CARE HOMES FOR OLDER PEOPLE
Balliol Lodge Balliol Lodge 57-60 Balliol Road Bootle Liverpool Merseyside L20 7EJ Lead Inspector
Diane Sharrock Key Unannounced Inspection 25th July 2007 10:30 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 Balliol Lodge DS0000065370.V341048.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. Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Balliol Lodge Address Balliol Lodge 57-60 Balliol Road Bootle Liverpool Merseyside L20 7EJ 0151 9336202 0151 9336070 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) Mr Bharat Modhvadia Mrs Jaya Bharat Modhvadia ** Post Vacant *** Care Home 32 Category(ies) of Dementia (32) registration, with number of places Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service is registered to provide nursing or personal care up to a maximum of 32 service users in the category of DE(E) Service users to include up to 32 DE(E) Date of last inspection 13th March 2007 Brief Description of the Service: Balliol Lodge is a care home that provides nursing and personal care for up to 32 Residents. The care provided is for residents with a diagnosed condition of dementia. Balliol Lodge is situated on a busy main road near a college. The local train station is accessible at the bottom of the road and there are a number of shops within walking distance and a main shopping centre a little further. The main shopping areas of Liverpool can be accessed via public transport. The home is a privately owned by Mr and Mrs Bharat Modhvadia who became the new Providers in April 2006. The Provider has jus recently recruited a new Manager. Balliol Lodge is 2 converted buildings over 3 floors, there is a passenger lift to some of the bedrooms. There are various single rooms, and a number of double bedrooms none with en-suite facilities There are 3 lounge areas and 2 dining rooms on the ground floor. There is also a smoking area available for the residents. The Home has gardens to the rear. Parking is available to the front and the rear of the building. The Manager gave details for fees at the home from £395 per week to £491.50 Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one day. There have been 2 random visits since the home had its last key inspection. These visits were made to ensure improvements had been made by the provider as detailed in his improvement plan for the home. Inspections involve measuring a number of standards considered as important by the Commission. During the inspection discussions took place with 6 staff and the Inspector met with approximately 4 residents that were in the lounge and bedroom area. The homes records were looked at and a tour of the building made. A representative of the Primary Care Trust (pct) was present during this visit to observe the process of Inspection Usually the Inspector would send a sample of comment cards to residents prior to a visit to gain their opinion about the home, however, selections of comment cards were left during this visit, as the provider had not returned the pre inspection questionnaire. to CSCI as required. Feedback was given to the manager at the end of this site visit. What the service does well: What has improved since the last inspection?
Care plans were very organised and detailed and gave enough updated information to describe the care needing to be given to all residents. Quality assurance audits are carried out on a regular basis covering care plans. These company audits help to show how the home is being managed to make
Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 6 sure the residents receive the care and support necessary as identified and agreed in their care plans. There were positive comments about the food provided and the chef with everyone knowing his name and talking favourably about him. The manager has stated that over 50 of Staff have already achieved their national qualification in care, which exceeds the basic standard of over half the carers with this qualification. What they could do better:
Full feedback was given to the manager at the end of this inspection including written feedback. This inspection was able to evidence improvements in some areas especially with the development of the residents care plans. However some issues needed to be developed further to meet the standards and show consistent improvements to the home. A review of medications must take place to improve on certain areas of management of medicines; this will enable the management of medications to be safe and well managed. Daily records of temperatures of the drug fridge must be consistently recorded. An audit of the recording of the administration of medication will help to make sure that safe procedures are carried out at all times and will make sure all records are accurate and reflect the Doctors prescription of care. Training and development of staff should be updated and evidence should be in place to show that all staff are given at least 3 days training a year including mandatory training for moving and handling and food hygiene. This was pointed out at the previous inspection. Some outstanding maintenance issues were in need of attention e.g. Some nasty smells were noted in a sample of bedrooms and ground floor toilets, holes were seen in the bed linen in one residents room, there was no curtain or covering to the frosted glass in the ground floor toilet which did not promote peoples dignity or privacy. The lounge carpet was worn and stained in parts, the staff room was in a poor state of repair with ripped seats and stains to walls, some curtains were seen hanging off tracks. These areas showed poor management of the maintenance and standard of living offered in the home. One bedroom had a high window but no restrictor and no risk assessment in place to identify if this was safe or not, one room had additional mobile heaters there was no evidence of a risk assessment or evidence of testing these small appliances, the linen cupboard door was falling off its hinge and couldn’t be closed or easily open, the hot water was noted to be very hot in one bathroom, with no thermometer to check the temperature available. This needed checking
Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 7 to make sure the water is within safe and acceptable limits, some rooms had access to cool water however, had problems offering hot water from basins. The dryer had still not been repaired and staff felt it had been broken since March 07. The gas installation certificate was noted to have expired 19/5/07. These concerns showed ongoing poor management of the safety of the environment. The above concerns around poor management of the environment have been reported on previous inspections. Some areas have improved but the ongoing work is not consistent in offering a well managed home to live in. The new Manager has already developed maintenance and decorating plan, which he feels, will improve the overall standards in the environment and will evidence ongoing improvements and management to this area. Activities should continue to be reviewed so that resident’s opinions and needs are taken into account. Further work should be undertaken to ensure residents social and diverse needs are met. One resident said they would like to get involved with more activities An organised programme of events should be displayed and easily accessible to all residents. Most personnel files seen were noted to be much improved however one file showed no evidence of a police check in place prior to their employment at the home. The homes recruitment and selection policy must show how it will ensure the safety of all residents at the home by having the right checks in place for all staff including regular police checks. This has also been repeated at previous inspections and must be reviewed to prevent any further breaches of regulations. Finances should continue to be developed and actions taken to provide clear and accurate information for all residents regarding the management of their monies, this will give residents added safety in showing how their funds are managed in their best interest. Residents should be supported to have their own bank accounts or given informed choices and support in choosing how they want to manage their finances. Three requirements were found to be outstanding from the previous inspection and the provider will be required to provide an improvement plan to all requirements issued within this report. 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.
Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 8 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 Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 9 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): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s needs are assessed before moving to the home in order to ensure their needs can be met . EVIDENCE: The homes statement of purpose and service user guide were openly displayed in reception for everyone to look at. These records included all relevant information necessary for people to make a decision about the home. A review of one resident records showed a detailed assessment carried out prior to their admission. This helped the home to assess that they could meet the person’s needs. There was enough detail for staff to support the resident with their needs. The documentation in place covered all diverse needs of potential residents to the home ensuring the persons individual’s needs and requests could be met prior to moving into the home and they also included local authority assessments.
Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 10 Staff stated they had been told that one resident had mental health needs and were worried and concerned as they felt they did not have the support and guidance for this need. There was no care plan for this mental health need and this concern was discussed with the manager.. This indicated that staff may have admitted a new resident that was out of category and no application for a variation had been submitted to CSCI. The new manager agreed to review all residents’ needs and categories. This was a repeated concern regarding the homes staff admitting a resident who was out of category. The staff do not always follow guidelines in applying for a variation with the Commission and they do not always have evidence in place with e.g. appropriate assessments to show how they could safely and adequately meet a persons needs. It showed that staff in the home might not have the skills and experience to fully meet this persons needs. Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 11 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): 7/8/9/10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home did show they were adequately managing residents health and personal care needs. EVIDENCE: Three care plans were reviewed for case tracking. All of the care plans gave good details of the residents needs and the care and support required. The care plans seen were personalised and well maintained. General comments from some residents were very positive about the staff and especially about the new manager who most people had already met. The company had also implemented care plan audits, which are regularly carried out by the trained nurses who check each other’s care plans to ensure they have the right information for each resident. One care plan covered a residents needs such as, chest infection, shortness of breath, activities and it also had recorded monthly reviews to check the care plan was appropriate and updated to meet the resident’s needs.
Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 12 One resident explained they were happy with the home and their bedroom they felt they had everything, another resident’s felt they should have moved along time ago but was happy enough to stay. One resident indicated they would like to look at other options of moving into the community, this was discussed with the manager who agreed to arrange a meeting for the resident and respected their right to ask for a review and assistance in this request. Most residents seen during this visit were noted to be appropriately dressed and clean and well presented and supported by staff. Just one person was noted to have facial bristles, which did not respect her dignity. Another resident had no support to their recliner chair and their feet were dangling and in need of support, another resident had a wheelchair cushion positioned under her heels which would not offer any pressure care and may even provide a problem to her pressure areas. These issues were pointed out to the manager as it highlighted a training issue and a need for quality checks on the care and support provided in the home. During interviews with staff they were able to discuss the personal, nursing and social care needs and individual routines of residents and explained how they gave that care. Some home Other home staff gave positive comments about the manager and how they felt the was improving. staff felt that more needed to be done especially in investing into the and providing a stable staff team and regular activities. Some staff stated they had not yet received updated moving and handling training and some staff were unsure how many hoists they had in the home. One Staff member felt that the hoist “tipped” over when it felt a strain to certain weights carried on the hoist. This identified a need for updated training in safe moving and handling and in observing care practices within the home so that all residents are assisted safely throughout the home with safe well maintained equipment. Staff also gave their opinions to staffing levels at the home and felt that at times if they were short staffed at night they would try to put extra residents to bed. This was discussed with staff, as they did not initially recognise that they were not respecting the resident’s choices. Staff talked about how they could change routines in the home to promote more choice to individual residents preferences. The management of medications was mostly well managed but other areas needed review and improvements to be implemented. A sample of medication records and storage of medicines was seen during this visit. The medications and administrations were mostly found to be in good order. Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 13 However, temperatures of the drug fridge had not been recorded consistently each day. Some handwritten entries were seen on the daily drug records with no staff signatures to show safe checks were carried out in the dosage and amount and date commenced. One record sheet showed that staff had changed the prescription by hand from 4 times a day to once a day. Staff explained this was on the instructions of the doctor but this wasn’t clear on the medication records, and the prescription labels still had the initial doctors prescription of 4 times a day. These concerns show that the management of medications does not always follow the homes policies, which should be implemented to prevent any type of errors in the administration and recording of medicines. One bathroom was noted to not have any coverings to the frosted glass windows. This is a longstanding issue and does not promote a residents privacy or dignity. Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 14 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): 12/13/14/15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provided adequate support to residents to meet their social needs. EVIDENCE: The home have their own activities organiser who has recently returned from long term sick leave and works 4 hours daily during the week. The following events are organised and offered to all residents including, bingo, pub lunches, shopping at the strand, nail care, hair washed. The activities person has a file that she records on daily to say what the residents have done and participated in e.g. one record stated that the residents had ”Had nails done, made cakes, listened to music, making cards, foot spa.”All documented for July 07 The events and activities were not displayed on the notice boards, so they were not able to keep everyone at the home and visiting the home up to date on what was happening or being planned. There had been no recent residents meetings and no evidence to show how they are involved in organising
Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 15 activities or making requests. The last recorded resident and relative meeting was dated 9th January 07. The manager explained that he had already planned on having at least monthly trips out and developing and reviewing the activities on offer. He advised that the owner had received a grant from the local authority to improve access to the building and would be looking at how this would be spent in the home to improve facilities to residents. The Cook currently caters for different dietary needs e.g. diabetic diets and gluten free and was able to discuss the likes and dislikes of the residents. Staff had been involved in basic food hygiene training but they acknowledged they all needed updates to their training including training on gluten free diets. A Representative of the Primary Care Trust (pct) advised that the local community Dietician would provide training if contacted. Updated training will make sure that all staff are knowledgeable in providing and assisting with appropriate meals for all Residents. During meal times, staff were observed providing support to residents with their meals. Lunch served during this visit looked appetising and was well presented. Several residents stated they were very happy with the food and menus offered. The kitchen area was clean and tidy, well organised and well stocked with food, especially a large stock of dry stores. Staff felt that menus and the ordering of food stuffs had improved and that planned menus could be provided. The lunch for the day was corned beef, mash, vegetables and gravy. The chef also had salads for some residents and corned beef and chips for others. The chef said he visits the residents daily to discuss the food but the manager had advised him that he needed to start documenting the menus served which he acknowledged he needed to do. The storage of foods stuffs, looked large in supply with various fridges and freezers and lots of small tins and packets, which adds to more individual choices. There was some storage of frozen cauliflower seen and discussed with the chef who stated that he did have supplies of fresh fruit and vegetables and that he was due a delivery and that he always tried to serve fresh vegetables. Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16/18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures provide adequate support to protect and support residents. EVIDENCE: The homes complaints procedure is available in reception and included in the homes statement of purpose. Staff felt they could air their views with the manager and could openly speak up at staff meetings. One staff member felt that previously they found it hard to talk at meeting but felt that with the new manager things would be different. During discussions with staff most had attended a lot of mandatory training and were happy with the training on offer and that they had received Abuse awareness training helping staff safeguard residents at the home. Residents are protected by the homes policies regarding abuse and complaints procedures. The homes complaints record book was seen during this inspection; however there had been no recorded concerns or complaints and the provided had not submitted the homes pre inspection questionnaire, which asks for details of any complaints, managed by the company Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19/26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides an adequate environment for residents to live in. EVIDENCE: Samples of areas throughout the home were seen during this key inspection. Some improvements noted included, the touch up of paint to scrapes on woodwork throughout the home. A sample of bedrooms seen showed personalised rooms with various personal belongings. One resident explained they were happy with the home and their bedroom they felt they had everything, they did make a request to have their bedroom redecorated, this was passed to the manager who discussed this with the Resident. Most areas were clean and tidy and some bedrooms had no nasty smells. However some areas still needed attention with repairs and maintenance.
Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 18 e.g. Some nasty smells were noted in a sample of bedrooms and in the ground floor toilets, holes were seen in the bed linen to one residents room, there was no curtain or covering to the frosted glass in the ground floor toilet which did not promote peoples dignity or privacy. The lounge carpet was worn and stained in parts, the staff room was in a poor state of repair with ripped seats and stains to walls, some curtains were seen hanging off tracks. These areas showed poor management of the maintenance and standard of living and working offered in the home. One bedroom had a high window but no restrictor and no risk assessment in place to identify if this was safe or not, one room had additional mobile heaters again with no risk assessment or evidence of attesting these small appliances, the linen cupboard door was falling off its hinge and couldn’t be closed or easily open, the hot water was noted to be very hot in one bathroom, with no thermometer to check but it felt hotter than the recommended 43’ C and needed checking to make sure the water was in safe and acceptable limits, some rooms had access to cool water still and had problems offering hot water from basins. These concerns showed ongoing poor management of the safety of the environment. The laundry area was clean and tidy, all the laundry had been completed and the laundry left clear. However it was noted some dirty laundry was on the laundry floor. There was also a supply and storage of towels seen stored on open shelves in the laundry. There did not seem to be any procedure for reducing risks of cross infection or any area to show clean and dirty areas or practices to prevent cross infection. The Manager produced a detailed maintenance and decorating plan that he had developed since starting at the home and acknowledged the areas that needed improvement to the homes environment. Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 19 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): 27/28/29/30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriately qualified staff support residents needs. EVIDENCE: Observation of staff and discussions with them indicate that most of the staff know the needs of the residents well and know their likes and dislikes. It was evident they had a good understanding of how to support residents and how to ensure their needs are met and their individuality respected and catered for The Manager organises a training matrix and showed recent training events attended by staff A sample of staff training records showed most to be up to date and clear and staff stated they were enjoying all the training offered by the company. (This showed evidence of most staff being experienced in meeting the resident’s needs.) However, during interviews with staff and in reviewing staff training records it was acknowledged that some staff had not yet received their mandatory training in some areas including food hygiene and moving and handling. A sample of 4 Personnel files were looked at and most were noted to be very organised and detailed with all necessary records and checks including police (CRB) and Protection of Vulnerable Adults (POVA) checks. This showed a good recruitment and selection policy, which helps to safe guard Residents in the
Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 20 home. However one file showed no evidence of a police check in place prior to their employment at the home. This continued practice could potentially put residents at risk. The personnel files show that the support and supervision of staff had not always been carried out. The manager stated that he had already made plans to develop supervision so that all staff are offered regular support throughout the year. This will help support staff in their training needs and help them develop while working at the home. Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 21 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): 31/33/35/38 Quality in this outcome area is, good. This judgement has been made using available evidence including a visit to this service. The health, welfare and safety of residents and staff is promoted and protected. EVIDENCE: The homes new manager explained he had only been in post as manager for the past 3 weeks. However he did work as a manager at another home and is experienced in the category of resident supported at the home and is well qualified in management. There had been positive comments about the new manager and already the staff and residents had met him and felt confident in seeing the home improve. Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 22 In just a very short space of time the manager had acknowledged various areas that needed review attention and development and he felt confident he could evidence how the home will improve under his management. Currently the manager works 2 days providing Nursing care and 3 days for managing the home. Discussion took place in how this should be reviewed so that the manager was able to evidence he had enough managerial hours to safely and adequately manager the home to show continued improvements Finance records were much more organised and improved with clear records and receipts kept, so that auditing accounts was much more accurate. Finances were only accessible by the provider and the manager. One record showed the provider was signing the residents balance sheet however it was agreed that the resident was able to sign for them self and the manager agreed it would be better practice for the Resident to sign for his own money. The company have various procedures in place to show how the home is being managed e.g. the inspector looked at a sample of maintenance certificates, fire safety checks, risk assessments, accident records which showed what actions were taken to ensure the safety of everyone at the home. However the dryer had still not been repaired and staff felt it had been broken since March 07.This left staff without enough equipment to manage and carry out laundry at the home with no information or reassurance to repair broken equipment. The gas installation certificate was noted to have expired 19/5/07. These concerns showed ongoing and inconsistent poor management of the safety of some areas within the environment. Therefore putting the residents at risk. Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 23 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 X 2 X x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 x X 2 Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 1) 2) Requirement All residents admitted to the home must be within the category for which the home is registered. To ensure that the care home can meet the residents needs. (Outstanding from the last inspection) Carry out regular medication audits to evidence what actions are taken to meet the standards and ensure safe practice in the administration and recording of medicines. The home must have competent and trained staff to meet the residents needs at all times. Staff must have training in moving and handling and food hygiene to improve on care current practices. (Concerns around training is outstanding from the last inspection) 4. OP29 Reg 19 schedule 2 Staff recruitment and selection procedures must make sure that staff have police checks in place
DS0000065370.V341048.R01.S.doc Timescale for action 10/09/07 2. OP9 13 2 10/09/07 3. OP18 18 (1) a c 10/09/07 10/09/07 Balliol Lodge Version 5.2 Page 25 6. OP38 Reg 23(1)(2)b )(c)Reg 13 4 a)c) so that residents are protected by these policies. All health and safety procedures must be reviewed to show how the home is made safe for residents and staff. Regular repairs and maintenance must be undertaken to ensure the environment is suitable for everyone at the home. (Outstanding from the last inspection) 10/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations Residents need to be consulted about what activities they would like and arrangements in place to support residents with their social needs. Activities should be further planned and developed and displayed to meet Residents social needs. The homes environment should be developed further to meet the needs of Residents with Dementia including safe access to the garden. The use of space within the home should be reviewed to ensure that there is sufficient room available to residents, including those who like to walk around. To develop regular minuted resident/relative meetings. To continue with ongoing staff meetings and develop the implementation of supervision and appraisals To continue developing and updating training records and provide evidence of 3 days paid training for all staff each year. The Provider should continue with development of NVQ training so as to meet the target of 50 by 2005 and provide written evidence of this. To review practices in the laundry and make sure policies
DS0000065370.V341048.R01.S.doc Version 5.2 Page 26 2. 3. OP32 OP30 4 OP19 Balliol Lodge 5 OP7 and procedures are clear in promoting clean and dirty areas with clear guidance on actions to be taken to prevent risks of across infection To review care practices and carry out regular care reviews covering, moving and handling, equipment used for support and pressure care, personal care of residents. To look at general routines in the home and ensure practices are promoted in giving residents as much choice as possible especially in going to bed when they want to. To make sure all staff are updated and trained in the basic principles of care so that residents are supported with choice, rights privacy and dignity. Balliol Lodge DS0000065370.V341048.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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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