CARE HOMES FOR OLDER PEOPLE
Cherry Lodge Rest Home Cherry Lodge 75 Whyteleafe Road Caterham Surrey CR3 5EJ Lead Inspector
Lisa Johnson Unannounced Inspection 29th September 2005 9.30 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.V252902.R01.S.doc Version 5.0 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.V252902.R01.S.doc Version 5.0 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 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) Mr Michael George Callender 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.V252902.R01.S.doc Version 5.0 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) 08 July 2005 2. 3. Date of last inspection Brief Description of the Service: Cherry lodge is a large detached property situated in a residential road in Caterham. The home has an attractive garden to the rear of the property and car parking facilities at the front of the home. The home is registered for fourteen service users . Accommodation consists of`two floors with a stair lift for easier access to the upstairs rooms. Ten of the bedrooms are for single occupancy and there are two double bedrooms. Some of the bedrooms have en-suite facilities. A disabled bathroom is available downstairs and another new bathroom has been installed recently. There is a large lounge and separate dining room. Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes third inspection carried out in 2005/2006. One inspector and a Commission for Social Care pharmacy inspector carried out this unannounced inspection over four and half hours. A previous additional inspection had been carried out by the both the inspector and pharmacy inspector to look at immediate requirements that had been made and copy of this report is available by contacting the Surrey Commission for Social Care Inspection office. The main focus of this inspection was to review any requirements made at the last inspections. Care plans, policies and procedures and other required documents were sampled. The inspector spoke to five of the residents who live in the home and spoke to two members of staff. The inspector would like to thank the service users and staff for their hospitality and cooperation in carrying out this inspection. What the service does well: What has improved since the last inspection?
Immediate requirements were made at the previous inspections in relation to the administration of medication. The home has significantly improved their procedures for administering and recording medication and could demonstrate
Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 6 safe practices. Medication stocks and records were sampled and showed that service users were receiving their medication as intended by their doctors. Clear records were kept of all medication received into the home, administered to service users and returned to the pharmacy for disposal and all medication was stored securely for the protection of service users. Requirements were made at the previous inspections that all service users care plans must be reviewed, updated and based on assessment. The home has now acquired a new care plan system, which is much more detailed, and some progress has been made in starting to complete the plans. Immediate requirements were made that all moving and handling risk assessments were carried for all individuals and these have now been completed. The homes complaint procedure has now been amended to state that the Commission for Social Care Inspection can be contacted any stage of a complaint. The home has also obtained the local authority protection of vulnerable adult policy, which ensures that the home has all the relevant information to ensure that the safety and welfare of service users is protected. Evidence was seen that records of police checks were now available which protects the welfare and safety of service users through good recruitment practices A requirement was made at the last inspection that all opened packets of food must be stored in sealed containers. The food storage cupboard was checked and food was stored appropriately adhering to food hygiene regulations. The home has made some progress in informing the Commission for Social Care Inspection of accidents and incidents sustained by service users. What they could do better:
All individual care plans must be updated to ensure that service users health, personal and social needs are being met. The registered manager must ensure that an intervention for individuals who are identified at risk of falls must be completed on the new care plans to ensure the health, wellbeing and safety of service users. It was positive to note that a new care planning system is to be implemented for all individuals in the near future. Further requirements and recommendations were made in respect of medication. Two service users were prescribed medication to be given ‘as needed’ with no clear guidelines as to what constituted needed. Medicines were administered by named care staff, but staff had not received up to date training in the safe handling of medicines. One service user was administering one of their own medicines but there was no risk assessment to support them in this activity. Written procedures on the handling of medication were available and were accessible to the staff. However they did not provide
Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 7 sufficient detail on how staff were expected to perform the tasks described and referred to equipment not used in the home. A policy for handling death and dying was in place. However a requirement was made each individuals personal wishes about what they wish to happen and instructions about formalities to be observed including the individuals family and friends (if the service user wishes this) must be recorded on individuals plans. Although staff stated that there was a number of activities being undertaken there was no written information available to state what and when activities were taking place. A requirement was made that up to date information about the homes leisure and activities be made available to ensure that service users have opportunities to receive recreational and leisure activities, which suits their needs and preferences. A requirement was made at the previous inspection that all staff must receive formal supervision at least six times a year. As the registered manager was unavailable for this inspection records could not be accessed, but staff spoken to were unable to confirm that they had received a formal, recorded supervision with their manager/supervisor. A further requirement was made that all formal supervision is updated to ensure that staff are supported to carry out their job. The registered manager has since confirmed that supervisions were last completed in June 2005. A requirement was made that an updated quality assurance questionnaire is implemented based on providing feedback from service users. The outcome of this survey is to be made available to service users, relatives and the Commission for Social Care Inspection to ensure that feedback is sought from service users about the services provided. A recommendation was made that the registered manager should consider implementing service user meetings. Information was gained that a service user had passed away and it was noted that the Commission for Social Care inspection had not been informed. An immediate requirement was made that the Commission for Social Care inspection must be informed without delay of the occurrence of the death of any service user and that this shall be confirmed in writing. 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. Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 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.V252902.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed on this inspection. EVIDENCE: Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &11 All care plans must be completed based on assessment to ensure the health, personal and social needs of the individual are being met. Moving and handling risk assessments have been updated. Appropriate interventions are to be recorded for service users who are at risk of falls to ensure their health, welfare and safety. A review of medication handling was undertaken by a CSCI pharmacist inspector. The home has significantly improved their procedures for administering and recording medication and could demonstrate safe practices. EVIDENCE: The home has now obtained a new care plan system, which is currently in progress of being completed so that all service users will have an up to date plan. A further requirement was made that all plans must be completed to ensure that the health, personal and social needs of service users are being met. Moving and handling assessments are completed. However interventions must be documented on the new care plans for service users identified at risk of falls. This is to ensure the health, wellbeing and safety of individuals. Medication stocks and records were sampled and showed that service users were receiving their medication as intended by their doctors. Clear records were kept of all medication received into the home, administered to service
Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 11 users and returned to the pharmacy for disposal and all medication was stored securely for the protection of service users. Two service users were prescribed medication to be given ‘as needed’ with no clear guidelines as to what constituted needed. Medicines were administered by named care staff, but staff had not received up to date training in the safe handling of medicines. One service user was administering one of their own medicines but there was no risk assessment to support them in this activity. Written procedures on the handling of medication were available and were accessible to the staff. However they did not provide sufficient detail on how staff were expected to perform the tasks described and referred to equipment not used in the home. A death and dying policy is in place. However the individual wishes of the service user about what they wish to happen and instructions about formalities to be observed including the service users family and friends (if the service user wishes this) must be recorded in the individual plan. Action has been required in respect of the aforementioned matters. Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 &15 The home needs to supply service users with information about what and when activities are taking place and to gain feedback from service users on the recreational facilities to be provided. Service users maintain contact with their family and friends EVIDENCE: Service users were seen watching the television in the lounge. Staff spoken to stated that sing-along take place and an entertainer visits occasionally. There are opportunities for service users to play card games, ludo and reminiscence cards. There is a library in the home, which had a range of reading materials. A church service takes place every six to eight weeks and a recent communion had been held. One service user spoken to felt that there was adequate recreational facilities. However a requirement was made that information is to be provided to all service service users about the activities that are offered in the home. A requirement was made that an up-to-date quality assurance survey is implemented to gain feedback about the services that the home provides to include service users views on recreational activities and individual preferences. Service users spoken to confirmed that they maintain contact with their families. Telephones are available for the use of service users in the lounge and some service users have access to their own telephones in their rooms.
Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 13 Service users are supported to make choices and were able to keep some of their personal possessions. One service spoken to stated,” There’s no pressure here, its relaxed you can do what you like”. The lunchtime meal was observed and was of a good standard and nutritious. Four service users confirmed that the “food is very good”. Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17&18 The home is able to demonstrate that there is an adequate complaints procedure in place. Policies and procedures were in place to ensure that service users are protected from abuse. EVIDENCE: There was an accessible complaints procedure in place, which has now been amended. The complaints register was sampled and no complaints have been received since the previous inspections. Service users spoken to were clear that they knew whom they could talk to if they had a problem or a concern. Two staff stated that staff are approachable and helpful. There is a resident’s charter in place and a rights policy and service users were given the opportunity to vote in the election. Policies and procedures were available for the protection of vulnerable adults including the updated local authority procedure. Two staff spoken to confirmed they have been booked on the protection of vulnerable adult training and were clear in their responses as to what constitutes abuse and what action they would take if they ever witnessed any abuse of service users taking place. Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The service is able to demonstrate that service users have specialist equipment they require to maximise independence. EVIDENCE: The home has a stair lift in place. Assisted toilets and bathrooms have been installed and the home has provided grab rails. There is a call system in place. Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 & 30 The home is able to demonstrate that service users are protected by the homes recruitment policy and practices. Staff are supported to undertake training and development to ensure that they are competent to carry out their job. EVIDENCE: The manager is able to provide evidence that records of police checks are in place for staff employed in the home. It was evident that new staff complete an induction and receive foundation training which was confirmed by a member of staff spoken to. Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,35,36,37&38 Staff feel supported by the management of the home. Some items were identified for action. Staff must receive regular formal supervision to ensure their practice and development needs are met and to ensure the health and safety of service users. The manager must ensure that all serious incidents are reported to protect the health, welfare and safety of service users. EVIDENCE: Staff spoken to stated that they felt supported by the manager and that she was approachable. One member of staff spoken to had been completing her induction and foundation training and had received progress meetings with the manager. The registered manager was unavailable for this inspection and staff were unable to confirm if a quality assurance system gaining feedback fro service users had been completed. A requirement was made that the outcome of an updated quality assurance system based on feedback from service users on
Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 18 their views of the service must be provided to service users, relatives and the Commission for Social Care Inspection. A recommendation was also made that the registered manager should consider implementing service users meetings. The registered manager was now able to provide records to show that all staff employed have received police checks. The home does not handle service users monies. Records of formal staff supervision could not be accessed and staff were unable to confirm that they have received a formal supervision meeting with their manager/supervisor. A further requirement was made that all staff receive formal supervision at least six times a year, which must be documented. This is to ensure that staff are supported to carry out their job. Policies and procedures were sampled including the staff disciplinary procedure, equal opportunities, and protection of vulnerable adults, aggression, discharge and the accident procedure. However information was gained that a service user had passed away and it was noted that the Commission for Social Care Inspection was not informed. An immediate requirement was made that this was confirmed in writing and that the registered manager must in future report to the Commission for Social Care inspection without delay of the occurrence of the death of any service user, including the circumstances of his/her death. Adequate records were available that an updated health and safety audit had been carried out; PACT and emergency light testing had been completed. Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 X X X 3 X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 2 X 3 2 3 2 Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 20 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(1)(a)( b)(c)(d) Requirement All care plans must continue be updated and based on assessment ensuring that all service users health, personal, emotional needs are set out in the individual plan. The registered manager must ensure that interventions are recorded in individual plans for service users who at risk of falls. A documented risk assessment must be in place for all service users who undertake to selfadminister any of their own medicines. All staff who receive medication must receive training in the handling of medication and there must be evidence that this has taken place. The registered manager must record each individuals plan the personal wishes in respect of death and dying about what they want to happen and to provide instructions about the formalities to be observed involving the service users family and friends (if that is what the service user
DS0000013596.V252902.R01.S.doc Timescale for action 07/10/05 2 OP 13(5) 07/10/05 3 OP9 13(4)(b) 06/10/05 4 OP9 18(1)(c)(i ) 07/11/05 5 OP11 22(7) 29/10/05 Cherry Lodge Rest Home Version 5.0 Page 21 6 OP12 16(2)(n) 7 OP33 24 8 OP36 18(2) 9 OP38 37(1)(a) (2) wants). The home must provide information on the recreational and social activities provided in the home so that they have the relevant information which suits their needs and preferences The registered manager must provide an updated quality assurance questionnaire to gain feedback from service users on the services provided and to ensure the outcomes are made available to service users, relatives and to the Commission for Social Care Inspection. All staff must receive formal supervision at least six times a year. (Timescale 8th September not met) The registered manager must give notice to the Commission for Social Care without delay of the occurrence of the death of a service user, including the circumstances of his/her death. Any notification made in accordance with this regulation, which is given orally, must be confirmed in writing. 29/11/05 29/12/05 29/10/05 29/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The registered person is strongly recommended to produce a clear care plan for each service user who is prescribed medication ‘to be given as needed’, to provide detailed instructions to staff as to when to give the medication. This will ensure that medication is administered in a clear and consistent way for the benefit of service users.
DS0000013596.V252902.R01.S.doc Version 5.0 Page 22 Cherry Lodge Rest Home 2. OP9 3 OP9 It is strongly recommended that when it is necessary to handwrite on a medication administration record chart in the home that the member of staff writing the chart signs and dates the chart and that a second carer checks the entry for accuracy and then initials the chart. In addition the entry should include a reference to where this information was sourced, such as the prescriber’s name. The registered manager should consider implementing service user meetings to gain feedback from service users about the services provided and to increase service user involvement and decision making in the home. Cherry Lodge Rest Home DS0000013596.V252902.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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