Care Home: Stewart Lodge

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What the care home does well Comments from surveys included: `The most important thing and best with this place is transparency about every matter of the job performed and to be done.` `It really feels like home.` `Pictorial care plans and risk assessments`. `Very kind, always smiling.` [comment from person who lives in the home] `They are already good. God bless them.` [comment from person who lives in the home]. We found that staff supported individuals to be independent and listened to what the person wanted. The atmosphere was homely and people were able to make visitors feel welcome. Care is taken to make sure that the person is at the centre of care planned and their involvement in deciding what they want is clearly documented. Stewart Lodge has maintained consistency over a period of time. This has resulted in an excellent rating. What has improved since the last inspection? No requirements were made at the previous inspection. What the care home could do better: We have not made any requirements as a result of this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: Stewart Lodge 24 Rosecourt Road Croydon Surrey CR0 3BS     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janet Pitt     Date: 2 0 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Stewart Lodge 24 Rosecourt Road Croydon Surrey CR0 3BS 02086847333 02086847333 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Harvey Stewart & Smith Ltd Name of registered manager (if applicable) Angela Doreen Gordon Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is:3 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD (o the following age range: 18 years to 65 years) Date of last inspection Brief description of the care home Stewart Lodge is a residential care home for adults who have experienced long-term mental health problems. Three people are currently living there.The home is a 3 bed roomed terraced house situated in a quiet residential road in Croydon. Local transport facilities are good.Fees for this service are from GBP1,000 per week. Information about CSCI is available at the home. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 3 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: three star excellent 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: The quality rating for this service is three star. This means that people who use the service experience excellent quality outcomes. One inspector undertook this unannounced inspection. A site visit was made that lasted two hours. We were able to speak with people that live at Stewart Lodge, staff and the manager. We looked around the premises and examined documentation relating to the running of the home. The service sent us their Annual Quality Assurance Assessment [AQAA] this gives us details of how the home is operating and its plans for improvement. Surveys were received from people that live in the home and members of staff. Information from all these sources have been used to inform this report. Care Homes for Adults (18-65 years) Page 5 of 27 Care Homes for Adults (18-65 years) Page 6 of 27 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 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 27 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 27 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 can be confident that Stewart Lodge will provide them with sufficient information to enable them to make a choice about moving in. The Statement of Purpose and contracts detail what the service provision is and what is included in the fee. Evidence: During our site visit we looked at the Statement of Purpose. This document gives people information about the service provision and what is included in the fees. There is a copy of the complaints procedure and safeguarding policy contained within the Statement of Purpose. We saw that prospective occupants have a needs assessment undertaken before moving into the home. The assessments contained good details of individuals needs and was fully completed. Each person has a contract that states their room number to be occupied and communal areas available. People are able to have a key to the front door and their Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: room if they want. People spoken with at the time of the site visit said they had made a positive choice to move into the home. One person who had been living at Stewart Lodge for a short time said they were happy and becoming more settled. Staff were able to support them and promote their independence. All survey respondents said that they were given enough information about the home before moving in. They all stated that they were asked if they wanted to move into Stewart Lodge. Care Homes for Adults (18-65 years) Page 10 of 27 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. People are involved in planning the care to meet their needs. Individuals are able to make choices about what they do. Risk assessments protect them from harm. Evidence: Service users are encouraged to be as independent as possible. One service user prepares their lunch independently, while other service users consume a mixture of food prepared by both themselves, and by a staff and resident working together.[AQAA 2010] On our site visit all three people were at home. They were kind enough to make us feel welcome and offered refreshments. One person was having a lie in as they had had a busy day the day before. Staff had been asked to wake them up at 12pm. We heard a member of staff going to their room and knocking on the door. The staff member then suggested that when the person was ready they could go shopping. Another person told us that they had breakfast in bed. One person was having lunch Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: in the dining room. Care plans that we looked at had information about individuals interests and what they wanted to do in the future. One person we spoke with said that they eventually hoped to be in a position to live independently. Individual risk assessments were in place and were noted to be reviewed routinely. The assessments covered areas such as vulnerability whilst in the community, handling money and daily living skills. The home told us in their AQAA that they plans to improve in the next twelve months by actively listening to the service users and improve their quality of life, through