Care Home: Wesley Lodge

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What the care home does well Prospective residents and their representatives have accurate information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures ensure that prospective residents needs are appropriately identified and met and prospective residents can visit the home prior to residency. Risk assessments are well documented to promote the safety and wellbeing of residents at all times. Residents are consulted about matters which affect their daily lives. Residents have the rights to exercise choice and take part in planned social, spiritual and recreational activities. Residents are supported to maintain bonds with their family and friends. The dining arrangements, menu options and support residents receive during mealtimes promotes their best interests and health and welfare. Residents health care needs are well met. Medication procedures are well managed to ensure that medication is administered to all residents in a safe way at all times. An open culture of raising complaints or concerns is promoted. The physical design and layout of the home enables residents to live in a safe and comfortable environment. Equipment and facilities meet the current needs of the residents and the control of the spread of infection in the home is well managed. The corporate policies and procedures for the recruitment of staff promote residents protection and welfare. Staff receive a structured induction programme and are well supervised in their work. What has improved since the last inspection? This is the first inspection of the care home since the home was granted registration in June 2009. What the care home could do better: Documented contracts or a statement of terms and conditions must be supplied to residents or their representatives in order that they have a clear understanding of what residents can expect regarding their provision of care and accommodation. The documentation of care plans and residents daily records need to be further developed to incorporate a more person centred approach. The process of care plan reviews and recording of the outcomes of reviews needs to be strengthened. Arrangements for improved systems regarding residents rights to confidentiality of their information stored in the home must be improved. The recording of residents health care consultations needs to be reviewed to offer a clear audit trail. Residents rights to privacy and dignity must be upheld at all times. Residents end of life arrangements must be consistently documented in order that their wishes and those of their family are respected and acted upon. Procedures and policies are not readily available in the home to promote the protection of residents from harm and the majority of staff have not received training in the safeguarding of vulnerable adults from harm or abuse. The recruitment and staff training records were not well managed and significant shortfalls in the staff mandatory training programme must be addressed in order to ensure that residents are supported safely. Key inspection report Care homes for adults (18-65 years) Name: Address: Wesley Lodge Wesley Lodge 2 Waverley Close West Molesey Surrey KT8 2NP     The quality rating for this care home is:   one star adequate 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: Suzanne Magnier     Date: 2 5 1 1 2 0 0 9 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 40 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 40 Information about the care home Name of care home: Address: Wesley Lodge Wesley Lodge 2 Waverley Close West Molesey Surrey KT8 2NP 02089418826 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): robert.dibdin@kpct.nhs.uk Kingston Primary Care Trust Name of registered manager (if applicable) Mr Robert Alexander Dibdin Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 8. 1 The registered person may provide the following category/ies of service only: Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection Brief description of the care home Wesley Lodge is a detached single storey property located in a residential area of West Molesey in Surrey. The home has been purpose built in the late 1990s to provide accommodation and nursing care to 8 people who have learning disabilities, severe physical disabilities and a high degree of nursing and personal care needs. The home has been operating as an NHS continuing care service for twelve years and Care Homes for Adults (18-65 years) Page 4 of 40 Over 65 0 8 Brief description of the care home is owned by Kingston Primary Care Trust. The home applied and was granted registration with the Care Quality Commission in June 2009 to provide care and accomodation under the National Minimum Standards for Care Homes for Adults. The homes accommodation consists of a staff office, eight individual bedrooms, a small lounge, and main lounge, an open plan kitchen and dining room, two bathrooms and toilets, a laundry, clinical room, sluice and staff toilet. The home is well equipped with specialist aids including overhead hoisting mechanisms in residents bedrooms, bathrooms and communal areas. All areas of the home are wheelchair accessible and ramps are sited in the home to give residents the opporutunity to access their external enclosed garden and car park. Care Homes for Adults (18-65 years) Page 5 of 40 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: one star adequate 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 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection of the care home was an unannounced Key Inspection and was the first inspection since the home was granted registration on the 5th June 2009. The inspection was carried out by Ms S Magnier Regulation Inspector. The registered manager in charge of the day to day running of the home represented the service throughout the inspection. For the purpose of the report the individuals using the service are referred to as residents. The inspector arrived at the service at 08.00 and was in the home for eight hours. It was a thorough look at how well the service was meeting all the National Minimum Care Homes for Adults (18-65 years) Page 6 of 40 Standards for Younger Adults and within the report judgements have been made about the standard of the service. As part of the inspection the commission requested written surveys from people associated with the home and received four surveys completed on behalf of residents by carers or their significant others, three surveys from health care professionals and twelve surveys from staff. The written comments have been included within the report. The inspector spent time being with and talking to residents and staff in order to gain their views and opinions