Inspection on 29/10/07 for Cherry Lodge Rest Home

This inspection was carried out on 29th October 2007.

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 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 29/01/08

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 October 2007 10:00 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.V352393.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.V352393.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.V352393.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) 2nd July 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.V352393.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection site visit was carried out by the Commission for Social Care Inspection (CSCI) under the Inspecting for Better Lives process. Mrs Sandra Holland and Mrs Pauline Long, Regulation Inspectors carried out the inspection visit over five and three quarter hours. Mrs Cherie Callender, Registered Provider and Registered Manager was present representing the service. For clarity, Mrs Callender will be referred to as the manager throughout this report. A tour of the premises was carried out and a number of records and documents were sampled, including medication administration records, residents care plans, fire safety records, staff recruitment and training files. The people living at the home prefer to be known as residents and that is the term that will be used throughout this report. The inspectors would like to thank residents and staff for their hospitality, time and assistance. What the service does well: Many areas of the home are being improved in order to provide better facilities for residents. These include the provision of more en-suite toilets and bathrooms and the upgrading of existing facilities. Residents’ relatives have commented in the home’s survey that the home has continued to run smoothly even during the building works. A number of positive comments were made in response to the home’s survey, including – “I am pleased my relative is well looked after”; “I feel the home is very well run and most of the staff are helpful and friendly” and “Management and staff provide an excellent care service to residents at Cheery Lodge”. Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Seven of the thirteen requirements made following the last inspection carried out on 2nd July 2007, have not been complied with. These related to the Statement of Purpose and Service User’s Guide, pre-admission assessments of residents’ needs, reviewing residents’ care plans, the assessing of daily living risks to residents, updating the home’s policies and procedures, including those regarding abuse and safeguarding adults, carrying out a risk assessment regarding staff who should have first aid training, reviewing staff training needs. Due to the shortfalls listed above, the registered manager was informed at the end of the inspection that evidence was gathered during the inspection, in line with Code B of the Police And Criminal Evidence Act. CSCI will determine what action is to be taken to secure compliance and to ensure good outcomes for those living at the home. Care plans must be drawn up to guide staff to the care and support needs of residents. The range of social and leisure activities should be reviewed in consultation with residents. A programme of the planned activities should be displayed to ensure residents can choose those activities they would like to take part in. Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 7 The menu should be displayed to inform residents of the meals on offer and to enable them to choose an alternative if preferred. Staffing in the home must be reviewed to ensure there are sufficient staff to meet all the needs of residents. Persons must not be employed to work in the home unless the specified information and documents have been obtained in relation to those persons. The home must be managed to promote and protect the health and welfare of residents. The results of the quality survey carried out in the home should be reviewed and a report supplied, to inform residents and others of the outcomes. Products and equipment that may be hazardous to health must be stored in a locked provision. 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.V352393.R01.S.doc Version 5.2 Page 8 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.V352393.R01.S.doc Version 5.2 Page 9 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. As the home’s Statement of Purpose and Service User Guide are not up to date, prospective residents are not provided with the information they need to make an informed choice about where to live. It is not known how the home would know if it could meet the needs of recently admitted residents, because their needs were not assessed before they moved into the home. EVIDENCE: A requirement was made following the last inspection carried out on 2nd July 2007, that the home’s Statement of Purpose and Service User Guide must be revised, to include all the required information. A timescale of 28th September 2007 was given, but this has not been complied with. The manager had made a written response to the requirements and recommendations made at the last inspection. This stated that “the statement of purpose and service user guide would be completely overhauled by the end Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 10 of September and a copy will be supplied to CSCI”. This has not been fully carried out and a copy was not supplied to CSCI. A copy of the Service User’s Guide was provided at the inspection visit, but this was not complete. Information relating to the numbers of staff and their qualifications, the organisational structure of the home, the range of needs that the care home is intending to meet and the number and sizes of rooms was