Care Home: Wellington Lodge

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What the care home does well A resident praised the support that they received from staff saying that it was "good, excellent, includes everyone (everyone working in the home)". They thought that the home provided "good counselling". Another resident said that they received good support from everyone working in the home "even the office staff are helpful" and that there was a family atmosphere in the home. Residents also commented on the housekeeping services in the home and said that they were happy with their individual rooms and praised the meals served. There was a sense of purpose throughout the day and the structure of the daily timetable supported residents working through the 12-step programme. Counsellors were approachable and all members of staff in the home were committed to their work and enthusiastic. The genuine feeling of care was evident when an ex-resident telephoned the home and was given practical advice and support. Although there are rules in the home these were known to residents. The reasons behind them were understood and accepted. Within this framework residents were encouraged to become more confident of their abilities and this was part of each day`s philosophy. The service is primarily one of rehabilitation for people that have misused drugs or alcohol and want to follow a life of abstinence in the future. However, during their stay at Wellington Lodge the whole person is important and where necessary, the resident is encouraged to deal with any health care problems that they have. What has improved since the last inspection? The new rooms on the second floor in the loft extension have now been furnished and are in use. These rooms (2) are for the use of residents and increase the communal areas available in the home. One room can be used for holding meetings and so there is now a meetings room on the first floor and on the second floor. This enables different groups to have meetings at the same time. The other room is an IT suite where there is space for a resident to work privately or for someone to sit with a resident and help the resident to improve their IT skills, either for private or business use. New carpets have been laid throughout the home and the choice of colour, a biscuit shade, is more practical for hallway, stairs and landing. The new carpets give the home a bright and welcoming appearance for residents to enjoy. Communal areas and most of the bedrooms have been redecorated so that residents can benefit from fresh and attractive surroundings. CARE HOME ADULTS 18-65 Wellington Lodge 47 Wellington Road Hatch End Middlesex HA5 4NF Lead Inspector Julie Schofield Key Unannounced Inspection 14th May 2008 08:40 Wellington Lodge DS0000065106.V364375.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 Wellington Lodge DS0000065106.V364375.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. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wellington Lodge Address 47 Wellington Road Hatch End Middlesex HA5 4NF 020 8421 2266 F/P 020 8421 2266 info@wellingtonlodge.org 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) Forini Limited Manager post vacant Care Home 15 Category(ies) of Past or present alcohol dependence (15), Past or registration, with number present drug dependence (15) of places Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Past or present drug dependence 2. - Code D Past or present alcohol dependence - Code A The maximum number of service users who can be accommodated is: 15 29th August 2007 Date of last inspection Brief Description of the Service: Wellington Lodge is a registered care home that offers residential second-stage treatment to 15 adults aged 18 to 65 years who are recovering from drug/alcohol addiction. It can also offer a medicated withdrawal from alcohol service. Structured therapeutic programmes are offered to residents for between 6 and 24-week periods. The aim of these programmes is to assist residents in their recovery from drug/alcohol abuse, maintain their long term abstinence and reintegration back into the community. There was no Registered Manager at the time of the inspection. The Registered Provider is Forino Limited and the Responsible Individual is Mrs Ciara Aylett. The care home is located on a quiet road in Hatch End. It is close to community recreational, shopping, leisure and transport facilities. The care home is a large detached property that offers 11 single and 2 double bedrooms to residents. Bedrooms, lounges, bathing and toilet facilities are situated on both floors of the house. There are two rooms in a loft conversion for the use of residents. There are patio doors leading from the lounge on the ground floor to the garden area. On the day of the inspection 3 residents were accommodated in the home. Information about the service can be provided, on request, from the home. Details of the fees charged for the service were not available in the home. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 5 Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 6 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 inspection took place on a Wednesday in May. The inspection started at 8.40am and finished at 4.30pm. During the inspection we spoke with members of staff, counsellors and with 2 of the 3 residents. Records were examined and the care of each of residents was case tracked. A tour of the building took place and compliance with the statutory requirements identified during the previous key inspection in August 2007 was checked. We would like to thank everyone for their assistance and for their comments during the inspection. As part of this inspection we carried out a special survey regarding safeguarding adults. The CSCI has asked all Inspectors to gather information about safeguarding during inspections carried out within a 2-week period in May. We gathered information by asking the manger, members of staff and residents specific questions and we looked at certain records and policies. The information gathered has been recorded and will be analysed centrally so that, if necessary, the CSCI can make recommendations to improve practices in respect of safeguarding adults. What the service does well: A resident praised the support that they received from staff saying that it was “good, excellent, includes everyone (everyone working in the home)”. They thought that the home provided “good counselling”. Another resident said that they received good support from everyone working in the home “even the office staff are helpful” and that there was a family atmosphere in