about the service. The home has submitted an Annual Quality Assurance Assessment AQAA prior to the inspection which gave the commission some detailed information about the home prior to the inspection. Documents sampled during the inspection included the homes Statement of Purpose and Service User Guide. Two residents care and person centred plans and associated risk assessments, the homes medication procedures, several staff recruitment files and training records, several of the services policies and procedures, records related to health and safety, complaints and safeguarding and an escorted tour of the premises was undertaken. No complainant has contacted the commission with information concerning the service since the home was granted registration and no safeguarding referrals have been brought to the attention of the local authority. From the evidence seen by the inspector it is considered that the home provides a service that meets the needs of residents who have diverse religious, racial or cultural needs. The registered manager was not available during the last hour of the inspection and as a result feedback regarding the inspection was given to the registered manager via a telephone call following the completion of the draft report. Care Homes for Adults (18-65 years) Page 7 of 40 What the care home does well: What has improved since the last inspection? What they could do better: Documented contracts or a statement of terms and conditions must be supplied to residents or their representatives in order that they have a clear understanding of what residents can expect regarding their provision of care and accommodation. The documentation of care plans and residents daily records need to be further Care Homes for Adults (18-65 years) Page 8 of 40 developed to incorporate a more person centred approach. The process of care plan reviews and recording of the outcomes of reviews needs to be strengthened. Arrangements for improved systems regarding residents rights to confidentiality of their information stored in the home must be improved. The recording of residents health care consultations needs to be reviewed to offer a clear audit trail. Residents rights to privacy and dignity must be upheld at all times. Residents end of life arrangements must be consistently documented in order that their wishes and those of their family are respected and acted upon. Procedures and policies are not readily available in the home to promote the protection of residents from harm and the majority of staff have not received training in the safeguarding of vulnerable adults from harm or abuse. The recruitment and staff training records were not well managed and significant shortfalls in the staff mandatory training programme must be addressed in order to ensure that residents are supported safely. 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 9 of 40 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 10 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representatives have accurate information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures ensures that prospective residents needs are appropriately identified and met and prospective residents can visit the home prior to residency. Documented contracts or a statement of terms and conditions must be supplied to residents or their representatives in order that they have a clear understanding of what residents can expect regarding their provision of care and accommodation. Evidence: The homes Statement of Purpose and Service user Guide included large print and photographs of the home. The documents included information on the services to be provided and how those services are to be met. These included information on the aims and objectives of the service, staffing structures, facilities and care and social services to be offered in order that any prospective residents or their representatives are informed of what services and facilities the home offers. The registered manager advised that the current Statement of Purpose and Service User Guide will be further Care Homes for Adults (18-65 years) Page 11 of 40 Evidence: improved by more recent photographs of the home. The home have a pre admission and assessment policy and procedure which enables any prospective resident and their representative the time to meet and get to know the home and the other residents prior to moving in. The home have a process to ensure that a prospective residents needs are fully assessed in order that staff can meet the persons needs. The registered manager explained that the home are anticipating a person moving to the home and specific transitional arrangements have been made to suit them regarding their care, support and environmental needs. The registered manager confirmed that the prospective residents family and other health care professionals have been and are fully involved in supporting the persons admission to the home and the ongoing support and care the person requires will be continually monitored to ensure their well being and safety. The AQAA advises that the home will enlist the support of advocates to ensure prospective residents best interests are represented and their rights maintained prior to and during the admission process. During discussion with the registered manager it was confirmed that no evidence was available to support that residents had received a written and costed contract or statement of terms and conditions setting out in detail what is included in the fee, the role and responsibility of the provider and the rights and obligations of the individual. It has been required that arrangements must be made that each resident or their representative are supplied with a contract or statement of terms and conditions which gives a clear understanding of what residents can expect regarding their provision of care and accommodation. Care Homes for Adults (18-65 years) Page 12 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The documentation of care plans and residents daily records need to be further developed to incorporate a more person centred approach. Risk assessments are well documented to promote the safety and wellbeing of residents at all times. Residents are consulted about matters which affect their daily lives. The process of care plan reviews and recording of the outcomes of reviews needs to be strengthened. Arrangements for improved systems regarding residents rights to confidentiality of their information stored in the home must be improved. Evidence: It is acknowledged by the commission that prior to the recent registration of the home that the residents have been residing at the home for several years. The staff team have remained generally consistent and know the residents well and