Inspection on 08/04/08 for York Lodge

This is the latest available inspection report for this service, carried out on 8th April 2008.

CSCI 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.

Other inspections for this house

York Lodge 24/05/06

York Lodge 25/10/05

York Lodge 26/04/05

York Lodge 05/12/04

York Lodge 20/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE York Lodge Myrtle Road Crowborough East Sussex TN6 1EY Lead Inspector Rebecca Shewan Unannounced Inspection 09:25 8th April 2008 X10015.doc Version 1.40 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 DS0000021294.V360862.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 Older People. 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 DS0000021294.V360862.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service York Lodge Address Myrtle Road Crowborough East Sussex TN6 1EY 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) 01892 661457 01892 661457 fred@millcroft.plus.com Millcroft and York Lodge Care Homes Ltd Mr Fred Bramble Care Home 22 Category(ies) of Dementia - over 65 years of age (22) registration, with number of places York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty-two (22). Service users must be aged sixty-five (65) years or over on admission. Only adults with a dementia type illness are to be accommodated. Date of last inspection 24th May 2007 Brief Description of the Service: York Lodge is a care home providing care for up to twenty-two (22) residents over the age of sixty-five (65) with a dementia type illness. Nursing care is not provided at this establishment. The home is located in a quiet residential area of Crowborough. The town centre is located within walking distance of the home. There is nearby access to public bus routes. There are car-parking facilities at the home for approximately seven cars. York Lodge is a large detached three-storey building. Rooms are located over three floors, all of which are served by a passenger shaft lift. Twenty rooms are for single occupancy, of which eighteen have en suite facilities. There is one double room that is provided with en suite facilities. There are two communal toilets located near communal areas and a bathroom located on each floor, two of these being assisted facilities. There are grab rails placed throughout the home in areas where residents may require some assistance with mobilisation. Weekly fees range between £400 and £575. There are additional fees; hairdressing (£10 to £22), Chiropody (£15), newspapers and personal toiletries (at cost). The cost of having some entertainment brought into the home is shared amongst the residents who attend the session. Residents are invoiced for food when they are taken out of the home for outings. This information was provided to the CSCI on the 8th April 2008. Potential new service users can obtain information relating to the home by word of mouth, CSCI inspection reports, placing authorities/care managers, contacting the home direct and Social Services. York Lodge DS0000021294.V360862.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 the people who use this service experience good quality outcomes. This unannounced inspection took place during the morning and afternoon of the 8th April 2008. Incident reports and previous inspection reports, held by the Commission for Social Care Inspection, were read before the inspection. The inspection of the home took six and a half hours. Records such as care plans, staff files and medication records were also viewed. Twenty two service users (known as residents) were accommodated at the home at the time of the inspection. A tour of the whole home was undertaken and the Registered Manager, Assistant Manager, four residents and three relatives were spoken with. The CSCI also conducted Service User, Staff and Health Professional surveys. Of which four Service User, nine Staff and one Health Professional surveys were received. What the service does well: Potential new residents benefit from a through pre- admission assessment that allows for only those who needs can be met, being admitted to the home. The health needs of residents are well met with evidence of good multi disciplinary working taking place. Staff provide personal support to residents in such a way that promotes and protects resident’s privacy and dignity. Resident’s benefit from a well planned activities calendar that is both stimulating and meaningful and arranged according to their choice. Residents experience mealtimes that are unhurried, whilst all meals are home cooked with an alternative option being available for each mealtime. Residents can be assured that there is an efficient complaints procedure in place and that the homes processes and staff training should protect residents in the event of an allegation of abuse. The location and layout of the home are suitable for its stated purpose. All areas of the home are accessible to residents. York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 6 Residents experience the benefits of a staff team that have the necessary skills and experience to the meet their needs. Staff training is on going and is appropriate to the level of needs of current residents. The management and administration of the home is good, with evidence of consideration being given to resident’s and/or relatives opinion at all times. What has improved since the last inspection? What they could do better: 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 DS0000021294.V360862.