Care Home: Stoke Lodge

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What the care home does well There are very good systems to assess people`s needs before they move into the home. This helps to reassure people that the home will be able to meet their needs. Staff support people to make decisions about their lives. Details of the support people need are set out in clear plans, which are regularly reviewed with people. The home provides good support for people to take part in a range of activities they have chosen, to maintain contact with family and friends and to maintain a healthy diet. People`s personal and health care is well met by staff who know their needs. The home is generally well maintained and provides a clean, comfortable and safe environment for people. Staff are well trained and there are good systems to check staff before they work in the home. This helps to keep people safe and ensure staff can meet their needs. The home is well managed and there are good systems to make improvements to the service based on the views of people who live there. What has improved since the last inspection? The manager has developed safeguarding children procedures. These are needed as people who are under 18 sometimes use the service. The manager is in the process of making the complaints procedure more accessible by producing it in a video format, using Makaton sign language. What the care home could do better: There are good systems to safely store and administer people`s medication, however, staff need to keep better records when they have supported people to take their medication. CARE HOME ADULTS 18-65 Stoke Lodge 85 Cliddesden Road Basingstoke Hampshire RG21 3EY Lead Inspector Craig Willis Key Unannounced Inspection 29th February 2008 9:45 Stoke Lodge DS0000055569.V357027.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 Stoke Lodge DS0000055569.V357027.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. Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stoke Lodge Address 85 Cliddesden Road Basingstoke Hampshire RG21 3EY 1256 842446 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) jon.webb@choiceltd.co.uk Choice Ltd Mr Jonathan Mark Webb Care Home 9 Category(ies) of Learning disability (0) registration, with number of places Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 9. Date of last inspection 29th August 2006 Brief Description of the Service: Stoke Lodge provides a service to nine younger adults with learning disabilities. The home has been developed to work with people with complex needs including people who challenge the services provided for them. The home is owned and managed by CHOICE Ltd. Accommodation is provided on two floors in a large house that has been refurbished and redeveloped to provide this service. The house is situated on the outskirts of Basingstoke and is close to all local services. Fees are based on individual assessed needs and currently vary between £1695.74 and £2023.50 a week. Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The evidence used to write this report was gained from a review of the information the provider sent to us since the last visit and the previous inspection report. This information included incident reports and an annual quality assurance assessment. A site visit to the home was made on 29 February 2008. During the visit we spoke with one person who lives in the home and observed other people’s interactions with staff. We received comments from three relatives and a care manager. We spoke with the assistant manager and staff on duty. Following the visit we spoke with the manager by phone. The communal areas of the building were viewed and documents relating to the running of the home were inspected during the visit. What the service does well: There are very good systems to assess people’s needs before they move into the home. This helps to reassure people that the home will be able to meet their needs. Staff support people to make decisions about their lives. Details of the support people need are set out in clear plans, which are regularly reviewed with people. The home provides good support for people to take part in a range of activities they have chosen, to maintain contact with family and friends and to maintain a healthy diet. People’s personal and health care is well met by staff who know their needs. The home is generally well maintained and provides a clean, comfortable and safe environment for people. Staff are well trained and there are good systems to check staff before they work in the home. This helps to keep people safe and ensure staff can meet their needs. The home is well managed and there are good systems to make improvements to the service based on the views of people who live there. Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Stoke Lodge DS0000055569.V357027.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 Stoke Lodge DS0000055569.V357027.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): Standard 2. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are excellent systems to assess people’s needs before they move into the home. This reassures people that the home will be able to meet their needs. EVIDENCE: The manager reported in the annual quality assurance assessment that the company has a referral team based at their head office. Referrals are received from adult services and people’s needs are assessed by the referrals team and the home manager. The assessment process involves visits to the person’s current accommodation, for example family home, school or care home. Information is gained from professionals who are currently supporting the person. The person visits Stoke Lodge several times, including overnight stays. We looked at the records of three people who live in the home. All had a full needs assessment which included communication, personal care, social activities, cultural and spiritual needs and a personal history, including likes and dislikes. The manager reported that on two occasions the assessment process has demonstrated that Stoke Lodge was not the right placement for people and they would not be able to meet their needs. Identifying this before the person moved into the home prevented the service breaking down at a later date. One survey was received from a care manager, who reported that Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 9 the home’s assessment arrangements always ensure that accurate information is gathered and the right service is planned. Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 10 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): Standards 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are clear care planning and risk assessment systems, which involve people in making decisions about their lives and helps staff to provide the support that people need. EVIDENCE: We looked at the records of three people who live in the home during the visit. People had a care plan, which set out how their assessed needs should be met. The care plans seen contained detailed information about how staff should provide support to meet people’s different needs, for example detailed information about communication and how to support people when they are anxious and aggressive. All three relatives who completed a survey for us felt the home meets people’s individual needs. Plans are formally reviewed every six months and there was evidence that plans had been amended where people’s needs have changed. Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 11 Details of how people should be supported to make decisions are set out in the care plans. One person spoken with said they were able to make decisions about their activities and felt well supported by staff. Risk assessments have been completed for all people living in the home and include clear information about how to minimise the identified hazards, including the effects of people’s challenging behaviour. These assessments are reviewed as part of the care planning meetings and had been amended where assessed as necessary. Evidence was also seen of the assessments being reviewed following incidents; for example, one was reviewed by a psychologist following an incident of challenging behaviour to assess whether the guidelines in place were still applicable. Staff spoken with demonstrated a good understanding of people’s needs and the importance of supporting people to make decisions about their lives. Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 12 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): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good support for people to take part in a range of activities they have chosen, to maintain contact with family and friends and to maintain a healthy diet. EVIDENCE: People are supported to take part in a structured programme of communitybased activities, with a day services co-ordinator employed in the home. People have an individual programme of activities, which is based on their needs and wishes. There is a heated ‘summerhouse’ in the garden, which is used for the home-based activities. This provides a separate area, away from the domestic areas that people can use to concentrate on their activities. Activities include college courses, swimming, bowling, art and computer work. The home has a chef, who is also responsible for providing individual cooking sessions for people. One relative commented that “day services and activities are well organised and my son is able to take part in lots of things.” One person spoken with said he keeps very busy with activities he enjoys. The Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 13 home is aware of peoples spiritual needs and people are supported to practise their religion. People are supported to maintain contact with their friends and family, with staff providing support for people to visit family where necessary. Three relatives completed a survey for us. All said they are always kept up to date with important issues affecting their relative. People are able to lock their bedrooms and staff were observed asking permission to enter people’s bedrooms. Staff spoken with demonstrated a good understanding of people’s rights. People are supported to plan a weekly menu, with help from staff to provide a balanced diet. People are encouraged to take part in meal preparation. Mealtimes are flexible to fit round activities and snacks are available at any time. People spoken with said they liked the food. One person follows a specific diet for medical reasons. Details of this diet are clearly available and staff demonstrated a good understanding of the person’s needs. Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 14 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): Standards 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s personal and health care is well met by staff who know their needs. There is a good system to safely store and administer people’s medication, although this would be improved by more consistent record keeping. EVIDENCE: Care plans contain details of the personal care support people need and how it should be provided. One person spoken with said staff treat them well and provide the support they need. All three relatives who completed a survey for us said the home provides the support and care that their relative expected. The care manager who completed a survey for us said staff always respected people’s privacy and dignity. People are supported to attend a range of health services, including GP, nurse, dentist, chiropodist and optician. Details of consultations are recorded, including any advice given by the practitioner. Medication is securely stored in a locked cabinet in the office and most tablets are supplied in a monitored dosage system. A record is kept of medication Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 15 coming into the home and returned to the pharmacist for disposal. The medication administration record for the current month was inspected and there were several gaps where staff had not signed to indicate they had administered the medication. Because the home operates a system where two members of staff sign the records, one to administer the medication and one as a witness, it was clear that people had received their medication as it had been prescribed as the witness had signed the record. The assistant manager reported that they were aware of the problems of recording and were taking this up with individual members of staff concerned. All staff administering medication have received training. None of the people who live in the home are currently able to administer their own medication. Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 16 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): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems for dealing with complaints and responding to allegations of abuse. This gives people confidence that any complaints will be taken seriously and responded to EVIDENCE: The home has a complaints procedure, which is provided to all people living at the home. Since the last inspection the manager has started work to provide the complaints procedure in a more accessible format for people who live at the home, developing it on video format with Makaton sign language. One person spoken with during the visit said they would speak to staff if they wanted to complain and were confident that any complaint would be taken seriously. All three relatives who completed a survey for us said they know how to make a complaint and the home has always responded appropriately to any concerns they have raised. The home has received two complaints in the last year, both from neighbours concerning noise. The complaints have been recorded, including the action taken by the manager to respond to the complainant. Information was provided in team and service user meetings about actions to take to minimise the disruption to the neighbours. Staff have completed training in safeguarding adults procedures. Staff spoken with demonstrated a good understanding of the action they should take if abuse is witnessed, reported or suspected. There is a policy and procedure on safeguarding adults and the prevention of abuse. A recommendation was made at the last inspection that the home should develop safeguarding Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 17 children procedures, as people who are under 18 sometimes use the service. The manager reported that these procedures have now been developed. All of the people currently using the service are over 18, however, the manager reported they have received a referral for a person who is under 18 and they are currently assessing whether they would be able to meet their needs. Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 18 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): Standards 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 is generally well maintained and provides a clean, comfortable and safe environment for people. EVIDENCE: All of the home’s communal areas were viewed during the visit. The home is generally well maintained and there are plans to redecorate the lounge and dining room and lay new flooring that is more appropriate to people’s needs. Minutes of service users meetings demonstrated that people had been involved in decisions about décor. People living in the home have access to a lounge, dining room and quiet room. There is a planned maintenance and renewal programme and staff reported that maintenance issues are usually resolved quickly. There is a bathroom on both floors and all of the rooms has an ensuite. There is a large, well-maintained garden to the rear of the home, with a Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 19 trampoline and seating area. People have been supported to create a sensory garden. The home has a separate laundry room, with equipment capable of safely washing soiled items. There are infection control procedures in place and personal protective clothing is available for staff. Hand washing facilities are suitably situated in the kitchen, laundry, toilets and bathrooms. Since the last inspection the home has employed a cleaner and staff reported this has made a big difference to the cleanliness of the home. Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 20 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): Standards 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are well trained and there are good systems to check staff before they work in the home. This helps to keep people safe and ensure staff can meet their needs. EVIDENCE: The manager reported in the annual quality assurance assessment that nine of the eighteen support staff have achieved the National Vocational Qualification (NVQ) at level 2 or above and one is currently completing the award. Staff members were observed spending time listening to people who live in the home. All three relatives who completed a survey said staff had the right skills and experience to meet people’s needs. One person was spoken with and said they felt there were enough staff to provide the support they need. Staff spoken with said they felt there were sufficient staff on each shift to provide the support that people need. The manager reported in the annual quality assurance assessment that all staff that have worked in the home over the last twelve months have had Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 21 satisfactory pre-employment checks. The files of four members of staff were inspected. All had written references on file and confirmation that a Criminal Records Bureau (CRB) disclosure had been obtained. The home has an on-going training programme and staff reported that they receive good training, which helps them meet people’s needs. Staff training records indicated people had completed an induction and courses including medication administration, first aid, safeguarding adults, food hygiene, moving and handling, challenging behaviour, strategies for crisis intervention and prevention, effective communication, epilepsy, autism and fire safety. The manager has identified where there are gaps in people’s training and planned courses throughout the year. Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 22 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): Standards 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, which helps to keep people safe and there are good systems to make improvements to the service based on the views of people who live there. EVIDENCE: The manager has been in post since September 2007 and has completed the registration process with us. The manager has completed the National Vocational Qualification in management at level 4 and a City and Guilds foundation in care management. Staff spoken with said they thought the manager was supportive. Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 23 A senior manager from CHOICE Ltd visits the home every month to assess the quality of the service that is being provided. Reports of these visits are made and sent to the manager. The reports contain a list of any actions that are needed and an update of actions that were required in the previous report. The home completes an annual survey of people who live in the home, staff and other stakeholders, for example GPs and care managers. The responses to these surveys are collated and used to plan improvements to the service. The home has an annual action plan, with specific objectives to improve the service provided. The dates on the action plan are monitored during the monthly visits by a senior manager. The manager reported in the annual quality assurance assessment that the electrical system, fire detection and fighting equipment and gas system are regularly serviced and maintained. These records were sampled during the visit and confirmed the manager’s report. Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 24 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 X 2 4 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 3 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 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 25 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. Refer to Standard Good Practice Recommendations Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Stoke Lodge DS0000055569.V357027.R01.S.doc Version 5.2 Page 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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