Inspection on 19/09/06 for Buxton Lodge Care Home

This inspection was carried out on 19th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 15/11/05

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 Key Unannounced Inspection 19th September 2006 08:00 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.V315402.R01.S.doc Version 5.2 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.V315402.R01.S.doc Version 5.2 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 Mr Satya-Prakash Bundun 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.V315402.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Up to ten (10) service users from the age of 50 may be accommodated. One named service user under 49 years may be accommodated. Date of last inspection 15th November 2005 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. The range of fees of the home are £600.00-£800.00 per week. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven and a half hours and was the first key inspection to be undertaken in the Commission for Social Care Inspection year April 2006 to 2007. Suzanne Magnier and Lesley Garrett, Regulation Inspectors carried out this inspection and the registered manager represented the service and was joined by the operations manager. A tour of the premises took place and the inspectors saw the majority of the service users and spoke to some of them in more detail. Service users, relatives, friends and other health care professionals comments, which were gained prior to the inspection have been included in the report. Records were also sampled as part of the inspection process including care plans, health and safety records, menus, accident records, policies, procedures and staff files. The inspectors would like to thank the service users, staff and managers for their time, assistance and hospitality during this inspection. What the service does well: What has improved since the last inspection? There has been significant improvement in the day to day management of the home and the documentation and recording of the service users care plans and risk assessments. The inspectors observed that the medication system in the home had been changed to a monitoring dosage system, which the manager advised was an improved and more efficient system in order to ensure the safe handling of medicines in the home. The food at the home was of an improved good standard and skills and practice of staff supporting service users at meal times and the crockery and equipment provided had been improved. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 6 A relative advised the inspector that the actions by the home regarding response to concerns or complaints had improved. The inspectors noted that staff morale of had improved since the previous inspection and the home had a relaxed atmosphere. 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 Care Home DS0000063422.V315402.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 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 the following standard(s): 3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes admission and assessment procedures ensure that service users needs are appropriately identified and met. EVIDENCE: The care plans sampled by the inspector evidenced sound pre admission assessments of service users needs and a full assessment of the service users activities of daily living. No intermediate care is offered by the home. The home has a folder in the front foyer, which has a statement of purpose, aims and objectives, the last Commission for Social Care report (CSCI) report and also the visiting arrangements of the home. The folder also contains comment cards and quality assurance records. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users individual plans of care are comprehensive and demonstrate that their health and personal care needs are met. There was clear demonstration that medication was administered to all service users in a safe and appropriate way. Further development is recommended in obtaining service users wishes regarding death, resuscitation and gender specific care. EVIDENCE: There has been significant improvement in the documentation and recording of the service users care plans. The care plans sampled had been developed from appropriate pre assessment documentation regarding the care needs and support of the service user and reviewed monthly to reflect any changes in the service users needs. Where possible, and depending on the service users choice, it was noted that family members had input regarding their relatives care plans. The care plans included risk assessments for example the use and consent for bed rails. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 10 The inspector spoke with the deputy manager regarding the requests of the service users or their relatives regarding resuscitation. The care plans evidenced a shortfall in the documentation of the clear wishes of the service user, or their families or friends, regarding their death and choice of resuscitation. It is recommended that the home develop a care plan regarding resuscitation and where possible includes the service users and their representative’s choices. The inspector was advised that the home has a policy and procedure regarding resuscitation, which includes the guidance from the Royal College of Nursing and also the Nursing Homes Association. During the inspection the inspector met with two relatives who spoke highly of the skill and care the staff and managers had given to their relative in their final weeks at the home. It was noted that the home displays discreet printed cards in the foyer of the home to advise visitors and residents of the death of residents