were observed to support the residents in a competent and efficient manner. During the inspection it was noted that the residents have complex physical, medical Care Homes for Adults (18-65 years) Page 13 of 40 Evidence: and communication needs and where possible staff were encouraging residents to take control over their lives through being attentive to the residents physical and emotional demeanour. For example one resident was unwell and had been supported by staff to rest in bed whilst another resident was a receiving a sensory session with a private aide. Residents communication styles were recorded within the care plans and staff were observed to listen to residents and when asked what the residents tone or sound signified the staff member was able to interpret the communication with assurance. The registered manager confirmed that the home is proactive in assuring that residents have a voice about their lives and the care they receive. Contact with advocacy services is promoted in order that residents are involved with and consulted about matters that affect their lives. One written comment from a health care professional regarding what they thought the home could do better was to make the home more of a total communication environment with the further development of a person centred approach and goals to promote greater involvement of service users in day to day decisions about their lives. The registered manager confirmed that this topic was currently being addressed with the multi disciplinary team involved in the home and outcomes for the residents will be assessed during the next key inspection. It was noted during the inspection that staff did not refer to the residents care plans during the course of the inspection. In one care plan there was evidence that a monthly review of some aspects of the residents life had been taken into account yet the reviews offered limited evidence to support that the focus centred on asking what were the changes in the care and support needs, and the progress and achievements in the residents life and limited documented evidence to support what action had been taken by staff to reflect the changes. It has been recommended that the review process of the residents care plans be strengthened to take into account any changes in the care and support of the resident and their progress and achievements which are documented and acted upon in the best interests of the residents. The registered manager confirmed that during the last six months the staff team had made efforts to bring together documented information regarding the care and support needs of the residents which had been developed into individual care plans and risk assessments for each resident. In discussion with the registered manager it was evident that they had a good understanding of the value and importance of appropriate care plans and risk assessments in order to ensure the wellbeing and Care Homes for Adults (18-65 years) Page 14 of 40 Evidence: safety of the residents as far as reasonably practicable. The two person centred plans sampled were well written and easy to understand and gave the reader an insight of the person in comparison with the care plans which were written as a nursing model yet contained complex comprehensive information about the care and support required by the resident and how staff should provide the support and care through documented agreed working practises. The risk assessments sampled within the care plans were well recorded to reflect hazards identified in the residents daily lives which included the residents mobility, moving and handling, medical conditions, eating and drinking and behaviours that may test the service. Where limitations to the residents lives had been identified there was evidence to support that decisions had been made through a multi disciplinary best interests assessment which resulted in implementing the guidance of the deprivation of liberty safeguards in order to ensure the rights and well being of the resident were promoted. There was limited information available to demonstrate that residents or their representatives had been consulted about their care plans and risk assessments and their ongoing development yet the plans sampled had been signed by a staff member. The staff advised that the home has a named nurse and key worker system which allows staff to work on a one to one basis and contribute to the care plan for the resident. It is recommended that residents care plans clearly document if the residents are able or not able to participate in the development of their plan so it is clear to the reader who has developed the plan on behalf of the resident. The daily records written by staff regarding the care and support the residents receive were sampled. The records were written in a respectful manner yet the emphasis was generally on what care and support the resident had received from staff. There was limited documentation on the residents general demeanour, the activities or response to activities or meaningful interactions the resident had expressed. This was discussed with the registered manager who agreed that the records did not embrace a holistic person centred approach and a recommendation has been made that the recording of daily records be reviewed to incorporate a more person centred approach which reflects the demeanour and communicative interactions of residents in their daily lives. During the inspection it was noted that residents records were stored in the homes office. Some residents records were stored openly on shelves and others left on the desktops. Several staff when asked advised that residents records were not locked Care Homes for Adults (18-65 years) Page 15 of 40 Evidence: away as the staff records were. The homes confidentiality policy and procedure was sampled. It is acknowledged that the office door has a key pad system for entry yet it was observed that the door was kept open throughout the inspection. It has been required that further arrangements must be made for the safe storage of residents records to comply with promoting residents rights to privacy and confidentiality. Staff were confident to talk with the inspector about their roles and responsibilities and it was evident that they were motivated in the ongoing improvement of the service for the benefit of the residents. Care Homes for Adults (18-65 years) Page 16 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the rights to exercise choice and take part in planned social, spiritual and recreational activities. Residents are supported to maintain bonds with their family and friends. The dining arrangements, menu options and support residents receive during mealtimes promotes residents best interests and