CARE HOMES FOR OLDER PEOPLE
Abigail Lodge Care Home Gloucester Road Delves Lane Consett Durham DH8 7LB Lead Inspector
John Trainor Unannounced Inspection 13th December 2006 10:50 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 Abigail Lodge Care Home DS0000000686.V321780.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. Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Abigail Lodge Care Home Address Gloucester Road Delves Lane Consett Durham DH8 7LB 01207 502405 01207 502439 abigail.lodge@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Judith Mallaburn Care Home 60 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) Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (30), Old age, not falling within any other of places category (30), Physical disability (3) Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Three persons within the category of PD aged 55 years and over may be accommodated commensurate with the home`s Statement of Purpose. 14th November 2005 Date of last inspection Brief Description of the Service: Abigail Lodge is a care home with nursing. It has two units, each with 30 beds. One is registered to provide care (including 24 hour nursing care) for people aged 65 or older, together with convalescence and palliative care for people aged 55 or older. The other accommodates people with dementia care needs (including 24 hour nursing care). The home is located on the edge of Consett, close to a supermarket and a public house. It was opened in 1995 and is a purpose-built, two storey building. All bedrooms are single with en suite facilities. There is a passenger lift in each unit. The home has large gardens that are well maintained and easily accessible. Fees at the time of inspection were £365.00 to £576.00 Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection involved the home providing information to the Commission for Social Care Inspection before a site visit which was unannounced and lasted 6 hours. During this visit records were inspected including care plans and health and safety records. Care practices were observed. People were spoken to including people resident, staff and management. There was a tour of the building What the service does well: What has improved since the last inspection? What they could do better:
The home did not have enough staff deployed to meet all of peoples needs and had failed to increase them as recommended in the previous report. Staffing in care homes needs to be maintained in line with peoples needs. Although staff were maintaining peoples physical care needs, their social and occupational needs were not always met.
Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 6 This was supported by the views of people resident and staff spoken to during the visit. National Minimum Standards also require at least 50 of staff are trained to NVQ level 2 in care but the home did not meet this benchmark and should make efforts to ensure this is maintained as a minimum. People needed to have individual activity plans implemented to ensure their lifestyle met their expectation and preference. One person said there was not enough to do during the day, “just sit and watch telly that’s all it’s boring.” Care plans were in place on all files inspected though some of them needed revision to update information. When care plans are reviewed they must be revised if needs have changed. In particular risk assessment on the use of bed rails needed revision, as care plans had risk assessments in place advocating their use, when in fact none were being used in the home. Some people had problems identified with dietary intake but the home did not have the facility to monitor their weight, as they could not use the scales in the home. One person with these problems had a care plan record that stated, “unable to weigh due to balance problems,” and had therefore not been weighed for over a year despite having problems with dietary intake identified. There was no alternative method recorded for monitoring this problem. It was recommended the home obtain a scale which can be attached to the hoist to record weight for those unable to use the scales in the home. There was one medication error where a person had tablets administered from a box belonging to another service user. The dose and medication were the same so the person had not been at any risk but staff were reminded to only administer from boxes for named individuals and to check the name on boxes when giving out tablets. The Commission for Social Care Inspection had been made aware of a complaint investigation carried out in the home by the company. No records were maintained in the home of this complaint and the manager was unaware there had been a complaint. The home was reminded to maintain records of complaints for inspection. Although the home had a clear and auditable system for managing peoples finances, people who could not manage their own money and did not have relatives to look after it for them, had their money looked after in a communal account. It was unclear as to how interest was allocated if at all for these people and it seemed therefore they were at a disadvantage. It was recommended alternatives be explored to ensure those people who had capital benefited from an interest gaining account. The home did not have a policy on sexuality and relationships available for inspection and should develop one. 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.
Abigail Lodge Care Home DS0000000686.V321780.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 Abigail Lodge Care Home DS0000000686.V321780.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): 2, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs were assessed and they had access to information to make a choice before they moved in. EVIDENCE: All files inspected had an assessment to enable the home to plan to meet peoples assessed needs. The home manager said all people got a copy of the home’s statement of purpose and service user guide. Care files did not contain evidence that people had received a copy. There was a sign on the door referring people to the library or Commission for Social Care Inspection website if they wanted access to reports so the provider was not making these available to people. Contracts inspected were not all filled in, where there was space provided, with the breakdown of fees and who was responsible for paying which element.
Abigail Lodge Care Home DS0000000686.V321780.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People had their health and personal care needs met in a planned way, based on assessment of need and risk management principles. Plans were not always revised as needs changed and so people could not be guaranteed to have all their needs met consistently. EVIDENCE: All files inspected had care plans following assessment to meet people needs. There was evidence of access to Doctors and other specialist health services including opticians. Care files had risk assessments and risk management plans though in some areas these needed revision to ensure they were up to date. Bed rails were not used in the home though risk management plans did not reflect this and required revision. Some people who were unable to use scales were not having their weight monitored and the home needed to find a way to record this to monitor people’s health and nutritional needs. One person clearly had oral hygiene needs but had no care plan to reflect this.
Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 10 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People could make choices about their day to day living arrangements but did not have enough activities to keep them meaningfully occupied. Food was good and met peoples dietary needs. EVIDENCE: The activities co-ordinator had recently left and people said they did not have enough to do during the day, “just sit and watch telly that’s all it’s boring.” The manager did say things were provided though not to a great extent. There was a plan to advertise for a new activities co-ordinator after Christmas. People did not have individual social, occupational or activity plans. From observation people could make choices with regard to diet, where they wished to eat, where they wished to be, communal lounge or private room.
Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 11 Families could visit when they wished. Food was reported to be good with a choice of meal. On the day of inspection the main meal was at lunch time because they had a buffet tea which people seemed to enjoy. There was a selection of sandwiches for people to choose from and a selection of cakes. Staff were seen to be treating people with dignity and respect offering them choice, “What sandwiches would you like,” “ How many would you like.” One lady asked to sit in the dining room as she preferred it to having tea in the lounge and this was organised by staff. Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 12 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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People could be assured procedures were in place to protect them from abuse and there was a complaints procedure. However complaints were not being recorded robustly in the home. EVIDENCE: There was no record of the recent complaint about the home which the Commission had been copied into the reply. Complaints were therefore not being recorded in the home. The manager claimed no knowledge of the complaint. The complaints investigation did not appear to allow for an interview with the complainant or other witnesses but merely followed a paper trail. This would seem to imply that the methodology for complaints investigation can be flawed within the homes current complaints procedure. Investigation methodology is not explicit in the complaints procedure though there are specified timescales for response. There was a POVA procedure and staff were trained in POVA issues. Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 13 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was fit for purpose though some decoration works still needed to be completed and sluice disinfectors needed repair. EVIDENCE: There had been some improvement to the décor in the home since the last inspection though the manager acknowledged she had not finished yet the work that needed doing. This work was scheduled and the home had a handyman to complete jobs as they were identified. Corridors had been redecorated as had the downstairs lounge with new carpets. Shower doors in assisted bathrooms were all broken at the hinges and needed repair.
Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 14 Rooms all had individual thermostatic controls on radiators so temperature could be adjusted to suit peoples requirements. Curtains in the first floor lounge were being replaced on the day of inspection. Sluice disinfectors in the home were out of order and needed repair. Disabled access in the home was adequate with assisted bathrooms and shower rooms. Most people who were wheelchair users used them for transfers and required assistance to do so. Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 15 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff had some skill to meet people’s needs though were not deployed in sufficient number to ensure people’s lifestyle matched their expectation and preference. EVIDENCE: Staff received training to ensure they could provide care safely for people. Due to staff leaving the level of staff with NVQ level 2 or above did not meet the required 50 . Staff were observed to treat people with dignity and respect and had been recruited safely. Staff were also seen to move people safely with regard for their dignity. There were sufficient domestic and ancillary staff though numbers of care staff would benefit from increase to ensure peoples needs could be met at all times. On the dementia care unit staff should be trained and deployed in sufficient number to enable diversion so that the use of locking parts of the floor to restrict access for people does not need to be used as a matter of course. Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 16 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, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was managed safely in the interests of service users. EVIDENCE: The manger was personable had been in post for 3 years and had the Registered Managers Award. She was committed and had made improvement to the environment which was a work in progress. Health and safety checks were completed. Service user monies were accurately recorded and audited though these monies were kept in a communal bank account and it was unclear as to how interest was allocated.
Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 17 This meant people without relatives to manage their money for them were at a disadvantage if they could no longer manage themselves. The home did not have a policy on sexuality and relationships, this needed development. There was a quality assurance and management system in place. Staff received supervision through a cascading model where the manager supervised heads of departments who in turn supervised their staff. Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 18 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 3 Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 19 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 (c) Requirement Timescale for action 31/05/07 2 OP12 16(2(n)) 3 OP16 17(2) Risk assessments with regard to the use of bed rails for service users needed revision to accurately describe the assessed risk and risk management employed. Care plans must be revised when reviewed, if needs have changed and must include all peoples needs. Service users must be provided 31/05/07 with activities which meet their expectation and preference and provide for meaningful social and occupational activity. Accurate records of complaints 31/01/07 should be maintained in the home including methodology and outcomes. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 20 1 OP7 2 OP9 3 4 OP26 OP27 5 6 7 OP28 OP33 OP35 Some people could not make use of the scales provided by the home and therefore weight could not be monitored. Care plans did not provide for any alternative method of managing this even when identified as an assessed need. It is recommended the home obtain a scale which can be attached to the hoist to accurately record weight for people unable to use the scales. Medication should only be administered to people from boxes dispensed for the named individual. Staff should be reminded of this through supervision and encouraged to check the name on boxes when administering. Sluice disinfectors should be maintained in working order. Staff should be deployed in sufficient number to meet the needs of the people resident. It is recommended staffing hours should, at a minimum, meet residential forum guidance. At least 50 of the staff team should be qualified to NVQ level 2 or above. The home should develop a policy on sexuality and intimate relationships. People unable to make financial decisions for themselves and without family to assist this process should be referred to care management processes to have accounts managed in their names by local authority appointed persons and have their capital in interest gaining accounts. Abigail Lodge Care Home DS0000000686.V321780.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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
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