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Inspection on 28/05/09 for Caxton Lodge

Also see our care home review for Caxton Lodge for more information

This is the latest available inspection report for this service, carried out on 28th May 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Comments we received from people spoken to were very pleased with the quality of food and meals provided. We saw the cook preparing lunch and home prepared food is high on the agenda so that people receive a wholesome diet. The staff all work together in the kitchen and anyone preparing food has completed a `Food and Hygiene` course to ensure they are confident in cooking and preparing meals. One staff member spoken to said, "We make sure people eat well". Other comments from people who live at the home included "Plenty of food available", And, "The meals are good". We saw people during the day being treated with respect and dignity by the staff and owner and this was confirmed through talking to people and records looked at. One person who lives at the home said, "They are always nice to you and helpful". one member of staff wrote in a survey "Equality, diversity, respect and dignity is covered when we start to work here". We sat and talked to residents in the lounge and in their rooms and watched people coming and going throughout the day and found routines to be relaxed and informal with staff talking and helping residents. This is a small home with a settled staff team and little turnover which helps with consistency and the continuity of care. One staff member said, "We get on well together".

What has improved since the last inspection?

The requirements from the previous have been addressed to ensure improvements continue to be made on how the home is run and improve outcomes for people. The owner has introduced new care plans and ways of recording so that detailed information is provided on each individual, outlining health,social and welfare needs. One member of staff spoken to said, "It will be better and we will be able to monitor residents more closely". Care records of people who live at the home are now reviewed monthly to ensure people`s health is closely monitored and any changes are reflected in the care plan.

What the care home could do better:

General redecoration and some refurbishment of the home should be carried out to improve the outlook of the building and provide comfortable, pleasant surroundings for people to live in. The owner of the home should complete the management and care qualifications, or provide a manager who has completed them so that the person who is running the home has the competencies and skills to support and manage a care home. Staff who support people with dementia should complete some formal training so that they have a better understanding and are confident they have the skills to care for people living at Caxton Lodge. One member of staff spoken to said, "It would help to complete a dementia training course".There is a `safeguarding adults` policy and procedure, however talking to staff it was clear no formal training has been provided. Staff should receive `Safeguarding adults` training so that they can be aware and act upon any signs of abuse.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Caxton Lodge 25 Caxton Avenue Blackpool Lancashire FY2 9AP     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: Kevan Royston     Date: 2 8 0 5 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 Older People 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 Older People Page 2 of 25 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Caxton Lodge 25 Caxton Avenue Blackpool Lancashire FY2 9AP 01253356100 01253356100 nichconnor@aol.com 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) : Mrs Isobel Conner care home 7 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 7 The registered person may provide the following categories of service only. Care home only - code PC, to service users of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Dementia - Code DE The maximum number of service users who can be accommodated is: 7 Date of last inspection Brief description of the care home Caxton Lodge is situated in a residential area between Bispham and Norbreck, within easy access of shops and local amenities. The home can accommodate a maximum of seven persons, who have dementia. There are seven single bedrooms, none of which have en-suite facilities. The home has a separate lounge and dining room and sufficient toilet and bathing facilities to meet the needs of the residents. There is a passenger lift, which enables residents to move between the ground and first floor easily. A copy of the Statement of Purpose/ Service User Guide is available for anyone making enquiries about the home. In addition there is a Brochure, copies of which are kept in the entrance hall of the home. The written information explains the care service that is Care Homes for Older People Page 4 of 25 0 4 1 2 2 0 0 8 Brief description of the care home offered and what the residents can expect if they decide to live at the home. A copy of the latest report is available for relatives to read if they so wish. The fees for care at the home are £350.00 per week which includes payment for chiropody and hairdressing. Care Homes for Older People Page 5 of 25 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced visit was part of the key inspection process and took place on the 28/5/05. We spoke to people who live at the home, staff, the owner and a group of residents in the lounge. Care, maintenance, previous inspection reports and other records were looked at as well as a walk around the building. As part of the inspection process we talked to people using the service and asked staff about those people needs. we also looked at their rooms, care plans and daily notes, this is called case tracking. Other people who live at the home were invited to pass their opinions to us if they wish. Although the response was poor we had returned surveys/ questionnaires sent to Care Homes for Older People Page 6 of 25 people who live at the Caxton Lodge and staff for their views on how the home is run. Comments we did receive were positive and some are included in this report. Every year the person in charge or manager is asked to provide us with written information about the quality of their service they provide and to make an assessment of the quality of their service. This document is called an Annual Quality Assurance Assessment (AQAA). We use this information, in part, to focus our inspection activity. What the care home does well: What has improved since the last inspection? What they could do better: General redecoration and some refurbishment of the home should be carried out to improve the outlook of the building and provide comfortable, pleasant surroundings for people to live in. The owner of the home should complete the management and care qualifications, or provide a manager who has completed them so that the person who is running the home has the competencies and skills to support and manage a care home. Staff who support people with dementia should complete some formal training so that they have a better understanding and are confident they have the skills to care for people living at Caxton Lodge. One member of staff spoken to said, It would help to complete a dementia training course. Care Homes for Older People Page 8 of 25 There is a safeguarding adults policy and procedure, however talking to staff it was clear no formal training has been provided. Staff should receive Safeguarding adults training so that they can be aware and act upon any signs of abuse. 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.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 Older People Page 9 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. The admission and assessment procedures were clear to ensure care needs of residents are met. Evidence: People who come to live at the home are assessed before admission so that staff are aware of their specific care needs and know they are able to provide the support and care needed. The owner informs the prospective resident in writing whether Caxton Lodge staff can meet their needs. One member of staff spoken to said, We get the information at the beginning as much as possible. We also looked at Mental health assessment information which was available to look at for residents we case tracked. We spoke to members of staff and they understood the importance of getting the right information and meet potential residents before they move in, so that they are sure they can provide the care and support required and meet the needs of the people. One Care Homes for Older People Page 11 of 25 Evidence: person who lives at the home said to us, Everything was done right before I moved in. Standard 6 was not assessed as the home does not provide intermediate care. Care Homes for Older People Page 12 of 25 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. People who live at the home have their health and personal care needs met by staff who respect their privacy and dignity. Evidence: We looked at records of care for people living at the home, each had a plan setting out what support was needed and action to be taken by staff to make sure health, social and personal needs are met and monitored regularly. Improvements have been made since the last inspection in December 2008, now each individual has a review of care every month and records are updated if required. One member of staff spoken to said, We have reviewed all residents since the last inspection and now will do monthly. The owner informs us in the AQAA how they have introduced a new system of developing care plans and keeping them up to date ensuring the welfare of people living at the home is continuously monitored. We watched medication being given out of people we case tracked with the owner and found safe practices in place to ensure residents receive the right medicine at the right Care Homes for Older People Page 13 of 25 Evidence: time and they are protected by the procedures in place. Improved procedures have been put in place to ensure medicine is given out correctly and medication returned to the pharmacist is recorded. A staff member said, We have improved medication practices. We observed during the day staff treating people who live at the home with respect and dignity by the way they talked to people, knocking on doors before entering rooms