not included. Some of this information was provided at the time of the inspection visit, but the documents were not complete, and would not provide a prospective resident with the information needed to make an informed decision. A requirement was also made following the last inspection carried out on 2nd July 2007, that the home must develop the pre-admission assessment of prospective residents’ needs. This must ensure that more detailed information is gathered about the needs of prospective residents, especially regarding mental health, dementia or any other specific health need, in order for the home to confirm that it can meet those needs. A timescale of 6th June 2007 was given but this has not been complied with. The written response stated, “the pre-admission assessment has been updated to include specific health details. This will make it clear to CSCI that the home has made the assessment and is able to meet the individual service users needs”. During the inspection visit however, the manager stated that two residents have been admitted since the last inspection, but their needs have not been assessed before they moved into the home. The manager stated that the needs of the two newly admitted residents had not been assessed because one was a relative of the manager and the other had been known to the manager for many years. 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. As the home does not keep a record of which residents are in which category, it is not clear how the home would know if they could admit prospective residents to these categories, particularly as the needs of prospective residents have not been assessed. 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.V352393.R01.S.doc Version 5.2 Page 11 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ care plans need to be drawn up promptly when residents move into the home to ensure staff have clear guidance in meeting residents’ needs. The care plans for existing residents need to be developed further to ensure staff are fully aware of the support and care needs of residents. Residents’ healthcare needs are well met and medication appears to be managed appropriately. EVIDENCE: A requirement was made following the last inspection carried out on 2nd July 2007, that residents’ care plans must be reviewed, where possible with the resident or their relative, to make sure the information provided is up to date and will provide staff with enough detail to meet residents’ needs. The reviews must clearly state what changes in residents needs have taken place. A timescale of 28th September 2007 was given but this has not been complied with. Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 12 The manager’s written response regarding the requirement stated that “the home is in the process of updating the care plans and this will be completed by the end of September 2007”. The care plans of a number of residents were seen and these contained a lot of information about the needs of individual residents. It was clear however, that these still need to be developed further, to ensure they effectively guide staff to residents’ needs and the support required to meet those needs. Staff advised that they are not involved in care planning as the home’s management carries this out. It was noted that no care plan or assessments of risks had been drawn up for the two recently admitted residents, so it is not clear how staff would know of the care and support needs of these residents. A requirement was also made following the last inspection carried out on 2nd July 2007, that an assessment must be carried out of the risks to residents associated with the activities of daily living, including mobility and the use of bed rails. The assessments must take into account the assessed needs of the resident, to make sure that any support, activity or care which is carried out, considers the well being and safety of the resident. A timescale of 31st August 2007 was given but this has not been complied with. The written response to this requirement stated “done”, but no risk assessment was available as part of any residents’ care plan. For a resident who uses a bed rail, agreement to this had been supplied by a residents’ family. This did not demonstrate however, that the home has considered all the possible risks to the resident, or informed staff of any control measures which may be used to minimise these risks. From records seen and speaking to staff, it was clear that a number of healthcare professionals are involved in the support of residents. These include general practitioners (GPs), dentist, chiropodist, community psychiatric nurse (CPN), district nurse, optician and physiotherapy technician. Medication in the home is stored appropriately and most aspects of the administration of medication appeared to be well managed. A senior member of staff advised that they take the lead in ordering and receiving medication stocks. The lunch-time administration of medication was observed to be carried out in a calm and unhurried manner, giving residents time to take their medication. It was noted that a fridge is available for the storage of medication which needs to be chilled, but no thermometer is available to check the temperature reading of the fridge. It is recommended that a thermometer is obtained and Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 13 regular checks are made of the fridge temperature, to ensure that medications are stored correctly. Staff were observed to treat residents with respect and to assist with personal care in a discreet way that ensured residents’ dignity. Staff spoke to residents in a friendly, informal way, using their preferred names. Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents need to be provided with a greater variety of social and leisure activities and to be informed about these in advance. Visitors are welcomed to the home and residents are supported to keep in touch with their families and friends. The home’s menu plan should be supplied to residents and displayed to enable residents to make choices about the meals offered. EVIDENCE: The manager stated that a programme of activities is displayed on the notice board in the lounge and that a member of staff takes the lead in arranging activities. It was noted however, that no activities programme was displayed to advise residents of any planned activities. Staff stated that they are not able to carry out any social activities with residents during the mornings, as they are too busy helping residents with their personal care, and carrying out laundry and housekeeping tasks. Staff advised that they try to arrange activities during the afternoons, but this appears to be reliant on enough staff being on duty, and is likely to be arranged at short notice rather than planned. This does not enable residents Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 15 to look forward to an activity, to choose what they would like to do in advance, or to arrange other aspects of their daily lives. A recommendation was made following the last inspection, that the activities in the home should be reviewed, taking into account the views of residents. This would help the home to ensure that residents preferred activities are available. The manager’s written response to the requirements and recommendations stated “review in progress”. It is recommended that this review is completed and actions taken in accordance with the outcomes, as a number of people who responded to the home’s quality survey indicated that there needs to be more activities in the home, and a greater variety of these. Comments included “ could be more activities for service users”, “more activities for residents – I feel they just sit in chairs and watch TV” and the hope that more activities would be organised, and when there were more staff, residents could go out for a walk. Under the section of the survey titled “What can we do better”, a comment was made “make me aware of the activities programme”. Residents are encouraged to maintain contact with their families and friends, and visitors to the home are made welcome. One resident’s relative spoke appreciatively of being able to keep in touch by phone, when they were not able to visit. 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 is attractively decorated and furnished with tables for varying numbers of residents. The cook stated that a four-week menu plan is followed and traditional British meals are served, as the resident group prefers these. It was noted that the menu plan is not displayed or provided to residents, so residents have no way of knowing what meals are to be served each day, or if any alternative is available. Staff advised that residents can 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 served, this limits their choice and would cause a delay whilst an alternative is prepared. It is recommended that the menu is displayed and provided to residents in a format that is suited to their needs. Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s procedures regarding complaints need to be updated and provided to residents and others, so that residents can be sure their complaints will be listened to and acted on. Residents are not fully protected from abuse because the home’s safeguarding procedures still need to be updated, and staff need to be trained in safeguarding adults. EVIDENCE: The home’s complaints record was seen and no complaints had been recorded. It was noted however, that the home’s complaints policy and procedure needs to be updated. The complaints procedure was dated 2004 and marked for review in 2005, but this had not been carried out. The complaints procedure refers to the National Commission for Social Care (NCSC) which ceased to exist in 2004. Responses to the home’s quality survey indicated that a number of residents’ relatives and friends were not aware of the home’s complaints procedure. It is recommended that this is supplied to all residents and their supporters and displayed more prominently. A requirement was made following the last inspection carried out on 2nd July 2007, that the home’s policies and procedures must be reviewed and revised, to include the policies and procedures regarding adult protection, whistleCherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 17 blowing and dealing with aggression. Where necessary, these must take into account the guidelines of other agencies, such as the local authority multiagency guidelines for safeguarding adults. A timescale of 28th September 2007 was given but this has not been complied with. The home’s abuse policy was seen, was dated 2005 and was marked for review in 2006, but this had not taken place. It was noted that the home’s abuse policy and procedure does not refer to the local authority safeguarding adults procedures and refers to the manager investigating any allegations, which may not be appropriate. The manager stated that the home would refer to the Surrey Multi-Agency Safeguarding Adults procedure in the event of any suspicion or allegation of abuse. An up to date copy of the procedure is kept in the home for staff to refer to if needed. Staff stated that they were aware of the home’s whistle-blowing procedure and would use it if they needed to. Staff advised that they would report any concerns about residents to the manager or the person in charge. It was noted from staff training records, that not all staff working in the home have received training in safeguarding adults. Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 18 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements are being made to the facilities in the home to ensure that residents live in a well maintained and comfortable environment. The home is kept clean, freshly aired and appeared hygienic. EVIDENCE: From the tour of the premises and speaking to residents and staff, it was clear that there have been major investments in the home, and a number of improvements are being made to the premises of the home to update the facilities. The manager stated that en-suite toilets are being provided to a number of resident bedrooms, and many areas of the home have been, or are being, refurbished. A hairdressing salon has been created, the dining room has been decorated and re-carpeted and the stair carpet is also being renewed. Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 19 The building work to make the improvements has been going on for a long period, but residents and their supporters appear to understand that these will be of benefit in the long term. Comments were made in the home’s quality survey that the “building work was being carried out to improve the property” and “things are running smoothly despite the building works”. The communal areas of the home consist of a large lounge with a television and music facilities. An archway leads through into the adjoining dining room. Residents’ bedrooms were seen with their agreement, and were observed to be well presented and clean. Residents advised that they had been able to bring small items of furniture and other belongings into the home to make their rooms more personal. There is a large garden which can be accessed from doors in the lounge and dining rooms, which lead onto an extensive patio. A ramp provides access to the lawn area for people using wheelchairs. All areas of the home that were seen were clean, freshly aired and appeared hygienic. Staff advised that personal protective equipment, such as aprons and gloves, are provided and used in the home to prevent infection and the spread of infection. Paper towels and liquid soap were seen in appropriate places to maintain hygiene. Two hazards to the health and safety of residents were noted during the tour of the premises and these are referred to at Standard 38 that relates to safe working practices. Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A small team of staff are employed to meet all the needs of residents. The standards of recruitment and staff training need to be improved, to ensure residents are supported by staff who are fit to work in a care home and are competent to carry out their role. EVIDENCE: The manager stated that a small team of care staff are employed to meet the needs of residents. In the absence of ancilliary staff, the care team carry out laundry, housekeeping and activity tasks, in addition to assisting residents with their personal care. The previous housekeeper had recently left, the manager stated, and these tasks were currently being carried out by day and night care staff. A cook, a general administrator and an accounts administrator are also employed at the home, the manager advised. It was observed during the inspection visit that a number of residents are quite dependent on staff and have a high level of need. As mentioned previously, staff advised that they are not able to carry out social or leisure activities with residents in the mornings, as they are too busy with their other tasks. A requirement has been made that staffing levels in the home must be reviewed to ensure that these are sufficient to meet all the needs of residents. Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 21 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. The recruitment files of recently recruited staff were sampled and these indicated that most of the required information had been obtained, but the required checks had not been effectively carried out, and may not fully protect residents. It was noted that for two recently recruited staff only one reference was held on each of their files. The manager explained that for one member of staff, the second reference was a verbal reference, although no record had been made of this at the time it was obtained. The manager completed this record during the inspection visit. For another member of staff, who had previously worked with vulnerable people, repeated requests for a reference had been made to the last employer, the manager stated. The previous employer sent an emailed reference during the inspection visit, but it was noted that this did not state the email address of the employer. Another reference for this member of staff was dated after the date the person started working in the home, although The Care Homes Regulations 2001 (As Amended) state that persons must not be employed to work in the care home until all the specified information and documents have been obtained. A Criminal Records Bureau (CRB) disclosure was not held on file for either of these members of staff as they had been recruited only very recently, the manager stated. A check had been carried out with the POVA (Protection Of Vulnerable Adults) register however, for the member of staff who was employed to work in direct contact with residents. A requirement was made following the last inspection carried out on 2nd July 2007, that an assessment must be carried out to determine what level of first aid training is required by staff. A timescale of 10th August 2007 was given, but this has not been complied with. The manager’s written response stated, “risk assessment identified that Care Home is medium risk for needing First aiders in the work place (FAW). This assessment requires one FAW for every 45-50 staff. The registered manager has trained as FAW and will also enrol the senior night staff and two other prominent members of the day staff as an Appointed Person. The rest of the staff will all receive detailed