in the shared room we visited to promote peoples privacy and dignity. This was discussed with the manager and a recommendation is made. The home has built up good working relationships with outside professionals, which benefits the people living at the home. Three outside professionals told us that individual health care needs were properly monitored and attended to. One told us, The are quick to respond to emergencies, another said, This is a very impressive place. Staff always call us promptly and appropriately. Protocols within care plans provide good guidelines on how to manage complex health needs. Care plans described individuals health care needs and showed their needs were monitored and specialist health professionals are regularly consulted. Staff have received a range of training on health issues relevant to the people they care for, such as epilepsy. A District Nurse was visiting to train staff in a new procedure. She told us that one member of staff had come in on their day off for training. She added, Staff have a good attitude to learning. Records show that people receive additional specialist support from physiotherapists, occupational therapists and speech and language therapists to ensure their individual needs are met. Guidelines from various health specialists were included in care plans. Health professionals told us the home sought advice and acted upon it, one added, They are very good in the main. Another said, They always take our advice. People here are very well taken care of. Records show that peoples weights are monitored two or three times a year and that three of the four looked at had a stable weight. One person identified as being at risk of losing weight did not have regular weight records, which could provide important measurable comparisons for health professionals. Staff responsible for the administration of medicines have been trained to so. There is secure storage for most medicines in the Lodges, with the exception of Northam Lodge, which does not have the required facilities for controlled drugs. At the time of this inspection no controlled drugs were stored but the AQAA shows that controlled Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: drugs had been used in the past. We explained that the present facilities for controlled drugs at Northam Lodge do not meet the current requirements for secure storage. If controlled drugs are prescribed at any time in the future the home must provide secure storage that meets with the required standard. Medication Administration Records (MAR) show that people get the medicine they are prescribed when needed. Codes are used to indicate why medication has not been given. Several medication records instruct staff to give medication with food. We were told that some people cannot take medication in tablet form and medication is given with food to make it easier to swallow. However, there were no clear guidelines in care plans about how medication should be given and no consideration about whether mixing medication with food or drink would affect medicines. Also, disguising medication in the absence of consent may be regarded as deception, as the person may be led to believe that they are not receiving medication when in fact they are. We discussed this with the manager who will ensure that this practice is reviewed and agreed with representatives and professionals. Care Homes for Adults (18-65 years) Page 22 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally confident that any concerns would be listened to and acted upon; and people living at the home are protected from abuse by clear procedures and appropriately trained staff. The current arrangements for managing peoples money could be improved. Evidence: People responding with surveys said they know who to speak with should they have any concerns. Many people living here have limited communication and would be unable to tell people if they wanted to complain about something. Surveys indicated that parents, family members and key workers would advocate on behalf of individuals if they felt they were unhappy about something. Three visiting professionals told us the home always responded appropriately should any concerns be raised about peoples care. One told us, Excellent response. Another said, We have no concerns. One relative told us I have no complaints but know who to talk to should I need to. No complaints have been received by the Commission or the home about the service or care provided since the last inspection. Survey responses told us that people were always treated well by staff and that staff Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: listened and acted on what people said. We talked to the staff about their understanding of the way potential abuse issues should be dealt with. All staff said they had received safeguarding adults training and all were aware of the correct procedure for dealing with any concerns about peoples wellbeing. Since the key last inspection, a safeguarding alert was made by the home. We are satisfied that this was handled promptly and effectively and that the vulnerable person involved was immediately protected. Excellent written evidence was produced by Northam Lodge, which greatly assisted the investigation. The home assists some people with personal finances, and we looked at the system in place by reviewing three peoples records. The home has a Bursar, who administers all monies. We found that records clearly account for any purchases made on behalf of people living at the home and receipts are kept. An independent audit of how the home accounts for peoples money is completed annually and has just been completed, and improvements to record keeping were noted. We found that peoples money was held in one bank account, the clients bank account, rather than individual bank accounts, which would be good practice. This was discussed with the management team who had already made contact with some banks about the possibility of setting up individual accounts for people. Any interest accrued in the clients bank account is allocated appropriately to each individual. Care Homes for Adults (18-65 years) Page 24 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Northam Lodge offers people a safe, homely and clean environment with equipment and facilities to meet their needs. Evidence: The home comprises of three Lodges, Northam, Christopher and Gibson. Northam Lodge is an older building