Inspection on 29/06/06 for Sherwood Lodge

This inspection was carried out on 29th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sherwood Lodge 01/06/05

Sherwood Lodge 07/02/05

Sherwood Lodge 25/05/04

Sherwood Lodge 04/12/03

Sherwood Lodge 19/08/03

Sherwood Lodge 28/01/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Sherwood Lodge 71 Atheldene Road Wandsworth London SW18 3BU Lead Inspector Louise Phillips Unannounced Inspection 29th June 2006 10:20a 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 Sherwood Lodge DS0000010223.V305295.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. Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sherwood Lodge Address 71 Atheldene Road Wandsworth London SW18 3BU 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) 020 8874-4251 020 8870 3185 Servite Houses Mrs Nelly Iweha Care Home 47 Category(ies) of Dementia - over 65 years of age (47), Old age, registration, with number not falling within any other category (47) of places Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Sherwood Lodge provides care and support for up to 47 residents who may also have dementia care needs. Accommodation is provided over two floors divided into the four units of Jasmine, Bluebell, Rosemary and Lavender. Each unit has its own kitchen/ dining area, lounge, bathroom and toilet facilities. The home is situated in a quiet residential road and is close to transport links and public amenities. The Service User Guide, Statement of Purpose and latest inspection report for the home are on display in each unit and in the reception area of the home. Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day with time spent talking to six staff, six residents and the manager. A tour of the premises was carried out and care records were inspected along with other relevant paperwork. Information has also been gained from the inspection record for the home. Questionnaires were sent to 18 health and social care professionals, of which 6 were received back and are referred to in the report. What the service does well: 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. Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 6 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 Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made as residents are assessed prior to moving to the home and individual preferences catered for. EVIDENCE: Standard 6 is not applicable to this service. The file for a resident recently admitted to the home was examined. Findings indicate that the home continues to have a good process for assessing and admitting new residents, with appropriate referral information being sought from the social worker, psychiatrist or other care professionals as necessary. The home uses it own assessment format that provides good information about the residents social and medical history, likes and dislikes, strengths and limitations which is then used to develop an individualised care plan. Records indicate that after six weeks of living at the home a review is held with the resident, their family, the manager and social worker to establish whether they are happy living at the home, and that the home can meet their needs. Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 8 One resident spoke to the inspector about their move to the home, stating that the staff “…re-arranged my room to the way I like…”. Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made as the feedback received from health and social care professionals and residents indicates that their needs are met. However the service needs to improve the care plan format to one that is workable for the care staff. EVIDENCE: Comments from health and social care professionals associated with Sherwood Lodge are positive, with all indicating that they feel the needs of the residents are well met, the home works in partnership with them and there is good communication from the home. Where asked where they feel the home provides an excellent service, the professionals commented: “…the care is generally satisfactory…” “…any relevant information is obtained quickly…” “…medicines management…” One professional commented that “…they work well and will take clients who are challenging…”. An observation during the inspection indicates that staff Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 10 can work with challenging behaviours. This is where a resident was seen shouting and being rude to staff, where another staff member calmly intervened and distracted the resident from doing this – complimenting them on what they were wearing and continuing to do this until the resident was calm and they could establish what they wanted. Areas where the professionals said the home could improve were in the staff following instructions they give regarding healthcare – though they did state that this only tends to falter when there are agency staff working. Another professional commented that “…they work well within reason. The main office staff when working on units do not have an answering machine by phone, this would be useful…”. Residents spoken to said that they feel they get good care and support, one resident saying: “…they do my medication, which helps me remember to take it…”, another saying “..the staff are wonderful, kind and caring…”. On the day of inspection a chiropodist was visiting the home and attending to the residents, where the manager stated that they visit each resident every three months. A dental hygienist also visits approximately every three months to keep a check on the oral care needs of each resident. The home maintains a record of the weekly visits of the doctor. This details the healthcare complaint/ symptom of the resident, a record of the outcome/ treatment prescribed, followed by a record of where the home has informed the relative or next of kin of the outcome. Five care plans were looked at on different units throughout the home. The care plans for each resident have recently changed to a newer format. These include an initial summary of the residents needs on a morning, afternoon and night basis, followed by a care plan for areas such as personal hygiene, personal safety, mental health or moving and handling. The care plans detail what the resident can do independently and where they require assistance. The care plan for one resident details how they prefer to be attended to by a female carer, this has been signed by the resident and the manager stated that this request is met through there only being female staff working on that unit. Staff feedback on the newer care plan format is that they are “…time consuming…” and that the “…am/pm/night and then care plan for each individual activity is repetitious…”. Feedback from a senior staff member, when