Inspection on 12/04/05 for Angel Lodge

This inspection was carried out on 12th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Angel Lodge 27/07/07

Angel Lodge 17/08/06

Angel Lodge 11/11/05

Angel Lodge 13/01/05

Angel Lodge 12/07/04

Angel Lodge 02/03/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Angel Lodge 15-17 Eastwood Road Goodmayes Ilford, Essex IG3 8UW Lead Inspector Gwen Lording Unannounced 12 April 2005 09:30 a.m. 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. Angel Lodge Version 1.10 Page 3 SERVICE INFORMATION Name of service Angel Lodge Address 15-17 Eastwood Road, Goodmayes, Ilford, Essex IG3 8UW 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) 020 8597 4399 020 8597 4399 Chana Bros Limited Pauline Ann Baker Care Home 20 Category(ies) of OP Old age (20) registration, with number of places Angel Lodge Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: There are no conditions of registration Date of last inspection 13/01/05 Brief Description of the Service: Angel Lodge is registered to provide personal care and acommodation for up to 20 service users over the age of 65 years who have related illnesses/ conditions. Five of the beds are contracted by the London Borough of Barking and Dagenham to provide admission for respite care. The home is owned and operated by a family business. The premises are situated in a residential area of Goodmayes, close to the busy Ilford High Road with access to shops and other community facilities. The home provides accommodation on two floors, which is mainly in single bedrooms with one double bedroom and there is a passenger lift. Angel Lodge Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 9.30 a.m. It took place over six hours during the morning and afternoon. The Inspector spoke to one service user who was admitted to the home for a period of respite care and six other service users, two who have been resident in the home for a number of years. The registered manager, senior care staff and other care staff were spoken to. There was also an opportunity to speak to the cook, a member of domestic staff working in the home that day and four visitors. A tour of the home took place and a number of staff and care records were inspected. Contact was made by telephone to the responsible individual for the home to discuss concerns regarding the lack of progress in the required refurbishment of the kitchen. What the service does well: What has improved since the last inspection? Since the last inspection the manager has formalised the supervision system for all staff and staff spoken to said that they are receiving supervision approximately every two months and that a written record is being maintained. All staff now have photographic identity included in their personnel files. Angel Lodge Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Angel Lodge Version 1.10 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 Angel Lodge Version 1.10 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) 3 The assessments for service users admitted for regular periods of respite care are not being reviewed prior to each admission. Without this there is no assurance that changing care needs will be met. The home does not provide intermediate care. EVIDENCE: The admission procedure for respite care is not adequate to inform staff of the actions to be taken to ensure that needs of service users requiring respite care are properly assessed and planned for. The relative of one service user spoken to was able to provide information about his care that had not been recorded. Staff on duty who spoke to the inspector were aware of his care needs but this was informed through verbal handovers and information recorded in a general communication book used by staff on a daily basis. Angel Lodge Version 1.10 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 standard(s) 7, 9 and 10 There has been a marked deterioration in the standard of care planning since the last inspection and the health care needs of services users are not being adequately identified. This shortfall has the potential to place service users at risk if their care needs are not being met. The medication policies and procedures are clear and staff have received training. There is some isolated inconsistent recording resulting in unsafe practices. Service users are treated with respect and the arrangements for their personal care ensure that their right to privacy is upheld. EVIDENCE: Information in some of the care plans examined was not being regularly reviewed or updated to reflect changing needs. The standard of care planning was not consistent for all service users. Most care plans were recording very basic information and two service users admitted for a period of respite had no current care plan. Angel Lodge Version 1.10 Page 10 Discussions with staff indicated that they were aware of most individuals needs and that these needs were being addressed despite the lack of clear plans. However, the source of this information is mainly through verbal handovers, discussions with the manager and through the use of daily entries in a ‘Communication’ book. This approach is dependent on staff memory and verbal communication systems. Residents are at risk of not having their health care needs met if these informal systems break down. One service user requires the use of ‘thickeners’ in all his