Care Home: York Lodge

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What the care home does well The home is clean and tidy and rooms are comfortable, very individual and kept as the person wishes. People who use the service told the inspector that they felt very happy with their rooms and the communal spaces. York Lodge provides an environment where people are treated as individuals as their rights, wishes and choices are respected and they feel safe. People are supported by members of staff who know them well as they have worked in the home for a number of years. The home has a very friendly, comfortable and relaxed atmosphere. The inspector saw positive contact between the staff and people who live in the home. Comments that were received from surveys were: A person living in the home said, "I am very happy here. It`s a great care home and I am well cared for. I live as I want and the Manager is excellent." A professional said, "I have recommended this service to colleagues as I have been impressed by their quality of care and overall attitude toward individuals."A relative said, "York Lodge provides a safe, secure and happy environment." Another said, "York Lodge has succeeded where care in the community failed. He has been stable and settled at York Lodge I cannot thank them enough." Another said, "Since being at York Lodge my son is now loving, appreciative, thoughtful, perceptive and welcoming. I have got my son back and I thought I never would." What has improved since the last inspection? CARE HOME ADULTS 18-65 York Lodge 1-5 York Road Worthing West Sussex BN11 3EN Lead Inspector Jan Aston Unannounced Inspection 5th March 2008 09:40 York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service York Lodge Address 1-5 York Road Worthing West Sussex BN11 3EN 01903 212187 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) tonymckernan1@yahoo.co.uk Mrs Marie Anne Harrity Mr Austin Harrity Anthony McKernan Care Home 24 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (24), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (12) York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The total number of persons accommodated should not exceed 24. 12 Service Users will be over the age of 65 years. Date of last inspection Brief Description of the Service: York Lodge is registered for the accommodation of up to 24 residents in the category of mental disorder, 12 of who may be over the age of 65. The property is situated close to the seafront in central Worthing with access to local bus and train services. The registered provider is Mrs M. Harrity, and the registered manager is Mr Tony McKernan. The current fees for the service are £303-£750 York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means that people who use this service experience good quality outcomes. Prior to the inspection surveys were sent to the home for the Manager to distribute to people living in the home, members of staff, Health Professionals and a number of G.P’s. The Annual Quality Assurance Assessment form (AQAA) that was completed by the manager of the service was also used in the preparation and planning of this inspection. A visit to the home was made on Wednesday 5th March 2008 and eight hours were spent in the home. The Inspector looked around the home, examined a sample of records in relation to care plans, training, staff, complaints, accidents and Health and safety checks. The Registered Manager was in the home throughout the inspection. The Inspector spoke privately with four people living in the home but a number of other people living in the home were seen throughout the day. Two members of staff were spoken with. Information and comments were received from surveys sent out prior to the visit to the home and they have been used to inform this inspection and are referred to in this report. Six were received from people living in the home, four from relatives and seven from professionals that included three G.P’s, two psychiatrists and two community psychiatric nurses. What the service does well: The home is clean and tidy and rooms are comfortable, very individual and kept as the person wishes. People who use the service told the inspector that they felt very happy with their rooms and the communal spaces. York Lodge provides an environment where people are treated as individuals as their rights, wishes and choices are respected and they feel safe. People are supported by members of staff who know them well as they have worked in the home for a number of years. The home has a very friendly, comfortable and relaxed atmosphere. The inspector saw positive contact between the staff and people who live in the home. Comments that were received from surveys were: A person living in the home said, “I am very happy here. It’s a great care home and I am well cared for. I live as I want and the Manager is excellent.” A professional said, “I have recommended this service to colleagues as I have been impressed by their quality of care and overall attitude toward individuals.” York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 6 A relative said, “York Lodge provides a safe, secure and happy environment.” Another said, “York Lodge has succeeded where care in the community failed. He has been stable and settled at York Lodge I cannot thank them enough.” Another said, “Since being at York Lodge my son is now loving, appreciative, thoughtful, perceptive and welcoming. I have got my son back and I thought I never would.” What has improved since the last inspection? At the last key inspection in July 2006 requirements were made for improvement in the following areas: • • • • Care plans should be made more comprehensive in respect of recording risks. Replacement of furniture, carpets and redecoration of areas of the home. Providing a lockable space in people’s rooms for valuables or medication. Risk assessments required updating. Since the last inspection new flooring has been laid in the dining/lounge area of the home and some furniture replaced. People’s rooms, bathrooms, toilets and communal area that were seen were in good order. Lockable spaces have not yet been provided but the Registered Manager is in discussion with each person about their wishes for this. As all people living in the home have a key to their rooms and during the visit to the home it was seen some rooms were locked where the person was out or in another part of the home the requirement has not been repeated. Care plans had been reviewed with the person living in the home and this included discussing or assessing any potential risk to the person. The documentation in relation to recording risks is in place but could be improved by providing more information about how the risk could be minimised. As the risks for each individual has been reviewed and the Registered Manager is in the process of reviewing the recording of risk the requirement is considered as partially met and has not been repeated. What they could do better: Record all information relating to visits or assessments undertaken prior to a person moving into the home. Continue to improve risk assessment documentation. Ensure that POVA first checks are undertaken where necessary. Members of staff receive refresher training in the health and safety topics. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 7 Members of staff receive regular supervision and annual appraisals. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good written information about the service that contains all the necessary information that a person who is thinking about moving into the home would need. An assessment of a person’s needs undertaken with them, their relatives and professionals, prior to and on admission to the home ensures that the service and the person know that the service can meet their needs. Visits to the home prior to admission gives a person an opportunity to find out more about the home. A person will understand 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. EVIDENCE: The Statement of Purpose and service user guide have been updated. They contain all the necessary information that a person who is thinking about moving into the home would need. The guides have been produced using some pictures and symbols. A new person was admitted to the home in December 2007. The Registered Manager explained the admission process that had taken place. This confirmed that the person had made an initial visit to the home and then on at least three occasions visited for lunch. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 10 The Manager visited the person in hospital and spoke with a relative and consultant psychiatrist and undertook a full needs assessment. The Registered Manager did not record any of this on the care records but had kept notes. It is recommended that all planning and preparation for a new person to move into the home be recorded on the care records. The care records for the new person were examined and there was evidence of copies of assessments undertaken by health professionals that assisted the manager in making the decision that the service could meet the person’s needs. A full needs assessment and risk assessment had been put in place on admission. The person’s Social Worker and Consultant had undertaken a review of the placement. There was evidence that the assessment and care plan had been compiled with the person and some agreements about the terms and conditions of the home were made. The person had signed the documents. Contracts are made with the service and authorities. The person will sign a service user plan that describes all conditions for living in the home and what they can expect from the service. There was evidence from the sample of care records examined that these were in place for all people. They have been reviewed recently. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 members of 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 EVIDENCE: A requirement was made at the last inspection in July 2006 for care plans to provide more comprehensive information about how each person should be supported and to ensure there were sufficient information about any potential risk to a person in order for the service to minimise the risk. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 12 A sample of five care records was examined at this inspection. They contained the following information: • • • A basic information sheet recording date of birth, next of kin and GP etc. A needs assessment undertaken by the service that covered all aspects of a person’s needs. A service user plan agreement that covers any restrictions agreed with the person, support required, contact details, finances, housekeeping tasks, nutritional needs, medication, needs if they are over 65, staff access to their room and final wishes. A risk assessment-screening document that identifies if there are any potential risks for a person. An assessment review document that covers relationship with peers/staff, chiropody, bedding & furniture, physical exercise & health checks, bathing/personal hygiene, social needs, dental needs, relatives, changes in health/ medication, family friends, key worker, clothing needs, budgeting, short term/long term goals. A current care plan that identifies needs and what action is required to support an individual. A daily log that records areas of concern, incidents, health appointments and outcomes etc. • • • • From the sample it was seen that all of these documents were in place for each person. The Inspector was satisfied that all the documents contained sufficient information about each person and that this information had been reviewed recently with them. The format is suitable for each person to understand and hold a copy of if they so wish. The requirement is met but it is recommended that old documentation that is not now relevant be removed from the care records to ensure that the records kept form an efficient working document. People living in the home are able to make decisions in their lives. This is a fundamental principle in the home and this is respected in all aspects of the service. People living in the home are consulted about their lifestyle opportunities and wishes and how the home is run. What is written about them is agreed and is open and transparent. The Registered Manager ensures that where and if necessary an advocate is provided to ensure that a person’s rights are respected at all times. People told the Inspector that they are able to make their own decisions and this is respected but they are supported where there maybe a risk. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 13 A requirement was made at the last inspection to provide more information about the support to be provided or action to be taken where it had been identified through the risk screening assessment that a person may be at risk. At this inspection there was evidence that potential risks for people are identified and support is provided to minimise those risks. People living in the home told the Inspector about how service helps them to manage alcohol dependence or mishandling of their finances by making agreements with them and setting realistic restrictions. A relative said, “He is allowed to find his own level. He is not restricted but he is protected from undesirable acquaintances.” A professional said, “I feel they are good at tolerating unpredictable and risky behaviour in an understanding and sensible manner, they are good at managing risk.” A risk-screening tool has been used to assess potential risk for people within the home and in the community. Where a risk has been identified actions to be taken to support a person and to minimise the risk have been recorded on the risk-screening tool. The assessment review that has been undertaken with people in the sample also considers and discusses risks with the person so the risks have been reviewed. However the risk screening tools were dated in 2003/2004 so the documentation needs to be updated. The documentation also does not clearly set out each risk and what action/support should be provided to minimise the risk. This was discussed with the Registered Manager and a different format considered. The Inspector was satisfied that the requirement was partially met and that the Registered Manager will improve the documentation. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11, 12, 13, 14, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People 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. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 15 EVIDENCE: The Inspector was informed that where possible and the person wishes to people are supported to attend college. There are no people who undertake paid or voluntary work as the Registered manager explained that this had been difficult to arrange as this had and would affect peoples’ benefits. It is also difficult to find an employer who will provide work opportunities. The home is situated in an ideal location near shops, cafes, the seafront and other community facilities. People said they could go out whenever they want. They said they go out to the local shops, visit café’s, local community clubs, go swimming and attend college. One person told the Inspector that they have a mobile phone so they can let the home know if they are going to be late or are in any difficulty. The home arranges theme nights and parties throughout the year. Arranged for this year is an Irish theme night, a 20th Anniversary celebration for York Lodge being in operation for twenty years, a Hawaiian night, bonfire night celebrations and a Christmas party. There is a quiet lounge on the first floor where there is a selection of music and a television for people to use. A person told the Inspector he went on holiday to Hastings last year and is planning to go to Butlins somewhere this year. The Registered Manager ensures that each person goes on a holiday of their choice or out for day trips. People living in the home told the Inspector how they are supported to visit relatives or stay with them at weekends. It was noted that for the 20th Anniversary celebrations people living in the home are able to ask friends to come along. People are supported to visit relatives or friends. One person told the Inspector how he spends the weekends with his Mother and another was going home to visit her father for the day. A professional said, “They are good at communicating with families and other agencies.” A relative said, “I can discuss the smallest concerns and ask for advice. I feel supported too.” The philosophy of York Lodge is to treat people with dignity, respect and as individuals with rights and to support a person to achieve fulfilment and contentment in their lives and this is stated in their statement of purpose. From the information gained through the inspection and from speaking with people who live in the home it was demonstrated that the home is run with this philosophy at the core of what the service does. There were examples where peoples’ rights are respected: A person’s right to decide whether they see health professionals, whether they drink alcohol, smoke, have an unhealthy diet, how they keep their room and York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 16 wishes around clothing and personal hygiene are all respected but advice and support are provided to protect or to keep people safe. Their right to come and go within the home is respected and they are supported to do this by having a key to the front door and to their rooms. There was evidence that a person’s sexual preference and their right to have a relationship is respected. The Registered Manager ensures that people are aware of their rights and responsibilities of living in the home. People living in the home know the consequences if they do not adhere to the few house rules that are in place. People are able to make suggestions or raise concerns at residents meetings or through speaking with staff, the manager or through the complaints procedure. They said they were happy to do this and felt they would be listened to. A professional said, “They have respect for residents and their wishes and their choices.” People spoken with said they liked the food. The main meal is provided at lunchtime and there is always a choice. People living in the home had been consulted recently about the food provided. There were some suggestions about where people ate, at what time and whether they wished to have supper in the evenings and actions have been taken to accommodate this has been respected. A person told the Inspector that they are offered a cooked breakfast on a Wednesday and Saturday and they really enjoy this. Meals are planned and a healthy, balanced diet is provided. The meal on the day of the visit was macaroni cheese or jacket potatoes with cheese and beans. This was a lighter meal as a cooked breakfast had been provided. Where necessary a person’s food and fluid intake is recorded to monitor eating habits. Extra nutritional support is accessed where a person’s wishes lead them to eating an unhealthy diet. There was evidence that a person had been supported to attend a weight management clinic every four weeks. A relative said, “her diet is fantastic as she eats proper home cooked food.” York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People 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 members of 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. EVIDENCE: The information provided on the AQAA confirmed that most people living in the home are independent in dressing and washing. Some people may require supervision with changing clothes and personal hygiene and bathing but support is minimal. People spoken with said that members of staff were friendly and treated them well and provided the assistance they required. From the sample of care records that were examined it was seen that people living in the home are supported to access health care professionals and services, as they are needed. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 18 People had seen their G.P with minor health matters, the diabetic nurse to monitor diabetes, consultant neurologist in respect of changes in epilepsy, continence advisor in respect of managing mild incontinence, regular chiropody appointments, dentist and optician. There is also a weekly health clinic that people can access monthly to monitor general health. Health professionals who returned surveys said, “The service are in regular contact with me to discuss proposals to optimise his independence, physical health and overall quality of life. They strive to address his individual needs.” Another said, “They do their best to meet the health care needs of people living in the home within the limitations of their illnesses.” Two requirements were made at the last inspection in July 2006 relation to medication. Where people were able to take their own medication the risk assessment undertaken to ensure a person is safe to do this needed reviewing and updating and people who take their own medication should be provided with a lockable space to store medication in their rooms. At this inspection it was confirmed that there are two people who take their own medication. It was seen that the risk assessments were in place and had been reviewed very recently. Both people who take their own medication can lock their rooms and one has their own fridge to store insulin. The Registered Manager confirmed that he had told them about having a lockable space in their rooms to store medication but both declined. A further requirement in respect of this matter has not been made as the Registered Manager is respecting their wishes. If lockable spaces are not to be provided then the Registered Manager must ensure this is documented on the risk assessment and taken into account when assessing the safety of a person taking their own medication. The storage of medication was examined during the visit to the home. The system used for the administration is provided by a local pharmacy and the nomad system is used. All medication is delivered in pre-dispensed boxes so members of staff do not have any dispensing of mediation to do. The recording sheets used to record whether a person has taken their medication were in good order. A member of staff confirmed that the pharmacy provide training on the safe handling of medication every year. They also described how medication was given to people living in the home and this indicated that this was undertaken according to recommended guidelines. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: The AQAA recorded that no complaints had been received. The Commission has not received any complaints. There is a complaints procedure in place in the Statement of Purpose, service user guide and in the entrance to the home. People spoken with said they knew how to made a complaint and told the Inspector who they would speak with if they were not satisfied with anything. They felt they would be listened to and action taken. People living in the home can also make comments about the service at personal reviews, at residents meetings and through the quality assurance questionnaires. The AQAA recorded that there have been no safeguarding adult referrals. The Commission has not been informed of any safeguarding referrals in respect of this service. The Registered Manager had attended a briefing on the new safeguarding adult procedures within West Susses. There was evidence that this had then been passed onto the staff team in a staff meeting. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 20 People living in the home are supported to manage their financial affairs and arrangements. People told the Inspector about how they received their money and they were in agreement to this arrangement. The Registered Manager confirmed that each person has his or her benefits paid into a bank account called the York Lodge Representatives account. This is the sole purpose of this account and is separate from any accounts used for the running of the home. The Manager withdraws money each week to pay personal allowance. The Inspector saw a personal allowance book where people sign to say they have received their personal allowance each week if they are able. It was confirmed also that receipts are kept of any money spent and an account kept. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. York Lodge provides a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. EVIDENCE: A tour of the premises was undertaken. The areas of the home that were seen were clean and well maintained. A notice board in the office records anything in the home that requires repair or replacing. Health & Safety checks and inspections have been undertaken on gas, electricity and the Portable Appliance Test being arranged. The Fire Officer visited on the 31/1/08 and found everything to be satisfactory. Hot water outlets have been fitted with thermostatic valves to regulate the temperature to prevent scalding. It is recommended that the safety valves be checked at appropriate times. The bedrooms that were seen looked clean and comfortable and had been personalised with the person’s belongings. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 22 The Registered Manager confirmed that he was consulting with people living in the home about providing lockable spaces. As all people living in the home have a key to their bedroom door and it was seen that they do lock their doors when they go out of the room a requirement has not been repeated. People have tea-making facilities in their rooms and there is a kitchen that is used by two people living in the home to make snacks etc in order for them to maintain their independence. They have a key to the kitchen and can use it when they wish. There are adequate numbers of toilets and bathrooms. They were clean and can be locked. It was noted that a record of checks are now kept in each bathroom and people living in the home are encouraged to tell staff if there is a problem. Grip rails have been installed in bathrooms to assist people getting in and out of the bath. A requirement was made at the last inspection for some flooring and furniture to be replaced. Since the last inspection the flooring in the dining and lounge area had been replaced. This area now looks attractive and clean. The furniture and decoration in the rooms that were seen were in good order. The lounge on the ground floor is used as a smoking room. The Registered Manager is aware of the new smoking legislation, although currently care homes are exempt from this legislation, and confirmed that this will be reviewed after 31st July 2008 when the next piece of legislation comes into affect. There are no people living in the home that require specialist equipment. A person who is registered blind has a talking alarm clock and has access to talking books. He confirmed he knows the environment well and does not need any other equipment to help him. There is evidence from fitting grab rails that the Registered Manager is considering and providing for people’s changing needs. There is a plan for a walk in shower to be installed on the ground floor. On the day of the visit the home was clean and there were adequate staff to ensure that the home is kept clean. People living in the home are also encouraged to undertake household tasks. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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. Training in mandatory health and safety topics should be improved to ensure the health and welfare of people living in the home. Members of staff would be better supported if they received regular individual supervision and annual appraisals. EVIDENCE: York Lodge employes fourteen members of staff including a first level nurse. There are members of staff who have dedicated responsiblities within the home for example the cook. Other members of staff work as a team and are responsible for supporting people living in the home and undertaking household tasks. Training for members of staff at York Lodge has concentrated on National Vocational Qualifications (NVQ). York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 24 Five members of staff have achieved NVQ 2 or above and one is working towards this. Two members of staff are currently working through the Registered Managers Award. The Registered Manager has undertaken training in the new safeguarding adult procedures and this has been passed to all staff at a recent staff meeting. A sample of training records was examined. A new member of staff confirmed that he was working through an induction training programme and he was finding this helpful and felt well supported. It could be seen that training provided to staff since working in the home has been relevant to the work they are expected to perform and in relation to people living in the home. For example; understanding psychosis, equal opportunities, working as a team, food hygiene, core values, heath & safety, observation skills, infection control, emergency aid and training & development. Most staff undertook training in mandatory health & safety topics some years ago apart from fire training that was undertaken at the end of last year. The Registered Manager confirmed that the next training session for all staff would be in food hygiene and this is being arranged. It is recommended that refresher training be provided to all staff in the mandatory health and safety topics; food hygiene, first aid, moving and handling, health and safety and infection control. The recruitment records relating to a new member of staff were examined and for four existing members of staff. There was evidence that a recruitment process had been followed with an application form completed, an interview held and a criminal record check in place. The member of staff confirmed the process and that references and a criminal record check had been done. The Registered Manager confirmed that verbal references had been taken up but not recorded. From the records it could be seen that the member of staff commenced working in the home before the criminal record check had come through. Both the Registered Manager and member of staff confirmed that they were supervised. However there was no evidence that a check against the Protection of Vulnerable Adults Register (POVA first check) had been undertaken which is essential if the person is to start working in the home before a criminal record check is received. It is recommended therefore that a POVA first check be undertaken if this situation arises again. The organisation of staff records could be improved. The Registered Manager confirmed that he will be re-organising the staff files and using a standard format to record information Although members of staff are supervised on a daily basis and staff have received formal individual supervision and annual appraisals it was noted that this has lapsed over the last year. This needs to be addressed. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: Mr McKernan has completed the Registered Manager Award in Management at NVQ level 4 and ensures that his training and knowledge is continually updated. He continues to develop a service that treats people as individuals, respects their decisions and choices and consults them on the quality of the service. From the information gained through surveys it is clear that he maintains a professional and good working relationship with health professionals. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 26 A professional said, “The care service liaise and communicate with the community mental health team closely to improve health needs and quality life.” A relative said, “The Manager is very capable and professional. He has his finger on the pulse I think. A huge bonus is his sunny nature which promotes a happy atmosphere.” The views of residents on the performance of the service were gathered in January 2008 and residents have been encouraged to contribute their ideas to the running of the home and the planning of events and changes. Suggestions made by people living in the home have been listened to and acted upon. Training in mandatory health and safety topics needs to be updated for all staff. The health and safety checks on the utilities and equipment in the home are up to date. The Fire Officer’s visit and report confirmed that the fire detection, prevention and evacuation methods in the home are satisfactory. York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations York Lodge DS0000014865.V359552.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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