and funeral arrangements. A newly bereaved family told the inspectors that they often looked at the cards and were pleased to be informed, as they were so much part of the home. They advised that the home had sought their consent to display a card related their relatives funeral arrangements. The inspector was advised that the managers had been approved by New Century Care to undertake a certificated training course in palliative care at a local hospice. The home continues to maintain strong professional links with the local hospice and seeks support and training when necessary to promote the service users dignity, respect and care. The care plans evidenced that regular and appropriate health care appointments are attended and the GP visits the home on a weekly basis. The managers explained that the home has a good working partnership with the GP who will visit the home on an as necessary basis and is available on call. Comment cards received from the GP referred to the home as ‘splendid’. The inspectors were advised that service users could be registered with their own GP if they choose to and referrals to the district nurse, dietician, speech therapist or any other health care specialist can be made by the home. Throughout the inspection the inspectors observed that service users were addressed in a polite and courteous way by staff. Service users written comment cards stated that staff respect their privacy and dignity however one comment card received by CSCI indicated that the home does not always provide gender specific care for example male staff members support female service users with personal care. It is recommended that the home consider seeking feedback from service users or their representatives to ascertain their views on this matter to ensure that service users dignity is respected at all times. The inspectors observed that the medication system in the home had been changed to a monitoring dosage system, which the manager advised was an Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 11 improved and more efficient system in order to ensure the safe handling of medicines in the home. The manager administered the lunchtime medication in an efficient manner and all medication administration charts were well documented with no gaps. The manager explained that the local dispensing chemist undertakes regular audits and the GP surgery work well with the home to ensure that medication needs of the service users are met at all times. The home has a medication policy and procedure and all medication was observed as stored and checked, including controlled drugs. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 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): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A variety of activities take place both inside and outside of the home. Visitors are welcomed to the home to maintain contact with their family members. The food at the home was of an improved good standard. Skills and practice of staff supporting service users at meal times. Crockery and equipment available to service users at meal times had been improved to promote service users independence and choice. Further development is recommended that the home ensures all service users have a nutritional risk assessment in order to ensure that their nutritional needs are maintained. EVIDENCE: The manager advised that the home had had an Easter and Summer Fayre and BBQ. There were a variety of recent photographs in the foyer, which showed service users visiting places of interest. The manager explained that the staff are committed to ensuring that service users have a variety of stimulating activities both inside and outside of the home. Some of the activities include staff volunteering to support service users in the community Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 13 to church, day centres, public gardens, theatres, churches pubs, library, and garden centres. The home has arrangements for service users to receive spiritual support and Holy Communion in the home if they request. The ‘music man’ remains a regular feature in the home and the majority of service services told the inspector that they enjoy the music sessions yet one service user said they didn’t like it and did not attend. During the inspection an aroma therapist attended pre-planned appointments with several service users individually to have hand and foot massages. The hairdresser advised that most service users like to have their hair done in their bedrooms and also use the bathroom, which has a hairdressing sink and a portable hairdryer. The atmosphere of the home was peaceful and calm with service users moving freely around the home. The inspectors evidenced written commendations from visitors being made to feel welcome and always ‘time for a chat’. Several comments received by CSCI brought attention to the concern that visitors did not have the space to be with their relatives or friends in private. This was discussed with the managers of the home who were aware of the concerns and advised that they offer the service users the opportunity to have visitors in the privacy of their own room, yet the service user often declines this. A building extension has been proposed by the home, which will be able to offer more communal space for the comfort and privacy for service users and their relatives and friends when they are visiting to the home. The home has three chefs who work alternating shifts. The management of the kitchen was evidenced as much improved. The menu was sampled by the inspector and clearly evidenced a wholesome and varied meal. The chef advised that choices of the menu are available and the staff tell the chef what the service