the home. Residents also commented on the housekeeping services in the home and said that they were happy with their individual rooms and praised the meals served. There was a sense of purpose throughout the day and the structure of the daily timetable supported residents working through the 12-step programme. Counsellors were approachable and all members of staff in the home were committed to their work and enthusiastic. The genuine feeling of care was evident when an ex-resident telephoned the home and was given practical Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 7 advice and support. Although there are rules in the home these were known to residents. The reasons behind them were understood and accepted. Within this framework residents were encouraged to become more confident of their abilities and this was part of each day’s philosophy. The service is primarily one of rehabilitation for people that have misused drugs or alcohol and want to follow a life of abstinence in the future. However, during their stay at Wellington Lodge the whole person is important and where necessary, the resident is encouraged to deal with any health care problems that they have. What has improved since the last inspection? What they could do better: In order to ensure that all information given to the home is noted and can be verified during the assessment process a written record needs to be kept of the content of a telephone referral. This would assist the home to determine whether the service provided can meet the individual needs of the resident. NVQ training and DANOS accreditation would demonstrate to residents that the members of staff base their ways of working on an understanding of the needs of residents. NVQ training is almost complete and when members of staff have Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 8 been notified that they have been successful they need to then submit their evidence base to gain DANOS accreditation. Although in 2 instances the home has obtained a reference by telephoning the referee when the return of the reference has been outstanding the receipt of a written reference must follow this so that the recruitment process is thorough and protects residents by preventing the employment of unsuitable persons in the home. There is a need to hold regular fire drills so that members of staff and residents accommodated in the home are familiar with the process of safe evacuation from the home. The lack of a registered manager, and manager of the home, has been an ongoing problem since the beginning of 2006 and must be resolved. However, the decision by the Responsible Individual to take on the role of manager and to apply for registration will hopefully provide a satisfactory outcome to the problem and ensure that residents continue to receive continuity of care and an environment where stability underpins the aims and objectives of the service. 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. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 9 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 Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 10 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): 2 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment of the needs of the prospective resident enables the home, and the resident, to decide whether the service can meet the needs of the resident and whether the resident is prepared to give their commitment to the treatment/rehabilitation programme. EVIDENCE: Two of the 3 residents had been admitted to the home since the last key inspection and their case files were examined. Referrals are usually made by telephone and both of the residents were privately funded. There was no record on the file of the content of the initial telephone call. We saw that on the day of admission the nurse prescriber that supports the home completed a psychiatric and medical assessment form and a general assessment form was completed by one of the counsellors. The decision was then taken whether the home could provide the service appropriate to the resident’s needs and if so, the resident remained in the home to start their programme. A member of staff gave an example of how the home declined a referral when it was thought Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 11 that the service offered by the home and the needs of the prospective resident did not match. Both assessment forms required information from the prospective resident and the general assessment form included questions regarding sexuality, disability and ethnicity. On admission the resident signed a number of agreements in respect of any restrictions on choice, freedom and services or facilities. These were present on both of the case files and included a therapeutic contract, reasons for instant discharge document, a confidentiality document and an agreement to voluntary testing form. They had all been signed and dated by the resident. When a prospective resident needed a medicated withdrawal from alcohol service, prior to starting their rehabilitation programme, this was clearly set out with details of the medication involved. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 12 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, 7, 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Comprehensive care plans have been drawn up for each resident so that the service provided can meet the individual needs of the resident. The treatment programme gives residents the confidence and skills to make choices about their lifestyle both for the present and in the future. Responsible risk taking contributes towards the resident leading an independent lifestyle and reviewing these ensures that the changing needs of residents are identified and addressed. EVIDENCE: A resident confirmed that they had been involved in the formulation of their care plan and that they had signed the completed care plan. They said that it had been drawn up over 2 days. Each file examined contained a care and Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 13 support plan. These were signed and dated by the resident and a counsellor. Support issues were identified and included health, abstinence, aspirations, cultural needs, emotional needs and religious needs. Each issue identified the support needed, action required, goals established, assignment ideas and desired outcome. Each file contained a number of documents, signed by the resident, which related to restrictions or agreements that form part of the programme. Care plans were evaluated every 2 weeks and each evaluation reviewed the progress in keeping to the care