Inspection on 12/04/05 for Boscombe 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

Boscombe Lodge 23/04/07

Boscombe Lodge 19/04/06

Boscombe Lodge 13/12/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Boscombe Lodge 65 Boscombe Road SOUTHEND ON SEA Essex SS2 5JD Lead Inspector Patricia Stanton Unannounced 12 April 2005 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. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Boscombe Lodge Address 65 Boscombe Road, Southend on Sea, Essex SS2 5JD 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) 01702 603444 01702 660 Mr Rashid VACANT POSITION CRHN 30 Category(ies) of 30 OP, 4 TI, 1 DE(E) registration, with number of places Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Dementia - over 65 years of age (1), Old age, not falling within any other category (30), Terminally ill (4) Date of last inspection 25.01.05 Brief Description of the Service: Boscombe Lodge is an established care home, which provides both social and nursing care including terminally ill and dementia. The home is situated within a wholly private residential area and is formed from previously existing residential premises, which have been subject to extension and modification work, to suit its use as a care home for older people. Service users accommodation and communal areas are situated on two floors, with a passenger lift provided for assisted access. The premises are situated within relatively close proximity to both local, main shopping and other civic amenities. All bedrooms have private en suite shower and w.c. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over five hours and was carried out because of a protection of vulnerable adults concern regarding one service user accommodated in the home and a complaint made to the CSCI. The inspector also wished to follow up the progress of the previous inspection statutory requirements and recommendations, which took place on 25/1/05. The registered provider has since attended a meeting to discuss the issues from the last inspection at CSCI office and voluntary agreed not to admit residents to the home who are terminally ill until further notice. The home was left an immediate action notice on 12/4/05, as the home did not meet requirements for appropriate care planning and risk assessments for residents. Failure to comply with the requirements of this inspection and the immediate action notice may result in future enforcement action being taken by the CSCI. At inspection care and staff records were examined. Two staff members, three residents, the registered provider and new acting manager all were spoken to. What the service does well: What has improved since the last inspection? Staff spoken to at the inspection appeared pleased with changes regarding management and optimistic about the future of the home. Some staff training had been introduced since the last inspection and files evidenced this was ongoing. Within care plans staff had completed good manual handling assessments and peg feeding records. The new acting manager had introduced new food, fluid and turning charts for staff to record residents diet intake and positional changes. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 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. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 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 Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 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) 3,4. Limited progress had been made to improve records for residents regarding care planning and risk assessments and service users are not always consulted about their care. Without this there is no assurance that care needs are met and residents are protected. EVIDENCE: Sampled files omitted adequate pre assessments or care plans in the respect of management of residents. Care plans, risk assessments and details of prevention of pressure sores, did not guide staff on the actions to be taken to ensure that residents are properly assessed and cared for. There was no evidence that any action has been taken since the last inspection with regard to these requirements. The home does not consult residents’ regularly about their care to evidence how the home meets their needs. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 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) 7,8. Limited progress had been made on improving arrangements to ensure service users health needs are identified and met. These shortfalls have a potential risk to residents’ health and social needs and place residents at risk. EVIDENCE: Sampled care plans examined at inspection did not have sufficient details of why specific air mattress were being used for residents, no choice for personal care, no times for rising and retiring, no details of food preferences, interests, links with the community or religious services. There were no details of an accident on 11/4/05 to one resident who had fallen and daily records recorded only “found on floor” at 20.30 hours. One care plan recorded a resident was admitted with a grade 2 pressure sore and small cut on left, leg but did not indicate that the resident had a broken spot on his skin or that he had diabetes. There were no details of how staff were to manage diabetes or pressure sores for this person. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 Page 10 Discussion with the new acting manager, who had been employed in the home for only three days, suggested some improvement had been made in respect of record keeping. The registered provider has little knowledge of nursing care needs, but has employed a new acting manager, who had introduced in the short time she had been employed, new fluid charts and meal charts to record residents diet intake and turning charts to record positional changes of less mobile residents’. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 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) 12,13,14, Service users are not consulted regularly about their preferences and expectations regarding social and cultural interests and needs. Social activities provided appeared limited. The home needs to consider how best to seek the views and opinions of residents and their significant others on an ongoing basis. EVIDENCE: Care plans examined did not evidence service users preferences in respect of social interests, spiritual needs or preferred community links however one care plan evidenced what a resident did not like i.e. knitting or reading. Service users are asked to complete a quality assurance questionnaire on admission to the home and during the first three months of living in the home, but the registered provider does not meet on a regular basis with residents to obtain their views and opinions regarding social needs and interests. The registered provider informed the inspector he held one meeting but no one attended. The home does encourage relatives and friends to maintain contact with residents and take them out but no record of staff taking service users out was seen at inspection. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 Page 12 One staff member stated, she would be happy to work in the afternoons in addition to her morning shifts to coordinate activities for residents. The registered provider was informed of the comments received. The registered provider has been advised to contact the National Association for providers of Activities for older people on 01376 585225 in previous inspections for advice and guidance, but at inspection had made no contact. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 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) 16,18. Relatives do not feel confident the registered provider investigates complaints in the home objectively. The CSCI have investigated a number of complaints in the last 12 months regarding care provided in the home and lack of robust staff recruitment checks, which have all been upheld. These poor practices put residents at risk of harm or abuse. EVIDENCE: One service user has been referred under the protection of vulnerable adults policy. Four complaints received by the CSCI over the past year have alleged poor care practices. All four were upheld. Complaints had been received by the CSCI, as relatives were not happy with the outcomes of the registered providers investigations. The registered manager has introduced some training for all staff employed and staff spoken to were not always conversant with the signs of abuse and the procedures for reporting abuse. The home has a complaints book in reception for residents and visitors to complete. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 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) EVIDENCE: Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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) 28,29,30 The procedures for recruitment are not robust and do not safeguard or offer protection to people living in the home. The staff numbers and skill mix need to meet the needs of all residents in the home. Staff training was found to be lacking in respect of pressure sore care, risk assessments, nutritional care, palliative care, care planning and key working systems. EVIDENCE: One complaint from a carer regarding staff recruitment was upheld, as the carer had been employed in the home unsupervised without appropriate checks to safeguard service users accommodated. Records seen and staff spoken to at inspection confirmed they had only been employed in the home following criminal record checks and not allowed to work unsupervised. Staff numbers appeared adequate to meet the needs of residents at the time of inspection, but the home not admitting service users with high dependency needs. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 Page 16 The last registered manager had introduced a training programme for staff, but this did not include pressure area care, diabetes, care planning, risk assessments, nutritional needs, specialised equipments for relieving pressures areas, palliative care and key working systems. The new acting manager advised that she would arrange training for all staff in these conditions. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 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) 31,32,36,37,38. The registered manager of Boscombe left employment on 5/4/2005 and was replaced by a new acting manager on the 6/4/05. The new acting manager has the appropriate qualification and experience to run and lead the home and appeared respected and approachable by staff at inspection. The acting manager had made improvements in care planning at inspection and had an agenda for improving care in the home. The home has not produced a quality assurance and monitoring system report for the home. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 Page 18 EVIDENCE: The registered provider appeared to have limited knowledge of nursing care. The registered provider had employed an acting manager who appears to have excellent experience and qualifications to be able to run the home, but this position is not permanent as the home plans to employ a new registered manager. The present acting manager is to work part time overseeing and supervising care at Boscombe. An immediate requirement was left at this inspection regarding care and the new acting manger was to review all residents care plans within 28 from inspection. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 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 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 3 2 x x 2 x 1 Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 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 OP3 Regulation 14 (1) Timescale for action Service users are only admitted Previous to the home following an Timescale assessment, which determins the 25/2/05 home can meet all the service not met. users needs. 20/4/05 A record must be kept in respect Previous of each resident a record of all Timescale items in schedule 3 & 4. 25/2/05 not met 20/4/05. The home must ensure taking in account the number and needs of residents, the homes statement of purpose sufficient numbers of experienced carer staff and registered nurses to meet the needs of all residents accomodated. The home must be conducted so far as possible to ensure the proper provision of health and welfare of residents accomodated. All residents accomodated including residents who may have developed dementia must have regualr reviews from a general practitioner. All residents must have adequate risk assessemtns completed to Previous Timescale 01/07/04 notmet.20/ 4/05. Requirement 2. OP15 17 (1) (2) 3. OP4 10 18 4. OP7 12 (1) (a) 5. OP8 13 1 (a) (b) 6. OP38 13 (a) (b) Previous Timescale 25/2/05 not met. 20/4/05 Previous Timescale 25/2/05 not met 20/4/05. Timescale 25/2/05 Page 21 Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 identify risks to elimate them. 7. OP38 13 (4) The home must ensure unnecessary risk to health and welfare of residents are identified and eliminated. All care plans should be reviewed and include social histories, risk assessments, nutritional needs and preferences. Care plans must be developed with residents and or their representative with professinals which is detail individual nursing care needs with evidence of how and what action staff need to take to meet residents individual needs. The manager and staff must receive appropriate supervision where the home provides nursing care. Residents must be consulted about their social interests and arrangements made to engage them in local social and community activities arranged on their behalf. Staff must receive training in terminal care, diabetes, challenging behaviour and parkinsons disease. Staff must have training in care planning , pressure sores care and prevention, key working systems, risk assessments, record keeping and nutritional needs. Staff must have personal development and training plans. The home must produce a quality assurance and monitoring system to improve care in the home and give a report to the CSCI. All staff must have robust recritment checks before being employed in the home. not met. Timescale 25/2/05 not met. Previous Timescale 25/2/05 not met. Previous Timescale 01/08/04 not met.20/4/0 5 Previous Timescale 25/2/05 notmet.20/ 4/05 01/4/05 Timescale not met. 8. OP7 12 9. OP7 15 12 (3) 10. OP36 18 (1) (2) 11. OP12 16 (2) 12. OP30 12 Previous Timescale 1/11/04 not met.20/4/0 5. 13. OP33 24 14. OP29 19 Previous Timescales of 1.8.04 not met. 20/4/05 12/4/05 Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 Page 22 15. OP18 22 (3) All complaints made to the home must be fully investigated 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. 3. 4. Refer to Standard OP4.4 OP28 OP31 OP7 Good Practice Recommendations No residents should be admitted in the home until appropriate care planning and staff training is complete. 50 of all care staff employed in the home should have completed NVQ level 2 in care. An appropriate qualifed expereinced registered nurse manager should be employed to work in the home. Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 Page 23 Commission for Social Care Inspection Kingswood House Baxter Avenue SOUTHEND ON SEA Essex SS2 6BG 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 Boscombe Lodge I56-IO6 S61994 Boscombe Lodge V221475 120405 Stage4.doc Version 1.20 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!