drinks. One member of staff spoken to was aware of this, knew how to use the thickener but did not know the reason why thickeners had to be used. There was no information included in his care plan, indicating the need for thickeners. There are policies and procedures for the handling and recording of medicines in the home. There were a number of isolated omissions on the recording of medication on the Medication Administration Record (MAR) charts. It was not clear whether the medication had been refused by a service user or it had not been administered as prescribed, by staff. There were also some MAR charts where the dates did not correspond with the date of delivery of medicines to the home by the pharmacy. The manager must discuss these issues with the dispensing pharmacist providing the service to ensure that staff are able to accurately record all medicines dispensed for individuals in the home. Staff talked about and were observed to treat service users in a respectful and sensitive manner. They understood the need to promote their dignity through practices such as the way in which they addressed them and when entering bedrooms, bathrooms and toilets. Service users and their relatives spoken to said that all staff were very respectful and thoughtful when attending to their personal care. Angel Lodge Version 1.10 Page 11 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 and 15 The meals in the home are good, offering both choice and variety for service users living in the home. There is a limited range of social and leisure activities available, which suit individual needs, preferences and capacities. Visiting times are flexible and people are made to feel welcome in the home so that service users are able to maintain contact with their family and friends as they wish. EVIDENCE: Meals are served in the dining room or service users may choose to eat in their rooms. Menus were inspected and found to be balanced and a choice is offered each day. At lunchtime one service user said she has little appetite that day and staff were keen to offer her a more suitable alternative. Several service users spoken to commented that they enjoyed the food and that a choice was always offered. Staff are on hand to assist individuals with eating when necessary. During the inspection service users were offered frequent drinks and snacks such as fresh fruit. Angel Lodge Version 1.10 Page 12 The home does not have an activity organiser therefore care staff take responsibility for organising activities. A limited range of leisure and social activities are arranged and available to service users in the home and outside the home. The only planned weekly activity is on Fridays when an external person visits the home to do a session on ‘Keep Fit – Armchair Exercises’. One service user said she “liked the quizzes” and another that she ”enjoyed the music and when staff danced with her”. Visiting times are very flexible and visitors commented “ staff always make them feel very welcome and offer them tea/ coffee during the visit”. Service users are able to receive visitors in one of the lounges or in their own rooms. Angel Lodge Version 1.10 Page 13 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) 18 Staff working in the home have received training in Adult Protection/ Abuse Awareness to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. The majority of staff have received training as organised by the London Borough of Redbridge and all remaining staff will attend the next planned sessions. In discussion with several members of staff it was evident that they were conversant with the procedure for dealing with or reporting any suspected or witnessed abuse. Angel Lodge Version 1.10 Page 14 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, 20 and 21 The décor, furnishings and general maintenance do not provide service users living in the home with comfortable, homely or adequately furnished surroundings. The outstanding work required to refurbish the kitchen means that there is not suitable kitchen equipment and facilities available for the preparation, cooking and storage of food. EVIDENCE: Requirements made at the last two inspections for the kitchen to be refurbished have not been met. Contact was made with the responsible individual by phone during the visit. She stated that work is scheduled to commence on 18th April 2005 and is estimated to take approximately 5 – 7 days to complete. There are a number of areas in the home that are not being adequately maintained and are in need of refurbishment or renewal. This includes the décor in several service users’ bedrooms and in some communal areas of the Angel Lodge Version 1.10 Page 15 home. The enamel on the baths in two of the bathrooms has eroded in places and the front panel of one of the baths is cracked. Some of the dining room, bedroom and lounge furniture is old and worn and needs replacing. Work on an extension to the staff office began about two years ago but has since been curtailed. It has left the manager and staff with an untidy and inadequately furnished office in which to conduct the day-to-day management of the home and in which to store records and related documentation. It gives a poor impression of the home and is not conducive to conducting meetings/ interviews with visiting professionals, service users or their relatives/ representatives. Angel Lodge Version 1.10 Page 16 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 and 29 Staffing levels are satisfactory and there is sufficient staff on duty to meet the individual needs of the service users. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: A requirement made at the last inspection for all staff to have photographic identification on their personnel files has now been met. The home has a relatively stable workforce and in discussion with staff it was evident that they understand and fully support the main aims and values of the home. As well as care staff the home employs a cook and domestic staff. There is a written duty rota available, which records the staff on duty during the day and night, and in what capacity they are working. Service users and relatives spoken to said that staff in the home are kind and caring and are always in evidence in dining rooms and lounge areas. Angel Lodge Version 1.10 Page 17 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, 33, 36 and 37 The management of the home is satisfactory overall but care records are not well managed and communication of information relies too much on staff memory and verbal handovers. This practice could potentially put service users at risk. EVIDENCE: The manager has a good understanding of how the home needs to improve environmentally but requires the support of the registered providers to achieve this. She has completed the Registered Managers Award and is scheduled to commence a training course ‘Developing Dementia Training Skills’ at the end of April. The manager stated that, though she regularly sees the responsible individual for the home, she does not receive formal supervision with written records being maintained. She requires support and supervision by the registered providers to further develop and practice her management planning Angel Lodge Version 1.10 Page 18 skills to ensure that there are effective communication and record keeping systems in place. The manager has developed a formalised supervision system for all care staff and a written record is being maintained. Regulation 26 visits are undertaken by the registered providers but a copy of the report is not always sent to the Commission. Angel Lodge Version 1.10 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 1 2 2 x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 1 2 2 x x 2 x x Angel Lodge Version 1.10 Page 20 Yes 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 15 & 19 Regulation 16 & 23 Requirement It is a requirement that the registered providers provide sufficient and suitable kitchen equipment and adequate facilities for the preparation of food. The kitchen must be refurbished to an adequate standard to ensure it is suitable for its purpose, safe and well maintained (Timescale of 30/09/04 not met) The registered providers must ensure that the manager of the home receives formal supervision at least six times a year and that a written record is maintained (Timescale of 30/09/04 not met) A written report of each visit conducted by the responsible individual, as required by Regulation 26, must be provided to the Commission (Timescale of 28/02/05 not met) It is a requirement that service users interests are recorded and that they are given opportunities for stimulation through leisure and recreational activities in and outside the home, which suit their individual needs. Version 1.10 Timescale for action 30/04/05 2. 36 18 30/04/05 3. 33 26 31/05/05 and monthly thereafter 31/05/05 4. 12 16 Angel Lodge Page 21 5. 19 & 21 16 & 23 6. 3 14 7. 7 15 8. 9. 9 9 13 13 10. 19 23 11. 37 17 preferences and capacities (Timescale of 31/03/05 not met) The registered persons must ensure that service users live in a well maintained environment and that suitable bathing facilities are provided (Timescale of 31/03/05 not met) An assessment must be undertaken for all service users, including those admitted for respite care, prior to their admission to the home to ensure that their assessed needs can be met. All service users, including those admitted for respite care, must have a written care plan in sufficient detail to provide staff with clear guidance on the actions required to meet individual health, personal and social care needs. The care plan must be regularly reviewed and updated to reflect changing needs. Staff must accurately record the administration of all medicines prescribed. The manager must seek guidance from the homes dispensing pharmacist regarding the delivery of medicines to the home. The registered providers must ensure that service users live in a safe and well maintained home. An action plan must be developed with timescales, for a programme of routine maintenance and renewal of the fabric and decoration of the premises. This action plan must be sent to the Commission. Individual and home records must be kept up to date and in good order (Assesment documentation and service user Version 1.10 31/05/05 31/05/05 31/05/05 12/04/05 31/05/05 30/06/05 31/05/05 Angel Lodge Page 22 care plans) 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 Good Practice Recommendations Angel Lodge Version 1.10 Page 23 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU 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 Angel Lodge Version 1.10 Page 24 - 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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