Inspection on 08/08/05 for Addlestone Lodge

This inspection was carried out on 8th August 2005.

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 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

Addlestone Lodge 19/10/06

Addlestone Lodge 05/05/05

Addlestone Lodge 04/08/04

Addlestone Lodge 18/05/04

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 Addlestone Lodge Ongar Hill Addlestone Surrey KT15 1BS Lead Inspector Mr Deavanand Ramdas Announced 8 August 2005 10:00am th 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 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. Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Addlestone Lodge Address Ongar Hill Addlestone Surrey KT15 1BS 01932 846268 01932 847197 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Addlestone Care Home Ltd Care Home 25 Category(ies) of OP - Old Age (25) registration, with number of places Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nursing Care for elderly people from the age of 60 years. Date of last inspection 5th May 2005 Brief Description of the Service: Addlestone Lodge is a care home for older people located in Ongar Hill, Addlestone, Surrey. Addlestone Lodge is owned by Addlestone Care Homes Limited and is registered for 25 beds. Accommodation is provided on three floors which can be accessed by stairs or a lift. The home has single and shared bedrooms. The facilities on offer include a lounge, dining area, kitchen, laundry and adequate bathing and washing facilities. The property is located in a residential area close to public amenities which include shops, churches and pubs. The home is being extended into the back garden and as a result there is limited access for service users, however there is a well maintained patio area that is accessible and which service users are able to use. The home has adequate private parking to the front of the property. Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by one inspector over a period of six hours. A full tour of the premises took place and staff, service users and relatives were spoken to during the inspection. Documents and records were examined. The inspector would like to thank the operations director, manager, staff, relatives and service users for their contributions to the inspection. Comment cards, feedback forms and CSCI business cards were left at the home. What the service does well: What has improved since the last inspection? The home has met many of the previous requirements and recommendations that have resulted in improvements in staff training, activities for service users, guidelines for the administration of medications, the management of risks and up to date records and documentation. The home has introduced a standardised care planning system that has resulted in service users’ needs being assessed, identified and recorded. The home has recruited a manager and two senior care assistants to provide leadership and support to the staff team. Some relatives have expressed concern about the changes in management recently and the high turnover of staff. The home has recruited well and has only one staff vacancy. An activities co-ordinator has been recruited to work two hours a week at the home to provide activities for service users. The home has a training manager that is involved in the training and development of employees. The training manager stated ‘care is a lot better now’. Staff stated the quality of care has improved as a result of input from the training manager. One service user on respite care stated ‘ staff treat me well’ ‘they are very good’. Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 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. Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,5,6. The homes Statement of Purpose and Service User Guide are good providing service users and prospective service users with the details of the services the home provides enabling an informed choice to be made about admission to the home. The arrangement at the home for offering trial visits is adequate, however information on trial visits must be made available to service users, staff and relatives. EVIDENCE: The home had a Statement of Purpose and a Service User Guide that was nicely presented in a folder and kept in the foyer for information. The inspector noted the Statement of Purpose was revised and updated in 2005 to reflect the scale of fees charged. The manager stated the home offered trial visits to prospective service users who had the opportunity to visit the home, meet staff and other service users. Service user contracts specified the home offered a six weeks trial period. The inspector noted information on trial visits was not in the Statement of Purpose, Service User Guide or Admission Policy. This was discussed with the manager and action has been required in respect of this matter. Intermediate care is not offered by the home and this standard was not assessed. Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 9 Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9,10,11. There is a comprehensive care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users’ needs. The systems for the administration of medication are satisfactory with clear arrangements being in place to ensure service users medication needs are met, however it must be improved to ensure medicines are disposed of safely to reduce any potential risks to service users. Personal support at the home is offered in such a way as to maintain the privacy and dignity of service users. The system at the home ensures the death of a service user is handled with sensitivity and respect, however the policy must be written to ensure the information is clear and easily understood by service users, staff and relatives. EVIDENCE: The home had introduced a new care planning system that covered areas of health, personal and social care needs. The inspector noted service users had individual plans of care that were regularly reviewed and updated by key workers. Nursing assessments were completed by registered nurses, dated and signed. Service users had nutritional and manual handling assessments. One service user with a pressure sore had been seen by the Tissue Viability Nurse and had a wound assessment. The inspector noted the service user was given analgesics for pain relief that was recorded and evaluated. One service user stated I like it here. She remarked ‘staff would do anything for you’. The home Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 11 had a medication policy that was reviewed in January 2004. The inspector sampled medication records that were up to date and correct. Controlled drugs were stored safely in a lockable metal cupboard and the control drugs register was completed. The inspector noted a pharmacy assessment was completed on the 3. 