development of their individual independence. People who responded to our surveys told us that were make to make decisions about their everyday lives. They also said that staff listen and act on what they say. Care Homes for Adults (18-65 years) Page 12 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are able to chose what they do. Staff support them to maintain contact with family and friends. Mealtimes are flexible and preferences are taken into account when planning menus. Evidence: Group activities are arranged for service users, recent activities include: a visit to Regents Park, London Zoo, Brighton and Hastings for a short holiday break. The residents are assisted to go shopping, going for walks in the local area and parks. Friends and family of service users who are also welcome to visit. Also, there are facilities in place for service users to stay in contact with family and friends by telephone calls and letters and spend time away from the home with their families.[AQAA 2010] Survey respondents told us that they always do what they want at all times. We found Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: evidence in care plans of people being able to continue with or develop interests and hobbies. One person supports a particular football team and has gone to see matches. One person has their own computer with Internet access. Individuals are able to keep in contact with family and friends. For example one person has visited their relatives overnight and another regularly meets their parents. We discussed with the manager significant relationships. The manager told us that one person wanted to have a meaningful relationship and they were supporting the individual in developing social skills to achieve this aim. One person told us that they are able to keep in contact with family through telephone calls and staff support them to make visits. During our visit staff supported individuals to go to the shops. One person told us that they did attend college on their survey: I go to college every Thursday. I enjoy this. Peoples plans contained details of daily living skills and areas that a person needed prompting with. For example one individual has short term memory loss and needs motivation to complete household tasks. Dietary preferences were detailed in each persons plan. Staff told us that one individual enjoys pasta. They have devised a variety of meal that are healthy and nutritious with the person, that are based on types of pasta as the main ingredient. We saw that portion sizes were generous and food was available at all times. We spoke with one person whose care plan stated that they enjoyed spicy food, particularly curry, and they said that this was a dish that was prepared for them often. Comments on surveys included: they take me out, they cook for me, they help me, they are nice. and cooks very well Care Homes for Adults (18-65 years) Page 14 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their health and personal care needs will be met. Processes are in place for making sure that reviews are held regularly. Input from other health professionals is recorded and actioned. There is consistency in the planning and delivery of care to meet peoples needs. Evidence: The AQAA told us that Stewart Lodge: Access[es] health care and support[s] residents to access services from GP, hospital and Community Mental Health Team. Their evidence to support this is: our record of residents accessing services and correspondence indicate a positive relationship between external services and the care home. They AQAA continues: Independence is promoted in the way that support with personal care is offered. The staff team works closely as part of a multidisciplinary team to ensure mental health and healthcare needs of service users are met. We looked at care plans during our site visit. Each person had one main folder and a case notes file that contained letters, appointments, reports and general Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: correspondence. The files had a clear format and we were able to find information quickly. In the case notes there were details of the persons general practitioner, dentist, social worker and next of kin. Specialist input such as the Community Drugs Agency was also noted. The personal record contained information on the individuals religion and whether they were practising or not, a checklist of their possessions and medical history. If an individual needs one to one support in the community this was detailed, as was the habit of absconding. We found that specific record charts were available to record episodes when a person had gone missing. We noted that the home had applied for a Deprivation of Liberty assessment in one particular case. People sign their care plans to indicate that they have been involved in the process and agree with information contained in the plans. Peoples main care plan details what the person does for example time they prefer to wake up, personal hygiene needs, budgeting skills and mobility. One person told us that they had recently started reflexology sessions that were very helpful. Each plan had been evaluated monthly by the keyworker, with the person. There were goal evaluation sheets in place. Specified health needs had been identified and planned for. For example if an individual had epilepsy there was information on possible triggers, how to handle a seizure and medication. Individuals medical appointments were recorded with outcomes or further treatments if needed. Any challenging behaviours were detailed, with information on how these situations should be addressed. The manager told us that the Care Home Support team had been working with the home due to a Safeguarding referral. During this process areas such as medication handling, care planning and Safeguarding were looked at. The manager said that the report from the team did not raise any issues. No recommendations were made and the team had decided that no further input was needed. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: Information we hold on medication handling tells us that there are no issues. As the Care Home Support Team have recently undertaken an audit whereby no concerns were raised, we did not examine medications during our site visit. Care Homes for Adults (18-65 years) Page 17 of 27 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 who live at Stewart Lodge have access to a clear complaints procedure. Opportunities are given for individuals to be able to voice any concerns they have. The home works proactively with other agencies when there are Safeguarding alerts. Evidence: The complaints policy is included in the Statement of Purpose, which is made accessible to service users. Service users are able to raise concerns through a variety of methods, both inside and outside of the home: key worker meetings, residents meetings, informal meetings with staff or manager, or to their social worker or other outside professionals. There have been no formal complaints made by service users in the past year.[AQAA 2010] We have not received any concerns or complaints. All survey respondents stated they they would know how to make a complaint and who to speak to if they were not happy. During our site visit we discussed a recent Safeguarding alert with the manager. One individual suffered a fracture after a fall, that was not immediately detected by the hospital. The manager reported that assumptions had been made that the home did not detect a fracture. We found that staff had correctly followed procedures when the person fell and made sure they sought medical attention. At the time of writing this report investigations were still ongoing. The manager has a file prepared with all relevant information for ease of access. As a result of the Safeguarding all people that live in the home have been reviewed by placing authorities, no concerns have been Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: highlighted. We were able to evidence recent Safeguarding refresher training during our visit. Care Homes for Adults (18-65 years) Page 19 of 27 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. People live in a home that is maintained and homely. There are communal areas and private space available. Individuals are able to personalise their rooms if they chose. Evidence: The house has a homely and family atmosphere, with personal effects of service users in the lounge, as well as a variety of books, games and pictures.[AQAA 2010] When we visited we found that Stewart Lodge was clean, tidy and domestic in nature. The kitchen had enough space for people to work in with staff support. Individuals we spoke with said they were happy with their rooms. All survey respondents stated that the home was always clean and tidy. The lounge has comfortable seating and access to a television with Satellite channels. The dining area forms part of the kitchen and there is sufficient space for people to eat a meal together if they chose. Care Homes for Adults (18-65 years) Page 20 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are supported by a competent staff team, who are trained to carry out their role. Training and supervision are undertaken routinely. People can be confident that safe recruitment procedures protect them from harm. Evidence: When we visited Stewart Lodge there were two members of staff on duty. One had been working for four weeks and another for four months. Both confirmed that they had received induction training and all necessary checks had been carried out prior to them commencing employment. One said that they were due to start their NVQ level 3 in September 2010. The AQAA told us: recruitment checks are carried out on all staff prior to employment commencing, including obtaining satisfactory reference, POVA first and CRB checks and the completion of a confidential medical questionnaire. Staff receive a probationary review at three and six months. training needs are reviewed at supervision and training profiles are detailed on file on site. Training includes areas such as food hygiene, first aid, fire awareness, mental health awareness, health and safety, NVQs. Evidence we hold about the service confirms that people are recruited in a safe Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: manner. Staff survey respondents all stated that Criminal Record Bureau checks and references were obtained prior to them commencing employment. They also said that they had received induction and ongoing training suitable for the role they are to perform. We observe staff interacting positively with people and taking time to talk to individuals about what they want to do. Comments included: Complete induction regarding new jobs., It really feels like home, best interests of clients and staff are maintained.and I am learning and expanding my experience here, the residents are brilliant. Care Homes for Adults (18-65 years) Page 22 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is run in their best interests. They can be confident that health and safety is maintained. The manager runs Stewart Lodge proactively and makes sure that peoples views are heard and acted upon. Evidence: Stewart Lodges AQAA told us: Health and safety checks relevant to the home are up to date and information accessible, including: gas safety, electrical and fire equipment. Risk assessments pertaining to risk in areas such as fire, Control Of Substances Hazardous to Health and premises are comprehensive and up to date. We were able to confirm this on our site visit. We did not find any issues relating to health and safety during the time we spent in the home. Staff members told us that people are involved in the routine fire drills at the home. The manager has had many years experience and made herself available to talk with us. The manager is was open about the way the home runs and we noted that they had a good rapport with staff and the people that live in the home. The manager demonstrated awareness of each person as an individual. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: All staff surveys all stated that the manager is supportive: The manager always seeks our views and ideas and feedback. and the manager is always available for information and advice to staff when needed. People we spoke with said they they were able to comment on the running of Stewart Lodge. They considered that their views were taken into account. The manager reported that they have a Quality Monitoring System in place that assists in developing how the service operates. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 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 26 of 27 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 27 of 27 - 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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