Care Home: Shepherd`s Lodge

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What the care home does well What has improved since the last inspection? The manager stated that the home seek to continuously improve its quality of care and the requirement made in the last inspection in relation to the front door being locked for the security and safety of the residents was immediately dealt with by having the door left shut so that the residents can come in and go as they wishes, thus protecting their rights to freedom of movement. What the care home could do better: The `Statement of Purpose` and `Service User`s Guide` should be reviewed and kept up to date so that the correct information is made available to residents and other stakeholders. The current 24-hour record book used for recording the health care needs and activities of all residents in one book should be individualised so that confidentiality is protected. Hand written instructions on MAR sheets should be signed by the person making the entries so that staff are aware who has given the instructions. Medicines returned for disposal should be signed by the pharmacist to show that these medicines are no longer in the care home and for ease of auditing and reconciliation. The residents` cashbook should have numbered pages for ease of auditing, monitoring and reconciliation. CARE HOME ADULTS 18-65 Shepherd`s Lodge 66 Sheepcot Lane Watford Hertfordshire WD25 0DG Lead Inspector Bijayraj Ramkhelawon Unannounced Inspection 6th March 2008 10:00 Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shepherd`s Lodge Address 66 Sheepcot Lane Watford Hertfordshire WD25 0DG 01923 354 105 01923 465 647 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Chan Wan Fong Mr T-Chan Wan Fong Mrs Chan Wan Fong Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3), Old of places age, not falling within any other category (1) Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate one (named) service user who is over the age of 65 for as long as their needs can continue to be met. 13th March 2007 Date of last inspection Brief Description of the Service: Shepherds Lodge is a detached bungalow in a residential road in Garston. Public transport, local shops and leisure facilities are all reasonably close by. The home accommodates three service users with learning disabilities. There are three single bedrooms, a lounge/dining room, kitchen and bathroom/wc. The home has a large garden, which the proprietors are in the process of redesigning. It contains a large pond with a decorative footbridge over it, and a summerhouse. The fee range for this service is from £980 - £1200 per week. Information regarding the service can be obtained from the ‘Service User Guide’ and ‘Statement of Purpose’. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out on the 6th March 2008 and took one day. It included talking to people using the service, examining care plans, staff files, staff training records, fire safety procedures, maintenance records and all other records and documents. There was no Annual Quality Assurance Assessment (AQAA) form completed at the time of this inspection. ‘The overall quality rating for this service has been judged to be 2*, GOOD.’ What the service does well: What has improved since the last inspection? The manager stated that the home seek to continuously improve its quality of care and the requirement made in the last inspection in relation to the front door being locked for the security and safety of the residents was immediately dealt with by having the door left shut so that the residents can come in and go as they wishes, thus protecting their rights to freedom of movement. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A ‘Statement of Purpose’ and a Service User’s Guide is available that contains the required information about the service provision. These documents are made available to prospective and current residents and their representatives. EVIDENCE: Adequate information about the home is provided to current residents and is also available in the reception area. However, the ‘Statement of Purpose and the ‘Service User’s Guide’ were not reviewed and kept up to date which meant that the correct information was not provided including the current address and contact number of the Commission for Social Care Inspection. People using the service has their individual assessment of needs carried out prior to an offer of placement is made. Planned trial visits are facilitated to new and prospective residents so that there is a gradual ‘phase in’ admission to enable them to settle in and to get use to the home and its current occupants. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6-10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents’ needs and aspirations are detailed in individual care plans that provide information to facilitate consistent service provision. Each resident is enabled to make decisions about their lives and are supported to take risks as part of their independent lifestyle. EVIDENCE: Care plans examined were detailed and comprehensive which included individual’s identified needs, personal preferences, goals set, behavioural guidelines, aspirations and health care needs. These were reviewed and kept up to date to reflect the resident’s changing needs. Staff supported and enabled residents so that they are able to lead a safe and as near normal a life as possible, consulting them as appropriate over decision making and offering guidance where needed. Positive interaction was observed between the manager and residents during the inspection, demonstrating a Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 10 high level of respect and patience. Up to date risk assessments were in place covering a wide range of activities. There is a policy on confidentiality that staff are aware of and follow. Personal information about service users is handled sensitively and documents are stored securely. The current 24-hour record book used for recording the health care needs and activities of all residents in one book should be individualised so that confidentiality is protected. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are enabled and supported to develop and maintain their skills including social, emotional, communication and independent living skills. The practice of staff promotes individual rights, choice and considers protection of individuals within an informed and risk-assessed framework. Residents were provided with a varied and wholesome diet. EVIDENCE: Each resident has a programme of planned activities which includes accessing local amenities and facilities such as shopping trips, meals out, visiting the local library, the local gym for fitness and exercise and places of interest. The Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 12 home also offers annual holidays and day trips to the coasts. Residents also attend the local college for further education. People using the service are actively encouraged to participate in the domestic routines around the home, including weekly shopping trips, assisting with personal washing/drying of clothes, cooking and each week every resident thoroughly cleans their bedrooms. Residents are encouraged and supported to maintain links to the local community. They attend local social clubs including, the Magpie club and the Jubilee club. One resident is in full time employment. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18-20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service receive personal and healthcare support using a person centred approach. The current medication practices and maintenance for medication are adequate. EVIDENCE: Care plans examined showed that residents identified needs were being met with regular reviews undertaken within a multidisciplinary approach and person centred plan. Health records were maintained in good order and the services of other health care professionals including dentist, chiropodist (where appropriate) opticians and the CPN visits, when necessary. the services being accessed as and when needed. Each resident is registered with a G.P. The current arrangements for the storage and handling of medication are adequate and meet the current standards. The medication cupboard is situated within the main reception area of the home. All staff have been trained and inducted in the administering medication. However, hand written instructions Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 14 on the MAR sheets were not signed by the person making the entries and medicines returned for disposal to the chemist were not signed by the pharmacist. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure which people using the service and staff are aware of. There are policies, procedures and training in place to ensure residents are protected and safe. EVIDENCE: A detailed complaints procedure is in place and is on display. A record is maintained of any complaints made detailing actions and outcomes as necessary. No complaints have been received since the last inspection was carried out. People using the service have been informed about the complaints procedure. A detailed procedure is in place to ensure that people using the service are protected from abuse and harm. Staff have attended training in Safeguarding Adults and have had an enhanced Criminal Records Bureau (CRB) checked carried out prior to an offer of employment was made. Residents personal allowances is managed by the staff of the home that is well managed and all expenditures with receipts are kept. However, their individual cashbook should have numbered pages for ease of auditing, monitoring and reconciliation. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and comfortable environment for people using the service. Individual bedrooms were personalised which promoted independence, choices and preferences of the residents. EVIDENCE: People using the service said that it is a comfortable and homely environment to live in. There is a range of in-house entertainments, including a Television/DVD and video, which are located in the lounge. Each resident also has their own television in their bedrooms. The home has one bathroom/shower unit, a large lounge and dining room. The kitchen is domestic in style and has all the necessary appliances. Fridge and freezer temperatures are recorded. Hot water temperatures are maintained within safe limits. The home has a large back garden with a large pond and Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 17 vegetable patch in which the residents can grow their own selection of vegetables. All areas of the home are well-maintained. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate numbers of staff are rostered to work both days and nights. The home has a recruitment procedure. There is an enthusiastic, knowledgeable, experienced and well-trained staff team to support the residents in meeting their identified needs. EVIDENCE: Adequate number of staff are rostered to work on each shift. The manager was the only person on duty at the time of the inspection, although other staff were rostered for the afternoon shift. There were six other staff members on the rota and they work both day and night shifts. Staff have clearly defined job descriptions and person specifications in place. All staff have received a series of mandatory training course in order for them to meet the complex needs of the people using the service. Training in Safeguarding Adults is provided as part of a rolling mandatory training. The home has a recruitment procedure that involved a thorough vetting of applicants. Two staff files examined contained photographs of the person, application forms, two positive references and CRB disclosures. However, although an induction programme Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 19 for each care staff was in place, but this was not signed by the employees to indicate that they have completed the programme. Staff files examined showed that the home’s recruitment procedures were followed and staff were provided with the required training. Currently, there were 2 care staff who have completed their NVQ Level 3 and one staff has attained B/Tech in Care. The manager is still pursuing with her NVQ level 4. Formal supervision is provided to each care staff on a regular basis. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and people using the service benefit from the support they receive from a committed and enthusiastic staff team under the guidance of the manager. There is an ethos of being open and transparent in the day-to-day running of the home and the health, safety and welfare of people using the service are promoted and protected. EVIDENCE: The home is well managed and people using the service said that they well supported by the manager and the staff team. Adequate training was provided to ensure all staff have the necessary knowledge and skills to carry out their role effectively in supporting and meeting the needs of the residents. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 21 Service user finances were checked and reconciled. Separate ledgers are maintained for each person and a running record is kept and audited every time a withdrawal is made. However, a robust system should be implemented in ensuring that a proper cashbook with numbered pages is used for ease of auditing and reconciliation. Data Protection Act 1998 ensuring that service users rights and best interests are safe guarded by the polices and procedures. Supervision sessions are completed in line with the required standards. There are currently no outstanding issues relating to the health and safety. All fire records were up to date and accurate. A valid insurance certificate was displayed in the lounge and the expiry date is November 2008. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 3 X Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The ‘Statement of Purpose’ and ‘Service User’s Guide’ should be reviewed and kept up to date so that the correct information is made available to residents and other stakeholders. The current 24-hour record book used for recording the health care needs and activities of all residents in one book should be individualised so that confidentiality is protected. a) Hand written instructions on MAR sheets should be signed by the person making the entries so that staff are aware who have given the instructions. b) Medicines returned for disposal should be signed by the pharmacist to show that these medicines are no longer in the care home and for ease of auditing and reconciliation. The residents’ cashbook should have numbered pages for ease of auditing, monitoring and reconciliation. Induction programmes for each staff should be signed and DS0000019522.V360501.R01.S.doc Version 5.2 Page 24 2. 3. YA10 YA20 4. 5. YA23 YA35 Shepherd`s Lodge dated to indicate that they have undertaken this programme. Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Shepherd`s Lodge DS0000019522.V360501.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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