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has processes in place for assessing potential new resident’s with services being offered to only those resident’s whose needs can be met. EVIDENCE: The home’s Assistant Manager carries out pre- admission assessments. The Assistant Manager obtains copies of care management assessments from the placing authority, where these exist. The Assistant Manager addresses any issues, which are highlighted within this assessment. Documented records are maintained of all correspondence with the placing authority. Records inspected showed that pre- admission assessments are carried out on all new and potential residents. Relatives spoken to at the time of the inspection confirmed that they and the residents had been involved in the pre admission assessment process and that they had ample time to visit the home prior to York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 9 admission. A survey response included the comment ‘Management always consider skill base prior to accepting service user referrals’. Intermediate care is not offered by this home. York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are offered a good provision of health care and personal support by the home. All care is administered in way that protects residents privacy and dignity. Medication procedures ensure that all necessary precautions are taken to ensure errors do not occur and that medications are stored and administered safely. EVIDENCE: Care plans were sampled and it was evidenced that they were comprehensive, detailed in content and covered all aspects of resident’s needs. Care plans are written to allow the assessor to gain a good overview of individuals medical, nursing, mental health, social and personal care needs and provide the assessor with a clear overview of the Residents current needs, limitations and required assistance. Residents relatives said that they are involved in the care plans review process and found this a good opportunity to discuss how to improve the quality of life of the individual resident. York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 11 From the records sampled and surveys received, it was evidenced that the health needs of residents are well met with evidence of good multi disciplinary working taking place, on a required basis. Residents are registered with a GP from one of three local surgeries. Local residents are encouraged to maintain their own GP. GP visits to the home are arranged in order to review residents. Residents are also encouraged to attend appointments where able. A Domiciliary optician attends the home annually and on an as required basis. The residents of the home have access to both private dentists and the community dentist. Audiology, Dietician, Speech and Language Therapist, Community Psychiatric Nurse (CPN) and Community Mental Health Team are accessed via referrals made by the GP. The Chiropodist attends the home six to eight weekly and on an as required basis. The Stoma Nurse attends the home to review those residents that require Stoma Care and also provides training to staff. The home has good procedures in place for the monitoring and recording of all drugs administered, disposed of and those entering and leaving the home. The stores for medication were viewed and these were found to be maintained in a clean and orderly manner. Medication administration records were viewed and these were found to be maintained appropriately. Staff training in medication is conducted as part of the Induction process, refresher training is also provided. Staff records viewed confirmed this. Staff were observed providing personal support to service users in such a way that promoted and protected residents privacy and dignity. Survey responses commented that ‘the care team uphold high standards of respect for the individual’ and ‘privacy and personal dignity ensure the service user receives a positive quality of life’. York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience Excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home provides a wide range of social, cultural and recreational facilities, including specialist diets to residents, with resident’s choice and wishes being respected. EVIDENCE: There is a published list of activities which details that activities are arranged Monday to Friday (morning and afternoon) and on afternoons only on Saturday and Sunday. Activities include: quizzes, bingo, I-spy, dominoes, arts and crafts, music and movement, festive parties, shows and a clothes show. Outings in the mini bus are arranged twice weekly, as only six residents at a time can go, those attending outings are varied for each outing. Outings in the past have included: Ashdown Forest, Horam (for afternoon tea), seafront outings (Seaford, Eastbourne), Pantiles (Tunbridge Wells), pub lunches, trips to the Theatre and shopping to local shops/town. Residents and relatives spoken with said that residents attend activities and outings at a level of their York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 13 choosing. One relative also said that they also attended the activities and found them to be ‘very enjoyable’. Resident’s religious wishes are observed and arrangements are in place for residents to receive Holy Communion, if they wish. Discussions with the Assistant Manager highlighted that although the current residents had similar religious beliefs, the home would welcome any potential new resident who has special cultural/religious/spiritual beliefs and would make provision to accommodate their needs. The management of the home believes in promoting an equal and diverse culture among staff and residents. Residents are encouraged to attend local community events, two residents are assisted to attend the local choir and day centre on a weekly basis. Contact with family and friends is positively encouraged with visitors being able to attend the home at any time and in accordance with the resident’s wishes. Two residents were out to lunch with their relatives on the day of the inspection. Residents are treated with respect and there is a good rapport between staff of the home and residents. Residents reported that the home assists them to maintain their independence with their daily living and daily routines. The home’s menus are devised on a four week rolling programme. All meals are home cooked with an alternative option available for each mealtime. Mealtimes can be varied upon request and residents guests are also welcome to have meals at the home. Meals can be taken in the residents bedroom or in the communal dining room. Medical, therapeutic or religious diets are provided as needed. Drinks and snacks are available at all times. The meal served during the inspection was ample in quantity and attractively presented. The lunchtime meal was observed to be