CARE HOMES FOR OLDER PEOPLE
Buxton Lodge 53 Buxton Lane Caterham on the Hill Surrey CR3 5HL Lead Inspector
Ms S Magnier Unannounced 01 June 2005 16:00 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. Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Buxton Lodge Care Home Address 53 Buxton Lane, Caterham on the Hill, Surrey, CR3 5HL 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) 01833 340788 01833 350498 ncc@new-meronden.co.uk New Century Care (Caterham) Limited Ms Sheila Morgan CRH Care Home 38 Category(ies) of DE(E) Dementia - over 65, 12 registration, with number LD (E) Learning Disability - over 65, 8 of places OP Old Age, 38 PD Physical Disability, 6 PD(E) Physical Disability - over 65, 8 SI (E) Sensory Impairment - over 65, 8 TI (E) Terminally Ill, 10 Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. For the minimum age of service users within the category PD to be 50 years. Date of last inspection 31 January 2005 Brief Description of the Service: Buxton Lodge is a private care home with nursing situated in a quiet residential area of Caterhan on the Hill. The large detached Victorian building was extensively refurbished in 1985 and extended in 1992 to provide 38 places. The home changed ownership in January 2005 and is owned by New Century Care. The home is a short distance by car to the local shops and all community amenities. Service provision includes permanent, respite, convalescent and palliative nursing care for older people, some of whom may have dementia, learning or physical disabilities. The bedroom accommodation is arranged on two floors served by passesnger lifts. The majority of bedrooms are single with en-suite facilities. The home has seven shared bedrooms. All bedrooms have hand wash basins, emergency call system, telephone and remote controlled coloured televisions. The commumal lounge and combined dining facilities are situated on the ground floor. The room overlooks a south facing furnished patio and attractive and well maintained garden which includes a koi pool and waterfall. Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Unannounced inspection took place over 6 hours by two inspectors. The main focus of the inspection was to review the requirements made at the last inspection. A tour of the premises took place and care plans, staff records, health and safety records were sampled. A large majority of residents were spoken with during the inspection and their comments have been included in the report. The inspectors wish to thank the resident’s, staff and Acting Managers for their cooperation during the inspection. What the service does well: What has improved since the last inspection?
It was observed that the Managers and staff despite the recent management changes have maintained a professional, caring and committed relationship to each other and to the residents. The care plans and risk assessments continue to be reviewed to include clear details of the holistic needs, preferences and lifestyle of individual residents. Environmental risk assessments have been documented following the requirements made at the previous inspection to ensure the safety of all persons in the home. The Registered Persons have introduced, on a three-month trial basis the Monitored Dosage System for the administration of resident’s medication. All trained staff have received the appropriate training related to the use of the system. The Registered Persons have reviewed the use of the shared facility of the treatment and hairdressing room to offer a dedicated treatment room area where residents can receive treatment from trained nursing staff. Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 Page 6 The Registered Persons have reviewed the complaints procedure to ensure that complaints are fully investigated and conclusions of the complaint documented to the complainant. New Century Care supply internal facilitators to undertake staff training and are an accredited NVQ centre and have enrolled a significant number of staff to commence their Level 2 and 3 NVQ. The home has commenced a programme of staff appraisals, which have been received positively by staff. Following the previous inspection the dietician had visited the home to offer training to care staff regarding mealtime support needs for residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 Good information was available to enable prospective residents to make an informed choice about whether they wish to reside in the home. Contracts were in place and an assessment of need was completed prior to the admission of new residents. EVIDENCE: The homes statement of purpose and the service users guide has been recently updated. Pending the successful appointment of a Registered Manager the above documents will be amended to include the Managers details and a Registered Manager application to the Commission of Social Care Inspection will be made. Several residents files sampled detailed terms and conditions of stay in the home and full needs assessment prior to moving into the home to ensure that the residents needs are met. The home has developed a sensitive and reassuring welcome pack, which residents receive on admission to the home. Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 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) 7,8,9,10, The health and personal care needs of residents were met . The Acting Manager and staff have made a concerted effort to improve the care plans and risk assessments for the residents in order to ensure that the residents care and nursing needs are fully met. Medication arrangements were adequate. The promotion of residents dignity and privacy could be improved through a review of signage in the home. EVIDENCE: The care plans sampled evidenced that all staff and the Acting Manager have taken a systematic approach to the improvement of the care plans and risk assessments. The developed care plans sampled detailed clearly the care needs of the residents, medical history, reviews, named key worker detail, nursing care plans, daily notes, preferences and any other factors affecting the daily lives of the individual resident. The home maintains the strong professional links with a variety of health care professionals. Sampling the care plans and observations throughout the home indicated that the home continues to meet the health care needs of the residents.
Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 Page 10 The Acting Manager and Senior nurses have recently attended training regarding the implementation, on a three-month trial, of the Monitored Dosage system for administration of resident’s medication. The medication records sampled included resident’s photographs, relevant information regarding the medication and allergies, clear guidance on use of authorised homely remedies and well documented medication administration sheets. Medication stored in the homes refrigerators and Controlled drugs records, which are checked twice daily and signed by staff, indicated good practice. In discussion with the Managers the inspector has made a requirement that more discreet signage in a residents room regarding control of infection has been made to reflect the residents rights to confidentiality and privacy. Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 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) 12,13,14,15 The comments made from residents about their choices and lifestyle in the home was positive and all spoke highly of the home. Residents were able to participate in varied activities and maintain links with family, friends and the local community. Arrangements for residents meals were adequate. EVIDENCE: The home offers extensive social activities programme including organised excursions in a wheelchair accessible vehicle. A newsletter has been developed called the ‘Buxton Bugle’, which is available and designed for everyone in the home and includes topical issues, external events and occurrences in the home. It was observed that residents, who were able, were free to move around the home exercising their choice. One resident told the inspector that they liked to propel themselves in their wheelchair and another was observed to be free to have a cigarette outside the home. Several visitors to the home commented that their relatives and friends were well cared for and the service provided in the home by the staff was good. Two residents told the inspector that they liked living in Buxton Lodge. Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 Page 12 The inspector met with the kitchen staff who spoke favourably of the home. Whilst undertaking an inspection of the kitchen area the inspector evidenced that the residents were offered choice of meals which included sandwiches, spaghetti, omelettes and trifle. A list of resident’s meal preferences was displayed on the wall and fresh vegetables were available. The kitchen area was well maintained and managed and records sampled evidenced that the fridge and freezer temperatures and cooked food temperatures were checked in compliance with food hygiene guidance. It was noted that several items in the fridge for example the beef and vegetable stew and mayonnaise container did not include dates of cooking or when packages were opened. A requirement has been made that the Registered Persons must ensure that all food is stored to comply with the basic food hygiene guidance. One resident told the inspector that they did not like the curry and had told the staff. The general feedback from the residents to the inspector regarding the meals was mixed. In discussion with the Area Manager the inspector was advised that a quality audit for meals and food had been carried out and every effort to ensure that residents are offered choice was being maintained. Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 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 The complaints policy and procedure have been reviewed and conclusions to complaints implemented within the procedure. EVIDENCE: Following the last inspection the complaints procedure has been reviewed to ensure and demonstrate that complaints are fully investigated and conclusions of the complaint documented to the complainant. Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 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) 19,20,21,22,23,24,25,26. The home has a high standard of cleanliness and hygiene. All areas viewed were well maintained and safe, with attractive décor. The residents spoke favourably of their private and communal accommodation. Specialist equipment and adaptations required to meet residents needs was in place. EVIDENCE: The home is clean and bright and well maintained both internally and externally. Resident’s rooms were viewed as personalised with resident’s own furniture and fittings to suit their preferences and choice. Several resident’s rooms had televisions, radios, music centres, books and personal ornaments. Window restrictors were evidenced in order to ensure the safety and well being of residents accommodated above ground level. The home offers suitable bathroom and toilet facilities for the use of residents. During the tour of the premises it was noted that one shower was not in use and a requirement has been made that this is rendered back in use within the
Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 Page 15 timescales set. Specialist equipment, including hoists and other adaptations throughout the home are available to residents in order to maximise their independence and ensure comfort and safety. Following the previous inspection and the recommendation made the Registered Persons have reviewed the arrangements of the shared facility within the home of the clinical room and the hairdressing service. This review has resulted in the home having the space for a dedicated treatment room where residents can receive care and treatment from the trained nursing staff. The requirements regarding the completion of a documented risk assessment for the use of the upstairs sluice has been met and the Area Manager advised that consideration of this working space would remain under review. A documented risk assessment has also been completed for the basement area of the home, which has been rendered safe for use by staff with additional safety measures including signage, lockable door and use of portable torch. Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 The home has a hardworking staff team in sufficient numbers who demonstrated a commitment, competence and professionalism to the residents. EVIDENCE: The home has recently recruited new care staff and those staff spoken with during the inspection spoke highly of the home. Staff told the inspector that they receive supervision and training which was also evidenced in the staff files and training records. The staff files sampled indicated that annual appraisals have been commenced in a supportive way and the feedback from staff has been positive. The Area Manager advised the inspector that following the previous inspection the dietician had visited the home to offer training to care staff regarding meal time support needs for residents. It was encouraging to note that for staff training would be readily available as New Century Care supply internal facilitators to undertake staff training. Additionally New Century Care is an accredited NVQ centre and has enrolled a significant number of staff to commence their Level 2 and 3 NVQ. On examination of the staff file for the homes chef it was noted that no certificate of Intermediate Food Hygiene was available. A requirement has been made that the certificate is available on the staff members file to illustrate they have the appropriate level of training for the work they are to perform.
Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 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) 31,32,33,36,38 The current management promotes the smooth running of the home. Policies and procedures were in place to promote the residents and staff safety: however, a number of health and safety matters required attention at the time of the inspection resulting in a number of requirements. EVIDENCE: Due to the retirement of the previous Registered Manager the Deputy Manager of the home has been Acting Manager with the support from the Area Manager. Staff commented to the inspectors that the current management arrangements of the home had enabled the smooth changes within the home. It was observed that the Managers and staff maintained a professional, caring and committed relationship to each other and the residents. Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 Page 18 The inspector sampled the documentation regarding the homes fire drills and practices, which indicated the home maintains awareness and continues to monitor safe working practices in relation to fire safety. During the inspection the following health and safety hazards were identified and requirements made that these are met within the timescales identified: • • • The hot water temperature in Room 21 must be checked to ensure that it is within the safe temperature limits. It was noted that in several bathroom areas in the home that there was an insufficient supply of liquid soap and paper towels for general use in order to maintain adequate control of infection throughout the home. Bottles of hairdressing solutions were noted in an unlocked wardrobe and must be stored in compliance with the Control of Substances Hazardous to health guidance. Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 3 x x 3 x 2 Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 Page 20 NO 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 10 Regulation 12.(4)(a) Requirement The Registered Persons must ensure that the care home is conducted in a manner which reflects a residents right to confidentiality and privacy regarding signage related to control of infection. The Registered Persons must ensure that unnecessary risks to the health and safety of residents, including the storage of food, are identified and so far as possible eliminated. The Registered Persons must ensure that the water outlet in Room 21 is tested by a qualified technician and the water temperature reduced to the required safe limits to ensure the safety of the resident and staff. The Registered Persons nust ensure that suitable hand washing equipment is provided to staff working in the home to avoid the spread of infection in the home. The Registered Persons must ensure that all chemicals used within the home at all times are stored securely and safely in compliance with the Control of Timescale for action 7.6.05 2. 15 13.(4)c Immediate 1.6.05 3. 38 13.(4)(a)( b)(c) 7.6.05 4. 38 13.(3) 7.6.05 5. 38 13.(4)(a) Immediate 1.6.05 Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 Page 21 Substances Hazardous to Health (COSHH) legislation. 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 Good Practice Recommendations Buxton Lodge H58_s63422_Buxton Lodge_v228055_260505_stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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