Inspection on 15/11/05 for Buxton Lodge Care Home

This inspection was carried out on 15th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Buxton Lodge Care Home 04/11/08

Buxton Lodge Care Home 15/05/07

Buxton Lodge Care Home 19/09/06

Buxton Lodge Care Home 01/06/05

Buxton Lodge Care Home 31/01/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Buxton Lodge Care Home Buxton Lodge Care Home 53 Buxton Lane Caterham on the Hill Surrey CR3 5HL Lead Inspector Suzanne Magnier Announced Inspection 15th November 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 Buxton Lodge Care Home DS0000063422.V248968.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. Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Buxton Lodge Care Home Address Buxton Lodge Care Home 53 Buxton Lane Caterham on the Hill Surrey CR3 5HL 01833 340788 01833 350498 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) www.newcenturycare.co.uk New Century Care (Caterham) Limited Ms Sheila Morgan Care Home 38 Category(ies) of Dementia - over 65 years of age (12), Learning registration, with number disability over 65 years of age (8), Old age, not of places falling within any other category (38), Physical disability (6), Physical disability over 65 years of age (8), Sensory Impairment over 65 years of age (8), Terminally ill over 65 years of age (10) Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 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 Brief Description of the Service: Buxton Lodge is a private care home with nursing situated in a quiet residential area of Caterham 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 passenger 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 communal 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 Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place over 8 hours. It is noted that the information contained on Page 4 regarding the name of the Registered Manager is incorrect and will be changed on the next report. The newly appointed and approved Registered Manager, Mrs Kim Francis and the Area Manager were present during the inspection. Over the last 15 months the care home has undergone some significant changes, which have had a varied impact on the residents, their representatives and staff. The changes include ownership of the home, reassessment and evaluation of the homes budget, the day-to-day management of the home and staffing changes including staffing levels. The inspector spoke with various people during the inspection and it was evidenced that some of the changes have created uncertainty and loss for some residents and lowered staff morale. The main focus of the inspection was to ascertain that that the previous requirements and standards not assessed during the unannounced inspection in June 2005 had been met. During a tour of the premises the inspector met with a large majority of the residents, several relatives, members of staff and visiting health care professionals. Comments from people during the inspection and written feedback from a variety of sources have been included within the report. Documentation sampled included residents individual care plans, risk assessments, dietary needs and the menu and staff records. Direct observation, a tour of the premises and meeting with residents, relatives and staff were also undertaken during the inspection. The inspectors wish to thank the resident’s, staff and managers for their cooperation during the inspection. What the service does well: The staff continue to offer a good foundation of value, respect and sensitivity to the resident’s, which was observed during the inspection. Comments received by CSCI regarding the service included ‘ I think the staff do their best to provide good care’, ‘Buxton Lodge provides a friendly welcoming atmosphere’. The homes staff team have continued to make a concerted effort to improve the documentation of residents care plans and risk assessments which ensures Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 6 residents are supported with respect and dignity and their care and nursing needs are fully met. At the time of the inspection the home offered a homely, safe, relaxed and comfortable environment to the residents. 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 accommodation. It was encouraging to note that the home has significantly improved the standard of staff training. New Century Care have supplied internal facilitators to undertake all mandatory staff training and are an accredited National Vocational Qualification centre and have enrolled a significant number of staff to commence their Level 2 and 3 NVQ. All care staff had attended protection of vulnerable adults training. What has improved since the last inspection? What they could do better: Minor amendments to the homes Statement of Purpose must be made as discussed during the inspection and detailed within the report, to ensure that residents are provided with accurate information. The Registered Manager must ensure that resident’s preferences and wishes regarding their final affairs are fully documented, to demonstrate they have been fully consulted and their needs are met. In order to offer residents with additional stimulation, engagement and further development a requirement has been made that the homes vehicle is repaired. Various actions have been required by the Commission to ensure the home addresses the shortfalls identified regarding the menu planning, preparation, presentation and serving of meals. Several CSCI comment cards received regarding the standard of the food included ‘I only like some of the food’; ‘menus keep changing’; ‘suppers have been inedible’. A recommendation has been made that in order to promote good practice and clear auditing system, responses and actions taken by the home to any concerns/complaints received should be recorded. Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 7 The Registered Manager must attend the Surrey Multi Agency Protection of Vulnerable Adults training in order to ensure the welfare and protection of residents. The inspector concluded that an additional and important area for development was the relationships within the staff team. This was in view of the feedback and observations made at the time of the inspection. A requirement has been made that good professional and personal relationships are promoted and maintained in the service. Alternative hairdressing arrangements should be made in order to support residents whilst having their hair done in a more dignified, respectful and individualised way. The inspector has made a recommendation that the Quality Assurance findings are displayed within the home in order that they are more accessible to people. The clinical waste procedure must be reviewed to ensure the prevention of infection, toxic conditions and the spread of infection at the care home. 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 Care Home DS0000063422.V248968.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 Buxton Lodge Care Home DS0000063422.V248968.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): 4,5,6. Prospective residents and their representatives are welcomed by the home to have an informal visit. Information is available about the home in order that residents may make an informed choice about whether they wish to reside there and the service is able to meet their needs. Minor amendments were required to some of the documentation. EVIDENCE: The homes Statement of Purpose and the Service Users Guide offer good information to enable prospective residents to make an informed choice about whether they wish to reside in the home. During the inspection the inspector observed the Registered Manager conduct a telephone conversation with a prospective residents relative who later visited the home was given the Statement of Purpose and shown around the home by one of the Registered General Nurses (RGN’s) on duty. Following the CSCI approval of the Registered Manager the Statement of Purpose and the Service Users Guide must be amended to include the Registered Managers details and the updated copy sent to the Commission of Social Care Inspection (CSCI). Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 10 Minor amendments to the homes Statement of Purpose must include clear guidance regarding the homes policy of supporting and reviewing the needs of residents with Dementia in order that the home continues to meet their needs and promote the safety and wellbeing of other residents. The Registered Manager discussed the assessment, care and support offered by the home to people needing intermediate care and confirmed that the home offers a trial period of residency of four to six weeks. Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,10,11. The homes staff team have continued to make a concerted effort to improve the documentation of residents care plans and risk assessments which ensures residents are supported with respect and dignity and their care and nursing needs are fully met. The Registered Manager must ensure that resident’s preferences and wishes regarding their final affairs are fully documented. EVIDENCE: Following the last inspection the home has continued to have a systematic approach to the improvement of the care plans and risk assessments. The developed care plans detailed clearly the care needs of the residents and their daily progress. The home continues to maintain strong professional links with a variety of health care professionals. An aroma therapist, reflexologist and chiropodist were visiting the home during the inspection. During the tour of the premises the inspector noted that in some residents bedrooms the ‘old’ care plans were still in place. On examination of two residents ‘new’ care plans, stored in the office the documentation was Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 12 evidenced as a current reflection of the residents needs and both care plans had been recently reviewed. The home does not offer a key worker system whereby a named care assistant would promote a resident’s needs and care and be supervised by a more experienced care assistant or RGN. The Registered Manager explained that a key working system is being considered in the near future, following consultation with the staff team. This would offer continuity of a resident’s care, individual professional staff development and accountability. Pleas also refer to comments and the actions required by CSCI under Standard 15 of this report. The home demonstrated that residents and their relatives are supported sensitively with regard to loss and bereavement. The home continues to maintain strong professional links with the local undertakers and hospice, including training and support, to promote resident’s dignity, respect and care. Two care plans sampled by the inspector did not fully detail the preferences and wishes of the residents with regard to their final affairs and a requirement has been made that these forms are completed within the timescales set in order to promote the residents final wishes. Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 13 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): 12,14,15 The residents were observed to participate in a variety of activities. A requirement has been made that the homes vehicle is repaired and arrangements are made for meeting resident’s religious needs. The arrangements for resident‘s meals were inadequate and in need of improvement. EVIDENCE: During the inspection the ‘Music Man’ arrived to have a sing a long and give opportunities for residents to participate in playing the musical instruments this was enjoyed by the residents and has been an ongoing source of enjoyment. The Registered Manager explained that the homes vehicle was not currently in use and although an MOT certificate had been issued there was a problem with a petrol malodour, which was going to be further investigated. It is strongly recommended that the home must rectify the fault in order to promote opportunities and community activities for residents. It was observed that