users choices are for any meal. Comment cards received from service users noted that the majority enjoyed their meals and several only enjoyed their meal ‘sometimes’. Service users told the inspector that ‘the food hadn’t been good but it is getting better’, ‘There is always plenty of food’, ‘the food suits me nicely because its al plain cooking’. The inspector sampled the meals that were served during the lunchtime, which included a choice of chicken curry, sausages or cheese omelette. There was a noticeable improvement in the skills of staff supporting service users. Individual staff were noted on to be available to service users who needed additional support which was given in a dignified manner. New crockery, cutlery and equipment to assist service users to maintain independence had Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 14 been purchased and made available to service users. The meals served were hot and well presented. The seating and space arrangements in the dining area has been reviewed in order to offer the service users more space. The use of clothes protectors/aprons was discussed during the end of the inspection with the operations manager and manager. CSCI were informed that the protectors are only used for service users assessed as requiring them or those people who request them. Following the inspection the use of the protectors was discussed at the resident and relative meeting and the service users and their relatives advised that they wished for the use of protectors and aprons to continue. Whilst sampling the care plans the inspector has made a recommendation that all service users have a nutritional risk assessment in order to ensure that the service users nutritional needs are maintained. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users are protected by the homes complaints and safeguarding adults procedures. Actions taken by the home when investigating complaints must be more fully developed. EVIDENCE: The home has a complaints procedure. Several service users and visitors told the inspectors that they were confident that the manager or staff would deal with any concerns or complaints. A relative advised the inspector that the actions by the home regarding response to concerns or complaints had improved. Several service users spoken with were clear in identifying the different roles of staff members with regard to raising concerns or complaints with them. One service user said ‘I know who to complain to and they always listen’. The home had dealt with two complaints since the last inspection and whilst sampling the records it was noted that the manager had not fully recorded the actions and outcomes concerning the complaints. It is required that that any complaints made under the homes complaints procedures are fully investigated and a copy of the summary of the complaint, including the actions taken by the home, are fully documented. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 16 Records sampled indicated that all staff had attended safeguarding vulnerable adults training. New Century Care provides in-house staff training which is compliant with the Surrey Multi Agency safeguarding adult procedures. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 17 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): 19,20,21,22,23,24,25,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a clean and hygienic environment. It is required that all areas of the home are of sound construction and the kitchen flooring is replaced due to the hazards identified during the inspection. EVIDENCE: During the inspection the operations manager and registered manager discussed the proposals for an extension to the home in early 2007. The extension would include more communal room for service users in the dining and lounge areas. The managers explained that during the refurbishment all areas in the home will be redecorated, refurnished and all equipment reassessed, including replacement of the soiled lounge carpet. The indoor communal areas of the home were observed to be well decorated, sufficiently bright and pleasant and the gardens well maintained. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 18 Improvements had been within the home, which included the completion and full operation of a treatment room, where clinical items are stored. The home has purchased ten adjustable high/low beds, over bed tables and approx twenty-five-air pressure relieving mattresses. Door guards are in place on each service users bedroom door. Visitor chairs have been purchased and a Gazebo for the garden has been donated to the home and a fountain for the pond purchased. During the tour of the kitchen the inspector was advised that a new grill and double fridge had been purchased. Crockery and utensils to support service users needs at mealtimes had also been purchased. The inspector observed several hazards, which included the open back door in the kitchen corridor. The chef explained that it is usually shut. The door opened onto a parking area, which also had access to the main road. The home had taken immediate action and has placed a notice on both sides of the door to remind staff and other visitors to the home to close the door to reduce the risk of harm to service users. A pane of glass in the kitchen was evidenced as broken and needed a glazier to repair the operations manager advised that a glazier had been asked to attend to the repair immediately. The kitchen flooring in various areas was evidenced in need of repair as several areas of the flooring was broken and in one particular area the flooring had been repaired with nails and had re split causing a trip hazard. The corners of the flooring were in disrepair