Inspection on 10/09/07 for Abbeyfield Stangrove Lodge

This inspection was carried out on 10th September 2007.

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

Abbeyfield Stangrove Lodge 09/09/08

Abbeyfield Stangrove Lodge 04/10/06

Abbeyfield Stangrove Lodge 10/10/05

Abbeyfield Stangrove Lodge 22/06/05

Abbeyfield Stangrove Lodge 05/10/04

Abbeyfield Stangrove Lodge 13/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Abbeyfield Stangrove Lodge Manor House Gardens Edenbridge Kent TN8 5EG Lead Inspector Ruth Burnham Key Unannounced Inspection 10th September 2007 09:00 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 Abbeyfield Stangrove Lodge DS0000024017.V346352.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. Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeyfield Stangrove Lodge Address Manor House Gardens Edenbridge Kent TN8 5EG 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) 01732 864975 01732 866435 The Abbeyfield Kent Society Ruth Mills Care Home 49 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0) Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) maximum number of places 20. 2. Dementia (DE) 29. The maximum number of service users to be accommodated is 49. Date of last inspection 4th October 2006 Brief Description of the Service: Stangrove Lodge is located in a quiet residential area within easy walking distance of local shops. All accommodation is on the ground floor. The home is divided into 4 separate residential Units. There are plenty of communal areas for residents to access and the majority of bedrooms are single. The gardens include an enclosed sensory garden, which is attractively laid out and well maintained with a paved area and seating, the garden is easily accessible from the home. 24 hour care and support is provided to older people, some of whom have Dementia. The current fees range from £485.00 to £665.00 per week. Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced visit was made to the home on the 10th September 2007 at 09:00 by one inspector who was later joined by a pharmacy inspector. The assistant manager, a number of staff, two visitors and some of the people who live in the home were spoken with. Some documentation was seen and a tour of the home made. An observation tool was used in one of the units where people with dementia are cared for. The pharmacy inspector examined storage, recording and administration of medication. It was noted during the inspection that the staff on duty were insufficient to meet the assessed needs of residents. This was discussed with the assistant manager who said that there had been problems with recruitment and staff absence. The residents spoken with said the staff are always friendly and kind. Relatives said they were made welcome when they came to visit. Surveys were sent out to relatives, residents and health care professionals before the inspection. The majority of comments made were positive however there were some critical comments received. These were mainly about lack of activities or outings. Health care professionals raised some concerns about medication and communication, they were also concerned about the homes ability to understand and meet the needs of people with dementia. People who were observed in the dementia unit were interacting well with staff and a number of them were enjoying activities during the visit. The home will provide past inspection reports on request. What the service does well: What has improved since the last inspection? People are benefiting from the improvements in the environment. A number of areas have been redecorated and bathrooms have been refurbished. There are plans to make further improvements in the near future. People who live in the home are protected from risk of fire. Regular fire drills are being carried out and staff have fire safety awareness training. The needs of people who live in the home are understood and guidance is provided to staff in care plans on how to meet their needs. Improvements have been made in meeting the social needs of residents in that an activities coordinator is now employed through the week. Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 6 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. Abbeyfield Stangrove Lodge DS0000024017.V346352.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 Abbeyfield Stangrove Lodge DS0000024017.V346352.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): 1–6 Quality in this outcome area is good. People who are considering moving into the home are provided with good information to help them decide if the home will meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who are considering moving into the home are provided with good information to help them decide if the home will meet their needs. This information is in the form of a Statement of Purpose and Service Users Guide. Each person has a written agreement and statement of terms and conditions with the home. All needs are assessed before being admitted to the home. Residents and families can be confidant that the home will meet their needs and that their needs will be reviewed regularly. Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 9 People who are thinking about moving into the home and their relatives are invited to visit, meet staff and other people who live in the home to see if the home will be suitable for them. A new resident said that she had been made very welcome and helped to settle in. The home does not provide intermediate care. Abbeyfield Stangrove Lodge DS0000024017.V346352.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 – 11 Quality in this outcome area is adequate. People who live in the home can be confident that their health and personal care needs are understood. They are cared for with dignity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home can be confident that their health and personal care needs are understood. Each person has an individual plan of care which sets out their health, personal and social care needs and provides clear guidance to staff about how to meet these needs in accordance with the wishes and preferences of the person. Many people who live in the home are unable to understand their care plan due to their condition. Visitors who were spoken to and relatives who were contacted before the visit were generally satisfied with the care provided. One relative commented that staff are very helpful, friendly and caring. Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 11 People who live in the home were appropriately dressed for the season, they are treated with dignity and respect. Their health is promoted through good links with health care professionals. Some feedback from health care professionals indicated a need to improve communication. New systems are being introduced to address these concerns. Some adjustments need to be made to the way in which medication is managed to uphold the rights of residents and protect them from risk of harm. During the inspection it was noted that the corporate medication policy and procedures, in the medication room, were out of date and were replaced with a current version. Medicines were stored securely for the protection of residents. Staff kept daily records of the medication room and fridge temperatures but did not look at the range on the minimum/ maximum fridge thermometer. Clear records were made of medicines coming into and leaving the home and when medicines were given to residents. A risk assessment had not been written for medicines retained for self –administration. There was evidence that relatives had been consulted, over a year ago, on giving medicines in food or drink. Staff had sought pharmaceutical advice about crushing some tablets but this had not been updated, putting residents at risk of taking medicines, in a way that altered the action in the body. Although there are two medicine trolleys on some days when only one trained staff member is available for the morning medication round, this can take up to two and a half hours. Medication records did not include different times medicines were given during a round’ so that residents could be at risk of the morning and lunchtime doses being too close. Abbeyfield Stangrove Lodge DS0000024017.V346352.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 – 15 Quality in this outcome area is adequate. Inadequate staffing levels are having a detrimental effect on the daily lives of a proportion of the people who live in the home. Activities have improved however people would benefit from a more varied activities programme. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The experience of people who live in the home in their daily lives and social activities varies according to their needs and abilities and also which of the four residential units they live in. It was of concern that one unit had only one member of staff to provide care for 10 residents. This had also been noted at the last inspection when the member of staff had been trying to support service users’ individual personal needs while clearing away breakfast things. At this visit the member of staff was expected to serve lunch and support the individual needs of the 10 people on the unit. This was discussed with the assistant manager who acknowledged that there usually only one member of staff on this unit and there have been staff shortages with recruitment proving difficult. Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 13 A high proportion of surveys returned by residents, relatives and health care professionals prior to the visit commented on the need for more activities. The home now employs an activities coordinator during the week who is enthusiastic and has a good rapport with residents. The assistant manager confirmed that this member of staff would be provided with appropriate training to fulfil this role. There have been no outside activities or outings. There were three staff working with the service users in one of the dementia units and 2 staff in the other. It was not possible to spend time on the unit where more frail elderly residents are cared for at this visit. Staff were seen to interact in a very positive way with residents. People who live in the home have a varied diet with some choice. Feedback from people indicated some dissatisfaction with the tea time meal. The assistant manager explained that they did not currently have a tea time cook and recruitment was proving difficult. Abbeyfield Stangrove Lodge DS0000024017.V346352.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 Quality in this outcome area is good. People who live in the home and their relatives are listened to and are free to make comment or complaint. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home and their relatives are listened to and are free to make comment or complaint. The home has a compliments book. Relatives and relatives made a number of comments through surveys sent out before the inspection which included, ‘staff listen to me.’ ‘staff are friendly and caring.’ ‘Communication is good.’ There have been nine complaints made to the manager since the last inspection. The concerns raised have been taken seriously. They were investigated and responses made to the service users or their relatives. The concerns were fully documented and written responses made. People who were spoken with during the inspection said they felt confident that any concerns brought to the managers attention would be dealt with swiftly. The complaints procedure is part of the welcome pack provided when people move into the home. This includes the address of the Commission for Social Care and Inspection. The home’s policies and procedures ensure service users rights are protected. People are protected from abuse through good staff training. Abbeyfield Stangrove Lodge DS0000024017.V346352.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 Quality in this outcome area is adequate. People who live in the home benefit from the clean and homely environment. Further improvements are planned to improve the quality of life for people. The quality of life and safety of residents is compromised by failure to maintain gardens to a good standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home benefit from the homely atmosphere. Improvements have been made to the home since the last inspection and further work is planned to improve the environment. Each unit has it’s own secure area of garden however the grass had not been cut recently and was too long for residents to walk on safely or comfortably. All areas of the home were clean. There are plans to add a conservatory to the younger adults unit to increase the communal space available which is currently inadequate. People who have physical disabilities benefit from adapted bathrooms and adaptations throughout the home to make access easier for people who have Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 16 mobility difficulties. Lighting is being upgraded and a new chair has been ordered for the treatment room. People benefit from good laundry facilities however staff shortages and the breakdown of a washing machine had resulted in a backlog of dirty laundry which was piled up in the laundry on the day of the site visit. Good practice in managing soiled items protects people from risk of infection. Abbeyfield Stangrove Lodge DS0000024017.V346352.