Inspection on 20/07/07 for Cleeve Lodge

This inspection was carried out on 20th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cleeve Lodge 06/05/08

Cleeve Lodge 22/02/07

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cleeve Lodge Cleeve Lodge Close Downend South Glos BS16 6AQ Lead Inspector Grace Agu Key Unannounced Inspection 20th July 2007 09:30 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 DS0000068293.V343741.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. DS0000068293.V343741.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cleeve Lodge Address Cleeve Lodge Close Downend South Glos BS16 6AQ 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) 0117 970 2273 0117 956 6027 cleeve@lodge87.fsnet.co.uk Shields Care Limited Mrs Lesley Caron Maddox Mr Colin Maddox Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (3) of places DS0000068293.V343741.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 2007 Brief Description of the Service: Cleeve Lodge opened in 1993 to provide care and accommodation for 30 older people and 3 people with disabilities aged 45 and over. The property is a listed building, dating back to the 18th Century, which has been carefully restored and maintained in keeping with the period of the house. The home is located in the residential area of Downend, South Gloucestershire, close to the border of the City of Bristol. Local shops and other community facilities are close to the home and it is within easy reach of motorway connections. The homes 30 bedrooms (3 of double size) are situated on three floors and are equipped with TVs, emergency call systems and en-suite facilities. There are gardens and lawns to the front and side of the property. Fees range from £385-£510 weekly DS0000068293.V343741.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 visit was undertaken over ten hours by two inspectors to follow up medication and other requirements made at the last inspection to ensure that the action plan sent to the Commission for Social Care had been fully implemented and that it is effective in terms of meeting the needs of the residents. The pharmacy inspector reviewed the home’s medication and her report can be found in the body of the report under Standard 9. The inspection also followed up concerns raised through comment cards by relatives in relation to various areas of service provision including alleged staff shortages. A tour of the building was undertaken and a number of records were viewed. Ten residents three staff members and two relatives were spoken with on the day. What the service does well: Generally the home was found clean, tidy and warm. Staff were working as a team and interacting with residents in a positive, dignified and sensitive manner, residents were found to be relaxed and looked well cared for at the home. From the interaction noted on the day between staff and residents it was evident that staff know the residents very well and provide them with qualityindividualised care. The home supports and encourages the residents to maintain independence in order to enhance their quality of life. A comprehensive Service User’s Guide is given to the prospective resident to enable them to make an informed choice about moving to the home and residents and relatives are informed on admission of a one-month trial to enable the person to make a decision whether to stay. In order to ensure adequate nutrition for the residents, good meals are provided and are not hurried; those who are unable to feed themselves are fed in a respectful, sensitive and dignified manner. DS0000068293.V343741.R01.S.doc Version 5.2 Page 6 In addition, to ensure that residents are adequately protected, ongoing training courses are provided for staff and appropriate recruitment procedures have been followed for recently employed individuals at the home. Some of the comments received from relatives include: “Generally the Lodge is run to a high standard. It has good ethics and mission statements. It is generally a happy environment for staff and residents”. “I feel very happy with the service being given to my mother. Cleeve Lodge is a lovely place to live, there is a very calm and happy atmosphere there and I can sleep at night knowing she is safe and well cared for”. “Cleeve Lodge in my opinion provides a warm friendly and comfortable atmosphere. It always seems clean and tidy and free of unpleasant odours, sometimes associated with other homes. The recent introduction of a Newsletter is a good way of keeping the residents and visitors informed of events/activities”. What has improved since the last inspection? What they could do better: Residents would be better protected and their needs met if their care plans are clearly and holistically written after assessment and in consultation with them and or their representatives. The inspector saw that some care files contain risk assessments in relation to residents’ moving and handling and falls. The home must ensure that this is consistent especially for a resident with frequent and recent falls. In relation to the above the home must ensure that any accident that seriously affect the health and safety of individual resident is reported to the Commission for Social Care Inspection DS0000068293.V343741.R01.S.doc Version 5.2 Page 7 In addition, staff must receive appropriate training in this subject to enable them to identify unusual symptoms and concerns that could put the person’s health at risk. In order to promote and maintain effective Infection Control measures and prevent toxic conditions at the home it would be better if the identified house keeping staff attend training on infection control and Control of Substances Hazardous to Health. At this inspection, it was noted whilst touring the building that two residents were walking around in the lounge in an undignified condition. The home must ensure that better strategies are in place to meet residents’ personal care needs in order to uphold and respect