Inspection on 14/03/07 for Byron Lodge Residential Nursing Home

This inspection was carried out on 14th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Byron Lodge Residential Nursing... 09/09/05

Byron Lodge Residential Nursing... 28/04/05

Byron Lodge Residential Nursing... 15/02/05

Byron Lodge Residential Nursing... 17/06/04

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 Byron Lodge Residential Nursing Home 105 - 107 Rock Avenue Gillingham Kent ME7 5PX Lead Inspector Jo Griffiths Key Unannounced Inspection 10:00 14th March 2007 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 Byron Lodge Residential Nursing Home DS0000026156.V327949.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. Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Byron Lodge Residential Nursing Home Address 105 - 107 Rock Avenue Gillingham Kent ME7 5PX 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) 01634 855136 Dr Prathap Padmanabhan Jana Mrs Jyothi P Jana Mrs Margaret Joy Spurgeon Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th September 2005 Brief Description of the Service: Byron Lodge is a privately owned, purpose built, 28 bedded home, providing 24 hour nursing care to older people. The service users accommodation is sited on three floors with a passenger lift to all floors. There are a variety of aids and adaptations around the home, which enable more independence for the residents. All areas of the home used by the residents are wheel chair accessible. The home is situated in a residential area close to Gillingham and Chatham town centres. The home is located on a main bus route and within walking distance of shops and a Post Office. The home has an attractive garden to the rear of the property and also some limited parking facilities. Dr and Mrs Jana own the home, one of three in the area. A registered nurse manages the home and there are additional qualified staff on duty at all times, as well as care staff. The home also employs domestic and catering staff. At the time of this inspection 27 service users were living in the home and there was one vacancy. The fees for this service range from £496 - £525 per week. Fees charged are dependant individuals needs. Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced. Jo Griffiths carried out the inspection of the home between 10.00am and 4.00pm on 14th March 2007. The deputy Manager was on duty in the morning and the Manager was on duty in the afternoon. The owner Mrs Jana was available during the inspection. As part of the inspection of this home surveys were sent to residents and their relatives to gather their views of the home. Completed surveys were received from 2 GP’s, 6 residents and 4 relatives. The comments were overall very positive about the care. During the visit to the home the inspector had a look around the home, inspected some records and policies and spoke with residents, staff and visitors. What the service does well: What has improved since the last inspection? What they could do better: It is recommended that the Manager record any discussion about staff CRB disclosures on their staff file to further ensure that residents are protected during the recruitment of new staff. The training matrix should be updated to include all the courses staff have completed. Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 6 The risk assessment for one resident’s use of bedrails should be reviewed to make sure the person is kept safe at night. Residents would benefit from more activities in the home each week. The Manager has already taken steps to achieve this. 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. The summary of this inspection report can be made available in other formats on request. Byron Lodge Residential Nursing Home DS0000026156.V327949.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 Byron Lodge Residential Nursing Home DS0000026156.V327949.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1, 3, 4 and 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with the information they need to make a decision about moving to the home. Residents needs are assessed before they move to the home and they are informed that these needs can be met before they move in. They are offered the opportunity to visit the home to assess the facilities and service before they move in. EVIDENCE: A Service User Guide is available to people expressing an interest in the home. This lays out the service that can be provided, the facilities that are available and the qualifications of the staff team. It also includes the complaints procedure and other useful information about living at the home. A copy is given to each person when they move to the home. Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 9 The Manager assesses the needs of each person before they move to the home to ensure the needs can be met. The assessment is very detailed and covers all areas of the person’s life that in which they may need care or support. The Manager only agrees a place for the person in the home if, following the assessment, it is agreed that the person’s needs can be met by the staff in the home. Each person and their family are offered the opportunity to visit the home before making their decision about moving in. Clear records of these trial visits are kept and this is considered excellent practice. The home offers some respite care but does not provide intermediate or rehabilitative support. Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have a plan of care that meets their holistic needs including their health and nursing needs. Residents are protected by the homes procedure for managing and administering their medication. Residents feel they are treated with respect and that their dignity is maintained. They know that they well be cared for sensitively in their last days. EVIDENCE: Each resident has a care plan that is based on the assessment of their needs. The plans are written by the Manager or other qualified nurse in the home. The care plans direct care and nursing staff on how to provide the care and support needed by the person. The Manager reviews the care plans monthly or earlier if needed and records of the reviews and any amendments to the plan are kept. Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 11 The care plans are easy to follow for the care staff and cover all areas of the persons life including medical, personal care, emotional and social needs. Some excellent examples were seen of holistic care planning including care plans for personal care that instructed staff to support female residents with their make up if this was considered by them an important part of their identity. Residents’ health needs are met through the care plan and by the nurses on duty in the home. The GP and other health care professionals are used, for example, speech therapist or the tissue viability nurse. Pressure area care was seen to be vigilantly managed. The home arranges for a dentist, chiropodist and optician to visit at least annually. Clear and accurate nursing notes are retained to allow the Manager and nursing staff to monitor individuals’ well being. One GP commented, “Excellent care provided to our patients in this nursing home”. Comments received from residents and their relatives included, “ The person in the home is made to feel important and not just a number” and “ I am pleased with the care I receive”. Medication is stored, managed and administered safely by the qualified nurses in the home. There is an annual audit of medication carried out by the GP and the Manager monitors the temperatures of storage and the ordering of stock. Residents spoken with said that they felt they were treated with respect in the home and that the staff valued their opinions. Staff were observed supporting residents throughout the day. All the staff demonstrated a respectful approach and were very thoughtful in their interactions with residents. Residents were seen to be attended to quickly when they requested help. Privacy is well maintained in the home. When a new resident is admitted to the home the manager sensitively discusses with them and their relatives any wishes they may have for the end of life. This is held confidentially on record so that residents can be assured that they will be supported in the way they wish during their last days. People privacy is respected in this matter as it is acknowledged by the Manager that it is a sensitive subject. Byron Lodge Residential Nursing Home DS0000026156.V327949.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents would benefit from more regular activities within the home. They are supported to go out into the local community if they wish and can receive any visitors they wish to. Residents are supported to maintain control over their lives. Residents enjoy a balanced diet with plenty of choice and appetising meals. EVIDENCE: The home provides some activities for residents including a singer that entertains every 2 weeks and some activities in the afternoon. However, the home has recently lost its Activity coordinator and as a result there has not been a regular programme of activities available for residents. Feedback from residents indicated that they would like more activities, comments included, “ There are not always enough activities” and “more therapeutic activities are needed on a regular basis”. The Manager has been interviewing for a new Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 13 coordinator and aims to rein state the programme of regular activities as soon as possible. Residents can receive visitors when they wish to and can see them in private if they wish, either in their own rooms or one of the small lounge areas around the home. One resident said, “ My visitors are always offered a cup of tea and made to feel welcome”. Residents are offered the opportunity to go on a monthly shopping trip and where possible the carers take people out for walks if they request to do so. One relative said that residents can choose whether to be alone stating, “ the staff always leave decision whether to join in with others in the home to the individual”. Residents said that they can choose when to get up and go to bed and that they are supported to choose their meals, clothing and activities. They said they enjoy the meals and have plenty of choice each day. The menu shows 2 choices per meal and a balanced menu across 4 weeks. On the day of the inspection some residents did not want either choice and had been able to request a different meal. This had been catered for without question. The cook takes time to get to know the residents and talks with them daily about their choices. Comments from residents and relatives about the food include, “ We are always given a choice of meals” and “ I can have something else if I don’t like what’s on the menu” Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents know how to make a complaint and know they will be taken seriously. They are protected from abuse. EVIDENCE: Residents and relatives spoken with knew how to make a complaint if they needed to. They said they felt confident that the Manager would listen to them and deal with the concerns. There have been no complaints made recently. Previous complaints have been dealt with effectively and following the homes procedure. The Manager is accessible to residents, visitors and staff. The owner visits the home daily. There is a comments and suggestions book in the entrance hall for relatives to make comment about the service and the Manager responds to each item raised. The complaints procedure is clear to follow and is included in the Service User Guide, which is held in each resident’s room. All staff have been trained in safeguarding vulnerable adults and are aware of the policies of the home. There is an adult protection policy and a whistle blowing policy for staff to follow if they have any concerns. All staff are thoroughly checked when they are employed and are provided with the training they need to be able to support people effectively. Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 23 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and comfortable home with access to plenty of communal facilities and bathrooms to meet their needs. Residents bedrooms are appropriate to their needs. Residents benefit from a clean and hygienic home. EVIDENCE: The home is well maintained and decorated to the taste of the current residents. Those spoken with said they were happy with the way the home is maintained and that their bedrooms meet their needs. Most people have a single bedroom and there are three shared bedrooms. People only share a bedroom where they have chosen to do so and this is clearly recorded on their Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 16 care plan. Some bedrooms have ensuite facilities and there are sufficient bathrooms and toilets around the home to meet people’s needs. There is a large lounge and dining room on the ground floor and several smaller lounge areas on other floors that are mainly used by residents when they have visitors. All areas of the home are kept clean and hygienic. There are flowers around the home that the residents said they enjoy. Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by sufficient numbers of qualified and trained staff to meet their needs. They are protected by the homes recruitment procedures. EVIDENCE: Residents spoken with said that the staff are very good and there are enough staff to support them. Comments included, “ The carers are friendly and helpful” and “ sometimes the staff are very busy and you have to wait a short while but they always come as quick as they can”. There is always a registered nurse on duty to oversee the care and to provide nursing care. The Manager and the deputy Manager work alongside the carers to monitor standards and provide support. All the carers have completed their NVQ award or are working toward it. There are 3 carers that are at college doing a diploma in health and social care. The staff have completed the training they need to do to support residents including a full induction programme when they join the home. It is recommended that the training matrix be updated to reflect all the courses that staff have completed recently. Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 18 Recruitment files were inspected and it was found that the Manager follows robust procedures for recruiting new staff. It is recommended that any discussions the Manager has with an applicant regarding their CRB disclosure be fully documented on the personnel file. The carers were observed supporting residents throughout the visit and demonstrate empathy and respect in their approach. When dealing with confused residents they were patient and able to reassure the person quickly. The carers were aware of what was going on around them and able to respond quickly to any residents’ requests or needs. Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a home that is well run by a competent and approachable Manager. They are consulted on their views of the service at regular intervals. Residents’ finances are safeguarded and their health and welfare are protected. EVIDENCE: The Manager is a registered nurse and has been inn post at the home for a number of years. She demonstrates clear leadership of the service and a competent management style. The staff and residents said they felt they could Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 20 approach the Manager with any concerns and that they would be listened to. Equally the owner visits the home daily and is considered to be approachable. The owner carries out a quality assurance exercise every 6 months, which includes gathering the views of residents and relatives by survey. The results of the exercise are published on the notice board and any action taken as a response is shared through the 6 monthly relatives and residents meetings. The home does not manage any money on behalf of residents at this time. There are risk assessments in place for individual residents and for staff and the home as a whole. The Manager ensures that all equipment is serviced as needed and that any repairs are reported to the maintenance man. There are policies and procedures in place to protect the health and welfare of residents and staff. Staff receive training in health and safety. It is recommended that the risk assessment be expanded for the resident who has chosen not to have bumpers on her bedrails. This will further ensure her safety at night. Staff were observed to follow safe procedures when carry out their duties. Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 4 4 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 3 3 X 3 X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 X X 3 Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 2 Refer to Standard OP12 OP29 Good Practice Recommendations It is recommended that the weekly programme of activities be reintroduced as soon as possible. It is recommended that the Manager records any follow up discussions with staff about CRB disclosures on their staff file. It is recommended that the training matrix be updated to include all courses. It is recommended that the risk assessment for one resident’s use of bedrails be reviewed to state that bed bumpers are not used and how the person will be alternatively safeguarded. 3 4 OP30 OP38 Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © 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 Byron Lodge Residential Nursing Home DS0000026156.V327949.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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