Inspection on 04/11/08 for Buxton Lodge Care Home

This inspection was carried out on 4th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Buxton Lodge Care Home 15/05/07

Buxton Lodge Care Home 19/09/06

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 13/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Buxton Lodge Care Home Buxton Lodge Care Home 53 Buxton Lane Caterham on the Hill Surrey CR3 5HL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marion Weller     Date: 0 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Buxton Lodge Care Home 53 Buxton Lane Buxton Lodge Care Home Caterham on the Hill Surrey CR3 5HL 01883340788 01883340498 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) New Century Care (Caterham) Limited Type of registration: Number of places registered: care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability sensory impairment Additional conditions: The maximum number of service users to be accommodated is 38. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Learning disability (LD) Sensory impairment (SI) Physical disability (PD) Date of last inspection Care Homes for Older People Page 4 of 32 Over 65 0 0 38 0 0 38 38 0 38 38 Brief description of the care home 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-#850.00 per week. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was completed on 15th May 2007. An Annual Service Review (ASR) of Buxton Lodge was also undertaken on 15th May 2008. The ASR confirmed our judgment that the home was still providing a good service, but in light of ongoing issues that were being raised regarding staffing levels and no registered manager, it was recommended that a key inspection of the home be brought forward. This Key Unannounced Inspection was therefore conducted by Marion Weller, Regulatory Inspector who was in Buxton Lodge from 10:00 until 17:40 on 4th November 2008. An Expert by Experience accompanied the Inspector during the morning from Help the Aged. Experts by Experience provide an additional source of evidence. They pay Care Homes for Older People Page 6 of 32 particular attention to spending time with the people who use the service to establish their experiences of living in the home. The Expert by Experience produces a report of their findings for the Inspector, which informs and supports the Inspectors own judgments. On the day of the site visit the Expert by Experience spent time talking with residents in private and in communal areas of the home, spoke to some staff, viewed activities and observed lunch. The Inspector spoke with some residents and some members of staff. The Providers Operations Manager, the homes administrator and the new manager appointed to the home. Parts of the home and some records and documents were inspected and care practices were observed. Medication administration practices were also inspected on this visit. A number of survey forms were received prior to the inspection and some telephone conversations were conducted with people involved with the home who wished to provide information about their experiences. The inspection report takes into account all the information obtained about the home since the previous site visit. This includes formal notifications, phone calls, letters received and any complaints and allegations notified to the CSCI. The manager was asked to complete the homes Annual Quality Assurance Assessment( AQAA) prior to the inspection. The document was returned when we asked for it and within the timescale given. Survey respondents said they were generally satisfied with the care provided and staff were hard working. A number of surveys raised concerns about staffing levels, which they thought on occasions, were inadequate to consistently meet service users needs and some spoke of limited communal space. Survey forms included the comments: ...Sometimes the staffing levels are not sufficient which means the standard of care is difficult to uphold..... ......Staff work so hard and they do their best to care for us.... ....There are some wonderful staff but it is a hard job and more staff would be a big help, they get quite disheartened sometimes.... ...More space in the lounge would be good... The homes manager and staff gave their full cooperation and help throughout the inspection. What the care home does well: What has improved since the last inspection? What they could do better: The homes information documents and complaints procedure requires some minor review and development to ensure people accessing the service have all the information they need prior to moving in and later for reference. Information documents must be written to suit all levels of resident capacity. Current staffing levels do not demonstrate that residents needs are consistently being met at all times and must be reviewed. Medication administration practice must be closely monitored by the manager to ensure the home can evidence their good practice. Current shortfalls must be addressed. The homes large items of equipment must not encroach on residents communal corridors and become a hazard. Suitable storage facilities must be provided by the service Staffs name badges should be fit for their intended purpose. Care Homes for Older People Page 8 of 32 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users can be confident that their needs would be assessed prior to a place at the home being offered. The homes information documents would benefit from further review and development to ensure that prospective residents and existing service users have all the information they need. Evidence: The homes Statement of Purpose is available for visitors and residents to see. The document has recently been revised and