their dignity. To ensure that the residents are adequately protected, the kitchen must be kept clean, specifically areas identified with built up grease. Staff would be familiar with fire emergency procedures if they regularly attend fire drills to ensure that residents are adequately protected. To ensure that there are adequate numbers of care staff at the home the registered managers must review the dependency levels to ensure that the needs of the residents are adequately met. Staff members would be enabled to perform the duties effectively if regular formal documented supervision is provided. Staff must be appropriately trained and specifically on Protection of Vulnerable Adults from Abuse to ensure that staff are able to perform duties effectively and that residents are protected from harm and abuse. All medicines administered to residents must be given from the appropriately labelled container supplied by the pharmacist. Medicines stored in the fridge must be kept securely. The home must have a policy for the safe administration of medicines. Appropriate records must be kept of the receipt, administration and disposal of all medicines. All staff involved with medicines administration must receive suitable training to enable them to do this task safely and protect residents’ health. It is recommended that the minimum m/maximum thermometer should be obtained to accurately record the temperature of the medicines fridge to ensure that this is within the safe range. DS0000068293.V343741.R01.S.doc Version 5.2 Page 8 It is recommended that the questionnaire be given to the medical and other health professionals to provide the home feed back on care and other services provided at the home. 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. DS0000068293.V343741.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 DS0000068293.V343741.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): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that residents are assessed before admission to ensure that their needs will be met. EVIDENCE: The home has a Statement of Purpose and Service Users Guide, which contain information required by the regulations. The Service Users Guide is given to prospective residents and/or their relatives when they visit the home or make enquiries to enable them to make an informed choice about moving into the home. The document also contains information about the one month trial period to enable the prospective resident decide to stay. DS0000068293.V343741.R01.S.doc Version 5.2 Page 11 At a discussion with a resident admitted a few weeks ago the individual stated that they came with the family to look round and were satisfied with the home. The individual states, “I am most satisfied with the home so far”. Terms and conditions of their stay at Cleeve Lodge were noted in the files viewed. Records showed that residents were assessed before admission to the home. DS0000068293.V343741.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): 7,8,9,10,11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst the home offers care and support to residents including at the end of their life, it fails to protect an identified resident with care plans on how to meet their needs. Some aspects of medicine handling could put the residents’ health at risk. EVIDENCE: Three care files were reviewed. All the care files contained pre-admission information to enable the home to determine if it is able to meet the needs of the residents. Two of the files contained care plans, which described how the identified needs were being met. These care plans were regularly reviewed. However, one recently admitted individual that was also on respite had information obtained from the Care Management team before moving in. DS0000068293.V343741.R01.S.doc Version 5.2 Page 13 There was no care file for this individual and no care plans developed after the admission to enable staff to provide appropriate care to meet the needs of the resident. The Manager stated that the home was using the care plan from the Care Management team. A review of the care plan from the Care Management Team showed that this individual is at high risk of falls There was no risk assessment undertaken to ensure that this individual is protected. Review of accident records showed that this individual had three falls since admission. Furthermore the Commission for Social Care Inspection was not informed about the accident that resulted in hospital admission. The General Practitioner was visiting the individual on the day following another fall. There was detailed information on the general care hand over sheets diary of how care was provided. It is required that the identified resident is provided with a care plan in order to fully demonstrate how their needs will be met. The individual must have a risk assessment that is reviewed regularly. The manager commenced the process of developing care plans whilst the inspection was in progress. The inspector was informed by the home at a follow up call that the individual had been re-admitted to hospital. Residents spoken with stated that staff respect them and treat them with dignity. Residents also stated that they would get up and retire when they wanted and that staff knocked on the doors and waited for an answer before coming in to assist them with personal care. However one relative spoken with on the phone stated that they are not satisfied with care provided to their person. This was shared with the managers. They would ensure that all individuals living at the home receive value for their money. Other comments from the relatives though the comment cards were satisfactory. In addition two residents met walking round in the lounge and ground floor hall way had unpleasant odours due to their medical condition. This compromises their dignity and a requirement notice was issued for the home to ensure that the identified residents are adequately monitored and are kept clean and comfortable at all