Inspection on 29/01/08 for Cherry Lodge Rest Home

This inspection was carried out on 29th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cherry Lodge Rest Home 29/10/07

Cherry Lodge Rest Home 02/07/07

Cherry Lodge Rest Home 31/05/06

Cherry Lodge Rest Home 29/09/05

Cherry Lodge Rest Home 08/07/05

Cherry Lodge Rest Home 07/09/04

Cherry Lodge Rest Home 05/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

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 Cherry Lodge Rest Home Cherry Lodge 75 Whyteleafe Road Caterham Surrey CR3 5EJ Lead Inspector Sandra Holland Unannounced Inspection 29th January 2008 10:15 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 Cherry Lodge Rest Home DS0000013596.V357284.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. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Lodge Rest Home Address Cherry Lodge 75 Whyteleafe Road Caterham Surrey CR3 5EJ 01883 341471 01883 347706 cherrylodge@hotmail.com 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) Mrs Cherie Margaret Callender Mrs Cherie Margaret Callender Care Home 14 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (14), Physical disability (1), Physical disability over 65 years of age (1) Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be: OVER 65 YEARS, with one person in the category PD who may be in the age range 60 to 65 The age/age range of the persons to be accommodated will be: OVER 65 YEARS, with one person in the category PD who may be in the age range 60 to 65 years Of the service users accommodated up to 6 may be in the category Mental Disorder (Older Persons) MD (E) and/or Dementia (Older Persons) DE (E). Of the service users accommodated one person may be in the category Physical Disability (Older Persons) PD (E) 29th October 2007 2. 3. Date of last inspection Brief Description of the Service: Cherry Lodge is able to provide accommodation and care for up to fourteen (14) older people. Some of the people living at the home may also have a mental disorder or dementia. The home is a large detached property located in Caterham, Surrey and accommodation is provided on two floors accessed by a stair lift. The accommodation comprises of an office, lounge, dining area, kitchen, laundry room, toilets, bathrooms, showers, ten single and two double occupancy bedrooms. The home has a large garden to the rear of the property that is well maintained, private, secure and has wheelchair access. The home is close to the local shops and amenities. Limited parking is available to the front of the home. Fees at this service range from £400.00 per week to £570.00 per week. The home welcomes enquiries from local authorities regarding placements at the home and funding levels. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Commission has since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced “Key Inspection”. The two inspectors arrived at the service at 10.15 am and were in the service for seven and three quarter hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager and any information that CSCI has received about the service since the last inspection. Mrs Sandra Holland and Ms Ruth Burnham, Regulation Inspectors, carried out this key inspection site visit. Mrs Cherie Callender, Registered Provider and Registered Manager was present during the inspection, representing the service. For clarity, Mrs Callender will be referred to as the manager in this report. A tour of the home was carried out and most areas were seen. A number of records and documents were sampled including residents’ care plans, medication administration records, staff recruitment and training records and some of the home’s policies and procedures. Eight residents, five staff and two visitors were spoken with during the course of the inspection visit. The people who live at the home prefer to be known as residents, so that is the term that will be used in this report. The inspectors would like to thank the residents and staff for their time, assistance and hospitality. What the service does well: People who live at the home benefit from the support of a range of healthcare professionals, and their healthcare and physical needs appear to be well met. A relative of a person who lives at the home advised that the resident had been well looked after during a recent illness. The home is well decorated and furnished and a number of improvements have been or are being made, to provide better facilities for those living at the home. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 6 People living at the home are supported and cared for by staff who have been appropriately recruited. More than 50 of the care staff have been trained in care to a National Vocational Qualification level 2 or above. What has improved since the last inspection? What they could do better: So that staff and people moving in to the home are aware of the procedure, a policy stating the assessment and moving in process should be developed and followed. This should ensure that the home will be able to meet the needs of people who move in, and only those people who meet the home’s categories of registration will be allowed to move in. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 7 People living in the home, or their representatives, should be asked to sign their care plans to show they have been involved in drawing it up and agree to the information being held about them. Controlled drug medication must be stored, administered and recorded as required and a Controlled Drugs register must be obtained. A copy of the Royal Pharmaceutical Society guidelines for the administration of medication in care homes should be obtained to provide management and staff with up to date knowledge regarding all aspects of medication administration to enable them to ensure the safety of people who live in the home. People who live in the home must be enabled to make choices in their daily lives, specifically in what they wish to eat, and should be supported in how they choose to spend their time. The menu and programme of activities should both be displayed to enable residents to see what is offered and to enable them to make their choices. The home should develop a restraint policy and procedure, so that staff aware of the actions that can be considered as restraint and the circumstances when this may or may not be applicable. Liquid soap and paper towels must be provided and used in the home to maintain hygiene, to prevent infection and the spread of infection. Staffing levels in the home must be reviewed to ensure there are enough staff to meet all the needs of residents. The staff rota must be maintained as an accurate record of all staff working in the home, and must record if the rota was actually worked. Radiators in the home must be guaranteed to be of the low surface temperature variety or must be covered, to prevent anyone from burning. The temperature of hot food served in the home must be tested and recorded to ensure that it is adequately cooked. A record must be maintained of the food served in the home to ensure residents are adequately nourished and in case of the outbreak of any food related illness. The advice of the local authority environmental health officer should be sought regarding the best ways to reduce the risks of infection in communal bathroom and toilet areas, and regarding the records that are required to be kept in the home in relation to the food served. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 8 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. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 9 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 Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 10 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): 1, 3 and 6. People who use the service experience adequate outcomes in this area. People who are considering moving into the home are provided with helpful information to help them decide if the home will be suitable for them. There is no clear policy or procedure for assessing peoples’ needs before they move into the home, and it is not clear how people can be confident the home will understand their needs, particularly if they have a specialist need such as dementia. Lack of clarity within individual assessments of specialist needs, could lead to a breach of the home’s conditions of registration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Helpful information is available for people who are considering moving into the home to enable them to make an informed decision as to whether the home will be suitable for them. This is contained in the Statement of Purpose and Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 11 Service User Guide. These documents have been updated since the last visit and include all the required information. No one has moved into the home since the last inspection visit, so the use of the home’s new assessment form could not be tested. Everyone who lives in the home now has a recorded assessment of their needs within their care plan. The home does not have a pre-admission policy or procedure, to ensure that a thorough assessment is carried out before people move into the home. It is therefore difficult to see how people can be confident their needs will be fully met. This is of particular concern where people are experiencing dementia. Conversations with the manager and staff indicated a lack of understanding of current good practice that takes account of relevant clinical guidance. This was demonstrated by the use of phrases such as ‘happily confused’ or ‘pleasantly confused’, which were heard from the manager and staff and were being recorded on individual care plans. The majority of staff have not been trained in caring for, and understanding the specialist needs of, people with dementia. The manager has obtained a new in house training programme, this includes a training module on dementia, which all staff will undertake in the future. There was some concern that this training is not being delivered by, or the competency of staff is being assessed by, anyone with the relevant qualification in the field. Discussion took place about the home’s current registration categories. These currently include people with a mental disorder. Neither the staff or the manager have any training in caring for people in this category and the manager confirmed there is no-one living in the home at the moment with a mental disorder other than dementia. The manager said she did not intend to provide care for people with a mental disorder in the future and would be contacting the Commission’s Registration Team with a view to removing this category from the home’s registration. Currently the home is registered to provide accommodation to up to fourteen people over the age of 65 years. One person with a physical disability can be accommodated and up to six people can be accommodated with dementia or a mental disorder. There is still no record of which residents are in which category, so it is not clear how the home would know if they could admit prospective residents to these categories. The manager agreed to re-assess everyone who lives in the home to ensure compliance with the home’s conditions of registration. Staff and the manager stated that intermediate care is not provided at the home, so Standard 6 does not apply. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9 and 10. People who use the service experience adequate outcomes in this area. People can be confident their physical and healthcare needs will be met although their emotional and social needs are less well understood and may not be met, particularly where people are experiencing some degree of dementia. People who live in the home are not involved or consulted about their plan of care. People are not fully protected where medication handling does not comply with up to date guidance. The privacy and dignity of people who experience dementia and who share a bedroom may not be upheld, as it is not clear if they have made a positive choice to share with one another. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans have been updated since the last inspection visit and they are being reviewed every month. Four care plans were sampled, these were up to date and contained information about peoples’ individual care needs. They also contained goals and objectives, but this information was not always developed Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 13 to provide clear guidance for staff on how to provide support in line with individual’s wishes and preferences. It was clear throughout the visit that a high priority is given to meeting the physical and healthcare needs of people who live in the home. People who were spoken to throughout the visit were happy with the care they receive. It was of concern however that people who have more complex needs such as dementia may not have their social and emotional needs met where staff do not understand their specialist needs. Care plans contain no information about peoples’ lives and interests before they moved into the home. Some information is recorded about people’s spiritual needs, and a minister from a local church visits to provide communion for those who wish to take part. To safeguard residents from avoidable risks, individual assessments of risks have been recorded as part of the care plan. These cover some activities of daily living, including mobility, the risk of falls and the use of bed rails. People who live in the home have not been involved in drawing up their care plans and none of the care plans have been signed by them or their representatives. This was discussed with the manager who agreed to ensure people are fully involved in this process in the future. People can be confident their healthcare needs will be met. One person who was spoken with particularly appreciated being able to see a wide range of healthcare professionals in the home such as the dentist, optician, chiropodist and hearing specialist. Records show people receive regular health checks. Generally the safe handling of medication in the home protects residents from harm, although the manager was advised of the importance of keeping up to date with current good practice. Areas of medication guidance have recently been updated and the manager agreed to obtain a copy of the latest Royal Pharmaceutical Society guidelines. These relate to medication practice in care homes to ensure that current storage and administration arrangements comply with recommendations. There was some concern about the management of a controlled drug in the home, as there is no separate controlled drug record and the storage facility may not be fully compliant with the latest guidance. It is recommended that advice is sought to confirm whether the current medication storage facility complies with the latest guidance, as other arrangements may need to be made to ensure that any controlled drugs are stored as required. It was noted that a cool box is available for the storage of medication which needs to be chilled, although this is not used at the moment. Staff said the temperature would be checked if it were in use. Medication administration records were seen and were well maintained and up to date. The lunchtime administration of medication was observed to be carried out in a calm and unhurried manner, giving residents time to take their medication. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 14 People who were spoken to during the visit said staff are very good, helpful and kind. Staff were observed to treat people with respect and to assist with personal care in a discreet way that ensured people’s dignity is upheld. Staff speak to residents in a friendly, informal way, using their preferred names. There are currently two shared rooms in the home, these are shared by people who are experiencing some degree of dementia. A discussion was held with the manager that only people who have made a positive choice to share a room should be accommodated in these rooms. Care plans do not currently show how the decision to share these rooms came about, or if the people concerned had genuinely been able to make a positive choice to share with one another. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 and 15. People who use the service experience adequate outcomes in this area. People who live in the home are benefiting from the increased choice of activities available since the appointment of an activities coordinator. Visitors are welcomed to the home and residents are supported to keep in touch with their families and friends. Peoples’ individual needs and preferences are not taken account of at mealtimes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection visit, an activities coordinator has been appointed and people are looking forward to the introduction of an activities programme. This is due to be carried out when the new activities co-ordinator returns from leave in February. It was encouraging to see a start has already been made in getting to know each person’s interests. The manager agreed to make use of the personal life history information that has been collected so far, in developing each person’s care plan to include biographies, social interests and hobbies. A new notice board has been purchased so the programme of activities can be displayed once it has been developed. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 16 At the moment care staff are doing some activities with people, but they are unable to carry out any social activities with residents during the mornings. This is because they are too busy helping residents with their personal care and carrying out housekeeping tasks. Some activities were taking place during the afternoon of the visit. People are encouraged to maintain contact with their families and friends, and visitors to the home are made welcome. Visitors were seen in the home at the time of inspection and made positive comments about being able to visit at any time of day and the home contacting them if their relative required anything. The lunch-time meal was being served during the course of the inspection visit and it was clear that this was the main meal of the day. Meals are served in the dining room, which was attractively decorated and furnished with tables for varying numbers of residents. It was recommended following the last inspection visit that the menu should be displayed or provided to residents, to enable them to know what meals were being offered and to enable them to choose an alternative if preferred. It was disappointing to find that people still did not know what meal was being served until it was placed in front of them. Staff advised that residents could request an alternative meal if they do not like what is served, but as residents do not know what the meal consists of until it is actually served, this limits their choice and would cause a delay whilst an alternative is prepared. It is recommended again, that the menu is displayed and provided to residents in a format that is suited to their needs. As there is still no menu displayed, nor any menu plan held in the kitchen, the temporary cook uses whatever meat has been left out for her to prepare a meal of her choice without any consultation with residents. The meal served was very good with three different vegetables, mashed potato and pork cooked with onions, but the meals were plated up in the kitchen with no regard for individual preferences or requirements. There was plenty of food on each plate but all were the same size, which was daunting for people with smaller appetites. People who were spoken to were not aware they could choose an alternative if they did not like what was placed in front of them. The dessert served was bread and butter pudding with custard, again plated up in the kitchen with everyone receiving the same quantity. Once again, no alternative option was offered. This practice is severely limiting people’s choice and independence at mealtimes. The manager said a new cook has recently been appointed, it was anticipated that they would be starting very soon and that it was planned that the new chef will review and revise the menu. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 17 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): 16 and 18. People who use the service experience adequate outcomes in this area. The home’s policies and procedures relating to complaints, whistle blowing and safeguarding adults have been updated. This ensures that residents and staff know how to complain and what they should do if they have concerns about the care or support a resident receives, or about the way that the home is operated or managed. Guidance must be provided to staff about dealing with aggression and the use of restraint, to ensure the safety of residents and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints policy and procedure has been reviewed and updated since the last inspection. A copy of the procedure is included with the home’s statement of purpose, which the manager stated is made available to each resident in their room. The manager advised that a copy of the complaints procedure is to be displayed on the new notice board that has been purchased for the entrance hall. People who live at the home said they would speak to the deputy manager or the manager if they had any concerns or were unhappy about anything, but had not had cause to do so. A resident’s relative was spoken with and advised that they had no complaints, but felt confident that any dissatisfaction would Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 18 be listened to and dealt with. No person has contacted CSCI about any complaint made to the home. A requirement was made following the last two inspections, that the home must review and update its policies and procedures, including those relating to adult protection (now known as safeguarding adults), whistle blowing and dealing with aggression. A timescale of 28th September 2007 was given following the last inspection and this has been complied with. The home has updated the policy and procedure regarding abuse and whistle blowing. A procedure for dealing with aggression was not present in the policies and procedures file and should be developed to ensure the safety of residents and staff, in the event of an aggressive incident. It was positive to note that the abuse policy and procedure now refers to the Surrey local authority multi-agency guidelines, which the home would follow in the event of a suspicion or allegation of abuse. The home’s abuse policy and procedure does state it “is the duty of management to interview the informant”, which may not always be appropriate, and this was discussed with the manager. Staff spoken with were aware of differing types of abuse and understood their role in safeguarding those living at the home. Staff said they would report any concerns to the deputy manager or manager and would not hesitate to do so. From the staff training records seen at the time of inspection, and from the full staff training plan that was supplied to CSCI, it was noted that the majority of staff have received training in safeguarding adults or safeguarding adults awareness. Some discussion took place about the use of restraint. There is no restraint policy in the home, and it was observed that one resident’s walking stick was placed out of reach while she was having her lunch. This caused some anxiety and the need for staff to reassure her that it was safe. The manager was advised to update her knowledge about restraint and provide clear guidance and training for staff on this issue. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 19 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): 19 and 26. People who use the service experience adequate outcomes in this area. The home is attractively decorated, well maintained and presents as a comfortable place to live. Improvements are needed to ensure that hygiene is maintained and to safeguard those living and working in the home from infection or the spread of infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager advised that the building works that have been carried out at the home for a long period are almost complete, and an application to CSCI will shortly be made to register the additional resident bedrooms. Most areas of the home were seen, although this did not include any of the new bedrooms. A new hairdressing room has been created and was about to Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 20 be equipped the manager advised. The areas that were seen were clean, well maintained and freshly aired. Some resident’s rooms were seen with their agreement, and these appeared comfortable and well furnished. The manager advised that most of the furniture in resident bedrooms is supplied by the home, but residents can bring in their own televisions, pictures, ornaments and photographs to make their rooms more personal. A number of radiators in the home were very hot to touch and may present a risk to those living and working in the home. This is referred to at Standard 38, which relates to health and safety and safe working practices. It was positive to note that since the improvements works have been carried out, all ten single bedrooms now have an en-suite toilet and basin. There are two double bedrooms and curtains are provided to ensure privacy for the occupants. One of the double rooms also had a curtain around the wash-hand basin to ensure those using it could do so in private. It was observed in one of the double bedrooms, that a chest of drawers had been provided for each resident, but both of these were situated in the window bay. To access their chest of drawers, one resident would have to encroach on the personal space of the other resident and this was discussed with the manager. Improvements have been made to a number of bathrooms and toilets, including the fitting of a specialist easy access bath, which is fitted with a hoist chair. It was noted that in some bathrooms and toilets no liquid soap, soap or paper towels were provided, so it was not clear how residents or staff would adequately wash their hands after using these facilities. In other bathrooms fabric towels were present, but these are not considered hygienic because their use increases the risk of the spread of infection. This was discussed with the manager and it was recommended that the advice of the local authority environmental health officer should be sought on how best to reduce the risks of infection in communal bathroom and toilet areas. Staff advised that personal protective equipment including gloves and aprons are provided and used to prevent infection or the spread of infection and one member of staff advised that they had received infection control training. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29 and 30. People who use the service experience adequate outcomes in this area. A small team of staff are employed to meet the needs of people living at the home, but this needs to be reviewed to ensure there are enough staff to meet all the needs of those living there. Staff have been appropriately recruited and receive a range of training including National Vocational Qualifications. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A small team of staff are employed to meet the needs of the people living at the home. The team consists mainly of care staff, but a part-time cook and an administrator are also employed, and an activities co-ordinator has recently been employed. As no housekeeping or laundry staff are employed, these tasks are carried out by care staff, in addition to providing personal care and support to residents. Care staff advised that they also carry out social and leisure activities with residents when they have time. The staff rota was reviewed and is referred to at Standard 37, which relates to record keeping. A requirement was made following the last inspection that staffing levels in the home must be reviewed, to ensure there are enough staff working in the home to meet the health and welfare needs of the residents. A timescale of 26th November 2007 was given, but this has not been fully met. The manager Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 22 stated that she had reviewed the staffing levels, but did not have any documents to confirm this and had not used any recognised tool, such as the one provided by the Residential Forum. Information previously supplied stated that a number of staff have achieved a National Vocational Qualification (NVQ) to level 2 or above in care, and the home exceeds the recommended 50 of staff trained to this level. A member of staff who was spoken with advised that they would be starting their NVQ level 2 in care next month. A requirement had been made following the last inspection that persons must not be employed to work in the home unless they were fit to do so and the specified information and documents had been obtained. This requirement has been met and people who live in the home are now better protected. Staff recruitment files were