CARE HOMES FOR OLDER PEOPLE
Arun Lodge Rest Home 6-8 Stocker Road Bognor Regis West Sussex PO21 2QF Lead Inspector
Diane Peel Announced 27 July 2005, 10.00 am, V232576
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. Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Arun Lodge Rest Home Address 6-8 Stocker Road, Bognor Regis, West Sussex, PO21 2QF 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) 01243 866056 Mrs Annette Rawlins 6-8 Stocker Road, Bognor Regis, West Sussex, PO21 2QF Mrs Jacky Hambleton CRH 21 Category(ies) of OP-21 registration, with number of places Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28/02/05 Brief Description of the Service: Arun Lodge is a Care Home able to provide personal care and support to up to 21 Older People over 65 years of age. The property is detached and situated close to the sea, shops and other local facilities on the outskirts of Bognor Regis. It is easily accessible by public transport. Communal space consists of two lounges and a spacious dining room. There are twenty-one single bedrooms, many having en suite facilities. There are additional bathrooms and toilets situated throughout the home. Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over 6.75 hours on the 26th July 2005. The inspector arrived at 9.45 am and was welcomed by the manager and registered provider of Arun Lodge. A full tour of the home took place and the majority of the 16 residents living at the home were met. Five residents were spoken with in depth to find out if they felt that their needs were being met. The inspector joined residents for lunch to sample the meal and meet other residents who were not spoken with privately. The care records of four residents were inspected during the visit along with other records, which showed how care needs are to be met. The records of three staff were also inspected and two staff were spoken with informally during the visit. Eight service user comment cards, three relative/visitors comment cards and one letter were returned prior to the visit to Arun Lodge all indicating that residents and visitors/relatives were satisfied with the facilities at the home and the standard of care provided. The inspector met with one NHS professional visiting the home and gained positive feedback about the commitment of the management and staff of the home to providing a person centred service. What the service does well:
Arun Lodge provides a home from home environment for residents. People living at the home regard the other residents, staff and management of the home as their family. Residents, who are able, are encouraged to retain an independent lifestyle, accessing local communal facilities and maintaining relationships. Care plans are clear and provide staff with the information, which they need to meet the needs of the residents. The staff team treat residents as individuals and are able to assist them to maintain their dignity. Meals are varied, nicely presented, offer choice and are served in pleasant surroundings. Residents spoken with all had confidence in the manager and providers approach to running the home. Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 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 Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 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) 1,3,4,5 and 6 A service user guide provides information about the home and the service, which it offers to enable prospective residents to make an informed choice about moving into the home. Residents are assessed prior to moving into the home to make sure that the home can provide a care plan which residents or their families know will meet their needs. Prospective residents, their relatives and friends have an opportunity to visit the home to look at the facilities available and assess its suitability before moving in. EVIDENCE: The Statement of Purpose has been updated to show changes in staff and their qualifications. The manager was able to give examples of visiting residents prior to them moving into the home to carry out assessments. A recommendation has been made that assessments are included in the care records to ensure that all care staff have access to them. Residents spoken with commented that relatives had visited the home on their behalf or they had been to the home to visit another relative living at the home and had liked it enough to want to move in. One resident had been visiting the
Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 Page 9 home for meals before they moved into Arun Lodge. Intermediate care is not provided by the home although the home does offer periods of respite care. Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 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) 7,8,9and 10 Systems for care planning give clear information to assist with all aspects of health, personal and social care needs. Residents’ heath care needs are monitored to make sure that any signs of residents becoming unwell are recognised. Detailed medication policies and procedures are in place, but some practices potentially put residents health at risk. EVIDENCE: Care plans examined were clear and gave staff the information, which they need to meet the needs of the residents in all aspects of heath, personal and social care. They had been reviewed regularly to show the changing needs of the residents. Daily progress notes are in use to monitor the heath and well being of residents. Visits to residents by other heath care professionals are recorded and outcomes detailed in a separate recording system. Residents spoken with talked about visits to hospital appointments and some residents at the home are visited by district nurses. Medication is stored in a safe locked trolley. It was observed that procedures for recording disposal of medication are not always being followed. This had resulted in one controlled medication chosen at random for tracking, being one tablet short of the stated number in the controlled drugs recording book.
Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 Page 11 Other records of administration sheets viewed were in good order. The practice of using topical creams prescribed for a particular resident but in use by another resident was observed: one resident had three different creams in the bedroom all with different prescription labels for different named persons. All residents spoken with felt that staff treat them with respect and enable them to maintain their privacy. All eight residents returning comment cards to the inspector prior to the date of the visit reported that their privacy is respected. Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 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) 12,13,14and 15 The home provides a lifestyle that respects privacy, dignity and choice, matching residents’ expectations and individual preferences. Residents are able to have visitors and are encouraged to be part of the local community. Meals are well managed and provide choice and variation. EVIDENCE: Arun Lodge has a homely atmosphere where residents comment that it is like living in a family. Residents were noted to be relaxed in the company of the inspector and there was much laughing and joking during the visit. Residents say that they are encouraged to maintain their independence for as long as they are able but don’t feel worried about asking for help and advice. All residents and relatives/visitors returning comment cards to the inspector reported that residents like living at the home and that they are well cared for. There are some organised activities, which take place at Arun Lodge on a regular basis such as musical nostalgia and film shows, but residents are encouraged and supported to pursue their own individual interests, accessing community facilities and meeting other people outside the home. One resident spoke about her regular visits to Lourdes from the Church, which she attends, and the possibility of visiting an old school for a reunion lunch. Other residents have hobbies, which they pursue. One resident is knitting large blankets for a dog rescue centre. It was observed at lunchtime that residents using the dining room were combining their knowledge to complete the daily crossword
Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 Page 13 puzzle in the newspaper. According to residents this is a regular activity, which they share after lunch. The inspector joined residents for the main meal of the day. The meal was nicely presented and was of a good standard. Menus provided prior to the visit to the home show variety and choice and residents spoken with confirmed that they could have an alternative to what is on the menu. Comment cards returned to the inspector all reported that the food was of a good standard; one comment card reported that the resident thought the meals were “excellent”. Discussion with residents not eating in the dining room confirmed that residents can choose where they want to eat. One resident commented that “there is a new Chef and he is a good cook”. Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 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 and 18 There is a clear complaints procedure, which enables those using the service to have the confidence that their complaint will be responded to within a maximum of 28 days. Residents are protected by the homes adult protection procedure and staff have attended training in how to protect vulnerable adults. EVIDENCE: The complaints procedure is available in the Service User Guide and on display on the notice board. It is clear and specifies how complaints should be made, with an assurance that any complaint will be responded to within 28 days. There have been no complaints made to the home or to the Commission for Social Care and Inspection (CSCI) since the last visit to the home. Arun Lodge has its own policies and procedures to safeguard residents from abuse in addition to the West Sussex Multi-Agency Policy for protecting vulnerable adults from abuse and staff have undertaken training in adult protection procedures to ensure that they are aware of their responsibilities to report suspicion of abuse. Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,2425, and 26 The home is clean and residents have a comfortable, homely environment to live in. Bedrooms are comfortable and meet the needs of the residents. Residents are encouraged to contribute to making their bedrooms their own by having their own personal possessions around them. EVIDENCE: The inspector visited all parts of communal and private accommodation during this visit. Arun Lodge was observed to be clean and had a fresh appearance. It was well maintained and has homely touches to encourage residents to feel comfortable. Residents living at the home have made their bedrooms their own by having their own possessions around them. Some residents have items of furniture in their rooms, which they have been able to bring to the home. Radiators remain uncovered but the provider has confirmed that they will be covered when the plumbing work is completed. Risk assessments have been carried out to safe guard residents until the covers are put in place.
Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 Page 16 Regulators have now been fitted to hot water outlets and during the visit work was being carried out to set the regulators to a temperature of 43 degrees centigrade. The laundry room has now been relocated to a suitable site, which has a floor and walls, which can be washed. The upper floor not accessed by passenger lift now provides office accommodation for the manager and the provider. There is one bedroom on this floor, which is accommodated by a resident who can easily use the stairs. This resident spoke to the inspector about the accommodation and made it clear that it was their choice to have this room because it suited their needs. It is set out like a small flat with a lounge area, bedroom and toilet. Other accommodation has been offered but declined. There is an on going refurbishment programme at the home which continues to address environmental issues. Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 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 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) 27,29 and 30 The staffing numbers are set at level, which allows residents assessed needs to be met. Recruitment procedures safeguard and protect residents at the home. The staff-training programme provides staff with the majority of skills, which they need to do their job, and enables them to provide a reasonably safe environment for residents. EVIDENCE: Staffing rotas observed prior to the visit show that sufficient staff are employed with the appropriate skill mix to meet the needs of residents over the 24-hour period. Residents confirmed that there two staff on duty at night if they need assistance. There have been a few recent changes in staff but residents did not seem too concerned because the core staff team remain the same. There were many positive comments made to the inspector about the staff. One resident described the staff as “a beautiful team” and another resident said, “we are lucky to have nice staff”. The records of three members of staff were examined at this visit. Records showed that a recruitment procedure is followed, which includes applying for two satisfactory references and applying for Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA). Records also showed that identification of the person employed has been gathered. An induction process is followed with a probationary period and induction programme. The home is committed to training staff to provide them with the skills to do the job.
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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 home is well managed providing leadership and guidance for staff. Environmental risk assessments are in place, which protect residents from the majority of environmental risks to their heath and safety EVIDENCE: The residents at Arun Lodge spoke highly of the manager and provider. They look upon them as part of their extended family. Systems are in place to safeguard the financial interests of residents for which the home holds small amounts of money. Records sampled were in good order. Staff records showed that staff are supervised and that there is an annual appraisal system. Some residents had their bedroom doors wedged open during the visit. This matter should be discussed with the fire officer and appropriate measures taken to safeguard residents. Medication procedures were not being adhered to. When sampling the stock of controlled medication it was noted that one tablet could not be accounted for in
Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 Page 19 the administration records. This matter was discussed with the manager and a requirement has been made to improve the medication practices. Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4
COMPLAINTS AND PROTECTION 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x 3 3 3 1 1 Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 Page 21 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 9,37,38 Regulation 13.2 Timescale for action Medication practices must ensure 23/08/05 that all prescribed medication can be accounted for. Prescribed medications must not be used for anyone other than the person for whom they were prescribed. The Fire Officer must be 23/08/05 consulted about the practice of wedging bedroom doors open Requirement 2. 38 23.4 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. 2. Refer to Standard 3 22 Good Practice Recommendations Copies of the needs assessments should be kept in the care plan. Ensure that limited access to bedrooms on the upper floors are outlined in the Statement of Purpose. Arun Lodge Rest Home H60-H11 S14367 Arun Lodge V231929 260705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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