plan. A resident told us that after completing the care plan “2 weeks later it was back to the care plan”. If issues had been identified, the action or help needed was detailed and the date when matters had been resolved was recorded. Files also contained a general care plan relating to Wellington Lodge. Goals included being rested and able to commit to and concentrate on the treatment programme. Each resident has their own allocated counsellor. Residents are encouraged, through meetings and through counselling sessions to make decisions about their future life, first by recognising and facing the implications of their lifestyle, prior to admission to the home. During the time spent at Wellington Lodge residents are given support on how to achieve the changes necessary in their lives to maintain their decision about commitment to abstinence. Residents take part in fellowship meetings as part of their agreement on admission to the home. Each resident manages their own finances and they are advised that they will only need to bring a small amount of money with them for personal expenses. Although the home is not directly involved in residents’ finances they have in the past tried to assist residents in sorting out entitlement to benefits on leaving Wellington Lodge. On each of the residents’ case files was a general risk assessment that was completed shortly after admission. The risk assessments were signed and dated and covered areas including physical health, mental health, personal safety and literacy. They include risk management strategies and the risk assessments are kept under review. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 14 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, 13, 14, 15, 16, 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The treatment programme provides residents with the opportunity to make changes in their lifestyles and to prepare them for living independently in the community again. Residents are able to maintain contact with friends and family members who are supportive of the resident’s desire to change. Residents are offered a balanced diet to promote their physical health and well-being. EVIDENCE: The home offers a service based on the 12 Steps treatment programme and residents are able to undertake this over a varying number of weeks, depending on their individual needs. Residents referred to the reading Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 15 material that accompanied the 12 Step Programme and a resident said that they had read “many, many sections”. The weekly timetable is part of a rolling programme so that residents may join the home at any time. At the start of the inspection the residents had already started the day’s timetable and were taking part in a meditation session. Residents find this a helpful start to the day and a resident that had a weekend at home recently described how they had started the morning at home with meditation. This continued the momentum of their rehabilitation programme as they incorporated a new structure into their daily routine. We saw a copy of the timetable for the current week and it included meetings, counselling sessions, shiatsu, working on assignments, activities, therapeutic duties and information/discussion sessions on topics including health awareness, relapse prevention and harm minimisation. The new IT suite on the second floor gives residents the opportunity to develop IT skills. A condition of the placement and forming part of the weekly timetable is the need for residents to attend fellowship meetings in the community. These usually take place in the evenings. Residents attend these meetings several times a week and often travel there by taxi. Residents use some facilities in the community although agree not to leave the home without permission. At the end of the inspection one of the residents and one of the counsellors were returning to the home after visiting the local shops. Residents do have time to relax during the evenings although some time may be spent working on assignments, reading or attending fellowship meetings. At the weekend there is time to watch some television or to receive visits or to contact family and friends by telephone. Each resident agrees to and signs a therapeutic contract as part of the admission procedure to the home. The resident agrees that for the first 7 to 10 days after their admission to the home there will be no telephone calls, visitors or outings. After this period there are opportunities for residents to have contact with family and friends that will support the resident in their aim to come to terms with and to control their addiction. Residents agree not to leave the building unless it is with the permission of the counsellor and agree that only visitors approved by the counsellor may call during the weekend. Contact with people that might discourage the resident is prohibited. A section of the handbook was headed “Visitors and Going Out”. A resident said that they were looking forward to gradually going out and staying over. Acceptance of restrictions is part of the early stages of the treatment programme although the promotion of independence, choice and freedom of movement is included in the latter stages as preparation for leaving the home. A resident told us that they were given a copy of the resident’s handbook. This gave information about “the rules”, which the resident accepted as part of the conditions of their admission to the home. The residents saw the rules as Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 16 reasonable. Part of the expectation of living in the home was residents taking responsibility for keeping their surroundings clean and tidy and residents told us what “therapeutic duties” entailed. With only a few residents they were able to volunteer for certain tasks rather than there being a need for a formal rota. Residents had suggested that they would like to help with the garden and a resident said that they had planted a herb garden. Members of staff and residents are subject to random drug or alcohol tests. The counsellor requesting a resident to provide a breath or urine sample is the same gender as the resident to respect the dignity of the resident. An important part of the rehabilitation process is starting to eat again and to build up the body’s strength. Healthy eating patterns are encouraged and the emphasis is on good food that can be prepared without too much time or fuss. A member of staff said that the menus used in the home were based on the Drugs and Alcohol Toolkit Menu and included omega 3 oils, white meat and plenty of fresh vegetables