their health and welfare. Evidence: The routines of the home were flexible to offer residents some choice throughout their morning routine and it was observed that staff were observant and attentive and listened to residents throughout the day. One residents relatives had engaged the services of a personal aide for the resident and some of the duties included massage and physical exercises. The resident was observed to be calm and comfortable during the sessions and was supported in a dignified, efficient and safe manner by the personal aide. The homes staff were Care Homes for Adults (18-65 years) Page 17 of 40 Evidence: observed to consult with and offer any assistance to the residents personal aide in order to promote the best interests of the resident receiving support. The AQAA advises that the home have employed an activities organiser who works with the staff team in providing an individual plan of activities for each resident. It was evidenced through observation, sampling two care plans and the activities plan that the homes staff have made a effort to research and provide residents with fulfilling programmes of interests and activities. During the inspection the residents were visited in the afternoon by an interactive communication activity group who the residents clearly engaged with and enjoyed their session. As previously documented the residents person centred plans were well documented and gave the reader an insight into the residents life and contained well documented evidence of how the resident communicated in their own way. The daily records and care plan reviews did not fully detail the responses of residents to activities or meaningful interactions which could assist staff in further developing and focusing on activities which residents have shown an interest with and respond positively to. Whilst sampling the two care plans it was noted that the residents abilities and skills were recorded yet there was limited evidence that their skills and abilities were being monitored in order to be maintained and developed on a daily basis to offer the residents opportunities for change and personal growth. It has been required that arrangements must be made to made to maintain and promote residents skills and abilities to take into account their wishes and feelings. Within one residents care plan their weekly activities were recorded which included aromatherapy, physiotherapy, mobility, hydrotherapy, attendance to a Club, Get up and Go, going to church and spending time with their family. The registered manager confirmed that the home has an open door policy of visiting and residents family and friends were always welcomed into the home. The registered manager advised that staff have supported residents to become part of their local church fellowship and church members have taken an active interest in the home which has offered residents more interaction with their local community and an opportunity to make new friends. Twelve written surveys received from staff included comments regarding the homes activities which stated we give our residents every opportunity both at home and on outings to all sorts of activities eg theatre, cinema, going to the coast, going shopping for food, clothes and toiletries, visiting restaurants for dinning as well as tea and coffee and using a hydrotherapy pool. The home could improve by taking service users out more. More financial resources would enable the residents to lead an above Care Homes for Adults (18-65 years) Page 18 of 40 Evidence: average lifestyle for example more luxuries like a foreign holiday. Whilst touring the premises it was noted that the home has two lounges. The small lounge contained a music centre, sofas and some large exercise mattresses. The registered manager confirmed that the lounge was no being used to its full potential and thought had be given to using the space more effectively for residents to use as a sensory resource. The registered manager advised that several residents enjoyed listening and observing birds and that arrangements were being considered to develop a water feature in an area of the garden which residents could access easily through the small lounge to offer more additional interest and stimulation to residents in their home. Four written comments received by the commission which had been written on behalf of the resident by their relatives, advocates or staff included that there was good basic care, that various activities are organised and that residents are treated with respect and taken out in the homes vehicle to different places by the carers. One written comment from a health care professional included that the location of Wesley Lodge means that it is rather isolated from other local services and also the local community. Staff have worked very hard to engage with local activities e.g. regular attendance at church for some service users but potential isolation is an issue. Use of advocates to ensure that service users have a voice is being developed. Areas where improvements could be made included the provision of physiotherapy, a better diet selection, getting out more and better communication. The homes weekly menu was sampled and staff had made some effort to provide colourful pictures on the menus to make the menus more stimulating for residents to see. The care plans sampled included evidence of what food residents liked or disliked and where specific diets had been agreed by specialists the meals had been specifically designed to meet the residents medical requirements. It was confirmed that residents have received support and advice from the local authority dietitian and the home strives to improve their provision of healthy eating options to promote residents health and well being by ensuring the supply of a nutritious, varied and balanced diet. The homes dining area was observed as spacious with furniture that consisted of three solid wood tables and wooden chairs. The kitchen and dining area has a small partition which would not enable residents full access to their kitchen. This was discussed with the registered manager who confirmed that residents are supported to use the kitchen with staff in compliance with the homes kitchen risk assessment in order to ensure the Care Homes for Adults (18-65 years) Page 19 of 40 Evidence: safety and well being of residents. The staff confirmed that residents have their meals in their own adapted chairs to offer them comfort and safety whilst having their meals. It was observed that fresh fruit was available in the home and the fridge, freezer and cupboards in the kitchen contained a good quantity of food. The registered manager explained that residents do participate with the food shopping of the home yet sometimes