updated to include details about the new manager appointed by the provider. There is a separate Service Users Guide, which the manager calls an Information Pack. The manager said this document is provided to prospective service users, their relatives, and representatives to inform them of the services available and to existing residents as a source of reference. The copy seen requires some minor amendment to ensure it complies with the demands of regulation. For example, the document is not dated, which makes it unclear whether people are Care Homes for Older People Page 11 of 32 Evidence: referring to the most up to date information available. The homes complaints procedure is included in the document. The complaints procedure would benefit from the inclusion of the current contact details for the CSCI and those of the Local Health Authority. The address for the offices of the local Social Services Department is provided, but not a contact telephone number. Numerous telephone numbers are detailed to enable people to contact senior representatives of the provider organisation, but no address is given for people who may wish to contact the provider independently of the homes staff, and in a written format. A recommendation will be made in this report for the homes information documents to be reviewed and revised to ensure they fully comply. The home provided us with their annual quality assurance assessment (AQAA) before the site visit. the AQAA is a written self assessment that focuses on how well outcomes are being met for people using the service and also provides us with some numerical information. The manager records that in addition to the information documents discussed above, the provider offers a web site for those with computer access to the Internet. There are also plans to provide new up to date brochures about the service when the extension of the home is completed. The manager recognised that the homes current information documents could be improved upon. It was also discussed that consideration should be given to making the content of existing documents more user friendly to ensure information is available in plain English and accessible to people of all capacities. As the home provides for some individuals with learning disabilities, consideration should also be given to providing a pictorial format. The manager visits prospective residents prior to admission to make a decision as to whether the home can meet the persons needs. Information is obtained from other parties, including health care professionals to assist in assessment decisions. Two pre admissions assessments were inspected and found to be sufficiently detailed and comprehensive. The AQAA records that prospective residents and their representatives are encouraged to visit the home prior to making any firm decision to move in. Staff evidenced they had the clinical knowledge and practical skills to care for the individuals admitted to the home and were seen to be very hard working and focused. One resident spoken with said,........I get attention when I need it and staff are helpful, but they are sometimes too busy to talk...... Intermediate Care is not provided at Buxton Lodge. Care Homes for Older People Page 12 of 32 Evidence: Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users personal, social and health care needs are set out in an individual plan of care which is being regularly reviewed to ensure information provided to staff is current. Service users would benefit further from minor shortfalls in the homes medication administration procedures being addressed and the manager making regular audits to ensure compliance with good practice, designed to protect service users from any potential for harm. Evidence: Each service user has a care plan. Three were looked at in detail. Care plans were seen to be comprehensive and based on the managers pre admission assessment. They provided clear detail to inform and direct staff about how they should meet the individuals health, personal and social care needs. Care plans were signed either by the service user or their representative to evidence their involvement in its compilation and their agreement to the plan of care. Care plans were being regularly reviewed and changes to the main plan were evidenced as a result of the review. Risk assessments Care Homes for Older People Page 14 of 32 Evidence: identified potential and actual risks to service users and gave clear instruction to staff about how they should reduce or eliminate hazards. Daily records were being maintained which clearly evidenced what the home was doing for service users. The manager records in the homes AQAA that she has plans for further improvement. She states her intention to ensure that the gender preference of carers is accurately documented for individuals and the decisions made with a residents about getting up and going to bed times. This will ensure that the homes practice reflects and better evidences service users wishes rather than the demands of routine or the convenience of staff. Some concerns had been raised by survey respondents and informants about the existence of rigid routines in the the home prior to the site visit. One resident spoken with said,......I can get up when I want and when it suits me and go to bed when I want... Several similar comments to this were recorded and people spoken with were generally satisfied with the care they received. The existence of rigid routines could not be established on the day of the visit, other than those required to run a busy and demanding service which is also suffering additional pressures due to a building project to extend the size of the establishment. It is clear the building project is