randomly sampled and the appropriate checks had been carried out, including two written references, checks with the POVA (Protection Of Vulnerable Adults) register and Criminal Record Bureau (CRB) disclosures. The specified records and documents had been obtained before applicants had been allowed to work in the home. Individual staff training records have recently been introduced in the home and a small number of these were seen. These indicated that staff had received training at a fire safety workshop, in first aid awareness, moving and handling awareness and food safety. As training records were not easily available for all staff, the manager agreed to forward a training plan showing the training received by all staff. This was supplied to CSCI before this report was written and has been used to inform the judgements made. Most of the training was arranged in the home using a recently purchased care training package that is used on the computer, the manager advised. It is not clear whether the training package fully covers all the requirements of specific courses which staff must undertake by law, (mandatory and statutory training), such as food hygiene or moving and handling, and it recommended that advice is sought to confirm this. The manager stated that she supports staff using this training package and that she was qualified to train staff in moving and handling. Confirmation was seen that the manager was shortly to attend a refresher course in this, but it was not clear if the manager has undertaken any training in order to be able to train staff in other areas. It was observed that there was cultural and racial diversity amongst the staff team that was not reflected in the resident group, but as residents did not mention this, it was not understood to be an issue. Residents and staff appeared relaxed in each others company and staff were seen to treat the people living the home with respect and dignity. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35, 37 and 38. People who use the service experience adequate outcomes in this area. Progress has been made to improving the outcomes for people living at the home, but further work is required to ensure good outcomes. The number of requirements and recommendations made following this inspection site visit indicate that the management of the home needs to recognise any areas requiring improvement, and be pro-active in ensuring these are dealt with to fully safeguard those living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager stated that she has owned and run the home for many years. She advised that she started to undertake the NVQ Registered Manager’s Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 24 Award over two years ago, but has only completed half of the qualification because she could not obtain funding for the course. The manager stated that she is due to meet a representative of the Surrey Care Association to see if funding can be obtained. It is strongly recommended that the manager completes this course and other training, to ensure she has the knowledge and skills to manage the home to ensure good outcomes for the people living there. A requirement was made following the last inspection that the home must be conducted to promote and make proper provision for the health and welfare of residents. A timescale of 26th November 2007 was given and this has been partially met. Progress has been made in improving the outcomes for people living at the home and to meeting a number of the requirements made. Although the majority of the outcomes for people living at the home have been improved, they remain only adequate. Discussion took place with the manager about the need for the manager to be pro-active and to recognise weaknesses in the service being provided, rather than being re-active to inspections and any requirements made. Following the last inspection, the home was required to provide an improvement plan to state how improvements were to be made to ensure better outcomes for the people living at the home. The manager stated that this was not received and it was agreed that this would be provided within one week of the date of this inspection. The improvement plan was supplied before this report was written and has been used to inform the judgements made. It was recommended following the last inspection, that the results of the survey that was carried out to review the quality of the service should be provided to the people living at the home and their representatives. The manager stated that she is in the process of assessing the results and will supply them very shortly. The administrator advised that monies are not held for safekeeping on behalf of residents. Any additional expenses such as for hairdressing or chiropody are paid for by the home, and are then invoiced to the resident or their representative for repayment. The manager stated that a number of the home’s policies and procedures have been reviewed and updated, to ensure that they provide staff with effective guidance in good practice and staff are informed of updated changes to the law as it affects their work. These were seen and included the abuse procedure, the moving and handling procedure and whistle-blowing. It was noted that some of these still require further review and this was discussed with the manager. To ensure the safety of residents and staff, members of staff should also work in accordance with the home’s policies and procedures. It was noted that the Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 25 moving and handling policy states “Never manually lift a person”, but two staff were seen to help a resident out of their chair by holding the resident under her arms. The staff rota was reviewed to ensure that enough staff are provided to meet the needs of people living at the home. A