found the experience of visiting the large supermarket an ordeal which was not always a positive experience for the resident. The registered manager raised an option of on line shopping which would save on staff resources to enable staff to have more one to one time with residents to engage with them in potentially more meaningful activities. It was observed that food in the homes fridge was generally stored in compliance with food safety standards yet it was observed that some foodstuff had not been labelled after opening. This shortfall was promptly recognised and rectified by staff. The homes staff are reminded that food must be stored in compliance with the current food safety standards in order to ensure the well being and welfare of all persons in the home. Care Homes for Adults (18-65 years) Page 20 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health care needs are well met. The recording of residents health care consultations needs to be reviewed to offer a clear audit trail. Residents rights to privacy and dignity must be upheld at all times. Medication procedures are well managed to ensure that medication is administered to all residents in a safe way at all times. Residents end of life arrangements must be consistently documented in order that their wishes and those of their family are respected and acted upon. Evidence: The two care plans sampled evidenced that the residents have access to and receive a health care service both within the home and the local community. Documents sampled evidenced that the residents general practitioner, who visits on a weekly basis, and other health care professionals including consultations with the nurses, dentist, occupational therapists, optician, dietitian, speech and language therapists for eating and drinking assessments, physiotherapy, continence management consultations and specialist professionals provide support to residents in the home. Staff confirmed that the home work closely with the health care professionals and feel well supported by them in order to promote the wellbeing and welfare of the Care Homes for Adults (18-65 years) Page 21 of 40 Evidence: residents. The recording of health care appointments was discussed with the registered manager. There were clear records when the residents general practitioner and dentist had visited the resident yet dates of other health care consultations were incorporated into the residents daily records and could not easily be audited. It has been recommended that the home consider a system whereby documented information regarding health care consultations are more easily accessible for the purpose of auditing a residents care. In general throughout the inspection it was observed that residents were supported with respect, privacy and dignity and this was the culture of the home however on one occasion it was observed that the residents bedroom door had not been fully closed when they were receiving care from staff and staff are reminded and a requirement made that arrangements must be made that residents are supported in a manner which promotes their rights to privacy and dignity at all times. Written comments received by the commission which had been written on behalf of the resident by their relatives, advocates or staff included that the residents named nurse is very observant and knows when the resident is not feeling well and is a good friend to the resident. Additional comments also included that the home provides kind, considerate, sensitive staff and good health care. The home does the best it can to look after all the residents. Three written comments received from health care professionals stated that what the service do well is follow eating and drinking guidance for resident, seeking support from the learning disability team when needed and meeting residents medical needs. The home delivers a high standard of care to a group of severely disabled people with complex health needs. The home provides a caring approach and tries to maximise opportunities for individuals and are keen to use multi disciplinary expertise and advice. The care staff of Wesley Lodge provide a high standard of care to the residents and need to maintain what they are already doing. Twelve written surveys received from staff about the care the residents receive included I dont think we could improve our care but we do need to be aware of falling into a rut and to be aware of changes and not to forget what is best for our residents. The staff render a high quality of care to the residents and they support them physically, psychologically and spiritually. The staff provide a therapeutic and homely environment in caring for the physical, emotional well being of the residents. Care Homes for Adults (18-65 years) Page 22 of 40 Evidence: The home has a current medication policy and procedure in place. Staff confirmed that no residents are receiving controlled medicines, no resident self medicates and that as part of the health review all residents have had a review of their medication which has also included consultation with specialist health care professionals. Whilst sampling the two residents care plans it was noted that medication prescribed when required was well recorded and regularly reviewed to ensure the welfare and well being of the resident. The records regarding the ordering, stock taking and returns of medication and medication administration charts were well managed and staff demonstrated competence and efficiency regarding the administration of medicines at the time of the inspection. Information and confirmation regarding the storage of stock medicines in the home has been been confirmed by the commission to be in compliance with best practise. The home has a policy and procedure regarding guidance for staff on how to support the resident and their family when faced with terminal illness. The wishes of residents about their terminal care and arrangements after death were not evidenced in the two care records sampled and arrangements should be made that these details are addressed and recorded in order to promote the residents wishes and feelings at the time of their death. Care Homes for Adults (18-65 years) Page 23 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An open culture of raising complaints or concerns about the home is promoted. Procedures and policies are not readily available in the home to promote the protection of residents from harm and the majority of staff have not received training in the safeguarding of vulnerable adults from harm or abuse. Evidence: The home have an up to date complaints procedure, which is also in a pictorial format, to support residents or their representatives on how to make a complaint or raise a concern if they are