having an impact on the usual smooth running of the home and the amount of staff time and effort required to effectively deal with the changes demanded of staff. The planned environmental improvements however, will clearly be to service users benefit. One resident said, ....I believe most people here are happy with the service they receive and everything will be much better when the building work is at last completed.... Only registered nurses administer medication to service users and the home has a good record of compliance with the demands of safe medication administration. They have a medication policy and staff generally adhere to procedures and good practice guidance. Some minor shortfalls were evidenced however on this site visit. It was discussed that the new manager must ensure that regular management checks are taking place to monitor compliance with good practice and to address the shortfalls evidenced. A requirement will be issued to that effect in this report. Care and nursing staff were observed treating people living in the home with respect and maintained their dignity and privacy when observed delivering personal care. Each service users is registered with a general practitioner who visits the home on a weekly basis and more often when required. Arrangements are in place for services users to access the wider health provision, as their care needs demands. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines of daily living are not consistently meeting all residents expectations, preferences or needs. The home recognises this and has plans to make changes. Evidence: The homes AQAA records that a part time Activity Coordinator is employed in order to promote and offer a variety of diversional and leisure activities for people living in the home. Activities are provided on a one to one basis and in group settings. A residents Christmas party is being planned for the 15th December 2008, to which residents relatives and friends will also be invited. The manager said the event would take place in the proposed new day room. It was explained that the new day room is part of the extension to the home and is due for completion by December 2008. On the afternoon of the site visit a gentleman from the Tandridge Music Project was providing a musical activity in the main lounge, some people were joining in and were clearly enjoying the event. One Resident spoken with said they particularly look forward to the quiz afternoons and praised the activities coordinators work and involvement in the home. Care Homes for Older People Page 16 of 32 Evidence: It was observed that the homes communal living space for residents is very small and overcrowded. This has been a historical problem with Buxted Lodge and a limitation that the CSCI has mentioned in previous inspection reports. The area has currently been still further reduced to allow the builders to work on the proposed extension to the home. The cramped conditions are currently a major area of dissatisfaction and produced strong comments from survey respondents and from informants who had contacted the CSCI prior to the site visit. The reduced space affords little privacy if people living in the home have visitors arrive and often leaves residents with no alternative but to entertain guests in their bedrooms or if they do not wish to leave the lounge area, it results in visitors intruding on other residents available space. There is a large wall mounted TV either end of this small area that people spoken with thought was switched on as routine, with a volume that was experienced as either being to loud or too soft to enjoy properly. For some it was felt to be intrusive of their expectations of peace and quiet. After discussing the architects plans with the manager it is clear that the building work currently taking place is to extend the residents communal living area and to additionally provide a dedicated dining space. Currently, and the manager states as an interim measure only, people were seen eating their mid day meal from individual small tables placed in front of them. Two residents were using a table in the corridor outside of the communal lounge room. This area was observed to be very busy and not suitable for long -term use. One of the residents seated at the table had a bib type cover put on them and the table laid in front of them at 11:45am. Lunch was not served to them until 1pm. The wait and the period of inactivity resulted in the individual falling asleep. Some residents spoke of electing to eat their meals in their rooms, a request that the home was observed to accommodate. The home has seasonal menus and the AQAA records that they have changed some choices as a result of listening to residents feedback. They also state that they offer more flexibility within set meal times. While the homes policies and procedures promote individual independence and the right of individuals to choose when and where they take their meal, systems for checking good practice were not evident on this site visit, which results in the situation for the individual described above. The new manager reported that she is hoping to make better use of the homes pleasant gardens and provide more outings in future. The manager also spoke of the intention to provide Internet access to residents in both personal and communal areas as part of the refurbishment plans. Residents and relatives meetings, and newsletters to inform people living and visiting the home of forthcoming planned social events are also to be reintroduced. One relative spoken with particularly requested that group Care Homes for Older People Page 17 of 32 Evidence: relatives meetings should be reintroduced as they felt more confident to raise areas of concern or voice their opinion and views in this type of setting. Currently the manager puts aside dedicated time once a week when she ensures her availability to relatives on a one to one basis. It was clear from survey respondents and residents spoken with that visitors are welcomed to visit the home at any reasonable time. Arrangements were seen to be in place for service users wishing to practice their faith. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their Representatives can be confident that concerns and complaints raised with the service will be taken seriously and acted upon. Residents would benefit further from the homes complaints procedure being reviewed to ensure content meets all the demands of regulation. Service users are protected from abuse, neglect and self-harm. Evidence: The homes complaints procedure is readily available to residents and their relatives. As mentioned previously in this report the complaints procedure would benefit from the inclusion of the current contact details for the CSCI and those of the Local Health Authority. The address for the offices of the local Social Services Department is provided, but not a contact telephone number. Numerous telephone numbers are detailed to enable people to contact senior representatives of the provider organisation, but no address is given for people who may wish to contact the provider independently of the homes staff, and in a written format. A recommendation will be made in this report for the homes complaints procedure to be reviewed and revised to ensure content complies fully with the demands of regulation. As detailed in the homes Annual Service Review undertaken by the CSCI earlier in 2008. There have been ongoing concerns raised about the service that have had the Care Homes for Older People Page 19 of 32 Evidence: potential to impact on residents welfare and care. Some anonymous informants have also contacted the CSCI with concerns, mainly around inadequate staffing levels. Concerns raised have previously been sent to the provider, who was asked to investigate. Claims made could not be substantiated, but persisted. For this reason the homes Key Unannounced inspection was brought forward. The homes AQAA records that they have received 2 formal complaints since the last inspection. These have been dealt with in accordance with the homes complaints policy and procedure. Records of complaints received evidenced that the home had taken the complaint seriously and acted upon issues raised appropriately and within timescale. Residents and relatives have also been offered various forums in which to raise their concerns and air their views. Notes of these meetings evidenced that the service acted on feedback from individuals where it was possible or explained any limitations and constraints where it was not. One survey respondent said prior to the inspection,....whenever I have mentioned any concerns the service have dealt with the matter promptly... and another wrote, .....They do listen and try to respond favorably where they can... The homes AQAA records, ....There are weekly surgeries held which people can attend if they wish to raise their concerns....we have learnt from complaints to ensure issues do not arise again and we continue to encourage open discussion on all matters relating to the welfare of our residents... There are procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The staff induction and NVQ training have elements of adult protection and there has been mandatory POVA training for staff. Those spoken with had a generally good understanding of adult abuse and protection procedures. The Manager stated any allegation of abuse would be referred to the concerned agencies without delay and the home would be proactive in helping with any investigation felt necessary. The home is currently responding positively to a request to investigate a current open safeguarding alert and will report their conclusions to the local safeguarding team. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider is making a significant investment in the home to ensure it remains fit for purpose and provides residents with a safe and well maintained environment that meets their individual and collective needs. Evidence: Buxton Lodge is a large detached Victorian property, located in a quiet residential area of Caterham on the Hill. Residents bedroom accommodation is arranged over two floors and is served by passenger lifts. The majority of rooms are single with en suite facilities. The provider continues with the planned programme of refurbishment and upgrading of the home. The building is currently being extended to provide residents with additional communal space and to allow for an increase in occupancy to 44 beds. The Operations Manager stated that an application to vary the homes current registration with the CSCI is being prepared. The provider plans to have the additional communal space available to residents by the middle of December 2008 and the 8 new bedrooms early in 2009. The home is in a transitional stage with firm plans for improvement. Buxton Lodge is currently suffering some disruption due to the planned building project. A number of concerns about limited space and issues about inadequate staffing levels to adequately cope with the changes were raised with the inspector prior Care Homes for Older People Page 21 of 32 Evidence: to the site visit. Residents spoken with and those surveyed were aware of the timescales for completion and were looking forward to having additional lounge space and a dedicated dining area. The current dining arrangements, as mentioned elsewhere in this report, are not suitable in the long term. One resident