times. There was evidence of professionals’ visits to the home in relation to residents to include district nurses, GP, Opticians, Chiropodist and Dentist. One resident stated, “I can see my doctor any time I ask for him. DS0000068293.V343741.R01.S.doc Version 5.2 Page 14 The Pharmacy inspector reviewed storage, receipt, handling and administration of medication and it was noted that some practices were unsatisfactory. The report is as follows. Requirements about medication made at the last key inspection have been addressed but further requirements have been made following this pharmacist inspection. A local pharmacist orders the prescriptions from the doctors and dispenses medication for residents. Medicines are supplied using a weekly monitored dosage system. At the time of this inspection the weekly trays were labelled with the resident’s name but not the contents or the dosage instructions. One person who was self-medicating also had their medicines supplied in this way. This does not meet the legal requirements and action is needed to ensure that all medication is suitably labelled so that it can be given safely. Staff said that they always ask new residents if they want to look after their own medicines and several people do this. Since the last inspection risk assessments are being put in place to support this and ensure that residents are safe. Secure storage is available for medication and the medicine trolley is kept secured to the wall. A medicine fridge is available, however this was not locked and action is needed to make this storage area secure. The temperature of the fridge is recorded daily. On the day of the inspection the fridge felt very cold and the temperature appeared to below the recommended range. It is recommended that a minimum/maximum thermometer be obtained to allow the temperature to be more accurately monitored. Action must be taken to make sure that temperatures remain in the approved range of 2 to 8 degree C to ensure that medicines are safe to use. A cupboard and register is available for medicines needing extra security. Staff must make sure that all these medicines are entered into the register when they arrive at the home. Most medication is supplied by the pharmacy in the weekly trays. Staff said that they transfer medicines supplied separately into the weekly boxes to make medicines administration simpler and safer. This is not recommended as good practice and could mean that medicines are not given correctly and safely. DS0000068293.V343741.R01.S.doc Version 5.2 Page 15 This is because mistakes can be made, staff administering the medicines cannot check the instructions on the pharmacy label and some medicines may not keep well in the weekly boxes, making them less effective. No written medication policy was available. The home needs to have a medication policy available for all staff so that they know the correct procedures for safe administration of medicines to residents. The pharmacy provides printed medicines administration record sheets each month for staff to record all the medication they give. There were some gaps in this record and action needs to be taken to make sure that staff sign for all the medicines they administer and record a reason why regular medicines have not been administered. Records are kept of the receipt of medicines into the home but these were incomplete. Records of the disposal of unwanted medicines did not include the quantity. Records must be kept of the receipt and disposal of all medicines so that there is a clear audit trail of medicines received, administered and disposed of. Medication training is provided for staff by senior staff in the home. To protect residents’ health, staff involved in medication administration should all receive appropriate training from a suitably qualified person. A more detailed pharmacist inspection report has been sent in a letter to the home manager. Evidence of residents’ wishes in the event of death was noted in the care files reviewed. The home also has Death and Dying Policy. Evidence from staff discussion showed that staff are aware of the policies and procedures in relation to confidentiality. DS0000068293.V343741.R01.S.doc Version 5.2 Page 16 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home enables the residents to maintain contact with families, friends and local community. It also ensures that choice is provided to residents in respect of meals and meal times. However, the home has not provided the residents with structured and meaningful activities. EVIDENCE: Evidence of discussions with residents, relatives and staff showed that the home actively supports the residents to maintain contact with families, friends and representatives. DS0000068293.V343741.R01.S.doc Version 5.2 Page 17 One resident spoken with stated that their cousin visits regularly, another individual stated, “my grand daughter visit me regularly they live down the road, some times they take me out”. One relative spoken with on the day confirmed that they visit very often, the home is welcoming and “My relative is well looked after”. Whilst touring the building, it was noted that residents were either sitting in their rooms or in the lounges with little or no stimulation. Whilst the record evidenced that there are planned activities for the residents, for example on 31/5/07 there was a chocolate party for the residents, in June there was a trip to Mitchinhmpton Common and eleven residents attended. Other activities in June include singalong 11/6/07, 12/07/07 delivery of new library books, 26/06/07 external entertainment on reminiscence. A resident confirmed that that there is a church service at the home once a month. There is also a newsletter to inform residents and their families of forth-coming events. The inspector was informed and there was evidence of games or bingo on Monday afternoons. However some residents spoken with stated that they prefer to stay in their rooms. One resident spoken with states “I feel