dissatisfied regarding the service. The registered manager advised that the complaints procedure was currently being reviewed. Staff confirmed that the homes culture is to promote peoples rights to make a complaint or raise concerns and these would be dealt with transparently, recorded and actions taken to resolve the complaint. Staff stated that they would be aware of residents if they were unhappy by observing a change in their general demeanour, behaviour and by the residents vocal tones. Staff confirmed they would address the concerns with the registered manager or the deputy manager in order to support the resident and their rights to raise concerns. The AQAA advises that the home have not received any complaints since being granted registration on the 5th June 2009. The inspector did not sample a complaints log yet the home are reminded that documented evidence must be available to detail Care Homes for Adults (18-65 years) Page 24 of 40 Evidence: the chronology of events for investigating complaints which would be used should a complaint be received by the home. The current local authority multi agency procedures for safeguarding adults were not available to be sampled within the home. The registered manager confirmed that no safeguarding vulnerable adult referrals had been made to the local authority. The home has a policy statement regarding reporting abuse and a whistle blowing policy yet both documents were not readily accessible within the home as the inspector was advised that the documents could be downloaded by staff as they have password access to the homes computer. Seven staff training records were sampled and none included written evidence or certification to confirm that staff had undertaken safeguarding vulnerable adults training. Four staff were spoken with during the inspection and each staff member was uncertain regarding the procedures of reporting suspected abuse or harm in accordance with the local authority multi agency safeguarding vulnerable adults procedures. It has been required that arrangements must be made that all staff must receive safeguarding training in order to ensure they are aware of the current protocols of their duty to protect and safeguard residents in their care. Care Homes for Adults (18-65 years) Page 25 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe and comfortable environment. Equipment and facilities meet the current needs of the residents and the control of the spread of infection in the home is well managed. Evidence: As previously documented the home is pre existing and is of a small family style set up which does not need to meet the minimum standard for new registrations in terms of en suite facilities. All areas of the home are wheelchair accessible with ramp access to external garden and car park. During the tour of premises with the registered manager it was observed that the home is well maintained and decorated yet the registered manager confirmed that arrangements are being made for the hallways to contain fashionable ornaments and framed pictures to offer a more homely atmosphere. The corridors are wide to support the majority of residents who use wheelchairs and a non slip washable floor is fitted throughout the home that is in a wood effect creating a homely feel whilst being practical for the needs of the residents. The residents bedrooms are all the same size and layout and are in excess of twelve metres squared. Each room is fitted with a low level sink but no en suite facilities. Care Homes for Adults (18-65 years) Page 26 of 40 Evidence: Residents benefit from an overhead tracking hoist which is fitted to the ceiling and which the registered manager confirmed is used by staff and the resident to ensure their safety and well being. Low level radiators are fitted around two of the walls and each bedroom is fitted with two double electrical sockets and a nurse call system call point. It was noted that the bedrooms were furnished and decorated according to the residents individual preference and contained personalised ornaments, framed photos and pictures, objects of reference and meaning and leisure items. All rooms had an electric full profiling bed, wardrobe, chest of drawers, lockable bedside cabinet and a chair for visitors. Windows were seen to be double glazed with opening restrictors fitted. The communal areas of the home were decorated in neutral tones with coordinating soft furnishings. The small lounge, as previously documented is furnished with comfortable seating and has doors leading to the garden. The main lounge is large and also leads onto the enclosed garden. It was furnished with settees and armchairs, a large flat screen TV with a home cinema system and a range of chairs designed to the needs of individual residents. The kitchen is a good size with a range of units and domestic appliances suitable to meet the current needs of the residents. Staff confirmed that they take turns in preparing and cooking residents meals from the set menu. The bathrooms are a good size with a hi low electric Jacuzzi bath, toilet and sink in one and a shower trolley, toilet and sink in another. The laundry is well equipped with two commercial washing machines with sluice facility and a commercial gas powered dryer. There is also a separate sluice room with manual sluice, sink and secure storage for cleaning products. The home have provided suitable equipment including hand washing facilities throughout the home. It was observed that the disposal of general and clinical waste was well managed in order to ensure and promote the control the spread of infection in the home. The home has a good sized, enclosed, garden to the rear of the property which as previously documented arrangements are being considered for this facility to be improved. Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: Twelve staff written surveys were received by the commission and comments about the homes environment included there are big home improvements and the environment is very tidy and homely. It is a very well equipped house. Care Homes for Adults (18-65 years) Page 28 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The corporate policies and procedures for the recruitment of staff promote residents protection and welfare. Staff receive a structured induction programme and are well supervised in their work. The recruitment and staff training records were not well managed and significant shortfalls in the staff mandatory training programme must be addressed in order to ensure that residents are supported safely. Evidence: The home currently supports seven residents and employs twenty two staff. The registered manager advised that the majority of the staff have supported the residents for a long time and are aware of their needs by expression or body language. The staff are supported to offer gender specific care due to the gender ratios within the staff team. It was observed that there were sufficient staff available on the day of the inspection and they worked in a confident way which was well organised and not rushed. Residents were seen to be supported throughout their morning by staff who offered support and encouragement at all times. The registered manager confirmed that the staffing levels in the home were flexible to meet the needs of the residents should their needs change. Care Homes for Adults (18-65 years) Page 29 of 40 Evidence: The homes recruitment and selection policy was sampled and it was noted that documented job descriptions were available within the homes policy and procedure manual and some staff files sampled. Three staff files were sampled which included one file of a staff member employed over a year and two other files of staff who had been employed for several years. The staff file for the person newly recruited complied with the current guidance regarding the safe recruitment of staff. There was evidence to support a full application had been made, professional references had been sought, a face to face interview had been conducted, photographic evidence of identity was available and Criminal Record Disclosures had been sought. It is considered that the home currently operates a policy and procedure for the save recruitment of new staff in order to ensure the protection and best interests of the residents. Three staff training records were sampled and it was evidenced that there were some gaps in the attendance to mandatory training which included basic food hygiene, first aid, fire safety and moving and handling training. There was no evidence available to support that the staff members had been booked the training to be undertaken at a later date. It has been required that arrangements must be made that all staff must undertake mandatory training within the timescales set in order to ensure that they have the skills and abilities and up to date knowledge to provide the care and support needed by the residents living at the home. The AQAA identifies that two of the fifteen staff have achieved their National Vocational Qualification NVQ Level 2 or above in social care and all staff have undertaken the Skills for Care Induction programme. Whilst sampling the staff records it was noted that staff receive structured and well documented supervision of their work. Staff confirmed that they felt well supervised and would be able to raise any concerns with the registered or deputy manager of the home. Care Homes for Adults (18-65 years) Page 30 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is sound yet some improvements need to be made. The home is run in the best interests of the residents and residents views and opinions and those of other associated are sought. Policies and procedures are in place to ensure the smooth running of the home and the residents general safety and welfare is promoted yet needs to be strengthened in some areas. Evidence: The home has been operating as an NHS continuing care service for twelve years and is currently owned by Kingston Primary Care Trust however the commission have been advised that the ownership of the home is being transferred to Your Health care, a not for profit organisation set up by the Trust similar to a co operative society in order to separate service provision from commissioning. The manager was appointed and has been granted registration in June 2009 by the commission to be become the registered manager of the service. The registered manager demonstrated a good working knowledge of the home and the specialist needs of the residents during the inspection and has experience in managing services Care Homes for Adults (18-65 years) Page 31 of 40 Evidence: and supervising staff. There was evidence throughout the inspection that the registered manager is committed, with the staff team, in continuing to monitor and improve the standard of care and support provided to the residents at Wesley Lodge. Whilst sampling records at the home it was noted that the home is not in receipt of the current Care Homes Regulations and arrangements should be made that the registered manager obtain a copy of the Care Homes Regulations 2001, updated 2006, in order to ensure that the registered service is compliant with the Care Home Regulations. During the sampling of the staff recruitment files and training records it was observed that the management of the records could be improved and it has been recommended that the registered manager sets aside some time in order to ensure that the staff records are more robustly managed and a training matrix arranged in order to offer clarity and a clear audit trail regarding the training requirements of staff. Twelve written surveys received from staff about the management of the home included we have a very good manager and deputy manager and support workers who work very well as a team for our residents best interests. There is dynamic leadership, good team spirit who are supportive and always striving to enhance the lives of the residents and we are very happy and are a mixed group of staff from around the world. Written surveys received by the commission from a variety of people associated with the home about the management of the home included that all the staff give the residents one hundred per cent care. The home give a good care to the service users and the manager and staff do team work. The home has very experienced staff who have been in the profession a long time. The service users are all very well cared for. The home could improve by offering more staff training which reflects the conditions of the residents. The home must keep up the high standards that have been implemented in recent months. The home acknowledge the difficulties in seeking the views and opinions of residents and work within a multidisciplinary setting and in close contact with residents family and friends and advocates in order to ensure that residents views and opinions and those of others continue to be sought in order to benefit the residents in their daily lives. The registered manager advised that the homes policies and procedures were stored electronically yet hard copies were available and a comprehensive folder of the policies Care Homes for Adults (18-65 years) Page 32 of 40 Evidence: and procedures were also available. Some regulation 26 notifications were sampled during the inspection and it was noted that these had been attended by some health care professionals associated with the home. The records indicated that the visits were not held consistently at least every