CARE HOMES FOR OLDER PEOPLE
Carrick Lodge Belyars Lane St Ives Cornwall TR26 2BZ Lead Inspector
Paul Freeman Announced 15 June 2005 09.30 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. Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Carrick Lodge Address Belyars Lane St Ives Cornwall TR26 2BZ 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) 01736 794353 Mr Ronald James Cottam Mrs Trudy Anne Izatt Care Home 38 Category(ies) of Dementia (18), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (18), Old age, not falling within any other category (20) Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5 November 2004 Brief Description of the Service: Carrick Lodge is a residential home that is registered to accommodate 38 older people 18 of who can experience dementia or a mental disorder. The registered provider is Mr R Cottam and the Registered Manager is Ms T Izatt. They state the aims and objectives of Carrick Lodge are to meet individual residents needs in a manner that is not intrusive, but is respectful and promotes dignity and rights. Therefore the prime role of staff is to help, assist and enable service users when required and according to individual need. Carrick Lodge is situated near the centre of St. Ives and is in an elevated setting with panoramic views of the bay. Accommodation comprises of a large three floor house to which a two storey extension has been added. The bedrooms are located in three distinct areas on the ground, first and second floors. The ground floor accommodation also consists of two communal seating areas and a conservatory, the dining room, kitchen area, laundry and two offices. Two lifts and a stair lift are provided to assist access to the upper floors. A fenced garden is situated at the front of the home. Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over fourteen hours by two inspectors. The Inspectors looked over the building and at a number of records and documents. The Pre inspection Enquiry document that was sent to the Provider was not completed. Nine of the residents, four of the staff, the provider and registered manager were spoken to. The Inspector found the requirements and recommendations set at the last inspections had been worked upon. Another inspection visit occurred on 1 February 2005 and the conclusions are summarised in this report. What the service does well: What has improved since the last inspection?
The care planning arrangements continue to improve and the majority of care plans give the staff the information they require to meet the individual needs of residents. The arrangements to protect residents have been developed and are satisfactory and also meet the guideline laid down by the Department of
Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 6 Health. The registered manager and staff are clearly committed to taking positive steps to ensure that residents are properly protected. Plans have been established to change some of the furniture and equipment provided for residents’ comfort and convenience. The arrangements for the selection of new staff have improved but the home must provide an individual photograph of all staff members. The record keeping arrangements at the home continue to improve but the records about residents need to be further developed in order that a comprehensive picture can be provided. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 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 Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 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) 3 and 4 The admission process needs further attention in order that a clear picture is obtained of prospective residents’ needs and to make sure the home is able to meet the person’s assessed needs. The welcome provided to new residents is initially positive but further improvements can be made to help the person settle. EVIDENCE: The assessments examined for residents that had recently been admitted showed that specialist assessments are obtained where they have been completed. The assessments undertaken by the home to ensure that needs can be met were incomplete and did not satisfactorily address the needs of the residents. The residents commented they were initially positively welcomed by the staff but had clear views about how the welcome could be improved. The registered manager has agreed to review the arrangements. The home continues to improve the arrangements to demonstrate how residents’ needs are met. The current records are not robust enough to satisfactorily demonstrate this is achieved.
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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) 7,8,9 and 11 Residents are looked after satisfactorily in respect of their health and personal care. Care plans continue to improve and examples of good care planning can be found. EVIDENCE: The care planning arrangements continue to be improved and a high percentage of the plans examined detailed the person’s needs and provide suitable direction to the staff. The care plan also include a social history of the each resident which helps the staff to build a better picture of the individual and provides further guidance about meeting that persons needs and aspirations. Care plans are reviewed each month and suitable steps taken when a change of need is identified. Residents commented their health needs are well met and are confidant that medical assistance is promptly obtained when required. The records clearly indicate that careful account is taken of each individual residents health. The arrangements for storing and administering medication are well ordered and the staff involved have been suitably trained. Accurate records are also maintained. Records are also kept that make sure residents are treated with respect and sensitivity when their health is failing.
Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 11 Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 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 and 15 A wide range of activities is provided that reflect resident’s interests and provide a varied and stimulating experience. The meals at the home provide a varied and nutritionally balanced diet which reflects the residents preferences and choices. EVIDENCE: A varied and stimulating package of activities is provided at the care home and in the local community. Activities occur in groups and on an individual basis to take account of the residents’ needs, interests and hobbies. Residents commented they valued the opportunities provided and found them to be a great source of pleasure. An activities coordinator plays a key role in the organisation and provision of the programme. The coordinator should be commended for the valuable contribution they make in providing a stimulating and pleasurable experience for the residents. Everyone who commented on the food said they were satisfied with the range of meals available and the quality of the food. A balanced menu is provided which takes account of individual residents’ preference and choice. The kitchen is well organised and suitably equipped. Both the kitchen and the equipment are maintained to the required standard. Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 13 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 and 18 Arrangements for protecting residents and responding to their concerns are satisfactory. EVIDENCE: No complaints have been received by the home or the CSCI. Residents and staff comments showed that people feel comfortable and confident about discussing any concerns with the Registered Manager. Suitable arrangements are also in place to positively deal with any complaints that occur. The adult protection procedures have been improved and accurately reflect the guidance provided by the Department of Health. Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 14 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) 21and 23 Two of the communal bathrooms and the ground floor shower room are not usable and need to be available for use at the earliest opportunity. This will improve the facilities available to residents. EVIDENCE: A number of toilets are distributed throughout the home and are within reasonable access to communal areas. A number of bedrooms are also provided with ensuite facilities. Two of the bathrooms on the third and second floor of the main building are out of commission. The shower facility on the ground floor is also not in service as it is considered unsafe. One of the bathrooms is used as a storeroom and the second has been in the process of refurbishment, which commenced in January 2005. This places an additional burden on staff who have to rely on a bathroom in another parts of the building. In addition some residents are inconvenienced given the facilities are not readily available. The sink in the bathroom in the process of refurbishment is not standard size and this could prohibit access for some residents.
Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 15 The bedrooms provided are satisfactory and many of the residents have personalised their rooms. Generally the rooms are maintained to an acceptable standard and residents commented they were pleased with the accommodation provided. A high percentage of specialist mattresses are provided to meet the needs of the residents concerned. Some of the other mattresses appeared to be tired and it is recommended they be reviewed to make sure that resident’s comfort is not compromised. Commodes are also provided in rooms where this is required. A programme of replacement of this equipment is planned in the near future. One bedroom can accommodate four residents and it is recommended this is converted to single occupancy at the earliest opportunity. This will provide residents with the privacy they require. Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 16 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 and 29 At the time of the inspection sufficient numbers of staff were on duty. There are occasions when staffing levels are not sufficient to meet the needs of residents. Suitable arrangements for recruiting new staff are in place. EVIDENCE: On the day of the inspection there were thirty residents at the home. The staffing levels were sufficient to meet the needs of these residents. Additional staff will be required when the number of residents increases. The Commission have been notified of occasions when the staffing levels have fallen below the required numbers. This is not satisfactory and sufficient numbers of staff must be employed at all times to make sure that residents are not placed at risk. The home is currently advertising for new staff to make sure that enough staff are employed at all times. Residents commented they were treated with dignity and respect and they were very pleased with the manner in which staff provide the care and support they need. The arrangements for the recruitment and selection of staff are satisfactory but a photograph of each staff member must be provided. Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 17 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) 36, 37 and 38 Positive arrangements are in place to support and supervise staff. The management of risk is not satisfactory although this area has improved. Regular records are maintained but in certain instances more detail is required to make sure that a complete picture is provided. This will help the managers and staff to meet the residents’ needs and provide a safe environment. EVIDENCE: The Commission are not receiving monthly report from the provider as required by regulation. The record keeping arrangements at the care home continue to improve but further improvement is required. Records about residents are made every day but some of these records require further information to make sure that a
Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 18 comprehensive picture is provided. The home also has a satisfactory insurance policy. The staff are well supported and supervised by the managers, and a manager is on duty for all waking hours. A senior member of staff also takes the lead role in supporting and coordinating the night care staff. The staff commented they found the supervision arrangements to be positive and advice and guidance was readily available when required. Regular staff meetings are held and the staff said they found them to be helpful. The management of risk continues to improve but is not satisfactory at this time. Careful account must be taken of the risks to service users at all times. The equipment and services provided at the home are regularly maintained and serviced but a inspection cover at the front of the building requires urgent attention to be made safe. It was reported that an offensive odour occurs outside during hot weather. This matter needs urgent investigation. Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 x 15 3
COMPLAINTS AND PROTECTION x x 1 x 2 x x x STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 3 2 2 Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 20 yes 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. Standard 3 Regulation 14 Requirement Detailed assessments must be completed before a service user is admitted to the care home on a planned basis. The records maintained about service users must be developed to demonstrate that needs are met. All service users plans must be user friendly and completed in detail. All the bath and shower rooms at the care home must be functional and safe for use by service users. Commodes must be replaced where required. The staffing levels must not fall below the minimum required to meet service users needs and provide appropriate protection. (Previous timescale of 30 March 2005 not met). The registered manger must inform the commission of any occasion where the staffing level falls below the required minimum or suitable management cover is not provided. The arrangements for the Timescale for action 30.9.05 2. 4 12,13 and 18 15 23 30.10.05 3. 4. 7 21 30.11.05 30.6.05 5. 6. 24 27 23 18 30.7.05 30.6.05 7. 27 18 and 37 30.9.05 8. 29 19 Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 21 9. 37 26 10. 37 12 and 17 11. 38 13 12. 13. 38 38 13 23 recruitment and selection of staff must meet with the requirements detailed in the minimum standards and regulations. The registered person must visit each month to determine the quality of the services and facilities and send a report of their findings to the Commission. (Previous timescale of 30 January 2005 not met). Service users’ daily records must be developed in a manner that ensures the records detail the events of the day, any action taken by the staff and the outcome of this action. A risk assessment must be completed each time an accident occurs. (Previous timescale of 30 December 2004 not met) The inspection cover at the front of the building must be repaired The offensive odours outside the home must be investigated and rectified. 30.7.05 30.9.05 30.8.05 30.7.05 30.7.05 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 23 23 23 Good Practice Recommendations A standard sized sink should be fitted to the first floor bathroom currently in the process of refurbishment. The bedroom accomodating four service users should be converted to sinle occupancy rooms. Matresses in service users bedrooms should be reviewed and replaced where this is necessary. Carrick Lodge D52-D04 S8919 Carrick Lodge V222125 150605 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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