and fruit. During the inspection a lunch of cold turkey and ham, salad, coleslaw, potato salad and vine tomatoes was prepared. We were told that the evening meal would consist of pan-fried salmon with a honey and soya sauce, minted new potatoes and peas. A member of staff said that vegetarian options are available and that previously the home has catered for diabetic residents. He also said that culturally appropriate meals have been prepared for Muslim and for African-Caribbean residents. We discussed the food that had been prepared and what ingredients had been necessary and where these could be purchased. A resident said that the home offered good home cooking and that the resident’s appetite was now very good. They said that fish was on the menu 3 times in the week and that “it was heaven for me”. They added that the member of staff that prepared the food “made the best soups”. Another resident also praised the food served in the home and said that had put weight on. They added that enough food was prepared so that if a resident wanted to have a second helping the food was available. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 17 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, 19, 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to develop the skills to take control of their lives through the support of a team of staff. Residents’ health care needs are met through access to health care services in the community. Residents’ general health and well-being is promoted by staff that assist the residents to take prescribed medication. EVIDENCE: The current residents are self-caring although members of staff may need to encourage some residents admitted to the home to regain their self-esteem and to take pride in their appearance. Residents are encouraged to keep regular hours as the 12 Step programme provides a structure and timetable for their day. Counsellors and therapists provide specialist support, as part of the programme. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 18 During the medicated withdrawal from alcohol period of the placement residents confirmed that they were regularly checked, during the day and the night, and found this to be supportive. There was evidence on file that the nurse that carried out the psychiatric and medical assessment, prior to admission, continues to meet residents on a regular basis to assess their progress and to offer support. Notes of these meetings are kept on the resident’s case file. One resident that had stayed in the home for an extended placement had records of an appointment with the optician and a prescription for glasses. There was also a record of a hospital appointment for a minor ailment. The home offers a medicated withdrawal from alcohol service and the Responsible Individual confirmed that members of staff received medication management training in February 2008 from a nurse prescriber that specialises with clients that have drug or alcohol addictions. Members of staff had previously received general medication training in September 2007. When examining case files we saw that the psychiatrist had carried out a medication review for one of the residents. The storage of medication was secure and records were up to date and complete. Medication is taken from the bottle etc and a resident’s medication is kept together on one part of the shelf. However when a member of staff took one item of medication from a shelf it needed to be replaced elsewhere as it was closer to one of the other resident’s store. A named box would be helpful to stop medication becoming out of place. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 19 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, 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are aware of their right to complain if the care that they receive is not satisfactory. An adult protection policy and protection of vulnerable adults training for staff contribute towards the safety of residents. EVIDENCE: Residents confirmed that they were given a handbook on admission to the home. We saw a copy of this and noted that it contained a summary of the complaints procedure. The summary included an explanation of the various steps in the process, with timescales attached. It referred to the CSCI and noted the address of the local office but did not include the telephone number of the local office. Since the last key inspection one complaint has been received by the home. It was not upheld. The Responsible Individual provided the CSCI with a copy of the response sent to the complainant after the investigation had been completed. Community meetings take place each week and a resident said that if they had a concern or complaint they could raise this at the meeting. They said that everyone was given an opportunity to raise matters of concern. Another resident said that the daily diary sheets were also an opportunity to record concerns and that these were then discussed with the counsellors. Residents Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 20 were confident that they knew what to do if they had a complaint and confident about speaking out. A member of staff said that since the last inspection no allegations or incidents of abuse have been recorded. Staff receive training in the protection of vulnerable adults and receive a whistle blowing policy overview during their induction training. These topics formed module 5 of a 6-module induction training programme. We spoke with members of staff and they were familiar with safeguarding but the first examples given related to child protection issues. When families visited residents in the home this sometimes included young children and staff were aware of their duty of care and had received child protection training in September 2007. When discussing types of abuse in connection with adults members of staff gave examples of neglect, physical abuse, verbal, sexual, financial and emotional abuse. Members of staff confirmed that they had received training in protection of vulnerable adults procedures. They were familiar with whistle blowing and were able to explain what their responsibilities were in the event of an incident of abuse or a disclosure being made. They each said that they would speak to the manager or to the Responsible Individual. They knew of the existence of a policy within the home on safeguarding adults and also linked their knowledge about safeguarding to their NVQ training. Staff said that they had read the policy. A copy of the local authority’s interagency guidelines is available in the home. A resident said that they were made aware of safe guarding issues and gave an example of residents not being able to mix in another resident’s bedroom if they were of the opposite sex. When asked if they knew who to speak to if they felt unsafe or if something had happened that they didn’t feel comfortable about they said that they would talk to one of the members of staff (and gave their name) or to their counsellor. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 21 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, 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a home, which is comfortably furnished and provides a pleasing environment in which they can relax and enjoy themselves. Good standards of cleanliness provide residents with hygienic surroundings. EVIDENCE: During the inspection a site visit took place and we began by seeing the loft conversion, where 2 new rooms have been created. One is used as a meeting room for residents and the other is an IT suite, also for the use of residents. Both rooms are spacious and are light and airy. There are toilet and bathing facilities and bedrooms on both ground and first floors. The staff room and a meeting room are also situated on the first floor and there is an office and a laundry room on the ground floor. Since the last key inspection new carpet Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 22 has been laid in the hall, on the stairs, along the corridors and landing. Most of the bedrooms have been re-carpeted although the two shared rooms have laminated flooring. All the communal areas and most of the bedrooms have been redecorated. The home has a maintenance programme that includes redecoration and refurbishment on a regular basis. A resident said that their room was OK and that it was clean and tidy. They said that they made sure that the communal areas were also kept clean. Another resident said that it was homely in Wellington Lodge and that had been a pleasant surprise. They said that their room was comfortable. They pointed to an attractive lamp and said that the lights were kept on in the lounge during the night. The resident found this comforting, particularly during the initial period after their admission when occasionally they woke up during the night and came downstairs. It was noted during the site visit that all areas of the home inspected were clean and tidy and free from offensive odours. Laundry facilities are sited on the ground floor and do not involve carrying laundry through any areas where food is stored, prepared or consumed. A member of staff confirmed that staff received training in respect of infection control procedures. We saw that this topic was part of module 3 in the induction training programme for members of staff. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 23 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, 33, 34, 35 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Members of staff need NVQ training and DANOS accredited training to assure residents and to demonstrate that care practices are based on an understanding of the residents needs. The rota demonstrated that there were sufficient staff on duty to support the residents and to meet their needs. Recruitment practices lacked obtaining 2 written references for each member of staff and this compromises the safety and welfare of the residents. Residents benefit from support given by members of staff that are skilled and trained. EVIDENCE: A discussion took place with a member of staff regarding training. He confirmed that 6 members of staff (including the 2 counsellors) had almost completed their NVQ level 3 training. The Responsible Individual said that she expected the staff to complete their training next month. The NVQ Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 24 qualification provides the evidence base for the DANOS accreditation as it confirms compliance with the standards. Training for support workers includes familiarisation with the “12 Step Approach”. Therapists and counsellors are appropriately trained and qualified. Staffing levels partly depend on the number of residents accommodated. The number of support staff on the rota will reflect the number of residents and a member of staff said that the home hoped to recruit some “bank” staff to give more flexibility. The number of counsellors remains constant and the therapists employed in the home depend on the therapies included in the timetable. At the time of the inspection the ratio of members of staff to residents was very good. Health care support is also available when needed. There are systems in place that when a resident is undertaking a medicated withdrawal from alcohol the nurse prescriber visits the resident every 2 to 3 hours to check on their progress and there is a consultant psychiatrist on call. We examined 4 staff files. Two of these belonged to newly appointed office staff, one belonged to a newly appointed counsellor and the fourth file belonged to an alternative therapist. We saw that each file contained an enhanced CRB disclosure, proof of identity (passport details or driving licence with a photograph) and an application form for the counsellor and office staff. There were 2 satisfactory written references for the counsellor and therapist but only 1 written reference for each of the two office staff. The Responsible Individual supplied details of a telephone reference for each of the office staff and an email confirmation by the referees that they had been approached for a reference after the inspection. We noted that the counsellor had a Level 4 Diploma in Therapeutic Counselling and the therapist had a certificate for Shiatsu-Do and 1 credit at Level 2 and 2 credits at Level 3 in “Complementary Healthcare Practice with Substance Misusers”. The therapist had an insurance certificate (as a member of the Shiatsu Society). We discussed training opportunities with a member of staff. They confirmed that in addition to the current NVQ training and working towards DANOS accreditation they had also had training in child protection, medication and drug awareness. Staff have also attended training in safe working practices both as part of an initial induction programme and as “refresher” training. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 25 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, 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The appointment and registration of a manager would assure residents of the maintenance of good standards of care in the home. Information gained through quality assurance systems is used to shape the future development of the service and ensure that the needs of residents continue to be met. Training in safe working practice topics enables members of staff to safeguard the health, safety and welfare of the residents. Regular servicing and checking of all equipment and systems used in the home ensure that items are in working order and safe to use. To assure residents, staff and visitors to the home that in the event of the fire alarm sounding a safe evacuation of the home would ensue, regular fire drills are needed. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 26 EVIDENCE: Shortly after the home was opened the registered manager resigned. Since December 2005 there has been no registered manager in post although 3 people have been appointed as the manager. These people applied to be registered and then withdrew their applications before the process was complete. A statutory requirement was made during the previous key inspection that the registered person must ensure that the newly appointed manager successfully completes their application for registration with the CSCI. At the time of the inspection the manager referred to in the requirement had left and the post of manager was vacant. A discussion took place with the Responsible Individual. After seeking advice from the Regional Registration Team she contacted us to confirm that she will take over the manager’s post (which she has previously covered on a temporary basis until a new manager was appointed) and apply for registration. Subject to her application for registration being approved she will then resign as the Responsible Individual and an appointment will be made to this post. The Responsible Individual has already commenced NVQ level 4 training and has experience with the client group. She has also attended conferences and working groups to keep up to date with new developments in this field and takes an active part in the running of the home. She is assisted in the home by a competent staff team and so we are satisfied with the interim arrangements in place. Previously the Responsible Individual said that they ask for verbal feedback from the referral agency after the placement has ended and from any after care teams that the resident may have contact with. She said that the home is developing a feedback questionnaire for residents to complete immediately prior to their discharge, at the end of the placement. During the inspection residents also gave their opinions on the quality of the service offered by the home. This was not the first experience of support in a residential setting for some of the residents. Feedback from each of the residents was positive. The treatment programme includes house council meetings and residents’ meetings and residents confirmed that these were an opportunity to give feedback. A member of staff said that each day there was a verbal round up of “what could have been done better” and residents could develop their feelings and comments in the daily diary sheets. Policies and procedures are kept under review in the light of specialist advice and the Responsible individual recently attended a meeting where the new UK Guidelines on Clinical Management for Drug Misuse and Dependence were launched. Copies were available in the home. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 27 There was a valid certificate for the servicing/checking/inspection of the electrical installation for the loft conversion, the emergency lighting and fire alarm system, the fire extinguishers and the portable electrical appliances. The Gas Safety Record was current. The testing of the fire alarms was carried out on a weekly basis and records were kept. Records of fire drills were not available. There was evidence that staff had received training in safe working practice topics. There was a fire risk assessment in place. A copy of the Certificate of Employers’ Liability Insurance was available with an expiry date of the 3rd October 2008. Residents were aware of health and safety issues and one resident said that the handbook covered everything that a resident was and was not allowed to do. The resident gave a practical example of not being allowed to wear shorts in the kitchen in case of scalding. A copy of a valid certificate of Employer’s Liability insurance was present in the home. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 28 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 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 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 2 33 3 34 2 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 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 29 YES Are there any outstanding requirements from the last inspection? 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. 1 Standard YA2 Regulation 12(1) Requirement To assure residents that all information provided during the referral process is noted and acted upon a written record must be kept of any referral made by telephone. To assure residents that the ways of working of members of staff is based on current best practice staff must complete their NVQ training and achieve their DANOS accreditation. To assure residents that the home is satisfied as to the authenticity of the reference supplied and of the status of the person supplying the reference, 2 written references for each member of staff must be kept on file. To assure residents that good standards of care will be maintained in the home the new manager (who has been the Responsible Individual up to now) must successfully complete their application for registration with the CSCI. To assure residents and visitors that members of staff will assist DS0000065106.V364375.R01.S.doc Timescale for action 01/07/08 2 YA32 18(1) 01/09/08 3 YA34 19S2(5) 01/07/08 4 YA37 8(1) 01/11/08 5 YA42 23(4) 01/07/08 Wellington Lodge Version 5.2 Page 30 them to safely evacuate the building in the event of the fire alarms sounding, regular fire drills must be held. (Previous timescale of the 1st October 2007 not met). 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 2 3 Refer to Standard YA2 YA20 YA22 Good Practice Recommendations That the person making a telephone referral is asked to confirm the details by following this with a written referral. That each resident’s medication is kept in a named container that is placed on the shelf in the medication cabinet. That the telephone number of the Commission for Social Care Inspection is included in the complaints procedure that forms part of the Client’s Handbook. Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Wellington Lodge DS0000065106.V364375.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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