month. It has been required that arrangements must be made and notified to the commission regarding the ongoing arrangements of the unannounced Regulation 26 visits in order that the quality of care and processes of the home continue to be monitored and the findings documented and acted upon in order to ensure and promote the best interests of the residents. Health and safety checks within the home have been maintained and records were sampled. The gas safety, electrical certificates and a current insurance indemnity certificate and certificate of registration were sampled and all documents were up to date. The registered manager is aware of the reporting any incidences to the commission under Regulation 37 notifications of any event that affects the well being and welfare of people in home as notifications have been received by the commission since the home has been registered. It is acknowledged that the registered manager and the staff team, since the home has been granted registration, have worked to maintain a focus and have made efforts to monitor and improve the service and facilities offered to residents. A number of requirements have been made and documented within the report which include the following that documented contracts or a statement of terms and conditions must be supplied to residents or their representatives in order that they have a clear understanding of what residents can expect regarding their provision of care and accommodation. The documentation of care plans and residents daily records needs to be further developed to incorporate a more person centred approach. The process of care plan reviews and recording of the outcomes of reviews needs to be strengthened. Arrangements for improved systems regarding residents rights to confidentiality of their information stored in the home must be improved. The recording of residents health care consultations need to be reviewed to offer a clear audit trail. Residents rights to privacy and dignity must be upheld at all times.Residents end of life arrangements must be consistently documented in order that their wishes and those of their family are respected and acted upon. Procedures and policies must be readily available in the home to promote the protection of residents from harm and all staff must receive training in the safeguarding of vulnerable adults. The recruitment and staff training records must be better managed and the significant shortfalls in the staff Care Homes for Adults (18-65 years) Page 33 of 40 Evidence: mandatory training programme must be addressed in order to ensure that residents are supported safely. It is required that the home must forward to the commission an improvement plan detailing how the home intends to improve the services provided in the home to ensure the safety and well being of residents. The requirements made during the inspection and detailed within the report have a bearing on the safety of, and outcomes for, the residents who live at the home and failure to comply with the regulations is an offence and may lead to enforcement action. Care Homes for Adults (18-65 years) Page 34 of 40 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 35 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 5 5 Arrangements must be made that each resident or their representative is supplied with a contract or statement of terms and conditions. To offer a clear understanding of what residents can expect regarding their provision of care and accommodation. 26/04/2010 2 10 12 Arrangements must be 26/04/2010 made for the safe storage of residents records. To comply with promoting residents rights to privacy and confidentiality. Arrangements must be made to maintain and promote residents skills and abilities. To take into account residents wishes and feelings. 26/04/2010 3 11 12 Care Homes for Adults (18-65 years) Page 36 of 40 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 4 18 12 Arrangements must be made that at all times residents are supported in a manner which promotes their rights to privacy and dignity. In order to promote residents rights to privacy and dignity. 26/04/2010 5 23 13 Arrangements must be made that all staff receive safeguarding training. In order to ensure that staff are aware of the protocols of their duty to protect and safeguard residents in their care. 26/02/2010 6 35 18 Arrangements must be made that all staff must undertake mandatory training. In order to ensure that staff have the skills and abilities and up to date knowledge to provide the care and support needed by the residents living at the home. 26/04/2010 7 41 26 Arrangements must be 26/04/2010 made and notified to the commission regarding the ongoing arrangements of the unannounced Regulation 26 visits to the home. Care Homes for Adults (18-65 years) Page 37 of 40 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 In order that the quality of care and processes of the home continue to be monitored and the findings documented and acted upon to ensure and promote the best interests of the residents. 8 42 24A The home must forward to the commission an improvement plan. To detail how the home intends to improve the services provided to ensure the safety and well being of residents. 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 26/04/2010 1 6 It has been recommended that the review process of the residents care plans be strengthened to take into account any changes in the care and support of the resident and their progress and achievements which are documented and acted upon in the best interests of the residents. It is recommended that residents care plans clearly document if the residents are able or not able to participate in the development of their plan so it is clear to the reader who has developed the plan on behalf of the resident. It has been recommended that the recording of daily records be reviewed to incorporate a more person centred approach which reflects the demeanour and communicative interactions of residents in their daily lives. 2 6 3 10 Care Homes for Adults (18-65 years) Page 38 of 40 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 4 19 It has been recommended that the home consider a system whereby documented information regarding health care consultations are more easily accessible for the purpose of auditing a residents care. It has been recommended that the registered manager sets aside some time in order to ensure that the staff records are more robustly managed and a training matrix arranged in order to offer clarity and a clear audit trail regarding the training requirements of staff. 5 42 Care Homes for Adults (18-65 years) Page 39 of 40 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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