and offering support in a sensitive manner when needed. One staff member wrote in a survey,We make sure every one is treated as an individual. A person who lives here spoken to said of the staff, Caring respectful people. Care Homes for Older People Page 14 of 25 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. Social activities and meals are well managed, creative and provide daily variation and interest for people living at the home. Evidence: People who live at the home have the choice to take control over their everyday routines, this is dependent on their ability to understand and make their feelings known so people can be independent as possible. One member of staff wrote in a survey, We try and get as much information from families and friends to see what people like to do and food preferences if they have problems understanding. With this being a small home routines observed during the day looked relaxed and some people were sat in the lounge area, staff were seen chatting to residents and generally supporting people. We spoke to people who live here about activities and comments included, The girls always find time to spend with you during the day. Also, One lady likes to go to the shops with me its good. We had a look around the kitchen and found the plenty of fresh fruit and vegetables for lunch and tea and plenty of stocks in the fridge and cupboards to ensure people Care Homes for Older People Page 15 of 25 Evidence: who live here receive a healthy diet with plenty of choice. The staff all do the cooking between them and the owner said, Everyone has the food and Hygiene certificate.Comments about the standard of food from people who live at the home were very good and included,The food is always good, And, If you dont like it something else is provided. What the staff do well is monitor the intake of food of every person living at the home to ensure any concerns are identified and appropriate action taken. They have a visitors policy at Caxton Lodge and friends are welcome at any time. We confirmed this by talking to people during our visit, One member of staff spoken to said, It doesnt matter what time families and friends visit. We had walk around the building and were invited into some residents rooms and found personal items around the bedrooms to make sure people who live here feel at home and are comfortable. Care Homes for Older People Page 16 of 25 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Arrangements for complaints are handled well and taken seriously ensuring people feel listened to. Evidence: There is a detailed complaints policy and procedure which is available for new residents and families to ensure they know who to speak to should they have any concerns. Copies are displayed in the home for visitors to see. One person who lives at the home said when asked if he knew about the complaints system, Yes I would speak to the owner. There has been no complaints since the previous inspection. We found through speaking to staff and people who live at the home any concerns or grumbles are acted upon before they become formal complaints and sorted out. We spoke to staff members and the owner about safeguarding adults training and one person said, No not yet I have not completed abuse awareness training. Staff should complete safeguarding adults training to ensure they understand and are aware of any signs of abuse and how to deal with it. Care Homes for Older People Page 17 of 25 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, 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. 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 environment is safe, some redecoration and refurbishment of the home would improve the surroundings. Evidence: We had a walk around the premises and the outside areas, We found the home generally clean but a little untidy. The floor throughout the home needed hoovering and some bedrooms unkempt. Parts of the home in particular the hallways were in need of repainting and some furnishings in rooms should be replaced to ensure people live in comfortable surroundings. We spoke to the owner who said, I am aware and will be redoing parts of the home. The owner had recently been away and recognised that more time is needed to keep the home tidy. One member of staff said, We are looking for a domestic person. There are policies in place for laundry processes and for the control of infection ensuring the home is kept clean and hygienic. Care Homes for Older People Page 18 of 25 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. Access to training is good for staff is and helps staff to develop their skills and competencies. Recruitment procedures are in place to ensure suitable staff are employed. Evidence: We spoke to the owner and looked at staffing rotas and found sufficient numbers on duty to be able to support the people who live at the home. One staff member wrote in a survey, With only a few staff it helps. We spoke to a person who lives at the home who said, The girls are lovely. Most of the staff have worked in the home for several years and there is only a small staff turnover. This ensures that staff are familiar with the people who live at the home and their care needs and residents know the people caring for them. Staff training records were made available and confirmed each person has a development programme for training and attending courses relevant to there role to ensure staff have the skills and competencies to care for the residents. However staff should attend formal dementia training so that they have a better understanding of people who have complex mental health needs. One staff member spoken to said, No I havent had dementia training yet. Staff are trained and 90 of care staff have completed a National Vocational Qualification (NVQ) to at least level 2. Now some staff Care Homes for Older People Page 19 of 25 Evidence: are completing level 3 which will develop their skills and competencies and enable them to provide good quality care. One staff member spoken to said, I am doing level 3 NVQ. We looked at staff records of recruitment and found good systems in place. No new staff have been employed since the last inspection in December 08. Staff files looked at had the right checks in place before people started to work at the home and ensure they are suitable. Care Homes for Older People Page 20 of 25 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 home is run well with policies and procedures in place to ensure people are kept safe. Evidence: The owner has the experience to run a care home, however has not completed the qualifications needed to manage the home.The owner said, I will be looking to appoint a manager. The person who runs ths home should complete the necessary qualifications to manage a care home. Staff and people who live at the home spoken to about how the home operates said, No problems the home runs well. Also, he home runs well. We looked at records and they show systems are in place to get residents,families and staff views on how the home is run and suggestions are made and implemented to improve the home for the people who live here. Care Homes for Older People Page 21 of 25 Evidence: We checked records of health and safety and confirm regular tests are carried out to emergency lighting, fire procedures, gas appliances and electrical equipment,they have been completed ensuring the safety of people living at the home is maintained. Care Homes for Older People Page 22 of 25 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 Older People Page 23 of 25 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 18 People who work at the home should recieve Safeguarding adults training,to ensure staff are competent to identify any signs of abuse and action to be taken. The decoration and renewal of furnishings should be undertakenin parts of teh home to ensure people live in pleasant surroundings. The person who is in control of running the home should complete the necessary qualifications to ensure they have the competencies and skills to support the staff and people living there. 2 19 3 31 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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