asked what they feel needs to improve was: “…the expectations on staff regarding paperwork…” where they discussed that some staff simply do not have the literacy skills to be able to write the care plans. The previous inspection required that the care plans are in a format that is easily understandable and accessible to the staff and residents. It is acknowledged that improvements have been made to simplify the care plans, Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 11 and the organisation should ensure that this continues to be reviewed so that the format is workable for the care staff. Individual risk assessments detail risks such as falls or smoking, followed by a risk management plan that outlines how these are managed by the home. Limitations are also included in this, where for one resident this detailed their need to walk with the support of a walking stick. For another resident this detailed their difficultly in retaining information, and the need for staff to be aware of this when communicating with them. There are sufficient medication policies at the home, covering areas such as correct storage of medicines, safe checking of medication prior to administration and managing drug errors. The medicine administration charts are maintained well, signed appropriately and the prescribed medication corresponding with that in the blister packs. Sherwood Lodge DS0000010223.V305295.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made as the service provides activities for the residents. Residents are positive about the food and are able to choose an alternative if they do not like what is offered on the menu. EVIDENCE: The previous inspection required that staff who provide activities receive training specifically for providing activities for residents with dementia. The manager stated that the service is planning to train the senior staff to enable them to co-ordinate appropriate activities. This requirement has not been met within the timescale and has been restated. At present there is a member of staff who co-ordinates the activities in addition to their carer duties. Recent activities at the home have included a ‘UK day’ on the Queens birthday, ‘music and movement’ and there continues to be twice weekly bingo. The deputy manager stated that unit meetings were held on the previous day, where residents gave suggestions for day trips throughout the summer, and that these will be planned shortly. Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 13 One resident discussed how they enjoy living at the home, stating this is particularly because “…I can go to bed when I want…” and that “…my daughter visits, and I can ring her when I need to…”. Professionals surveyed said that they felt that the home operates in the best interest of the residents, one stating that the staff “…always appear caring towards residents…”. Observations throughout the inspection are that staff have a caring approach towards the residents. Such things as the carer bending down to the height of resident who was sat in chair to talk to them. Another carer was seen turning down the sound of the television as they said to the resident that they could not hear what they were saying. Staff were equally caring when serving lunch, offering support where necessary and gentle reminders such as “…leave the food to cool because it is hot…”. One resident was seen being helped to eat by a staff member who assisted the resident at their own pace, informing them of each forkful of food prior to putting it in their mouth. Lunch was serve in good portions, with a choice of chicken or liver, as the main course, though one resident was seen having a fried egg, which they said they had requested as an alternative. Each resident’s meal preferences are recorded as part of the assessment process and this is additionally recorded on the kitchen wall in each unit. During the summer months residents are also able to choose a ‘summer salad’ as an alternative to the menu. One resident commented about the meals, saying “…the food is really good…”. Sherwood Lodge DS0000010223.V305295.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made as residents feel confident to raise areas of concern they have and systems are in place to reduce the risk to residents. EVIDENCE: The home has the Servite Houses complaints procedure that is provided in the Service Users Guide and Statement of Purpose and is on display on each unit around the home. All the residents said that they knew who to speak to if there was something they were not happy about and that they know how to make a complaint. One complaint was received since the last inspection that was investigated by the home using their complaints procedure. Staff records indicate that they have received recent training in abuse awareness, so to minimise the risk to residents. There are also policies and procedures in place regarding abuse awareness and what to do in the event of this. Sherwood Lodge DS0000010223.V305295.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26 Quality in this outcome area is adequate. This judgement has been made as the staff and residents make the environment welcoming. However, feedback from health and social care professionals is that aspects of the home environment need to improve for the benefit of the residents. EVIDENCE: Since the last inspection some improvements had taken place, with the bathroom on Jasmine Unit having been redecorated, along with the sluice room on Bluebell unit. The manager stated that the communal areas throughout the home are due to be redecorated shortly. The comment from one healthcare professional who visits the home is that “…the home needs improvement in its décor as this would enhance the residents well-being. Relatives would also be happier about using the home…”. Another professional stated that “…the home could do with en-suite toilets/ showers…”. A further comment was that: “…I find it very hot in there, especially on summer days…”. Feedback from another professional was that the home Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 16 should have air-conditioning installed. During the inspection air-conditioning units were observed in the lounge areas of each unit, though switched off and it is required that these be used to ensure the comfort of the residents. The home is cleaned to a good standard by the dedicated domestic staff. A tour of the home found a couple of areas that need to be addressed: • Bluebell unit – new flooring required in the sluice area to replace that which is badly stained with lime-scale. The windows on this unit are able to be opened very wide and it is required that window restrictors are used on all windows throughout the home at all times. • Jasmine unit – a damp spot was observed on the ceiling around the smoke sensor just inside the entrance to the unit, and it is required that this is addressed. Sherwood Lodge DS0000010223.V305295.