training in first aid”. During the inspection visit, the risk assessment referred to above could not be provided. The manager was able to confirm that she had recently undertaken and completed a four-day first aid course, but there were no records to Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 22 demonstrate that any other staff had received first aid training. In the absence of the manager, it is not clear who would effectively deal with any accidents in the home. A further requirement was also made following the last inspection, that a review must be carried out of the training provided to staff, to ensure that staff are equipped to meet the specialist needs of residents, such as mental health needs. A timescale of 10th August 2007 was given, but this has not been complied with. The manager’s written response stated “this has been done and assessed training requirements have been arranged. All staff have an individual training plan and the home has an overall training plan. The home exceeds the standard for staff holding NVQ in Care”. It is clear that some residents have identified health needs as they receive support from a healthcare specialist, but there were no records to demonstrate that staff have received training to meet these needs. The manager stated during the inspection visit, that staff training in relation to mental health needs has not been carried out because it has not been possible to find a training provider. The manager has developed a staff training form to record the training planned or undertaken by staff, and a blank version of this was seen. The manager stated that she plans to implement the use of this to assist in monitoring the training needs of staff. Individual staff training files have been drawn up and these also contained a form to record training, but these had not yet been completed. As mentioned above, a number of staff need to receive updated training in first aid, safeguarding adults and other mandatory (required by law) training, such as fire safety and food hygiene. Staff must receive training in these areas to ensure they provide competent and safe care and support to residents. Cherry Lodge Rest Home DS0000013596.V352393.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 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home needs to be more effectively managed to ensure better outcomes for the people living there and to ensure their health, safety and welfare. EVIDENCE: Although the manager has owned and run the home for many years, it is clear from the unmet requirements and the number of poor or adequate outcomes for the people living at the home, that it is not being effectively managed. The manager stated that she has started to undertake the NVQ Registered Managers Award (RMA), but completion is on hold because the manager is awaiting further funding for this. Apart from a recent first aid course, the Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 24 manager has not undertaken any other training to update her skills or knowledge. The manager stated that she had not read the report of the last inspection, but was aware that the “paperwork” in the home was not being managed to the required standard. The manager stated that her priority and that of her staff, was the day to day needs of the residents, which the manager felt were being adequately met. With the support of new staff and that of an external consultant, the manager stated that she is aiming to “get things back on track”. It is recommended that the roles of staff, particularly senior staff and management, are clearly defined, so that each member of staff is fully aware of their responsibilities. This should enable the manager to more effectively monitor all aspects of the running of the home and ensure better outcomes for residents living there. A requirement was made following the last inspection carried out on 2nd July 2007, that specified a number of the home’s policies and procedures which needed to be reviewed and revised. It was noted at the inspection visit, that almost all of the home’s policies and procedures need to be updated, as most were dated 2004, for review 2005, but there was nothing to indicate that these had been reviewed. It is not clear how staff will be aware of current good practice or changes in legislation if up to date policies and procedures are not provided. A requirement was made following the last inspection, that an annual quality survey must be carried out, to ask residents, their representatives and others involved in their support for their views on the service provided. A report of the information collected must be produced, to ensure the home is run in the best interests of residents. A copy of the report was requested by CSCI. The manager’s written response stated that “the survey has been sent to all concerned and responses are still being received. The report will be forwarded to the commission once the cut-off date for responding has been reached and the report completed”. A timescale of 31st August 2007 was given and this has been partially met. The surveys have been distributed and responses received, but no analysis of the results has taken place, and no report has been drawn up. A number of the responses received were seen during the inspection visit and a number of these have been referred to in this report. Monies are not held for safekeeping on behalf of residents, the manager advised. If a resident incurs any additional expenses, such as hairdressing or chiropody, these are paid for by the home and residents or their representatives are sent an invoice for reimbursement. Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 25 Although most areas of the home were seen to be free from hazards to the health, safety and welfare of residents, during the tour of the premises two hazards were noted. A variety of products, which may be harmful to health, were stored in an unlocked cupboard in the hallway, and a number of tools were seen on the floor on the landing. These were all immediately moved by the manager to ensure residents were safeguarded. Cherry Lodge Rest Home DS0000013596.V352393.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 2 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 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 2 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 2 Cherry Lodge Rest Home DS0000013596.V352393.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 OP1 Regulation 4,5,6 Requirement The Statement of Purpose and the Service User Guide must be revised to make sure all the information required in the National Minimum Standards for Older People and The Care Homes Regulations 2001 are provided. This will make sure prospective residents and their relatives know what the home does or does not provide and what they can expect from the service. Timescale of 28/09/07 not met. The home must further develop and improve the information gathered for assessment purposes to make sure adequate detail is provided including whether the new resident has a mental health need, dementia or other specific health need. This will confirm the home will only offer a placement to residents whose assessed needs they can meet. Timescale of 06/08/07 not met. DS0000013596.V352393.R01.S.doc Timescale for action 21/12/07 2 OP3 14 12/11/07 Cherry Lodge Rest Home Version 5.2 Page 28 3 OP7 15 A written care plan must be 12/11/07 drawn up in consultation with the resident or their representative, stating how the resident’s needs in respect of their health and welfare are to be met. The care plans must be 21/12/07 reviewed, where possible with the resident, their relative or representative, to make sure the information provided is up to date and accurate and has adequate detail to make sure members of staff are aware of the residents needs and how they must be met. The reviews must make clear what, when and why any changes to the residents assessed needs have taken place. Timescale of 28/09/07 not met. Daily living risk assessment including mobility and the use of any bed rails must be carried out and reviewed regularly taking into account the assessed needs of the people who use the service to make sure that any support, care or activity carried out considers the well being and safety of the resident. Timescale of 31/08/07 not met. The policies and procedures of the home including adult protection, whistle blowing, dealing with aggression and accidents and incidents must be reviewed and revised taking into account the practice of the home, the assessed needs of the residents and where necessary other agencies guidelines, for example the local authority DS0000013596.V352393.R01.S.doc 4 OP7 15 5 OP7 13(4) 12/11/07 6 OP18 OP38 13(6) 21/12/07 Cherry Lodge Rest Home Version 5.2 Page 29 multi-agency guidelines for safeguarding adults. Timescale of 28/09/07 not met. 7 OP27 18 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. Persons must not be employed to work in the care home unless they are fit to do so and the specified information and documents have been obtained in respect of those persons. Specifically, two written references must be obtained before persons are permitted to work in the care home. 26/11/07 8 OP29 19 12/11/07 9 OP30 18(1) A risk assessment must be 26/11/07 carried out with regard to first aid training taking into account for example the assessed needs of the residents and the type and number of incidents and accidents at the home in order that the home can decide what level of training is required by members of staff and make the necessary arrangements to meet the outcome of the risk assessment. Timescale of 10/08/07 not met. A review of the training provided by the home must be carried out and action taken to make sure that all the members of staff receive the training they need to meet the assessed needs of the people who use the service DS0000013596.V352393.R01.S.doc 10 OP30 OP31 18(1) 26/11/07 Cherry Lodge Rest Home Version 5.2 Page 30 including specialist training such as mental health. Timescale of 10/08/07 not met. 11 OP31 12 The home must be conducted to promote and make proper provision for the health and welfare of residents. 26/11/07 12 OP38 13 (4) (a) All parts of the home to which 12/11/07 residents have access must so far as reasonably practicable, be free from hazards to their safety. Specifically products and equipment hazardous to health must be stored in a locked provision. 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 OP9 Good Practice Recommendations A fridge thermometer should be obtained and regular readings should be taken of the medication fridge, to ensure that medications in it are stored appropriately. 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 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. The home’s complaints procedure should be supplied to all residents and displayed prominently in the home, to ensure that residents and those involved in their support DS0000013596.V352393.R01.S.doc Version 5.2 Page 31 2 OP12 3 OP15 4 OP16 Cherry Lodge Rest Home are aware of the procedure to follow. 5 OP33 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. The home’s policies and procedures should be reviewed and revised to ensure staff are aware of good practices and are informed of updated changes to the law as it affects their work. 6 OP33 Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South East Regional Contact Team The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cherry Lodge Rest Home DS0000013596.V352393.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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