8. 05 and recommendations were made. Fridge temperatures were recorded and found within normal limits. The inspector noted the home did not have a system for the disposal of medications and action has been required in respect of this matter. The home had a statement on service user rights that was reflected in the staff induction checklist dated October 2004. The inspector noted staff addressed service users by their preferred names and the manager knocked on service user bedroom doors before entering. The home had a policy on Death of a Service User that was reviewed in January 2005. The inspector noted several handwritten amendments and additions were made to the policy that was discussed with the manager and action has been required in respect of this matter. Staff had recorded in service user care plans their specific wishes in the event of death and they were aware of the Death of a Service User policy. Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 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 standard(s) 12,13,15. The arrangements at the home ensure service users have the opportunity to be involved in daily living activities at the home. Links with relatives are good and support and enrich service users’ social and leisure opportunities. The meals in this home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: The home has an Activities Co-ordinator who provide activities to service users twice a week. The inspector noted information about activities was displayed on a notice board and included ‘gentle exercise’ and a ‘social hour’. Service users’ interests were recorded and staff were observed to support service users in reading books, magazines and the daily news papers. The home had a library and one service user stated she liked reading ‘love tales’ another service user stated he liked reading mystery books. The manager stated visitors are welcomed to the home and they can visit anytime during the day and evening. The inspector noted two visitors were in the home during the inspection and they had signed the visitor book. The manager remarked service users could meet their relatives in private in their bedroom or in the staff the office if requested. One service user likes gardening and the manager is going to invite someone from the local gardening society to give a talk at the home. On the day of the inspection service users had a lunch of steak and kidney pie with sprouts, carrots and potatoes followed by fruit crumble with custard or fresh fruits. Meals were nicely presented and mealtime was relaxed Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 13 and unhurried. The inspector noted staff supporting service users appropriately using verbal prompts. One service user who had recently lost her appetite was encouraged and supported to eat her meals. Hot and cold drinks were available during lunch. One service user stated the food is good and the steak and kidney pie was ‘home made’. The inspector noted the cook spoke to service users during lunch to enquire if they were happy with the meals provided. No complaints were made. Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 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 standard(s) 16,17,18. The home has a satisfactory complaints system with complaints information available to staff, service users and relatives. The systems at the home ensure service users are able to exercise their legal rights. Arrangements for protecting service users are satisfactory, however policies must be updated to ensure staff have up to date information to safeguard the welfare of service users. EVIDENCE: The home had a Complaint Policy dated May 2004 that was kept in the Policies Folder in the staff office. Since the last inspection two complaints were recorded and were partially substantiated. Feedback from relatives indicated some of them were aware of the complaint procedure and had made complaints to the management. During a meeting a key worker stated she was aware of the complaint procedure and would feel confident in supporting a service user to make a complaint. The manager stated she had recently attended a training course run by the National Care Home Association to do with advocacy. The inspector noted information on Care Aware, an advocacy service was readily available in the home. The operations director stated three service users had representatives acting on their behalf. The home had a Whistleblowing Policy that was kept in the Policies Folder in the staff office. The inspector noted ten staff had attended protection of vulnerable adults training on the 28. 7. 05. The local authority (Surrey County Council) policy on the protection of vulnerable adults dated February 2005 was available at the home. The inspector noted the category of professional abuse was not in the local policy and action has been required in respect of this matter. The manager stated one staff had been referred to the POVA register. One relative Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 15 who was in the home during the inspection stated they were happy with everything and had no complaints about the home, the staff or the care given to their relative. Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 16 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 standard(s) 19,21,24,26 The standard of the environment within this home is satisfactory providing service users with a homely place to live, however the flooring in the bathroom, toilets and kitchen must be improved to make it nice for service users. EVIDENCE: On the day of the inspection the home was found to be clean, well ventilated and free of mal odour. The standard of décor throughout the home was satisfactory and the heating, lighting and furnishings were adequate. The inspector noted the furniture in the lounge and dining areas were rearranged making it more spacious and safer for service users. The home employed a handyman who was responsible for general maintenance. The inspector noted a private consultancy firm had conducted a health and safety audit on the 7.4.05 and recommendations were made to improve the environment. Bathrooms and toilets were clean and hygienic. The inspector noted the flooring in the bathroom, kitchen and toilet areas needed replacement and action has been required in respect of this matter. Bedrooms were well presented and personalised with photographs, pictures, flowers, radio, Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 17 television, books, magazines and other personal effects. One service user stated ‘I like my bedroom’ he remarked ‘it is fairly pleasant’. The home had infection control measures in place with anti-bacterial hand wash widely available as well as aprons and gloves. Staff were observed to wash their hands regularly. The laundry facility was satisfactory and the manager stated the laundry floor would be replaced as part of the homes refurbishment programme. Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 The arrangement for staffing at the home is adequate ensuring there is sufficient numbers of staff with the right skills to meet the service users’ needs. The standard of vetting and recruitment practices at the home is unsatisfactory with appropriate checks not being carried out and potentially leaving service users at risk. EVIDENCE: On the day of the inspection the staffing level was adequate. The inspector noted the operations director was on the premises. On duty were the manager, the deputy, one registered nurse, three care assistants, one cook, one kitchen assistant, one agency cleaner, one laundry assistant and one handyman. The duty rota was checked and reflected the numbers of staff on duty. The manager stated staffing on night duty was adequate. The home has eight registered nurses and four staff with the NVQ Level 2 Care Award. The manager stated two senior care assistants have been recruited and the home has one vacancy for a cleaner. The home uses agency staff to cover any shortfall in staffing. During a meeting the deputy manager stated the staffing level has improved and ‘staffing is fine’. The inspector sampled staff recruitment files that were kept locked in the operations director office. The inspector noted one staff file did not have references. It was recorded the home had received a criminal record bureau disclosure on the 11.10.04 but no information about the disclosure was available on file. Photo identification was in need of updating. These areas were discussed with the manager and action has been required in respect of this matter. Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 19 Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34 35,36. The manager has a good understanding of the areas in which the home needs to improve. Planning was in place and set out how this improvement was going to be managed. The arrangement for the management of the home is adequate ensuring service users benefit from a well run home. The system for the management of finances is good with clear guidelines being in place to ensure service users’ money is safeguarded. The arrangement for the supervision of staff is unsatisfactory that could potentially place staff and service users at risk. EVIDENCE: The home has appointed a manager who has been in post for some two months. The manager is aware of her responsibilities and described her style of management as ‘hands on’, ‘leading by example’ and ‘treating people with respect’. Some relatives and other professionals are concerned about the high turnover of managers at the home that leads to management instability. The inspector noted the manager did not submit an application for registration and Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 21 action has been required in respect of this matter. During a meeting staff stated the new manager is ‘approachable’, ‘supportive’ and is trying to improve things. She was described as a good manager who communicated clear leadership to the staff team, service users and relatives. The home is a registered limited company with a business and financial plan that is open to inspection and has liability insurance that covers against loss or damage to the assets of the business that expires on the 31.5.06. The home does not control service users’ finance except for one service user who receives pocket money. The inspector checked the fees account for the period 1.4.05 to 1.8.05 and noted the records and receipts were correct. Financial records were stored in a locked cabinet in the operations director office. The home has a policy statement on staff supervision dated March 2005. The manager has introduced a supervision schedule and planner and stated she is responsible for the supervision of all staff. The inspector sampled the supervision records and noted the manager had supervised staff for the period July 2005, prior to this the supervision of staff was inconsistent and some supervision records were dated 2004. This was discussed with the manager and operations director and action has been required in respect of this matter. Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x 2 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 2 x x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 2 3 x 3 3 2 x x Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 23 No Are there any outstanding requirements from the last inspection? 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 OP1 Regulation 4(1)(c) Schedule 1 Requirement The registered person must ensure that the admission policy, statement of purpose and service user guide are updated to include information on trial visits for prospective service users to the home. The registered person must ensure that staff who work at the home have a recent photograph as proof of identity and that recruitment files contain the necessary documents including references and CRB disclosure information. The registered person must ensure a named staff is appointed to supervise a new employee for the duration of their induction. The registered person must ensure that formal arrangements for the supervision of staff are put in place, staff are supervised regularly and records are kept of all supervision meetings. The registered person must ensure the floor covering in the toilet, bathroom and kitchen areas are replaced to prevent the spread of infection. Timescale for action 01.10.05 2. OP29 19(4)(b) Schedule 2 01.10.05 3. OP36 18(2)(b) (i) 01.09.05 4. OP35 18(2)(a) 01.09.05 5. OP38 4(a)(c) 01.12.05 Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 24 6. OP9 13.2 7. 8. OP31 OP27 8 18(1)(a) The registered person must ensure the home has adequate arrangements for the disposal of medicines. An application for registration as manager must be submitted to the Commission without delay. For a cleaner to be employed 7days a week. 01.10.05 01.10.05 01.10.05 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 OP18 Good Practice Recommendations The registered person shall update the policy on the protection of vulnerable adults to include the category of professional abuse. Addlestone Lodge H58_s17657_Addlestone Lodge_v236852_080805_Stage4.doc Version 1.40 Page 25 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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. 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