and the chef explained that there was difficulty cleaning the floor, as the moisture would seep under the flooring potentially causing the flooring to lift. It is required that the flooring of the kitchen is replaced in order to ensure the safety and well being of the staff working in the kitchen area and to ensure that all areas of the home are kept clean. The operations manager took immediate remedial action and arranged for a financial quote in order to have the replacement of the flooring as soon as reasonably practicable. The bathrooms and toilets throughout the home were clean and sufficient in numbers for the service users current needs. The home provides single and shared bedrooms. The majority of the bedrooms were well decorated and contained personal items belonging to the service user. It was noted that the home has a majority of adjustable high/low profiling beds, which assist in the comfort and safe moving and handling of service users During the course of the inspection it was noted that a number of call bells, in service users rooms were not in their reach. The providers have advised CSCI that documented risk assessments regarding use or non-use of call bells for the protection and safety of service users are completed and regularly reviewed. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 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): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing levels of the home were evidenced as adequate to meet the current needs of service users. The service users were not fully protected by the homes recruitment policy and procedures. Staff are trained and competent to do their jobs. EVIDENCE: The inspectors noted that staff morale of had improved since the previous inspection and the home had a relaxed atmosphere. The staffing rota indicated three registered nurses on duty and eight care assistants were on duty during the inspection. The staffing levels of the home were evidenced as adequate to meet the current needs of service users. Relatives and visitors spoken with during the inspection commented that the staff were very attentive. Service users told the inspector ‘ I feel well cared for and staff are kind’, ‘I couldn’t wish for better care’, ‘staff are normally kind to you I get one or two that are not as good’, ‘Sometimes the staff are rushed off their feet, I feel well cared for and get nice clean clothes’. All staff are currently undertaking their National Vocational Qualification (NVQ) Level 2 and 3. The home is an NVQ centre with their own assessors, verifiers and are regulated by City and Guilds. Four staff have completed NVQ Level 3. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 20 The home is registered for the Nursing and Midwifery Council adaptation training and one staff has recently attained her adaptation course. The chef had undertaken the intermediate Food hygiene 3-day course. New Century Care promote in house training and have a large majority of training facilitators who work in all the homes to offer all mandatory training. The records sampled evidenced that all staff have received mandatory training. The inspectors were advised that two trained staff are undertaking incontinence management incontinence link training. The recruitment files sampled were generally in good order and contained all evidence of induction, training, two references, staff supervision and appraisal. A shortfall in the recruitment process was identified in sampling the homes job application form. The form lacked a request for a full employment history and reasons why the applicant left their previous employment. A requirement has been made that all newly recruited staff must give a full employment history in order to ensure that service users are protected by the homes recruitment and selection policies. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 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): 31,32,33,35,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home has improved to ensure the safety and wellbeing of service users. Requirements have been made that the home review the current policies and procedures with regard to the safekeeping of service users valuables and money, reporting of incidents and procedures to ensure the spread of infection in the home. EVIDENCE: The home has recently appointed a new manager who has been approved by the Commission for Social Care Inspection (CSCI). The Manager has recently achieved the advanced diploma in management studies level 5 at a nearby college and is a registered nurse. The manager has also worked as a senior charge nurse at the home for several years. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 22 All persons spoken with during the inspection spoke highly of the abilities and knowlegde of the manager and as previously noted the staff morale has significantly improved and the management of the home stabilised. Comments from relatives included ‘ My wife and I are very pleased with the care and attention my mother is receiving at Buxton Lodge,’ The operations manager explained to the inspectors that regular managers meetings, staff meetings and residents/relatives are held frequently and are a good source of discussion and sharing ideas. The home has a quality asurance procedeure which is undertaken annually. The inspectors sampled the questionaires which had been designed by the operations manager and included a variety of forms detailing all areas of the home, the good things in the last six months and the year. The inspectors were advised that all feedback and the outcomes are entered onto a graph form. The home advised that next year the home will be including the health care professionals and care