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 – 30 Quality in this outcome area is poor. People who live in the home benefit from the support of the well trained and supervised staff team. Not everyone who lives in the home has access to adequate staff support to ensure that their needs are met. People could be at risk where recruitment procedures are not sufficiently robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The deployment of staff throughout the home means that people on some units have to wait longer for the attention of staff than others. It is clearly not in the best interests of residents to have any unit with only one member of staff to support them. People who live in the home are supported by a well trained staff team. All new staff have a formal induction programme and staff are encouraged and supported to obtain National Vocational Qualifications. Basic care training including moving and handling is provided. Staff receive regular formal supervision. Recruitment procedures are not sufficiently robust which could mean that People who live in the home are inadequately protected. New staff are employed before references are obtained. Records examined for 2 members of staff had only on reference neither of which was from a previous employer. Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 18 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 – 38 Quality in this outcome area is adequate. People who live in the home benefit from the support of a well trained management team. Their health and safety is promoted through safe working practices. The welfare of people who live in the home would be better promoted through more effective quality assurance in recruitment and deployment of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home benefit from the support of an experienced manager who is qualified to NVQ level 4 and is about to undertake the Registered Managers Award. The manager has been appointed since the last inspection. Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 19 There is an effective quality assurance system in the home which takes account of the views of the people who live there and their relatives through surveys and meetings. The home has a development plan to ensure that improvement is sustained. The requirement in relation to staffing levels from the last inspection has not been met. Improvements are needed in the management of the recruitment and deployment of staff. The financial interests of people who live in the home are safeguarded through robust policies and procedures. The manager ensures peoples’ health and safety is promoted through safe working practices and training for staff in moving and handling, basic food hygiene, first aid, fire safety, Health and safety and infection control. People who live in the home are protected from risk of fire. Records show fire drills are carried out regularly and all fire safety equipment is regularly maintained and checked. It was not possible to check safety certificates for gas and electricity on the day of the visit and the assistant manager agreed to forward copies of these document to the Commission. There is a maintenance programme in place for redecoration and repairs and a handyman is employed in the home. Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 20 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 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 3 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 3 3 Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 21 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 OP9 Regulation 13(2) Timescale for action The registered person shall make 08/10/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home, in that Decisions on covert administration must be documented and reviewed. Pharmaceutical advice must be sought when it is intended to crush any medicine. A documented risk assessment must be in place for all service users who administer their own medicines. Service users receive their medicines at appropriate times and intervals. The registered person shall 30/09/07 having regard to the size of the care home and the number and needs of service users ensure that external grounds which are suitable for, and safe for use by, service users are provided and appropriately maintained; in that grass must be kept short The registered person shall, DS0000024017.V346352.R01.S.doc Requirement 2. OP19 20 (2) (o) 3. OP27 18(1)(a) 31/10/07 Version 5.2 Page 22 Abbeyfield Stangrove Lodge having regard to the size of the care home, the statement of purpose and the number and needs of the service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. In that, sufficient staff must be working at the home at weekends. All units must have sufficient staff to ensure that the needs of residents can be met without undue delay. This requirement has been carried forward from the last inspection 4. OP29 19(4) The registered person shall not allow a person to work at the care home in a position to which paragraph (3) applies, unless 2 written references have been obtained. The home must ensure the premises is maintained and a programme of maintenance and renewal is in place. This requirement has been carried forward from the last inspection. Some progress has been made towards this and further work is planned to meet this requirement. 30/09/07 5. OP19 13 30/10/07 Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 23 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 OP12 Good Practice Recommendations Activities should be planned and should include outings Abbeyfield Stangrove Lodge DS0000024017.V346352.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local 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. Extracts may not be used or reproduced without the express permission of CSCI Abbeyfield Stangrove Lodge DS0000024017.V346352.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!