said, .....everything will be better when the building work is finished, you cant bake a cake without cracking eggs I suppose... Residents and their relatives have been encouraged to voice their opinions and make suggestions about the proposed colour schemes and soft furnishing for the planned extension to the home and there have been meetings held for interested parties about the implications of the proposals and the impact on daily life in the home to ensure that people are informed and well prepared. There are additional plans to refurbish some other areas in the home and to address the homes current lack of storage. On this visit communal corridors were being used to store large items of the homes equipment such as hoists, laundry billies and sit in scales. The manager said that there are plans to provide suitable storage that does not impinge on residents communal space. She was aware that such large items left unattended in communal corridors have the potential to cause trip hazards to those of poor mobility. During a tour of the building residents bedrooms were seen to be highly personalised and comfortable. Some bedrooms however did not evidence the provision of a lockable storage space for the occupants and some residents bedroom doors are not fitted with door locks. The manager stated the firm intention to address these issues within the homes current refurbishment plan. Residents are protected from the risks of burns or scalds by radiators that are guarded and thermostatically controlled hot water outlets. There is a designated laundry that is suitably equipped with systems in place to reduce the risks of cross infection. The sluicing facilities are also clean and well ordered and there were no unpleasant odours in the home. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by staff who receive all the relevant training and support they need and are very hard working. Residents can be equally be confident that checks have been undertaken to ensure that staff are suitable to care for them. Current staffing levels however do not demonstrate that residents needs are being consistently met at all times. Evidence: People spoken with were generally satisfied with the care they receive to meet their needs, but there are times when they need to wait for staff support and attention. Survey respondents, people spoken with, and those individuals who contacted the inspector prior to the site visit, said how good the staff were, but that they were kept very busy and there were occasions when there were clearly not enough of them to meet demand. One resident said, ...we are treated well, but there are sometimes not enough staff and not enough personal contact, no time to chat... The home is registered to provide 38 beds in total. Occupancy is currently reduced to 33 residents to accommodate the building work and environmental disruption. The manager said that staff numbers are being reduced in line with occupancy. Although there were sufficient staff on duty during the day of the inspection, it is clearly evidenced, not least by the volume of concern raised, that there are times when there Care Homes for Older People Page 23 of 32 Evidence: may not be sufficient staff on duty. In addition, some personnel issues recorded in survey returns need management action. Survey respondents spoke of staff absence levels that have an impact on the rosters. For example, staff sometimes give short notice of absence from duty which leaves their colleagues under pressure, particularly if roster cover can not be arranged quickly. This situation has a direct impact on people living in the home. The home continues to recruit to vacant posts and have had some success but rely currently on staff recruited from overseas. The AQAA records that thirteen care staff/ registered nurses have left their employment in the home in the last 12 months. Dependency levels of residents was evidenced in the data section of the AQAA to be demanding and was observed to be high during the site visit, with some residents seen to be bedfast and others who have mental health issues requiring additional support at times. Staffing levels must be based on the homes statement of purpose, admission criteria and the specific need of individual service users. They must also take into account the numbers of service users, their dependency, social, recreational and cultural activities, the training and development requirements of staff, design and layout of the facility and any additional projects taking place that add to staff pressures. There is sufficient evidence to demonstrate that there may be times when residents needs are not be being met and therefore staffing levels in the home must be reviewed. To this effect a requirement will be issued in this report. People applying to work at the home have to complete an application form, provide two references and have a POVA and Criminal Records Bureau (CRB) check and attend an interview. The files of the most recently recruited staff show that appropriate checks are made prior to them commencing duties. All staff follows a recorded induction process, which includes the Common Induction Standards. Buxton Lodge is proactive in ensuring staff obtain NVQ qualifications. A number of staff already hold NVQ qualifications with others undertaking NVQs in care. Staff feel that the mandatory and developmental training offered to them is good. One staff member said.....I receive sufficient support and training to meet the needs of the people we care for and I have gained a lot of experience.... . A training matrix is used to give a management overview of staff training needs and staff records evidence certificates of completion. It was recommended in the last