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made because the service ensures that appropriate recruitment checks are carried out on staff. The service also provides training and support to staff so that residents receive the right level of care. EVIDENCE: The home holds recruitment information on each member of staff. Three staff files were examined and found to contain relevant information such as proof of identification, correspondence relating to offer of job, two references and record of the interview of staff. Staff files also evidence that annual staff appraisals have been carried out in the last two months, along with individual supervision sessions on a two monthly basis. New staff have an induction and work an initial six month probationary period, which includes relevant training that is in line with Skills for Care recommendations. Permanent and relief staff receive regular training and refresher courses that are provided by Servite Houses, which include medication awareness, first aid, fire safety and manual handling. One member of staff spoke about how they had recently completed the NVQ level three in care and how they use what they have learnt to enhance their work and guide other staff. Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 18 Feedback from one professional is that “…staff in the home are clear about what they can provide and if they have issues with care provision they will highlight it well…”. The previous inspection required that the staff receive up-to-date and formalised training in dementia care as the organisation provided training for two hours only. Feedback from the deputy manager and staff indicate that this training has improved and is now provided in stages, with two hour sessions over a period of months. One staff member described how the initial stage taught them about different types of dementia, adding that “…it helps me understand the people more that I am caring for…”. Due to the feedback received this requirement has been assessed as met, though will continue to be monitored through the inspection process. The inspector was informed that night staffing at the home has improved with their now being one senior and two care staff working through the night. There are some care staff vacancies at the home that are currently being recruited for. The vacancies are being managed through the use of relief and agency staff. One professional commented about this, stating that: “…staff who have been there over long period are generally very good – know the clients well and give good care and feedback…”. Another stated “…the regular staff are usually very good…”. However one care professional said that:“…the agency staff are not very good and are often quite rude and know little about the clients…”. In response to whether they feel the health and social care needs of the residents are met, they added “…if relevant staff are on duty…”. The home must ensure that the use of temporary/ agency staff does not prevent residents from receiving good care, and this is the subject of requirement 4. Sherwood Lodge DS0000010223.V305295.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 37 and 38 Quality in this outcome area is good. The home has a committed manager who promotes the choice, interests and safety of the residents. EVIDENCE: One healthcare professional commented that: “…the manager of the home is well versed in the up-to-date criteria of meeting needs of older people. Since her arrival the overall care of most residents have improved. The staff appear happier with the environment…”. Observations and discussions with the residents and staff during the inspection were positive, indicating that the manager is respected and well-liked by the those living and working at the home. The manager has a number of years experience of running a care home and is currently undertaking the NVQ Level four in Management, which will help develop the service further. Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 20 There are records to demonstrate that health and safety checks are carried out on the fire system and equipment, lifting equipment, water disinfection, gas safety and Portable Appliance Testing, etc. Health and safety risk assessments are carried out for different areas around the home eg. staff room, office equipment to ensure a safe working environment. Senior staff also carry out a weekly health and safety check, where the whole house is checked for such things as lights working, toilet/ basins blocked and the temperature of water from each tap. One professional who visits the home said that the home is good at: “…the report writing of daily events…”. Good record keeping was observed in the care files, where care staff describe what the resident has done throughout the day, enabling a clear picture of their life at the home. Sherwood Lodge DS0000010223.V305295.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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X x X 3 3 Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP12 Regulation 16(2)(n), 18(1) Requirement The Registered Persons must ensure that staff who provide activities receive specific training in providing appropriate activities for residents with dementia. (Previous timescale not met) The Registered Persons must ensure that the following maintenance/ hygiene issues are addressed: - the communal areas throughout the home are redecorated. (Previous timescale not met) - the flooring on the sluice area on Bluebell unit needs replacing - that window restrictors are used on all windows throughout the home at all times - that the damp spot on the ceiling around the smoke sensor just inside the entrance to Jasmine unit is addressed. The Registered Persons must ensure that the air-conditioning units on each unit are used to ensure the comfort of the DS0000010223.V305295.R01.S.doc Timescale for action 31/08/06 2. OP19 23(2) 30/09/06 3. OP25 23(2)(p) 31/07/06 Sherwood Lodge Version 5.2 Page 23 residents. 4. OP27 18(1) The Registered Persons must ensure that the use of temporary/ agency staff does not prevent residents from receiving good care. 30/09/06 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 OP7 Good Practice Recommendations The Registered Persons should ensure that the care plans are kept under review so that they home are in a format that is workable for the care staff. Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Sherwood Lodge DS0000010223.V305295.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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