small number of gaps were noted in the rota and the manager stated that she would have covered those shifts, but had not recorded them. The staff rota must be maintained as an accurate record of all staff working in the home and whether the rota was actually worked. A requirement was made following the last inspection that all parts of the home to which residents have access must be free from hazards to their safety. Specifically, products and equipment hazardous to health must be stored in a locked provision. A timescale of 12th November 2007 was given and this has been met, but different hazards to the health, safety or welfare or residents were noted during this inspection. As mentioned at Standard 19, during the tour of the home it was observed that a number of radiators were very hot to touch and had not been covered to prevent anyone from burning themselves. The manager stated that she had been advised that the radiators were low surface temperature radiators. Checks must be carried out to find out which radiators have guaranteed low surface temperatures, as any others must be covered to safeguard against burning. From discussions with staff, it was clear that no record is being maintained of the food served in the home, or of the temperature of hot food that is served. These records must be maintained to enable any person inspecting the record to know if the food served is adequately nourishing, and to know what special diets if any, are prepared for people who live at the home. This information would also be required in the event of an outbreak of any illness or disease which may be food related. It is recommended that the home contact the local authority environmental health officer regarding the records that are required to be kept in relation to food in the home, and as mentioned previously, in regard to maintaining hygiene in the home. Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 Requirement The care plans must provide staff with adequate detail and guidance as to how residents’ needs must be met. Timescale for action 26/02/08 2 OP9 13 (2) A Controlled Drugs register, 26/02/08 which is a bound book with numbered pages, must be provided for the secure recording of any Controlled Drugs prescribed for service users. People living at the home must 12/02/08 be enabled to make decisions with respect to the care they are to receive and their health and welfare. Specifically, the menu should be displayed in the home to enable residents to know what meals are offered and to enable them to choose an alternative if preferred. Residents must not be subjected to physical restraint, including the withdrawal of mobility aids, unless that is the only practicable means of ensuring the welfare of that or any other DS0000013596.V357284.R01.S.doc 3 OP15 12 (2) 4 OP18 13 (7) & (8) 12/02/08 Cherry Lodge Rest Home Version 5.2 Page 28 resident. 5 OP26 13 (3) Arrangements must be made to prevent infection, toxic conditions and the spread of infection. Liquid soap and paper towels must be provided and used in the home. The staffing levels in the home must be reviewed to ensure that there are enough suitably qualified, competent and experienced staff working at the home at all times, to meet the health and welfare needs of residents. A staff rota must be maintained as an accurate record of all staff working in the home and must record whether the rota was actually worked. 26/02/08 6 OP27 18 26/02/08 7 OP37 17 & Schedule 4.7 12/02/08 8 OP38 13 (4) (a) All parts of the home to which 26/02/08 residents have access must so far as reasonably practicable, be free from hazards to their safety. Specifically radiators must be safeguarded to prevent those living or working in the home from burning. Records of the food provided to 12/02/08 residents must be maintained in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition of otherwise, and of any special diets prepared for individual residents. 9 OP38 17 & Schedule 4.13 Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations The home should develop and follow an assessment and moving in policy and procedure so that staff and people moving in are aware of the processes involved. It is good practice to ask residents to be involved in drawing up their care plans and to sign the plan to show their involvement. It is recommended that the activities provided by the home be reviewed taking into account the views of the people who use the service. This will assist the home to make sure regular activities as preferred by the residents are available. The home should develop and follow a restraint policy and procedure to ensure staff are aware of what actions are considered as restraint and the circumstances when this may or may not be acceptable. It is good practice to seek the advice of the local authority environmental health officer regarding the best ways to reduce the risks of infection in communal bathroom and toilet areas, and regarding the records that are required to be kept in the home in relation to the food served. It is recommended that the manager completes the Registered Manager’s Award training course that she has started to ensure she has up to date knowledge of current good practice. The results of the quality survey should be made available to residents and others involved in their support, so that all are aware of the outcomes. It is good practice to maintain a record of the temperature of hot food served in the home, to ensure food is properly cooked and in case this information is required in the event of any food related illness in the home. 2 OP7 3 OP12 4 OP18 5 OP26 6 OP31 7 OP33 8 OP38 Cherry Lodge Rest Home DS0000013596.V357284.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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. 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