inspection report that staff wear their identification badges whilst on duty. This was seen to be happening on this inspection. However, the quality of some badges was poor, with names written indistinctly in ink and therefor unable to achieve the purpose for which they were intended. Care Homes for Older People Page 24 of 32 Evidence: Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is going through significant change. The provider and new manager have robust plans which seek to put the best interests of residents at their heart of their improvements. Residents will benefit further from current shortfalls being comprehensively addressed to secure their welfare and to ensure their needs are consistently met. Evidence: The new manager appointed by the provider has been in post at Buxton Lodge since June 2008 and was previously registered with the CSCI at another home owned by the same provider. The manager is currently in the process of making application to become the registered manager for the home and is going through the fit person process. She has the required nursing qualifications and management experience to support her application and clearly evidenced abilities that will enable her to run the Care Homes for Older People Page 26 of 32 Evidence: home effectively and meet its stated purpose, aims and objectives. A very experienced deputy manager and a full time administrator support the manager in her role. There are clear lines of accountability within the home and with external management. A member of staff recorded. .....the manager is easy to approach and I feel able to discuss anything with her without any problems... Staff receive regular supervision and annual appraisal and they consider supervision is useful. One survey respondent said, ....I am offered training at supervision and I am well supported and guided by experienced and trained staff.. The manager records in the homes AQAA that she intends to hold more regular staff meetings where staff will have the opportunity to discuss relevant issues. The provider holds regular management meetings and there are twice weekly support visits to the home by external management. The home has a quality assurance system and audit processes are in place. The manager states that annual residents surveys are carried out. These are designed to obtain the views of all stakeholders and results are collated to inform future planning for the home. Relatives are offered the opportunity to attend resident reviews where they can make comment about the service and the manager offers regular weekly surgeries. She stated her intention to reinstate regular residents and relatives meetings. There are monthly visits to the home by a representative of the provider organisation under regulation 26 and visits are recorded. All records were evidenced to be kept in a manner that preserves confidentiality. General record keeping is good and well ordered. The home assists some residents with day to day management of their monies. Records are held of transactions with receipts held detailing any expenditure on the residents behalf. These are checked by the organisation as part of their audit process. The residents spoken with said they had no worries regarding their finances and feel they are supported in managing their affairs efficiently. The Manager records in the homes AQAA that all records of maintenance and safety checks are up to date. These were not all inspected on this occasion. The manager must address some shortfalls in medication administration practice, appropriate storage for the homes large items of equipment and as mentioned previously, staffing levels require review. It is clear on this visit that the home is in a period of transition with clear plans for improvement that will benefit residents. Care Homes for Older People Page 27 of 32 Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The manager must undertake regular audit checks to monitor full compliance with the procedures and practice guidance in the homes Medication Policy. Records must be maintained of checks. The shortfalls in current practice must be fully addressed to ensure the safety and welfare of service users and regualr checks maintained in future to protect service users from the potential for harm. 29/12/2008 2 22 23 Suitable storage facilities must be provided for items of the homes equipment. The homes equipment must not encroach on residents communal space or cause a hazard to a residents welfare and safety 28/02/2009 Care Homes for Older People Page 30 of 32 3 27 18 A review of staffing levels must be carried out and therafter kept under review to ensure that staff are provided on all shifts in the numbers to meet the assesed needs of service users and the services own Statement Of Purpose and the homes published aims and objectives. The Registered Persons must ensure that there are sufficient numbers of suitably qualified, competent and experienced staff working at the home in sufficient numbers as are appropriate for the health and welfare needs of service users to be met in full. 31/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 It is recommended that the homes statement of purpose and service user guide are reviewed to ensure they contain all the required information and are made available in formats that suit everyone accommodated. Good practice demands that information documents are clearly dated and evidence a date for review to ensure they remain current. It is recommended that the homes complaints procedure is reviewed and revised to ensure content meets fully with the demands of regulation. 2 16 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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