Care Home: Wycar Leys (The Lodge)

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What the care home does well The service has commenced the development of person-centred care planning, which provides an individualised focus on the support needs of the service users. The written records contain detailed information about the service users and these are developed from comprehensive pre-admission assessment information, and thereafter on an ongoing basis. The documents provide suitable guidance for staff about how they can support the service users. Service users tell us that they are able to make decisions about what they do each day, with the support of staff where appropriate. A range of activities is available for service users to participate in. Staff listen and act on the opinions of the service users and there are regular meetings with service users on a one-to-one and group basis. The home provides a safe and comfortable environment for the service users to live in. What has improved since the last inspection? There were no requirements made at the previous inspection of this service. The service has told us that they have continued to work within the community looking at the development of further work placements and have also introduced new college courses. The service told us about environmental improvements, including redecoration throughout. They also told us that the complaints procedure has been made more user friendly and the menus have adopted the philosophy of healthy lifestyles. The service is introducing the concept of person-centred planning, in relation to the written support plans that are developed for each service user. What the care home could do better: It has not been necessary to make any requirements at this inspection. We have made recommendations to improve the written documentation about the assessment and support that services users receive at the home. The recommendations relate to developing the way that records demonstrate the capacity of service users to make decisions, and to ensuring that care records are always signed and dated. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Wycar Leys (The Lodge) Kirklington Road Bilsthorpe Newark Nottinghamshire NG22 8TT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andrew Bailey     Date: 2 5 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Wycar Leys (The Lodge) Kirklington Road Bilsthorpe Newark Nottinghamshire NG22 8TT 01623871752 01623871753 karen@wycarleys.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Wycar Leys Limited care home 10 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 10 The maximum number of service users to be accommodated is 10. Wycar Leys Limited is registered to provide accommodation and personal care at Wycar Leys (The Lodge) for service users of both sexes whose primary needs fall within the following category: Learning Disability. Date of last inspection Brief description of the care home Wycar Leys, The Lodge, is a privately-owned care home for adults who have a learning disability. It is situated on raised ground a short distance from the local amenities in the village of Bilsthorpe. The Lodge is one of four care homes on the site and provides facilities for ten service users between the ages of 18 and 65 years. It is run independently from the other units and has its own staff team, but shares some facilities with the other three homes: a central kitchen, laundry, transport and extensive grounds. The people who live at The Lodge prefer to be referred to as service users. The fees charged are based on individual needs. At the time of this inspection fees ranged between £1713 and £2875 per week. Care Homes for Adults (18-65 years) Page 4 of 28 Care Homes for Adults (18-65 years) Page 5 of 28 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: two star good 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 last inspection of this service was on 24 January 2007. The service has told us that the people living at the home prefer to be referred to as service users. This terminology is used within the inspection report. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people and their views of the service. The process considers the homes capacity to meet regulatory requirements and minimum standards of practice. The inspection visit was unannounced and took place over a 4 hour period. Care Homes for Adults (18-65 years) Page 6 of 28 There were nine service users living at the home on the day of the inspection, although many were out on activities at the time of the visit. Staff and the acting manager were spoken with during the inspection. We have considered the nine Have your say about... surveys that gave us the views of the service users living at the home, and their opinions have been included in this report. We looked at information that we have received since the last inspection. The information included the Annual Quality Assurance Assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. The service has also told us about things that have happened at the home and these are called Notifications. Records were examined during the inspection, including the care records of three of the service users who live at the home. This was part of the process called casetracking that we use to follow the experiences of individual service users. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 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 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have the opportunity to visit the home before choosing to live there and there are suitable pre-admission assessments to ensure that needs can be met. Evidence: In the Annual Quality Assurance Assessment (AQAA) that we received before this visit the service told us that there is a Statement of Purpose, and a Service User Guide in a user-friendly format. They stated that pre-admission stays and visits are available to prospective service users, and that they obtain external pre-admission assessments and also undertake their own pre-admission assessments. Following the assessment process a letter is compiled, which lays down the aims and objectives of the potential placement and includes costings and staffing arrangements. The Have your say about... surveys that contained the views of current service users told us that people felt that they had received enough information about the service before deciding to live there. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: We case-tracked three of the service users who live at the home as part of our inspection process. This included examination of the written records held about the service users. The written records contained evidence of external professional assessments as well as written assessments that had been completed by the service. The acting manager told us prospective service users are visited in their current setting during the pre-admission process. The acting manager told us that trial visits are offered to prospective service users. This often takes the form of a short visit, with subsequently longer visits, possibly followed by an overnight stay. The process looks at whether needs can be met and whether the prospective service user will fit in within the setting. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of service users are recorded in plans of care, and service users are supported to take responsible risks as part of an independent lifestyle. Evidence: The service told us in their Annual Quality Assurance Assessment (AQAA) that they were introducing person-centred support plans in collaboration with each service user. They told us about the care management reviews that take place annually, involving the service user, social worker, family and staff from the home. They stated that they also review the support plans routinely and undertake one-to-one discussions with service users about their care. The service said that they encourage service users to take responsible risks as part of an independent lifestyle. We spoke with two staff about the written support plans that are held for each service user. One of the staff had recently transferred to the unit and stated that they had found the records to be very informative, and that they contained relevant guidance to Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: assist them in supporting the service users. Not all of the service users currently have person-centred plans. The acting manager explained that the process has commenced and that all of the service users will eventually transfer from the old-style records to this more individualised system of record keeping. We looked at the records of three of the service users as part of the case-tracking process. We found evidence that service users had received annual reviews involving outside agencies. The acting manager told us that periodic reviews had additionally taken place within the unit (usually at three-monthly intervals), but not all in-house reviews had been signed and dated by staff. We examined examples where the independent support plans had been signed by staff and by the service user, indicating that the plans had been developed and agreed with the involvement of the service user. There was evidence of entries in the daily logs held for each service user, and these had been signed and dated by staff making the entries. We examined a range of other records held for the case-tracked service users, including records of dietary intake and participation in activities and it was clear that the service maintains detailed information about each service user to provide guidance to staff about their care needs. There was evidence within the case-tracked care plans of acknowledgement of where people had decreased ability to make decisions for themselves, for example in respect of the management of medications. The acting manager told us that more extensive recording of competency will be required in the future to meet with the principles of the Mental Capacity Act 2005. The acting manager has attended training on the Mental Capacity Act and Deprivation of Liberty Safeguards. The service is looking at ways that it can consistently record the capacity of each individual to make their own decisions. There was evidence of risk assessment within the care files of the three service users that we case-tracked and the majority of these were individualised risk assessments, but the activity risk assessments were generic. The service is currently introducing person-centred records and the acting manager confirmed that activity risk assessments will become person-centred as part of the transition. The survey responses told us that service users are always or usually able to make decisions for themselves. One service user commented: I am always given a choice. There is a key worker system within the home and one service user commented within their survey: I have a very good key worker who listens to me a lot. Care Homes for Adults (18-65 years) Page 13 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by staff to follow a lifestyle of their choosing. Evidence: In the AQAA self-assessment that we received before this visit the service told us that the range of activities had been increased, with new college courses introduced. The service said that there were opportunities for service users to have work and college placements and that activities take account of individual abilities. They told us that menus had changed to include more healthy options and that they would like to introduce more service user input into catering, including the purchasing of food items. The acting manager told us about the range of activities and educational opportunities on offer to service users. Four of the service users are currently undertaking courses, including cookery, computers and numeracy & literacy. We case-tracked three of the Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: service users and found that some enjoyed going out for meals, to the cinema, bowling, swimming, football and rambling. Activities take place during the evening as well as during the day. The service provides transportation for the service users and has its own people-carriers and mini-buses. We examined the written records held for service users and found that daily routines were reflected in support plans. Some of the service users visit family members, for example at weekends and the acting manager told us that families and friends are welcome to visit the home. One of the survey responses from the service users stated: If I want to go out somewhere, I ask the team leader or a member of staff will try to sort this for me. Each of the separate units on the site is served by a central kitchen. The menus offer a choice for each meal and alternatives are available. The acting manager told us about a healthy eating initiative, which has involved input from a dietician and nutritionalist. This healthy options group involves service users and meets weekly utilising games as one of the mechanisms to encourage a more healthy approach to diets. We spoke with two of the staff and they were able to confirm that the training that they receive includes basic food hygiene training. Care Homes for Adults (18-65 years) Page 15 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and healthcare support for service users is promoted by the assessment and monitoring systems in place at the home. Evidence: The service told us in their Annual Quality Assurance Assessment (AQAA) about the health support available to service users. The service facilitates psychiatric support for service users and a consultant psychiatrist holds a clinic at the home every two weeks. A General Practitioner (GP) visits regularly to see any service users that may be unable to attend the local surgery. Annual well-man and well-women checks are provided by the GP service for each service user. The service told us that the community pharmacy provides medication training for staff. Eight of the nine survey responses told us that service users consider that they receive the support that they need and that staff treat them well (one survey not completed for these sections). All respondents said that they can do what they want to do during the day, in the evening and at the weekend. One respondent commented: I am very happy here and another stated I get on well with the staff. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: The three person-centred support plans that we looked at as part of case-tracking identified the degree of ability of the service user to meet their own needs, and any support needed from staff to assist them to meet their needs, for example, help with hygiene needs. We examined the medication storage and recording system in so far as it related to the three service users that we case-tracked. The Medication Administration Records (MAR sheets) were suitably recorded and the medication storage was appropriate. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems for dealing with concerns and complaints and the service acts to protect service users from harm. Evidence: The AQAA self-assessment that we received prior to the inspection told us that the Service User Guide contains complaints information in a user-friendly style, with symbols included. The service told us that they have improved the confidentiality of the complaints system and that all staff receive training on safeguarding adults. The Commission for Social Care Inspection have not received any direct complaints about the service in the period since the last inspection. We case-tracked three of the service users at this inspection and there had not been any complaints recorded in respect of these service users. The responses that we received from the Have your say surveys indicate that service users know who to speak to if they are not happy and how to make a complaint. Several said that they would speak to the manager. Six of the nine respondents stated that staff always act on what they say, with one saying staff usually act and two did not respond. The manager informed us that all staff receive training in safeguarding adults, with ten staff trained since December 2008. Two staff members that we spoke with confirmed Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: that safeguarding training had taken place, and they had also received training in deescalation techniques, diversion, restraint and breakaway techniques. We examined the records for the personal finances of the case-tracked service users. The records system appeared to act in the best interests of the service users and there had been regular checking of the amounts held on behalf of service users. A dualsignature system was in operation for transactions. Care Homes for Adults (18-65 years) Page 19 of 28 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. A safe and comfortable environment is provided for the service users living at the home. Evidence: The AQAA self-assessment that we received from the service before the inspection told us that the home had been decorated throughout, with service users choosing the colour schemes. The service told us that they have their own maintenance team. A central laundry serves all of the homes on the site, and The Lodge additionally has its own washing machine. We toured parts of the home and we found that it was clean and tidy. The surveys that we received also told us that the service users feel that the home is kept fresh and clean. The acting manager told us that new carpets had been provided recently and that there were no outstanding maintenance issues awaiting attention. The acting manager informed us that all staff receive training in infection control and that there are infection control policies and procedures for staff to follow. Two members of staff that we spoke with were able to confirm that infection control training takes place for staff working at the home. Care Homes for Adults (18-65 years) Page 20 of 28 Care Homes for Adults (18-65 years) Page 21 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users welfare and safety is promoted by the training and recruitment systems in place at the home. Evidence: The service told us in the AQAA that a multi-racial team of mixed ages, gender and cultures support the service users. They told us that staff have undertaken sexuality training and they told us about the supernumerary induction training that staff undertake when they commence working at the home. They said that staff receive monthly supervision and have annual appraisals. The acting manager told us that the majority of staff have either undertaken or are now signed up for training to National Vocational Qualification (NVQ) Level 2 or above. We examined a sample of the staff recruitment files and we found that satisfactory checks had been carried out before staff had commenced employment at the home. This included Criminal Records Bureau clearance checks and two written references. We spoke with two members of staff and they told us that they have good training opportunities including training on safeguarding adults, fire safety, first-aid, manual handling, and health and safety. The acting manager confirmed that the induction Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: training meets Skills for Care standards. Annual update training is forward-planned and steps taken to ensure that each member of staff receives all mandatory updates. Care Homes for Adults (18-65 years) Page 23 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems in place promote the health, safety and welfare of the service users. Evidence: In the AQAA self-assessment the service told us about the monthly meetings that are held with service users. They told us that registered provider visits are undertaken in compliance with Regulation 26. The information provided in the AQAA dataset indicated that there is appropriate maintenance and checking of the equipment and services at The Lodge. The Lodge is currently managed by an acting manager, who has applied to the Commission for the position of registered manager. The application is currently being processed. The acting manager holds recognised qualifications for the post of registered manager of the home. Two members of staff confirmed that the necessary health and safety related training Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: is undertaken to enable them to support and protect the service users living at the home. Training includes fire safety and health and safety training. The acting manager informed us that he completes a weekly management report and a monthly quality assurance report. We looked at a recent quality assurance report and this covered areas such as health and safety and records management. We were able to confirm at inspection that the mandatory monthly visits and reports by the registered provider are taking place. These regulatory visits (Regulation 26) are part of the quality monitoring processes, which act in the best interests of service users living at the home. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Staff should sign and date all routine care review documentation so that it is clear that reviews have taken place. Documentation processes should be developed to consistently demonstrate that each service users capacity to take decisions has been fully considered, in accordance with the Mental Capacity Act 2005. 2 7 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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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