managers input. The inspector sampled service users personal financial records held at the care home and identified several shortfalls which included lack of documentation regarding transactions for example one service had been discharged yet the money and valuables had not been signed out from the home. A requirement has been made that the records are reviewed and updated accordingly to reflect an accurate account of service users monies and valuables in order to protect the service users and staff from the possibility of alleged financial abuse. Since the previous inspection the home has had visits from the Health and Safety Exectutive, and the Surrey and Fire Resue Services audit and actions from the Health and Safety Exectutive visit have been attended. Employers Liability Insurance up to date and displayed in the foyer. Whilst sampling the home incidents and accidents records it was noted that a service user had told a member staff that some money had gone missing. The inspector discussed and sampled documentation regarding the missing money and noted that the incident had not been reported under the CSCI regulation 37 notifications and no documented outcome could be found to support that the manager had undertaken an investigation yet the inspector was advised that the relatives had been fully consulted. A requirement has been made that the home must inform the Commission of any event which affects the well being and welfare of service users. The fridge freezer temperatures were noted as well recorded and food stored in an appropriate manner in the fridges and freezers. Fire safety equipment Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 23 and records were well documented and equipment serviced. The home has a vehicle, which had recently been fully maintained and serviced. The sluice areas were noted to be clean and tidy. Clinical waste was appropriately stored to reduce infection in the home and hand-washing facilities were available for staff. Special arrangements have been made for the collection of clinical waste, which the inspector saw was being collected by contractors during the inspection. The inspector observed that the laundry room had been tidied and was more orderly since the previous inspection. Risk assessments had been completed with regard to working in the laundry. The inspector noted that there were no hand towels, or protective aprons available in the laundry and observed the staff member taking used laundry from a red bag and placing it in the washing machine. The inspector was advised that ‘soiled’ laundry would be placed by the washing machine by staff for the laundry staff member to put in the washing machine. It is required that the procedure of laundering in the home is reviewed in order to ensure that suitable arrangements are in place to prevent infection, toxic conditions and the spread of infection in the home. Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 24 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 3 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 2 x x 2 Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 Page 25 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 OP16 Regulation 22.(3)(4) (8) Requirement The registered person must ensure that any complaints made under the homes complaints procedures are fully investigated and a copy of the summary of the complaint, including the actions taken by the home are fully documented. The registered person must ensure that the kitchen flooring is replaced in order to ensure the safety and well being of the staff working in the kitchen area and to ensure that all areas of the home are kept clean. The registered person must ensure that all newly recruited staff must submit a full employment history in order to ensure that service users are protected by the homes recruitment and selection policies. The registered person must ensure that arrangements are in place for service users to acknowledge in writing, where possible, the storage, transactions and return to them DS0000063422.V315402.R01.S.doc Timescale for action 19/10/06 2 OP19 23.(2)(b) (d) 19/12/06 3 OP29 7,9,19 Sch 2 (6) 19/10/06 4 OP35 13.(4)(6) 16.(2)(l) 19/10/06 Buxton Lodge Care Home Version 5.2 Page 26 5 OP38 13.(3) 6 OP38 37.(1)(ag) of any money or valuables deposited in order to protect the service users being placed at risk of financial abuse. The registered person must ensure that the procedure of laundering in the home is reviewed in order to ensure that suitable arrangements are in place to prevent infection, toxic conditions and the spread of infection in the home. The registered person must give notice to the CSCI without delay regarding any event, which affects the safety and welfare of service users. 19/10/06 19/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP10 Good Practice Recommendations It is recommended that the home consider seeking feedback from service users or their representatives to ascertain their views on gender specific care to ensure that service users dignity is respected at all times. It is recommended that the home develop a care plan regarding service users or their representative’s choices with regard to resuscitation in order to ensure that service users views and choices are taken into consideration. A recommendation has been made that all service users have a nutritional risk assessment in order to ensure that the service users nutritional needs are maintained. 2 OP11 3 OP15 Buxton Lodge Care Home DS0000063422.V315402.R01.S.doc Version 5.2 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.V315402.R01.S.doc Version 5.2 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. 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