lonely and isolated. A comment card received from a relative also states “ we feel because of our relative’s condition, there could be more provision to help stimulate them, she does spend a lot of time doing nothing. The home must demonstrate how the residents and particularly residents who prefer to stay in their rooms are engaged and stimulated after consultation whilst living in the care home to meet this requirement. The menu had been reviewed to provide the residents with more choices following the concerns raised by residents at the last residents meeting. The meal looked nutritious, residents stated that they enjoyed their meal. Residents are provided with alternatives if they were not satisfied with what is on the menu. One individual stated that the menu is not shown to them in advance to enable them to make a choice of what to have the following day. The manager stated that the home plans to purchase a board to display the menu in the lounge. The manager also stated that all staff working at the home have attended basic food hygiene training. The kitchen was not clean. Built up grease was noted in various areas of the kitchen. The kitchen floor was also noted to be untidy. DS0000068293.V343741.R01.S.doc Version 5.2 Page 18 The chef stated that there was a cleaning schedule, however, this was not being followed and that the provider organises a private company to deep clean the kitchen. The manager stated that there is a risk assessment for the kitchen kept in the folder however this is kept in the office. It is recommended that the risk assessment be kept in the kitchen for staff to access when necessary. Whilst touring the dry food store four canned items were noted several months out of date. This was discussed with the manager and they were discarded immediately. The home must ensure that dry food is regularly checked in accordance with food safety regulations in order to protect residents’ staff and visitors. The fridge and freezer temperatures were up to date and the foods in the fridge were labelled. DS0000068293.V343741.R01.S.doc Version 5.2 Page 19 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): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to complain and are confident that they would be listened to and protected from harm and abuse. EVIDENCE: The Home had a complaints procedure, which is displayed at the main entrance to the building. This document contained relevant information to enable residents and relatives to make a complaint to the Commission for Social Care Inspection if they were not satisfied with the outcome of a complaint to the organisation. Three Complaints recorded were satisfactorily resolved. Residents spoken with stated that they would complain to the manager if they had any complaint. One resident stated I have no complaint the home is a good place. One staff stated, “I know about complaint procedure and I will support residents if they want to complain”. One comment card received from a relative states “Anything I have concern about can always be dealt with by the staff on the spot or by referral to a more senior staff member.” DS0000068293.V343741.R01.S.doc Version 5.2 Page 20 Another comment card states, “ they provide a friendly and caring environment and are always willing to listen to any concerns.” However one relative contacted the Commission by the telephone and raised concerns about several aspects of the service provided at Cleeve Lodge. The individual was particularly concerned about personal care of their relative, medication, shortage of staff and activities. These concerns were looked into at this inspection and the findings have been included in the relevant sections. Staff showed awareness of the Whistle Blowing policy and would inform the Manager of any bad practices to ensure that residents are protected from abuse. However evidence show that staff have not attended Protection of Vulnerable Adults from Abuse training. The manager stated that staff are made aware of this subject at induction and would ensure that training days are booked with the South Gloucestershire Council. The home has a copy of the South Gloucestershire Council Policy on Protection of Vulnerable Adults from Abuse to ensure that the correct reporting procedure is followed if incidence of abuse is reported. Records of recently employed staff members evidenced that satisfactory documentation were received before the staff member commenced employment. Residents’ money checked showed that the money in the safe corresponded with the appropriate record. DS0000068293.V343741.R01.S.doc Version 5.2 Page 21 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): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents enjoy a pleasant, safe and homely environment however the kitchen fails to meet good standards of hygiene. EVIDENCE: The Home was found generally clean, tidy, well lit and free from offensive odours. Residents were found sitting in the communal areas, relaxed in their homely environment. A tour of the building showed that the environment was well maintained and suited to residents needs. The home’s standard of decoration is satisfactory and creates a comfortable environment for the residents. DS0000068293.V343741.R01.S.doc Version 5.2 Page 22 Residents’ bedrooms viewed looked homely, clean and had small items of personal possessions in individual rooms. Residents spoken with stated that they were happy with their bedrooms and felt safe at the home. The home’s Maintenance book was in order and appropriate action taken in relation to repairs to be carried out was recorded. There was evidence of regular hot and cold water temperature checks and other routine checks in line with the Health and Safety legislation. Whilst the home was found generally clean, it was noted that the kitchen was untidy with the worktop; the grill and the shelves filled with dried grease. The manager showed the inspector a cleaning schedule however this was not being followed. This situation