which has been adapted to meet peoples needs. The other Lodges are purpose built and offer good access and facilities. Each Lodge has a communal sitting/dining room, kitchen area and sufficient bathrooms and toilets. There is a second sitting room on the first floor of Northam lodge where families can meet in private. The AQAA tells us the home has a robust redecoration and replacement schedule. Overall the home was well maintained and decorated. Bedrooms visited had been decorated and personalised to reflect individual tastes and interests. The personal aids and equipment people need to maximise their independence and comfort are available. People told us the home was always clean and fresh. Comments included, Never smelly, when cleaner is here it is spotless, and There are never horrid smells. One Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: visiting health professional told us, The home is always clean. No smells at all. During our visit the home was clean and free from offensive odours. The laundry is separate from the Lodges, it was clean and organised, and has the necessary equipment. Infection control measures, such as hand washing facilities are good, and staff have protective equipment such as gloves and aprons to promote good practice. The AQAA shows that all staff have received training in prevention and control of infection. Care Homes for Adults (18-65 years) Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are usually sufficient numbers of staff on duty with appropriate skills and knowledge to meet the needs of the people living at the home. Recruitment practices are generally good ensuring people are protected from unsuitable staff. Evidence: Although the majority of people we met could not express their feelings verbally about the staff, several positive interactions with staff showed that peoples wellbeing was supported by most of the team. One relative spoken with praised the staff team saying they were, Excellent and very caring. Another described staff as brilliant. Health professionals told us Nothing is too much trouble for them (staff), and Staff are always kind to service users. Staff told us via surveys that there was usually enough staff on duty to meet peoples needs. Three members of staff said this was sometimes the case. Comments from staff included, We are fully staffed now. We never work with unsafe numbers of staff, We have 8 service users and usually have 5 staff on duty and Not enough staff all the time to cover all areas needed and give clients attention they need all the time. However, staff spoken with during our visit felt that staffing levels had improved with newly recruited staff in post. The AQAA shows a significant use of Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: agency staff over a three month period but this has decreased with the successful recruitment of permanent staff. Staff rotas show there are usually 13 staff on duty during the morning and 11 in the afternoon, providing care and support in the three Lodges. Although a member of staff expected at Northam Lodge was off sick, peoples needs appeared to be met. Care staff are supported by the manager and domestic and catering staff. During our visit staff were able to assist people in an unhurried manner and ensure that people enjoyed activities. The gender mix of the staff team matches that of the people living there and offers people a choice about who delivers personal care. One member of staff was concerned about staffing at night. They said, We normally have 2 on at night up the house (Northam Lodge), but lately because we are short staff this can go down to one, which I feel is taking huge risks on the clients health and ours because quite a few up the house are epileptic. The duty rota shows there are usually five staff on duty at night to cover the three Lodges. Records for October and November indicate that two staff are on duty at Northam Lodge with the exception of two occasions. The managers hours are not recorded on the rota, a recommendation has been made to ensure that the staff rota accurately reflects the staff on duty at any time. All staff responding to the CSCI survey said they receive the relevant training they need to meet peoples needs. Staff at the home told us training and development was good. Their comments included, Training 5 star, The service provides brilliant training. Cannot fault this area and The training is very good. We can request any training we feel we need. One staff member told us, Staff would gain if we could carry out more training relating to the actual disability, illness etc a service user suffers from. Staff told us (via surveys) that they always or usually have the skills and competence to care for people safely. One staff member wrote, Anything I need to know but do not can be found out by asking colleagues, team leader, or seniors. Two visiting professionals told us staff always have the right skills and experience to support individuals social and health care needs, one commented, The will ask for appropriate advice when necessary from other professional agencies. A third professional felt staff usually had the skills and experience to care for people. Staff told us about some the training they had received, this included, sessions with the District Nurses and speech and language therapist relating to special procedures and peoples health care needs. Several staff have attended total communication, gentle teaching training, Autism awareness, Epilepsy, and a session about the Mental Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: Capacity Act, which helps to ensure staff understand and meet peoples needs effectively and safely. The AQAA tells us that nearly 52 per cent of staff have obtained a nationally recognised qualification in care (NVQ2 or above), which helps to ensure general care needs are met. Where possible people living at the home are involved in the recruitment of staff, this is to be commended. We looked at the recruitment files for five people appointed since the last inspection and one volunteer. Relevant pre employment checks, Criminal Records Bureau checks (CRB and POVA) had been taken up prior to employment. This helps to ensure that individuals are suitable to work with vulnerable adults. We noticed that two references had been received by the home after the start date of the employees. This was discussed with the manager, who explained that verbal references were sought whilst waiting for full written references. We recommended that a record be kept of the date a verbal reference was obtained and any relevant comments about the persons abilities and reliability etc. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory. The quality assurance systems in place help the home to evaluate the quality of the service. Obtaining formal feedback from people living at the home and their representatives will ensure the service continues to provide good outcomes for people. Satisfactory systems are in place to promote the health and safety of people living and working at the home. Evidence: The registered manager, Jo Babb, has the experience and qualifications to ensure the home is well managed. During the inspection the manager was well organised and able to find all of the information we requested. The manager was also receptive to our recommendations for improvement to the service during the feedback session. She has an open and friendly approach. An executive director and a board of Trustees support the manager. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: The manager has resigned her post and will leave the home shortly. We saw that the home had been proactive with recruitment for a new manager, with adverts locally and a recruitment agency is also being used to find the right person for the post. In the meantime, the executive director has increased his hours to 5 days a week to support the home until a suitable person is appointed. Staff told us there was usually good communication between staff and the management team. One relative told us they felt the Board of Trustees were rather distant and out of touch with the service users. Better communication between people living at the home and their representatives could improve this perception. There are a number of ways the home reviews the quality of the service it is providing. They undertake regular audits of care, reviews of accidents and incidents, and reviews of the holidays arranged to ensure a good service is provided, which meets peoples needs and preferences. The home also uses questionnaires to get the views of people living at the home and their representatives, although this has not been completed for this year. As part of the homes quality assurance process, the executive director visits the home at least once a month to carry out regular management checks and ensure the home is running smoothly. Staff told us and records showed that mandatory training, such as moving and handling, fire safety, food hygiene and first aid is up to date. This ensures that staff can work safely and that people are protected. The AQAA showed maintenance or servicing of gas and electrical systems was up to date. Also that other equipment, such as fire detection equipment and the hoists and lift were serviced regularly. Windows checked on the upper floor of Northam Lodge are restricted to prevent accidents from falls. However we found one window in a first toilet which was not restricted and this was brought to the managers attention so that a risk assessments could be completed to identify if window restrictors were needed in this area. The use of radiator covers and controlled water temperatures helps to ensure that a safe environment is maintained for people. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 You must have 02/04/2009 arrangements in place for the safe storage of medicines You must review the arrangements for storing controlled drugs (including Temazepam) in Northam Lodge to ensure that, if such medicines are received into the home any time in the future secure storage facilities comply with current legislation. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose should be produced in a format that people with a learning disability could understand to ensure they have access to important information. The Statement of Purpose should provide people with information about fees charged, what they cover and the costs of extras. Care Homes for Adults (18-65 years) Page 33 of 36 2 5 It is recommended that a fairer and more equitable system of charging for the use of the homes transport be introduced which reflects the extent to which those charged use the facility. In order to promote a good quality of life, care plans should reflect peoples aspirations and reviews of care should demonstrate that individual goals have been achieved. In order to protect people rights, where decisions are made on behalf of individuals, which may restrict privacy or choice, the home should discuss actions with a multidisciplinary team and the persons representative. It is recommended that staff make mealtimes as sociable and pleasant as possible. Staff should sit with people when assisting them to eat. To promote peoples dignity, staff should consult with them when delivering personal care. The home should provide appropriate screening in shared rooms in order to maintain peoples privacy and dignity. In order to monitor peoples health needs properly, regular weights should be recorded and the appropriate action taken to manage peoples weight loss. There should be clear decision making process when medicines are given covertly (e.g. in food). This will promote an open and transparent process that ensures decisions are made in peoples best interests. You should ensure that each person has their own bank account where possible. Care plans should have clear guidance about how people are to be assisted to manage their finances. You should monitor staffing levels to ensure that sufficient staff are on duty at all times to meet peoples needs and preferences. The managers hours should be recorded on the staff rota to ensure an accurate record of who is on duty is kept. In order to ensure that the recruitment of staff remains robust, you should keep a written record of any verbal references received in respect of new staff. The quality assurance systems that check that the home is being run in the best interests of people, should include the views of the people living in home and outside stake holders, such as relatives and professionals. A risk assessment should be undertaken to ensure the 3 6 4 7 5 17 6 18 7 19 8 20 9 23 10 33 11 34 12 39 13 42 Care Homes for Adults (18-65 years) Page 34 of 36 window in the first floor toilet of Northam Lodge does not pose a risk to people living at the home. Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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