residents, who were able, were free to move around the home exercising their choice for example having a cigarette. One resident told the inspector that they prefer to stay in their room for meals and read, listen to the radio or watch television rather than mix with the other residents. It was Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 14 apparent that staff recognised the resident’s choice and promoted their independence of lifestyle. During discussion with several residents the inspector was told that the home has links with the local church and a representative or vicar visits to give some people Holy Communion. There was a lack of clarity regarding the frequency of the arrangement and a recommendation has been made that the Registered Manager clarifies the arrangements of Holy Communion with the local church. The arrangements can be discussed with the residents in order that they are prepared to receive Holy Communion and speak with the vicar or church representative. It was noted that during the late afternoon a church representative arrived, unexpectedly, to give some residents Holy Communion. CONCERNS REGARDING MENUS/FOOD STOCKS. The Registered Manager advised the inspector that there had been ongoing concern over several months by the residents and their representatives regarding the standard, quantity, menu planning and presentation of meals in the home. Several CSCI comment cards received regarding the standard of the food included ‘I only like some of the food’; ‘menus keep changing’; ‘suppers have been inedible’. The inspector sampled minutes of residents meetings and also spoke to various residents and their representatives in the home to clarify some of the concerns. The overall concerns were that requests for specific meals for example porridge, choice of sandwiches and bananas had not been met; there was difficulty in understanding the menu for example London Particular soup, meals served are not often what residents requested; the homes crockery and cutlery has been changed and was too heavy to hold. The inspector was advised that the home has three chefs (two of whom have been recruited in the last month) who work separate shifts. The past difficulties have been identified as a lack of effective communication regarding the ordering of adequate food supplies, menu planning and residents rights to choice. The inspector met with one of the new chefs who told the inspector that he has met with residents and asked them what they would like to eat but does not record the conversations. The menus sampled by the inspector did not include the breakfast choice and it was noted that in the kitchen that individual laminated cards detail breakfasts for each resident. The chef told the inspector that the main menus had been reviewed but the breakfast choices had not been discussed with the residents. It was noted that the cards did not contain any review date and this may also have been due to the difficulty of writing on the laminated cards in pen. The Registered Manager told the inspector that one chef was on annual leave Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 15 and was due to return the following week. It has been arranged that the menu will be revised and written in plain English so residents and staff will understand the meals available. Several requirements have been made that the Registered Manager ensures residents choices regarding clear menus and choices of meals are met and appropriate cutlery and crockery is available to residents in order that their independence and dignity is promoted. The Registered Manager advised the inspector that the home would introduce a food diary for any resident where an identified need to monitor dietary intake has been identified. DINING FACILITIES. The inspector observed the midday day meal in the lounge/dining area. The area is spacious and despite some residents choosing to sit at the dining room table the mealtime was observed to be chaotic. The atmosphere was noisy and busy with a high proportion of residents needing to be supported by staff to eat their meals. Due to the cramped environment two staff were observed standing whilst supporting residents to eat their meals. Staff were observed to be unsure if particular residents had received their meals and conversations were relayed across the dining area. One senior staff member, aware of the residents needs, was overseeing two resident’s whilst they ate their meals as she supported another resident. One resident was banging the table to attract attention and some residents had not received their meals. The inspector noted that some residents were sitting in armchairs and found it difficult to manage to pull themselves forward in order to manage their meals comfortably and in a dignified manner. A staff member entered the lounge area with a trolley and began to clear away residents crockery and disposing of waste in front of residents who were still eating or being supported by staff. The inspector raised concerns that the dining facilities, practice at mealtimes and numbers of staff do not currently meet the needs of the residents. The pre inspection questionnaire completed by the home details that twenty residents require help/supervision/prompts at meal times. As a result of these major shortfalls requirements have been made that the Registered Manager must review the current dining arrangements to ensure that resident’s needs are fully met. In discussion with the Registered Manager the inspector was advised that some residents choose not to sit at the dining room tables at meal times and preferred to stay in their chairs or have their meals in their rooms. Several requirements have been made that the Registered Manager must ensure that adequate dining space is provided for residents, the dining facilities offer dignity to residents and the health and welfare needs of the residents are met. Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. The home has a complaints policy and procedure. A recommendation has been made regarding improved practice in response to any complaints received by the home. Requirements have been made that the Registered Manager attends the local authority Multi Agency Protection of Vulnerable Adults training to ensure that at all times resident’s welfare is protected. EVIDENCE: A large majority of the CSCI comment cards received indicated that the home had received complaints. One comment card detailed that the resident would be unsure who to communicate to if they had a concern or were unhappy. The Registered Manager explained that concerns had been received at the home regarding the menus and resident choice in their daily lives. The inspector sampled resident meeting minutes, which detailed that the home was proactive in addressing the most current concerns raised by relatives of the residents. The inspector was advised that written acknowledgment of the concerns/complaints had not been addressed as the matters were discussed in the open meeting. A recommendation has been made that the Registered Manager, in order to promote good practice and clear auditing system, documents responses and actions taken by the home to any concerns/complaints received. Records sampled indicated that all care staff had attended protection of vulnerable adults training. A requirement has been made that the Registered Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 17 Manager attend the local authority Multi Agency Protection of Vulnerable Adults training. During a tour of the premises the inspector met with several residents. One resident who was in bed needed assistance and it was noted that their call bell was not within their reach. A requirement has been made that the Registered Manager must ensure that arrangements must be in place for residents to summon assistance when they need it. During the tour of the premises it was observed that hairdressing arrangements did not reflect dignity, respect and comfort for residents. The arrangements included residents having their hair washed in a communal bathroom (which several residents stated the room was too hot) followed by having their hair dried in the corridor opposite the bathroom. The inspector discussed the arrangements with the Registered and Area Manager and it was strongly recommended that alternative hairdressing arrangements are made in order to support residents whilst having their hair done in a more dignified, respectful and individualised way. Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 18 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): 19,23,26. 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 accommodation. 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. The inspector noted that the dedicated treatment room was being used for a private consultation between a resident and the chiropodist. Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30. The current staffing levels in the home must be reviewed in order to ensure staff are available in such numbers as is appropriate for the health and welfare of residents. The recruitment and selection procedures of the home are robust and on the whole the staff team demonstrated a commitment, competence and professionalism in the care provided to the residents. EVIDENCE: Written comments received from visitors to the home were varied and included ‘ I think the staff do their best to provide good care’, ‘Buxton Lodge provides a friendly welcoming atmosphere’. Additional comments included several concerns regarding the effective delegation of staff for example in the lounge/dining area. This was discussed during the inspection and it was noted that there was no documentation on the shift planner to evidence that a dedicated staff member was available in the lounge dining area during the day. A large majority of comment cards received detailed concerns regarding the insufficient staffing levels of the home. Several comment cards detailed that ‘some staff do take advantage of any slack periods in the absence of a senior sister on duty’. The Area Manager advised the inspector that in the past the homes staffing levels had been significantly above the national minimum standard and had been decreased following the purchase of the home by New Century Care following a full staffing evaluation. Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 20 In view of the concerns raised by relatives, residents and visitors to the home and observations made at the time of the inspection a requirement has been made that the Registered Manager reviews the current staffing levels in order to ensure that staff are available in such numbers as is appropriate for the health and welfare of residents. Several residents commented on the exceptional service by the laundry staff and the maintenance person. Residents told the inspector that ‘the staff are very good and caring’; ‘they (the staff) work very hard’. It was encouraging to note that that the home had made significant improvements in developing staff through training, which includes achievement of all mandatory training, and supporting staff to achieve their National Vocational Qualification (NVQ) Level 2 and 3. The inspector was advised that the home was supporting one staff member through a nursing adaptation course and another senior staff member through the Registered Managers Award and Level 5 NVQ in management. The home has recently recruited a new chef and a care assistant. The recruitment records sampled indicated that the home operates a robust recruitment and selection process to ensure the safety and well being of residents. Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,37,38. The changes in the homes overall management have continued to be unsettling for some residents, their relatives and staff. The home continues to promote residents views and opinions and one area of development regarding health and safety has been highlighted. EVIDENCE: During the inspection the inspector noted from conversations with residents, their relatives and staff that the home has continued to go through a process of change, which continues to be challenging in different ways for each individual. It has been noted that the Deputy Manager, prior to the appointment of the Registered Manager, has been instrumental in ensuring the continued effective smooth running of the service for the residents and working closely with the staff members through a time of change and transition. Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 22 Written and verbal comments received by the inspector included ongoing concerns about the changes in the running and management of the home and staff morale. The inspector concluded that an additional and important area for development was the relationships within the staff team. This was in view of the feedback and observations made at the time of the inspection. The home has undertaken a Quality Assurance programme and collated significant evidence regarding the views of residents and other people in contact with the service. The findings have been collated in a graph format, which are easy to understand and identify areas of improvement and development. The inspector has made a recommendation that the findings are displayed within the home in order that they are more accessible to people. The inspector noted that the pre inspection questionnaire detailed that the homes policies and procedures had been updated in March 2005. The policies and procedures were not evidenced during the inspection. The inspector noted that in the upstairs sluice disposable latex gloves had not been appropriately disposed of into the clinical waste bag, which was open on the floor. A requirement has been made that the home must review the policy of disposal of clinical waste in order to ensure appropriate control of infection. Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x 2 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x 3 x x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 2 2 X x x 3 2 Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 24 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. 1. Standard OP.2 Regulation 12.(3) Requirement Timescale for action 15/02/06 2 OP15 3 OP15 4 OP15 5 OP15 The Registered Persons must ensure that the care home is conducted in a manner, which takes into account the residents wishes and feelings with regard to their final affairs. 17.2.Sch The Registered Persons must 4.(13) ensure that the record of food provided e.g. menu must be maintained in sufficient detail (large print) and available to residents and staff on a weekly basis to offer choice and discussion with residents and to enable any person inspecting the record to determine whether the diet is satisfactory. 16.(2)(g) The Registered Persons must (i) ensure that sufficient appropriate crockery and cutlery is available to residents. 23.(2)(g) The Registered Persons must ensure that there is adequate recreational and dining space provided separately from the resident’s private accommodation. 12.(1)(a) The Registered Persons must (b)12.(4)a ensure that the care home is DS0000063422.V248968.R01.S.doc 15/01/06 15/01/06 15/01/06 15/01/06 Buxton Lodge Care Home Version 5.0 Page 25 6 OP15 7 OP.18 8 OP.18 9 OP.27 10 OP.32 11 OP.38 conducted to promote and make proper provision for the health, welfare and dignity of residents during mealtimes. 12.(1)aThe Registered Persons must b)14.(1)a) ensure that all staff supporting residents at mealtimes are aware of residents needs including the level of support and equipment required by them at mealtimes. It is recommended that the Occupational Therapist be consulted regarding this matter. 13.6 The Registered Manager must attend the local authority Multi Agency Protection of Vulnerable Adults training. 13.(6) The Registered Provider must ensure that arrangements are in place for residents to summon aid, for example the call bell within reach, to prevent them from being placed at risk of harm or abuse. 18.(1)(a) The Registered Provider must review the current staffing levels in the home in order to ensure that staff are available in such numbers as is appropriate for the health and welfare of residents. The details of the staffing review/outcomes must be forwarded to the Commission. 12.(5)(a) The Registered Manager must actively maintain good personal and professional relationships with residents and staff. 13.3 The Registered Person must review the clinical waste procedure for the prevention of infection, toxic conditions and the spread of infection at the care home. 15/01/06 15/02/06 17/11/05 19/12/05 17/11/05 15/02/05 Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 26 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 OP.4 Good Practice Recommendations Minor amendments to the homes Statement of Purpose include clear guidance regarding the homes policy of supporting and reviewing the needs of residents with Dementia. The homes vehicle should be repaired in order to provide residents with additional stimulation, engagement and further development to meet their aspirations and goals. The home clarifies the arrangements of Holy Communion with the local church. The home implements a documented risk assessment regarding the dining room/lounge environment to ensure the safety and well being of the residents. Documentation is available to support the responses and actions taken by the home to any concerns/complaints received. It is strongly recommended that the Registered Provider should ensure that alternative hairdressing arrangements are made in order to support residents whilst having their hair done in a more dignified, respectful and individualised way. The Quality Assurance findings are displayed within the home in order that they are more accessible to people. 2 3 4 5 6 OP.12 OP.14 OP.15 OP.16 OP.18 7 OP.33 Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Surrey Area Office 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 © 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 Buxton Lodge Care Home DS0000063422.V248968.R01.S.doc Version 5.0 Page 28 - 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!