puts the health and safety of the residents, staff and visitors at risk and must be addressed to ensure protection of all concerned. A requirement has been made for the kitchen to be deep cleaned and to ensure that the cleanliness is regularly maintained. The laundry area was found clean and tidy. DS0000068293.V343741.R01.S.doc Version 5.2 Page 23 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): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home’s recruitment process offers safety to the residents; however, the Home fails to ensure adequate protection through lack of training and adequate numbers of staff and job description. EVIDENCE: The home’s recruitment policy contained information that offers safeguards to residents. The inspector was informed that that the home had recently advertised for care staff and had received a good response. It is expected that two part time and one full time staff members would commence employment next week subject to satisfactory employment documentation. It was disappointing to note that the home has no job description for care and other roles to enable staff to be clear about their roles and responsibilities. The managers stated that they would put this in place. A requirement has been issued for this to happen. DS0000068293.V343741.R01.S.doc Version 5.2 Page 24 New staff have received induction. Areas covered include the call bell system, use of equipment, and bathing and washing, reporting and recording, along with guidance on abuse policy. A staff member met confirmed that they had undertaken the above induction training before assisting residents with their personal care. A review of records showed that staff members have not attended specific training on the protection of vulnerable adults from abuse. The manager stated that staff would attend the alerter training provided by the South Gloucestershire Council when the home is able to secure places. The training record showed that staff have undertaken training in First Aid, Food Hygiene, Moving and Handling, Health and Safety. However staff spoken with were concerned that they had not undertaken any training on medication before administrating medication to residents. This practice is puts the residents at risk and a requirement has been issued for all staff administering medication to receive appropriate training. A requirement notice has also been issued in relation to ensuring that the domestic staff that also in charge of the laundry attend infection control and Control Of Substances Hazardous to Health training. Some residents and their relatives made positive comments about the home and the services provided. For example, one relatives comment card states “I don’t know the qualification of the care staff but at times when my mother has not been well, the staff have been caring and attentive and her general needs have been met”. However, the inspector received three concerns from relatives before and after the inspection. These concerns included inadequate staffing level especially on weekends,‘ nobody to talk to residents because staff are stretched.’ Some times there appears to be fewer staff than expected.’ One staff member stated “ There is a very low morale amongst staff because people have to do different jobs either the laundry, kitchen, caring and cleaning. One relative spoken with on the telephone stated that staff members met on duty when the individual visited showed lack of knowledge about the relative’s condition. The individual requested a doctor’s visit and their relative was admitted to hospital. In addition to the above one comment card received from a relative states “majority of staff are kind but not skilled enough to anticipate issues”. DS0000068293.V343741.R01.S.doc Version 5.2 Page 25 Staff must receive training on recognition of signs of deterioration in any resident to enable them to summon medical assistance as appropriate. On the day of inspection there were thirty residents at the home. The rota showed that there were four care staff in the morning, three staff in the afternoon and early evening and two waking night staff. The rota for the last weekend was also reviewed and there were no short falls. The registered manager stated that the numbers of care staff on duty adequately meets the care needs of the residents. In addition to the above, one of the registered managers is on duty daily as well as well as the deputy manager, this provides an added advantage to the staffing level and would enable the home to provide cover for annual leave and sickness. The deputy manager is on duty on weekends to support the team on the floors in meeting the needs of the residents. To ensure that the residents receive good quality care and to deal with the concerns raised by relatives about the staffing level the home must review the staffing level against the dependency level of the residents. DS0000068293.V343741.R01.S.doc Version 5.2 Page 26 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): 31,32,33.35,36,37,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well maintained however staff have not received regular supervision in relation to their role. Some health and safety practices at the home do not fully protect the residents, staff and visitors. EVIDENCE: Experienced and well-qualified home managers manage Cleeve Lodge. Mr Colin and Lesley Maddox have achieved Registered Managers Award and are both National Vocational Qualification (NVQ) Assessors. The home also employs a deputy manager who also holds an NVQ at level 3 and has recently commenced the Registered Managers Award course. DS0000068293.V343741.R01.S.doc Version 5.2 Page 27 Residents and some relatives made positive comments about the manager and expressed satisfaction with the overall services and management of the home. One resident stated, “I am happy here, Lesley and Colin are good”. One relative stated in the comment card “The care home we use is Cleeve Lodge Residential Home. We have a good relationship