Inspection on 28/04/05 for Byron Lodge Residential Nursing Home

This inspection was carried out on 28th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Byron Lodge Residential Nursing... 14/03/07

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

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 105-107 Rock Avenue Gillingham Kent ME7 5PX Lead Inspector Lucy Ansell Unannounced 28 April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Byron Lodge Residential Nursing Home Address 105-107 Rock Avenue Gillingham Kent ME7 5PX 01634 855136 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr. P.P. Jana Mrs. M.J. Spurgeon Care Home with Nursing 28 Category(ies) of Older People (28) registration, with number of places Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15 February 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. Parking on the road is time restricted. Dr and Mrs Jana own the home, one of three in the area. A registered nurse manages the home and there is an 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 26 service users were living in the home and there were two vacancies. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection under the terms of the Care Standards Act 2000 carried out by two inspectors who were in the home from 10.30 to 13.30 on the 28th April 2005. During the inspection the owner and Manager were both in attendance. Documentation and records were read, including care plans. A tour of the premises was undertaken. The inspectors spent time talking with 16 service users and 4 relatives What the service does well: What has improved since the last inspection? There has been an improvement in the record keeping of records around the details of resident’s deaths. The home stated a representative or the resident have now signed most of the residents contracts . There is a significant improvement in the handling of controlled medications since the last report. The home has employed a new activities co-ordinator with increased hours and this has helped to fulfil residents with more meaningful activities during the day. Evidence was seen that improvements and changes needed from any requirements are implemented quickly by the home. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 6 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. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4 Prospective service users and their relatives have access to the information they require to make an informed choice about the home. Service users benefit from a comprehensive assessment of their needs prior to moving into the home that ensures their assessed needs can be met. EVIDENCE: The home has its statement of purpose and service users guide together in one format. It is clear and concise with all relevant information included, however these are two separate documents and they need to be used for their correct purpose of informing residents prior to choosing a home and as a source of reference after moving into the home. Residents are provided with a statement of terms and conditions when moving into the home. Evidence was seen of the homes contracts, which were very detailed and signed by the resident or their representative. The homes manager or the deputy manager admits residents following a full assessment both are registered nurses. The information gathered forms part of the overall care plan. The home uses a mini mental test within the preassessment paperwork and the “waterlow” test to determine levels of risk. The home does not offer intermediate care, but has got five short-term beds that are pre-paid for by Medway council. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 9 Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-10 Whilst residents benefit from a high standard of care planning the day-to-day recording of residents’ care by staff is inadequate. Although residents are treated with respect and dignity on a daily basis they are not consulted regarding their wishes concerning terminal care and arrangements after death. EVIDENCE: Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 11 Four residents care plans were looked at; these were detailed records that contained good personal and health care recording. The health needs of residents are well met with evidence of good multi-disciplinary working taking place on a regular basis. The risk assessments were clear and concise and evidence was seen they are reviewed regularly. The home would be advised to keep on file a checklist for questions to ask when a resident will be sharing a room to ensure complete agreement is gained from both residents. Evidence was seen that reviews of the care plans are taking place regularly. The manager has in place a system to monitor all care plans after the staff have completed their reviews. The home operates a key worker system where residents have an identified staff member. The staff are not recording enough detail in the daily report, it was also noted that when events and care delivery occurs during the day that the record does not indicate the time these happened. Also a full day’s report being written at lunchtime is not acceptable, as things do change. It was also noted that comments made about new health issues for individual residents were not followed up and no reference could be found on subsequent days. However it transpired that action had been taken on these issues but staff were not recording them in the daily log but the manager was able to evidence the action taken though other means. The home promotes and maintains residents health through supporting and facilitating medical appointments as required. At this time, one resident has a pressure area, which with treatment is now greatly reduced. The home has good links with other professionals and the home can offer a choice of G.Ps from the many surgeries situated locally. The staffs on duty were observed indirectly throughout the inspection, they were seen to interact in a positive and respectful manner with residents. Residents gave positive feedback during the inspection about the approach of the staff team, comments included “nothing is too much trouble for the girls” and “they are lovely”. In the residents shared rooms it was noted that privacy curtains were in place that ensured privacy and dignity for the occupier. Residents are not consulted regarding their wishes concerning terminal care and arrangements after death. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 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 standard(s) 12-15 Residents have access to a range of appropriate social activities, which improves their quality of life. On occasion residents would benefit from more interaction and support from staff. Residents’ dietary needs are well met and they enjoy a good standard of catering that the home provides. EVIDENCE: A new activity co-ordinator is now working at the home four days a week, and she appeared to be very aware of the needs of her client group and keen to promote their independence. In house activities now being provided include bingo, painting group, knitting group and artificial flower arranging. A local vicar visited once a month and one service user who was a Catholic had the priest come in to see her once a week. The home also once a month has access to a minibus for trips out and also a monthly shopping trip takes place. Someone living nearby brings in her dog every one to two weeks for people to stroke and talk to. The home also does have entertainers coming in monthly. Residents stated they’re happy with the level of activities offered. The home has started booking trips for the summer and a bus is booked for this month to go on a blossom trail and fish and chips supper paid for by the home. Evidence was seen of daily log of activities kept by co-ordinator with all clients being seen daily, for a one to one chat or a hand massage if not able/wanting to partake of the activity. This also need to be written In the residents daily records and a monthly chart held to have a good overview of all the clients and to check they are all seen regularly. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 13 It was felt that staff could do more to interact with the residents, as residents were seen in wheelchairs lined up for lunch and then left for over half an hour with no staff supervision or stimulation waiting for their lunch. A number of residents spoken to in the home who commented on the food said how good it was and that they welcomed the daily choices offered. Evidence was seen of the four-week rota and of stocked larders and fresh food orders. Residents were observed during meal- time and choice and variety was seen to be offered. One resident stated “ the food was excellent and they always have something on the menu which I like”. The residents requested that the day’s menu choice be displayed in the lounge where they are able to see it. Visitors are made welcome at any time and a private visitors room is made available with refreshments as required. This was evidenced during the inspection and on speaking to a relative. They stated, “They were free to visit when ever they wished and were very happy with the home”. The home can provide meals for a small charge to relatives who wish to stay for this. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents have access to a clear complaints procedure, which is acted upon by the home when necessary. EVIDENCE: The home has a clear step-by-step procedure that meets the requirement of the regulations. The complaints procedure had recently been rewritten and was displayed within the home. All residents and family and staff had been given a revised copy and evidence was seen of it included in the statement of purpose and service user guide. The home has received no complaints since the last inspection; evidence was seen of a copy of the complaints form. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23 and 25 Resident’s benefit from living in a safe, well maintained, clean and homely environment in which there are high standards of décor, furnishings and fittings. EVIDENCE: The home location and layout is suitable for its stated purpose; the home has just had a visit from an Occupational Therapist whose report is to follow and the recommendation identified during that visit is being actioned. The home has 22 bedrooms, 9 of which have ensuite toilet facilities; and 3 double rooms, all of which have en-suites. Over the three floors there are many communal toilets and bathrooms with assisted electric baths. There is a large comfortable communal lounge/dining room on the ground floor. A further quiet lounge and a visitor’s room are on the second floor. Bedrooms seen had all been personalised by the service users. The rooms were all clean and well decorated. Bedrooms have sufficient space to Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 16 accommodate the required furniture. The home has very high standards of cleanliness and no odours were detected anywhere in the house. On the last inspection, it was noted that the hot water was running at a high temperature in some of the bathrooms and advised the manager have the thermostatic valves checked. On this occasion, the plumber was at the home and evidence seen that water temperatures were being checked and recorded regularly. The home has a separate laundry room, which met infection control requirements. The kitchen was viewed and the flooring needs replacing around the sink area, the remaining areas were clean and tidy. The home has two sluice rooms and a large basement which doubles as a storage space and a staff room. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 and 30 Resident’s benefit from living in a home that is adequately staffed. The residents are cared for by competent staff that receives regular, on-going training. Residents were put at some potential risk because of the lack of some documentation required with regard to the recruitment and appointment of staff. EVIDENCE: Staff rotas were seen and evidenced that staffing was suitable to provide appropriate shift cover. The home does not use agency staff and has its own bank of care staff to call on. 2 qualified nurses and 5 carers staff the home on the morning shift, then in the afternoons by 1 qualified nurse and 4 carers and in the evenings 3 waking staff. The home also employs a Cook, Handyman, activity co-ordinator and several domestic staff for cleaning and laundry. The inspector sampled a number of staff files, which included all types of staff, who had been at the home for varying lengths of time. However some files seen did not contain all the correct information. Evidence was not seen of actual photos of staff; rather they were relying on the copy of the passport photo, which was not overly clear in all cases. The reference request needs to confirm dates that an employee worked for the said firm. Evidence was also not seen of interview notes. All staff had completed CRB disclosures. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 18 15 out of 21 care staff in the home has an NVQ ranging from NVQ 2 to some staff taking NVQ3 in care. Training records were looked at from this it was clear that health and safety, fire protection, first aid and food hygiene training had been provided to most staff in the last two years and a programme of updating this where necessary was in place. Evidence was seen in the staff office of nurse training and courses for care staff that were available. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31-35 The resident’s benefit from having a well supported and well led staff team. Residents are regularly consulted about the running of the home and their views are acted upon. EVIDENCE: The manager was seen to communicate a clear sense of leadership and direction to her staff. The process of management appeared to be open and transparent. Staff indicated that they felt part of a good team and this was due to the way the home was managed. The home holds six-monthly residents meetings the next is due in May and regular staff meetings are taking place with productive agenda’s and full involvement of all staff to improve the service provided. The owner is also very involved in the management side of the home and visits the home daily during the week. The home has sent out quality assurance questionnaires to all residents and relatives yearly. The owner and manager also speak to the residents on a fairly frequent basis to ascertain they are well with no complaints, this being confirmed by the residents, however they would like this happen more Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 20 frequently. The home does have procedures in place for the monitoring and accounting of resident’s money with in the home. Accounts checked were correct and receipts were seen for all transactions. There was evidence seen that formal staff supervision took place this was confirmed in discussion with staff and also by the manager who manages supervision as often as possible. During the course of the inspection a number of records, policies, procedures and other documents were examined. Records are stored securely and safely. The homes policies are reviewed under the Data Protection Act 1968. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x 3 x 3 x STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 3 3 3 x x x Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard OP7 OP11 OP12 Regulation 15, S3.1 (b) 12(1-4), 37 16 (2) n Requirement Timescale for action Sept 2005 Daily recordings need to show actual care delivered and at what time this is happening. residents wishes regarding death Sept 2005 and dying need to be held on the care plans consult residents about Sept 2005 programme of activities arranged for them,( not being left for long periods of time on their own whilst getting everyone down for dinner.) 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. 3. Refer to Standard 1 3 10 Good Practice Recommendations It is recommended that the statement of purpose and service user guide become separate identities and be used as two different sources of information. It is recommended that the home have an agreement kept on file where residents have been consulted about sharing a room. It is recommended that residents are transferred to armchairs in the mornings and use their wheelchairs for all transfers unless self propelling. H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 23 Byron Lodge 4. 12 5. 15 It is recommended that a weekly activity chart is posted up for all residents to see and a record is kept of all activities in the daily recordings as well as a monthly overview. It is requested that a daily menu be put up in big print, so residents can see what is on the menu for that day. Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent. ME16 9NT 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 Byron Lodge H56-H06 S26156 Byron Lodge V224568 280405 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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