unhurried. York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a robust and efficient complaints procedure, whilst the homes procedures, processes and staff training should protect resident’s in the event of an allegation of abuse. EVIDENCE: The home has an established complaints procedure in place. There is a need for the complaints policy to be amended, to indicate the timescales with which complaints will be formally responded to. Therefore a Recommendation for good practice has been made. The home has received three complaints within the past twelve months, all of which have been recorded as addressed. Each of the complaints have been resolved and appropriate action was taken by the Registered Manager and/or Assistant Manager, to address the concerns raised. Criminal Record Bureau (CRB) checks have been carried out on all existing staff. Both CRB and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. Staff have attended training in the Protection of Vulnerable adults within the last twelve months. This was evident from the staff files were viewed. There have been no Safeguarding Alerts raised by the home in last twelve months. York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides accommodation for residents that is safe, hygienic and odour free, whilst infection control procedures are adhered to at all times. EVIDENCE: The location and layout of the home are suitable for its stated purpose. The home is well maintained and all areas of the home, including the garden, are accessible to residents. The home has an ongoing plan of refurbishment in place. The home has an infection control policy in place and staff are trained in infection control procedures, staff training records viewed confirmed this. Staff were observed adhering to infection control procedures. The home was clean York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 16 and odour free throughout. There is a daily cleaning schedule in place. It was evidenced that a clinical waste contract is in place. York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a staff team that have the necessary skills and experience to the meet the needs of current residents. EVIDENCE: A competent staff team, sufficient in number, meets the resident’s needs. There is a staff rota in place, which details staff designations and hours of working. The home has a permanent staff team of the Registered Manager, Assistant Manager, thirteen care staff, one cook, one Hotel Services Manager, six housekeepers, one maintenance person and one administrator. Five care staff are National Vocational Qualification, level 2 or above, trained in care and five care staff are currently completing the NVQ level 2, in care training. The Assistant Manager is NVQ level trained, has achieved the Registered Managers Award and is also NVQ Assessor (A1 & A2) qualified. Staff recruitment files were viewed and it was evidenced that these files contain all items required under the Care Homes Regulations 2001. Some of the current staff team are from abroad. All necessary visa and Home Office related documents were found to have been obtained and kept on file for these York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 18 employees. The home has an Equal Opportunities policy in place and is an equal opportunities employer. Staff induction training is conducted in line with Care Skills Sector guidance. Mandatory training consists of Health & Safety, Fire Safety, Moving and Handling, First Aid, POVA, Basic Food Hygiene, Medication (for senior carers) and Infection Control. Additional training is also provided in Dementia, Stoma care, Prevention of Falls, Continence, Nutrition, Mental Capacity Act and other service user related subjects (as the need arises). Survey responses commented that ‘training is continually ongoing’ and ‘staff get a lot of opportunity to have training’. Three staff are ‘train the trainer’ qualified, one in Moving and Handling, one in POVA and one in Infection Control. York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents experience the benefits of a home that is well managed and administrated. Consideration is given to resident’s choice and opinion in all aspects of provisions provided. The health, safety and welfare of residents and staff are protected at all times. EVIDENCE: The Registered Manager of the home is also the Registered Provider and has worked in the care home industry for many years. Residents and relatives spoken with said that the Registered Manager was friendly, approachable and always takes residents concerns or comments about the home seriously. York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 20 Quality Assurance processes consist of resident’s meeting that are held three to four times a year, the records of which are maintained for all meetings held. Staff meetings are held six weekly and ad hoc, as necessary. All such meetings are minuted, which were viewed at the time of the inspection. Questionnaires are sent to service users, staff, relatives/representatives, GP’s and other professionals on an annual basis. The results of the next survey/questionnaire are to be given to service users/relatives and other stakeholders at meetings i.e. staff meetings, residents meetings and care reviews. The home does not take any responsibility for many of the resident’s finances and most residents have family, friends or representatives who protect their financial affairs. The home’s maintenance files were viewed and it was evident that fire drills, fire alarm testing and fire equipment checks, health & safety checks and water checks had been carried out. There were no health & safety issues noted at the time of this inspection. York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 York Lodge DS0000021294.V360862.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (2) (b) Requirement That residents individual care plans are reviewed on a consistent monthly basis. Timescale for action 08/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP16 Good Practice Recommendations That the Complaints Policy is updated to include the timescales with which all complaints will be formally addressed. 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