with staff. They are all friendly, helpful and willing to help in any way”. Another comment states, “Generally the Lodge is run to high standards. It has good ethics and mission statement. It is generally a happy environment for staff and residents”. In relation to health and safety, evidence showed that staff have attended fire drills. However not regularly. The Fire safety log-book was well maintained. All health and safety checks were up to date. There is a service record of the lifts, hoists, bath hoists and portable appliance tests (PAT) of all electrical appliances. The individual working in the laundry had received training on infection control to ensure that residents are adequately protected. Generic risk assessments have been undertaken to ensure adequate protection of residents. Specific areas include, the kitchen, laundry, residents’ bedrooms and other areas the residents have access to. A requirement has been made for the home to undertake the risk assessments for residents’ safety. Accidents to residents were recorded, however these had not been reviewed. A requirement had been issued for all accidents to be reviewed following falls and where appropriate care plans and risk assessments reviewed to ensure that the individual is adequately protected and to prevent further occurrences. Residents’ monies checked evidenced that the record is up to date, the amount stored in the safe corresponded with the balance recorded in the book. The home undertakes a yearly audit to monitor the quality of the services provided for the residents. These include, residents and relatives questionnaires. On the recent questionnaires seen, areas monitored included, care of residents, catering, house keeping, and administration. The result of the audit will enable the home to identify any deficiencies and ensure that they are addressed. It is recommended that the questionnaire be given to the medical and other health professionals to provide the home feed back on care and other services provided at the home. DS0000068293.V343741.R01.S.doc Version 5.2 Page 28 Other ways used to audit the service are, reviewing the Care plans; social worker reviews, observing staff interaction with residents. Encouraging the residents to raise any concerns that they have. Staff meeting and resident/ relative meetings provide a forum for discussion in relation to service improvement. The provider also undertakes a monthly visit as required by the regulations. Records show that staff are receiving supervision however not regularly to enable them to perform their duties effectively and deal with any areas that impacts on the care of residents. It was agreed that this needs to happen more regularly to ensure that staff are aware of the needs of the residents and are given the opportunity through supervision to express any areas of concern relating to their practice. The manager stated that a system has been put in place for the commencement of regular supervision of all staff. A requirement notice has been issued to ensure that this is implemented. Various Policies and procedures were in place, relevant and updated. Residents’ information was appropriately stored and locked away. DS0000068293.V343741.R01.S.doc Version 5.2 Page 29 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X X X 2 STAFFING Standard No Score 27 2 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 3 2 DS0000068293.V343741.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 Ensure that care plans are developed with the residents and /or their relatives following admission to the home. The registered person shall make arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received at the care home. 1. All medicines administered to residents must be given from the appropriately labelled container supplied by the pharmacist. 2. Medicines stored in the fridge must be kept securely. 3. The home must have a policy for the safe administration of medicines. 4. Appropriate records must be kept of the receipt, administration and disposal of all medicines. All staff involved with medicines administration must receive suitable training to enable them to do this task safely and protect residents’. DS0000068293.V343741.R01.S.doc Version 5.2 Page 31 Timescale for action 20/08/07 2. OP9 13 20/08/07 3. OP38 13 The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated Review all accident to residents Ensure that risk assessment is in place following accident and it reviewed regularly. Ensure that staff receive training on the Protection of Vulnerable Adults from Abuse. Identified staff member must undertake training on Control of Substances Hazardous to Health and infection control. Review the personal care plan for two identified residents with unpleasant smell in order to maintain their dignity. Review the staffing level in line with the dependency level of the residents. All staff must attend fire drills at regular intervals. Kitchen must be deep cleaned and cleanliness maintained at all times. Notify CSCI of any event that seriously affects the well being or safety of the residents. Ensure that staff are appropriately supervised. 20/08/07 4 OP30 18 20/10/07 5 OP10 12 20/08/07 6 7 8 9 10 OP27 OP38 OP26 OP38 OP36 18 23 23 37 18 20/08/07 28/09/07 20/08/07 20/08/07 20/08/07 DS0000068293.V343741.R01.S.doc Version 5.2 Page 32 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 OP33 Good Practice Recommendations It is recommended that the questionnaire be given to the medical and other health professionals to provide the home with feed-back on care and other services provided at the home. It is recommended that the minimum /maximum thermometer should be obtained to accurately record the temperature of the medicines fridge to ensure that this is within the safe range. 2 OP9 DS0000068293.V343741.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 DS0000068293.V343741.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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