Inspection on 13/12/05 for Boscombe Lodge

This inspection was carried out on 13th December 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 12/04/05

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 Inspection 13th December 2005 09:00 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 Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 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. Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 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 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) 01702 603444 01702 603377 Boscombe Care Homes Limited Manager post vacant Care Home 30 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (30) of places Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Nursing and personal care to be provided for up to 30 older people aged 65 years. Nursing and personal care may be provided for one older person aged over 65 years who has dementia. The total number of service users for which nursing and personal care can be provided must not exceed 30. The registered manager to commence NVQ level 4 training in Care Management within three months of appointment. The registered manager appoints a suitably qualified deputy manager within three months to be formalised to cover in the manager`s absence. 12th April 2005 Date of last inspection Brief Description of the Service: Boscombe Lodge is an established care home which provides nursing care. The home is situated within a residential area and formed from a previously existing residential premises, which has been subject to extension and modification work. Service users accommodation and communal areas are situated on two floors, with a passenger lift provided for assisted access. The home does not have a vechicle to transport resident’s. The premises are situated within close proximity to both local transport, main shopping areas, Southend sea frount and other civic amenities. All bedrooms have private en suite shower and w.c. Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 13th December 2005 following two additional inspections on the 20th May 2005 and the 31st August 2005. The additional inspections were completed following complaints made directly to the CSCI in relation to poor care practices. The CSCI investigated the complaints and requested the home withdraw conditions of registration to care for terminally ill residents and the CSCI made immediate requirements to the home to improve care, increase staffing, staff training, care planning and risk assessments. The home voluntarily withdrew their condition to admit terminal care residents and the registered provider employed a new suitably qualified and experienced nurse consultant/manager to oversee the homes management. At inspection, staff records were examined and all residents in the home seen, including seven residents who were nursed in bed. The skin condition of two residents was examined (with their permission) - the residents were hydrated, nourished and well cared for. Time was spent chatting to nine of the residents about their daily care plus two visiting relatives, four staff members, the registered provider and the new acting manager/consultant. All but one statutory requirement from the previous inspection had been met. The home’s staff and in particular the acting manager/consultant were praised for their achievements in raising standards of care for residents since the last inspection. The inspector would like to take this opportunity to thank the residents, their relatives and the staff for their time and cooperation during inspection. What the service does well: Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 Page 6 The home is welcoming to relatives and decorated to a good standard. Meals are varied and nutritious with good choice and variety. What has improved since the last inspection? What they could do better: Staff training regarding record keeping, catheter care and communication could be further improved in the home. Complaints could be recorded better with clear evidence of the investigation, timescales with outcome and parties involved. The home could improve community activities for residents who wish to go out and appoint an activities coordinator. The recruitment of a suitable experienced registered qualified manager in the home with NVQ level 4 in care management or equivalent could stabilise and further assist the development of the service. Staff could improve respect of privacy of residents. A staff response time audit could be completed for residents using the call bell system. Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 Page 7 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. Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 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 Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6. Progress has been made in pre assessments and record keeping ensuring the care needs of residents’ is identified at admission. Residents are helped to maximise their independence and return home. EVIDENCE: The acting manager/consultant visits residents in hospital or at home to assess their care needs prior to admission and only accepts residents, if these needs can be meet. Pre assessments are more comprehensive and residents recently admitted confirmed the home met their individual needs. One gentleman’s condition had improved so much since admission he confirmed he was having a home assessment on the day of inspection so he could go back to live at home. “The care here is very good.” The same gentleman was unable to walk on admission to Boscombe lodge but had since become fully mobile. Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9,10.11. Progress has been made on improving arrangements to ensure residents’ health needs are identified. Residents are treated with respect but their right to privacy not always upheld. Staff need further training in catheter care, record keeping. Staff do not always respond to residents call bells in appropriate timescales. EVIDENCE: Sampled care plans had sufficient details of resident’s health and social care needs including intervention for daily care, assessments, nutritional needs, safety, recreational preferences and communication needs. Files contained appropriate medical histories, medication records and instruction from residents in relation to the wishes regarding illness death and dying and evidence of appropriate aids supplied to assist independence. Risk assessments were comprehensive to enable the protection of residents’ health and safety. The acting manager/consultant had introduced an excellent tool to assess dependency needs of residents’ to ensure staffing levels are sufficient to meet needs but one resident stated “staff do not always come when I call.” The call Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 Page 11 bell system was tested and it was found that staff did not respond. After 5 minutes a member of staff was found to attend to the resident. Medication was examined at inspection and all controlled drugs examined and counted. Medication was correct, stored appropriately, labelled and dispensed as required by the homes medication policy. Residents stated at inspection that staff treat them with respect, but it was noted some staff did not always knock and wait before entering residents bedrooms. One resident stated, “Staff do sometimes walk in while I’m getting undressed.” The acting manager was informed of the inspector’s observation and stated she would speak to all her staff. It was noted at inspection that not all details of significant events were recorded in residents’ files and one resident’s catheter bag was not positioned appropriately below his body to allow drainage. The senior nurse on duty was asked to give this her immediate attention. Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 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 the following standard(s): 12,13,15. Social and community activities available in the home have improved but do not meet the needs of all residents. Residents maintain good contact with relatives who are made welcome in the home. The home provides wholesome appealing balanced meals for residents. EVIDENCE: Care plans examined confirmed the home records residents’ preferences in relation to social and spiritual needs but activities in the home are still limited, although some improvements have been made since the last inspection. The home records in house activities but does not provide an activity programme for residents or arrange trips out in the community. The home does not provide suitable transport to take residents out. Relatives take residents out for the day and staff occasionally take residents out in wheel chairs for a walk in the warmer months. The home does not have an activities coordinator. Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 Page 13 At inspection it was noted that relatives were made very welcome and able to stay all day with their loved ones. Drinks and refreshments were offered to relatives and one relative visiting her husband was seen to be assisted by the acting manager/consultant to complete a questionnaires to enable her seek assistance from social services. All relatives spoken to were complementary of the home but stated residents were not stimulated much. One relative who was also a member of staff stated that all residents are looked after well now and the home is good.” Another relative who had been visiting his aunt in the home stated “I have always found the home very good, clean and staff look after residents well. My brother and sister both have found the same and my aunt was happy living here although she did not go out much”. One card received from a relative thanked the staff for their care. The home provides good quality nutritious meals for residents and at inspection meals offered were fresh and appealing, sufficient to meet the needs of residents. Staff fed residents with dignity and respect and meals were taken in the day room or in the privacy of residents’ own rooms. Drinks were seen to be available during inspection within reach of residents who were being nursed in bed. All residents appeared well presented, clean and cared for. Residents are weighed on admission and thereafter monthly to ensure any inconsistency is detected early. Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 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 the following standard(s): 16,18. Relatives have not always felt confident that the registered provider has investigated complaints objectively in the past and the CSCI had investigated a number of complaints in the last 12 months, many of which were substantiated. The complaints procedure needs to be improved to ensure residents are protected. Residents are now protected from abuse. EVIDENCE: The home has recently taken steps to address all the issues brought about by complaints made in the last 12 months. The homes complaints log was incomplete with pages torn out at inspection. The acting manager/consultant was questioned about the missing pages and stated they were taken out before her employment in the home. Only one complaint was recorded in the logbook since the last inspection and a senior member of staff investigated the complaint, which was signed off by the acting manager/consultant. The CSCI have received one complaint since the last inspection which was as a result of an unexplained injury sustained to a resident in the home. The complaint was fully investigated by the homes inspector and it was concluded that the resident might have hit the wall whilst being hoisted to bed by only one carer. Due to the seriousness of the injury social services were informed and the home advised to ensure the policy for manual handling was updated to Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 Page 15 include two staff for hoisting at all times. The home has since completed further training for all staff in manual handling and introduced a new policy, which was examined at inspection and included the appropriate instructions for staff to ensure residents safety. All staff that read the policies now sign to say they have done so. The home was told on the 31/8/05 if improvements in the home were not made to ensure residents’ safety enforcement action might be taken by the CSCI. However the home has worked hard to improve care and meet all the requirements. Most of the homes staff have now completed appropriate protection of vulnerable adults (POVA) training and at inspection appeared conversant with the signs of abuse and the procedures for reporting abuse. Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. The home is well maintained, clean, pleasant and hygienic. EVIDENCE: At inspection the home was welcoming clean, warm and free from offensive odours. All residents looked comfortable and warm with sufficient specialist equipment to maximise their independence and prevent pressure care needs. Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The procedures for recruitment have improved with staff numbers and skill mix enhanced to meet the needs of residents. Staff are now appropriately trained to ensure residents are kept safe. EVIDENCE: The home has introduced a new key working system to help assist continuity of care for residents. Staff numbers have been increased to ensure residents have all their health care needs met. The home employs three staff now on each floor at each shift with two additional domestic workers plus a registered nurse. Staff training included COSSH training, which was being undertaken at inspection, plus manual handling, dementia, NVQ, care planning, Parkinson’s Disease , pressure area care, first aid, fire, TOPPS foundation induction course and palliative care. The training courses appeared to have enhanced staff skills and one member of staff stated, “I am happy working here now we are trained”. Another staff member stated “I have been here since the last manager was here and it is very different. Now we can approach the managers, as we are not scared. We can give suggestions. There is a much happier atmosphere and it has broadened my mind. If I come up with new ideas I can call a meeting. I have enjoyed my 12-week infection control training.” Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38. Since the recruitment of the new acting manager/consultant in April 05 the home has been managed by a person who is fit to be in charge, of good character and able to discharge her responsibilities. Improvements have been made in the home but these improvements need to continue to ensure the home is run in the best interest of the residents. EVIDENCE: The acting manager/consultant has recently employed a full time acting manager to run the home while she overseas the homes management and training. The acting manager is to apply for registration as the homes full time registered manager while the acting manager/consultant oversees the home’s future development. Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 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. 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 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x x x x 3 Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 Page 20 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 2 Standard OP8 OP28 Regulation 17 13 Requirement Daily care notes must be detailed and include vital information. The home must ensure unnecessary risk to residents’ health and welfare are identified and eliminated. This refers to catheter care and timescales for residents calling for assistance. Staff must receive further training in catheter care and record keeping. The home should produce a quality assurance and monitoring system to improve the service with a report sent to the CSCI. Residents must have access to local social and community activities arranged on their behalf. All complaints made to the home must be fully investigated by the acting manager/consultant or registered provider. Residents’ privacy must be respected at all times. Timescale for action 01/01/06 01/01/06 3 4 OP30 OP33 12 24 01/03/06 01/06/06 5 OP12 16 (2) 01/03/06 6 OP16 22(3) 01/01/06 7 OP10 16 01/01/06 Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 Page 21 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 OP31 Good Practice Recommendations An appropriate qualified experienced manager should be employed by the home that is experienced who can work full time. The home should also employ a full time experienced deputy manager to cover in the manager absence. Self-funding residents should have independent advocates allocated to them if required. The home should appoint an activities coordinator and arrange transport to take residents out into the community. The registered manager should have NVQ level 4 in care management or equivalent. 2 3 4 OP2 OP12 OP31 Boscombe Lodge DS0000061944.V265350.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection South Essex Local Office 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 DS0000061944.V265350.R01.S.doc Version 5.0 Page 23 - 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. 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