CARE HOMES FOR OLDER PEOPLE
Boscombe Lodge 65 Boscombe Road Southend On Sea Essex SS2 5JD Lead Inspector
Patricia Stanton Key Inspection 19th April 2006 1300 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.V291006.R01.S.doc Version 5.1 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.V291006.R01.S.doc Version 5.1 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.V291006.R01.S.doc Version 5.1 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. 13th December 2005 Date of last inspection Brief Description of the Service: Boscombe Lodge is an established care home, which provides both social and nursing care including 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. Residents’ 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 DS0000061944.V291006.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 19th April 2006. Staff records, care plans and the previous requirements were examined and the inspector was given a tour of the homes premises. All residents accommodated were seen at inspection and questionnaires were given to the acting manager, all residents, visiting health professionals and general practitioner. Responses were received from eight residents/relatives, and the acting manager/consultant. Details of which are included in the report. Time was spent chatting to seven residents, three relatives, two staff members and the acting manager/consultant about resident’s daily routine. The inspector would like to take this opportunity to thank the residents, their relatives and staff for their time and cooperation. The home’s staff and in particular the acting manager/consultant was praised again for continuing to raise standards of care at Boscombe Lodge. All the previous requirements and recommendations had been addressed. What the service does well:
The home is comfortable, welcoming and decorated to a good standard. Food is of good quality and residents have access to drinks at all times. Staff work well together as a team and better understand residents needs. Care planning and pre assessments are good and include all relevant information to help staff deliver appropriate care. The home has an excellent acting manager/consultant who overseas the homes day-to-day care ensuring residents are safe and protected from abuse. Training continues to help staff deliver day-to-day care. Record keeping is detailed and the acting manager seeks the views and opinions of residents, their relatives and staff. Staff numbers meet the needs of resident. Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 Page 7 Ensure risk assessments are reviewed regularly. The home could ensure the new acting manager completes NVQ level 4 in Care Management by 2007. The home could arrange days out locally for residents who wish to go out. 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.V291006.R01.S.doc Version 5.1 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.V291006.R01.S.doc Version 5.1 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): 1,3,4,6, The home has an updated statement of purpose and comprehensive pre assessments to ensure residents and they’re significant others know the home they enter will meet their needs. The home does not provide intermediate care. Quality in this outcome is good. EVIDENCE: The homes statement of purpose has been updated with relevant information required and pre assessments examined contained details of residents needs including completed dependency/living assessments, information with regard to lifestyle, food preferences and social history. The assessments identified risks to residents’ with details of allocated social workers, medical professionals and family. Care plans and assessments were signed and dated. Although the home does not provide intermediate care one resident admitted improved so much whilst living at Boscombe he was assessed and discharged back to his own home. Another resident spoken to at inspection stated since I have been here staff have helped me to walk again and I can now walk alone. Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 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): 7,8,10. Residents’ health, personal and social care needs are set out in care plans and the homes’ management ensure these are met. Residents’ privacy is respected. Quality in this outcome is good. EVIDENCE: Care plans examined were found to be more detailed with relevant information kept which could assist staff deliver appropriate care. Care plans included pictures of residents, preferred activities, manual handling and risk assessments plus nutritional, weight and waterlow scores. Daily notes were more detailed in respect of resident’s moods and daily life. The records evidenced staff had a greater knowledge understanding of residents than previously. One care plan examined found that a risk assessment for a lady resident had been completed on her admission but not reviewed following major surgery. The same resident had a fall and only then was the risk assessment reviewed.
Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 Page 11 The complaints and incident records examined confirmed some residents were unhappy about the attitude of a carer working at night. However, records evidenced the homes acting manager/consultant had taken appropriate investigation and action to the allegations to prevent further occurrence. One relative wrote” My wife had a stoke which affected her right side and speech, but fortunately she understands everything I say. The home has been so kind and supportive allowing me to spend most of the day with her. We are both most satisfied with the home in every respect and we are also pleased to receive the inspector of social care and know that these sort of inspection are carried out on nursing homes, for not all homes are as good as Boscombe Lodge”. Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 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. Residents’ lifestyle experiences have improved matching their cultural and religious needs but the home could improve access to community facilities for residents. Quality in this outcome is adequate. Residents receive wholesome appealing balanced meals in pleasing surroundings. EVIDENCE: The home has employed an activities coordinator solely to entertain residents each afternoon in the home. This appeared very popular with residents who looked more stimulated and happier. Residents appeared to be interacting more with each other and looked contented. One resident stated, “Its excellent here I don’t wish to be anywhere else” another stated, “the staff here are brilliant, I could not be treated better if I were royalty. We play games in the afternoon I like scrabble.” Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 Page 13 The home has arranged for the Church of England minister to come to the home to deliver a service for residents but residents still do not access community facilities or go out much. However staff stated this might improve in the warmer months now the home has an activities coordinator. All residents spoken to continue to be happy with the quality of food provided in the home and it was noted the home now record resident weight regularly to identify possible future health problems. One resident stated in a questionnaire “I am very happy here and the food is marvellous”. Menus examined confirmed residents receive varied and healthy meals. Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 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. Residents and relatives are now confident that their complaints will be taken seriously and acted upon and residents are more protected from abuse following appropriate staff training. Quality in this outcome is good. EVIDENCE: Records confirmed all complaints and incidents are thoroughly investigated and acted on appropriately. No serious complaints had been received by the CSCI or the home since the last inspection. Comments seen in letters’ sent to the home plus returned questionnaires were mostly very positive. One resident stated “Lovely staff, they take time to chat to me whilst another stated “If we do make any criticisms it always seems to have repercussions for the patient” Staff now have appropriate training in pressure sores, catheter care, nutritional care and record keeping resulting in more protection to residents. Staff spoken to including one new member of staff was conversant with the signs of abuse and the procedures for reporting abuse. Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20,26. Residents have access to comfortable indoor and outdoor facilities and the home is clean, pleasant and hygienic. Quality in this outcome is good. EVIDENCE: The home was clean, hygienic, welcoming and decorated to a good standard. Residents have the use of adequate community space indoors in the home and its gardens. Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 27,30. Residents’ needs are met by staff who are trained and in sufficient number to meet the needs of residents. Staff are more competent to do their jobs. Quality in this outcome is good. EVIDENCE: Staff work in sufficient numbers and trained in basic care skills improving care to residents’. Records confirmed staff have received health and safety care including manual handling, bedrail assessment, hoisting and cot sides. The staff team appears more stable and staff turnover less, improving staff morale. Six staff members have completed NVQ level 2 recently and the home has employed a member of staff with NVQ level 3. The acting manager is awaiting a place on a NVQ level 4 in care management course. Staff recording had improved and turn charts and nutritional records examined were complete and up to date. One staff member stated, “the new acting manager is brilliant and we can approach her. The residents all love her. Residents have more activities and there’s no shortage of staff. We are now listened too in meetings and staff are
Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 Page 17 much happier. The registered provider comes into the home regularly and everyone works as a team”. Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 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. The home is run by a acting/consultant manager who is fit to be in charge, of good character and able to discharge responsibilities to her staff. The home is now run in the best interest of residents. Quality in this outcome is good. EVIDENCE: The acting manager/consultant has progressed the home in the last six months to ensure the standard of care for residents has been raised and all staff now has appropriate sills to ensure the residents are protected. The home has now sought the views and opinions of residents to ensure their views along with the staff and visiting professionals are taken into account when making decisions in the home, which is now run in the best interest of the residents.
Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 Page 19 This has resulted in better outcomes for residents living at Boscombe Lodge. Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X 3 X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 x X x x 3 Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? no 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. 7. Standard OP38 Regulation 13(4) Requirement The home must ensure unnecessary risk to health and welfare of residents are identified and eliminated. This refers to reviewing risk assessments. Timescale for Action 25/02/05 Timescale for action 20/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. 3. 4 Refer to Standard OP28 OP31 OP12 Good Practice Recommendations 50 of all care staff employed in the home should have completed NVQ level 2 or above in care. The acting manager who should be an experienced registered nurse should have an appropriate management qualification. The home should arrange for residents to go out and access the community. Boscombe Lodge DS0000061944.V291006.R01.S.doc Version 5.1 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
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