Care Home: Shenley Lodge

What the care home does well The service has a positive and proactive approach to assessing and improving the residents` lives. Staff are well trained to meet the needs of the people living in the home. Despite resource limitations, the home continues to work to improve the physical environment. What has improved since the last inspection? Environmental requirements made at the last inspection have been met. The home also provided to CCQ with a business plan. What the care home could do better: The home could continue to improve the enviroment by upgrading and maintaining the garden. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Shenley Lodge 34 Abbey Road Enfield Middlesex EN1 2QN     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: Margaret Flaws     Date: 1 9 0 5 2 0 0 9 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 25 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Shenley Lodge 34 Abbey Road Enfield Middlesex EN1 2QN 02083631173 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr V Kowlessur care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The home must advise the regulating authority at such times as either of the specified service users vacates the home. Two specified service users who are over 65 years of age may remain accommodated in the home Date of last inspection Brief description of the care home Shenley Lodge is a privately run care home, which opened in 1993. The home is located in a pleasant residential are in Enfield and is registered to provide care and support for seven adults with a learning disability. The accommodation consists of five single bedrooms and a communal bath on the first floor. One bedroom has en-suite facilities, and there is a double room on the ground floor with an en-suite shower and toilet. There is a lounge and separate dining room and kitchen on the ground floor. There is a small garden and driveway at the front of the premises, and a large garden at the rear, which is accessible by the residents. The home is close to shops and Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 7 Brief description of the care home amenities and there are good public transport links. A minibus is available for taking residents to day centres and other activities in the community. The fees for the home range from #550 to #570 per week. Following Inspecting for Better Lives, the provider must make information available about the service, including inspection reports. Care Homes for Adults (18-65 years) Page 5 of 25 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: This key inspection report took place over one day by Margaret Flaws Regulatory Inspector. Senior staff members competantly assisted with the inspection. We spoke to two residents and observed interactions in the home, spoke to two staff members and the Registered Manager by telephone. We saw care and staff files, general home records and inspected the premises. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 25 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 8 of 25 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. Prospective residents can be confident that a full needs assessment will be made before they come to live in the home, to ensure that their needs can be met. New residents are provided with clear information about what to expect from the service. Evidence: One new resident had been admitted since the last inspection and there were no vacancies. Six men and one woman were living in the home. We saw three residents files. They all had comprehensive assessments completed by the home and by the placing authority. They also had terms and conditions contracts in place. These documents included the cost of the service and were signed by the next of kin. Each persons likes, dislikes and wishes were also covered in the assessment. The home has a clear Statement of Purpose which outlines what is offered. Care Homes for Adults (18-65 years) Page 9 of 25 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. Good quality care plans are in place to ensure that residents needs are regularly reviewed and met. Residents are encouraged and supported to make their own decisions and choices. Risk management is a positive process that addresses safety issues while helping residents to grow and improve their quality of life. Evidence: We saw three residents care plans and files. They contained good needs assessments, with clear goals and information on cultural and religeous needs. Care plans were signed by relatives as evidence of their involvement and their approval of the plan. The care plans were reviewed monthly by each residents key worker. Appropriate risk assessments were in place covering residents activities within the home and out in the community. Risks assessed included absconding, having an Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: epileptic seizure, choking, risks in eating hot food, crossing the road and being in the community, and putting on or losing weight. Key workers review the care plans and risk assessments monthly and update them as necessary. Regular placing authority reviews were also on file. Most residents have limited verbal communication but their preferences were recorded about a range of options and choices, including activities of daily living. Their daily notes were clear and specific and demonstrated how each person spent their day, reflecting their choices and any issues that arose. Staff hold regular meetings with the residents about day-to-day issues in the home. These meetings are minuted and show that residents are able to put forward their views and that staff understand them. Care Homes for Adults (18-65 years) Page 11 of 25 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 living in the home are involved in meaningful activities of their own choice, inside and outside the home, which reflect their interests and capabilities. Residents are supported to develop and maintain important personal and family relationships. Residents are supported to communicate their needs and wishes. They are provided with a balanced and nutritious diet, which caters for their individual needs and preferences. Evidence: Three residents were at home during the inspection. The four other residents were at day centres. Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: Residents participate in a range of activities inside and outside the home. They go out for meals with staff to local pubs and restaurants, go to church services, play football and going shopping. Regular holidays are a priority and staff told us that they had recently had a weeks holiday at Butlins on the South Coast. All activities are clearly documented in residents files and in photographs which we saw. We spoke to one resident, who is registered blind. He said how much he liked living in Shenley Lodge. He liked listening to television, to audio books and to music. He said that the staff were supportive and kind. He shares a room with another resident, and he said they got on very well together. Staff told us that this resident is supported by an advocate who sees him regularly. Throughout the day, we observed positive and respectful interactions between the staff and the residents. It was also clear that the staf understood the residents communication preferences and that they could understand each other. Other residents have regular visits from family. The kitchen has been refurbished since the last inspection. There was plenty of fresh food available, including fresh vegetables and fruit. The menus, which were varied and wholesome, are pictorial so that nonverbal residents can point to their choice. Residents had individualised choices at lunchtime to meet their dietary needs and preferences. Food was safely stored and fridge and freezer temperatures were monitored and recorded. Care Homes for Adults (18-65 years) Page 13 of 25 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. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each persons care plan. Staff respect the privacy and dignity of people who live in the home and are sensitive to their changing needs. Residents are protected by the homes medication policies and procedures. Evidence: Staff told us that male and female staff available on each shift to provide personal support to residents of each gender. This was reflected in the staffing rota on the day of the inspection. Care plans give good information about how people are respected and supported with personal care. There is a screen in the shared room to protect residents privacy. Residents are registered with the local doctors and it was evident from their files that they have regular check ups and appointments with doctors, dentists, opticians, nutritionists and other health and social care professionals. Residents also receive Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: support from the Community Learning Disability team and psychiatrists and psychologists. Three residents are receiving support to manage their weight. One resident has had some weight loss and two others have a tendency to put on weight. They have seen specialists and a dietitian. Their weights are recorded and their diets are individualised to address these issues. One person had been giving cause for concern about weight loss. Two residents are epileptic. Their epilepsy is monitored and staff said that it is under good control. Staff are trained in epilepsy management, including what to do if a resident has a seizure and how to safely administer emergency medication. This is included in each persons risk assessment. Medication administration records were satisfactory and there were no gaps or errors. Staff showed us the medication cupboard, where the medication dossett boxes were in good order. The home has clear medication policies and procedures, which the staff understand. Their medication training is kept up to date, to keep their knowledge fresh. Care Homes for Adults (18-65 years) Page 15 of 25 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. Residents are protected by sound complaints and safeguarding policies and procedures. Evidence: The home keeps a full record of complaints and this includes details of the investigation and any actions taken. No complaints have been recorded since the last inspection. The home has a copy of the local authoritys safeguarding adults policy and procedure in the home. Staff training records showed that they have attended safeguarding training and the staff we spoke to were able to describe what they would do if there were an allegation or concern about abuse. All staff working in the home have been screened by the Criminal Records Bureau. The residents we saw during the inspection appeared happy and said that they were well cared for and felt safe. Care Homes for Adults (18-65 years) Page 16 of 25 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. The physical environment generally meets the needs of people living there. Residents bedrooms are comfortable and reflect their individual styles and preferences. The home is kept clean and fresh. Evidence: Environmental requirements made at the last inspection from the last inspection have been met.The home was clean and tidy and there were no offensive odours. The lounge and dining room were comfortably furnished and appeared homely. Residents bedrooms were spacious, appropriately furnished and personalised with the residents interests in mind. They have all been very nicely refurbished since the last inspection. At the last inspection, a recommendation was made to improve the garden, which was not very attractive. It still appears unkept and would benefit from a concentrated improvement to make it a welcoming space for the residents to use, especially in good weather. It is also cluttered with rubbish that needs clearing. A requirement is made. Care Homes for Adults (18-65 years) Page 17 of 25 Evidence: The kitchen has been refurbished, with new units and surfaces. The old laundry floor has been repaired and the laundry itself moved into a garden shed, which is a bigger and brighter space. All bathrooms now have disposable towels. Creaking doors have been oiled. Care Homes for Adults (18-65 years) Page 18 of 25 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. The home is appropriately staffed to meet the residents needs. Residents benefit from appropriately recruited, trained and supported staff. Evidence: We saw the staff rota and it showed that there are normally two staff in the morning to support the residents when getting up, and three in the afternoon and evening when the residents return from day centres. Two staff work at night, with one staff member awake to meet the residents nightime needs. We saw several staff files, which were in good order. Each person had an application form, two reference checks, photographic identification and Criminal Records Bureau checks completed before staff started work. Staff NVQ qualification achievement is good and the home is proactive in supporting staff to achieve these qualifications. We saw the staff training files. There were certificates to show that staff have recently trained in health and safety, safeguarding adults, medication, epilepsy, Mental Capacity Act, First Aid, safeguarding adults, fire safety, manual handling, food Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: hygiene, infection control and managing challenging behaviour. Regular staff meetings are held and staff receive regular one to one supervision with the manager. Staff said that they valued the way they were able to work in the home and that they felt supported to do their job well. Care Homes for Adults (18-65 years) Page 20 of 25 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 home is well managed in the residents interests. Residents are protected by the homes heath and safety policies and procedures and consulted for their views. Evidence: The manager has completed the Registered Manager Award and is now registered with the Care Quality Commission. He has many years of experience of working in the home and with this client group. The home supplied us with an annual business plan to demonstrate how they were working to improve the service, meeting a requirement from the last inspection. We saw health and safety certificate for the gas, electrical systems and portable electrical appliances had been tested. A fire risk assessment of the home has been done and regular health and safety audits Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: are carried out. Fire alarms are tested weekly and drills are carried out at appropriate intervals. Staff have been trained in fire prevention. There is a current employers certificate of liability on display. No hazards to health and safety were identified during the inspection. Residents views are actively sought at regular meeting and a formal survey is carried out each year. Care Homes for Adults (18-65 years) Page 22 of 25 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 23 of 25 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 24 23 The Registered Persons should ensure that the garden is made into a permanently welcoming space and well kept space for the residents to enjoy. The residents should have a pleasant environment to live in 31/07/2009 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 Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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). 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. 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