Inspection on 18/07/06 for Cleveland Lodge

This inspection was carried out on 18th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Cleveland Lodge 17/08/09

Cleveland Lodge 22/08/07

Similar services:

Fairfields Country Rest Home

Fairfax House

Claremont Nursing Home

Doveridge Care Home

Dunmore

Chatsworth

Dunraven Lodge

Eastleigh Care Homes, South Molton

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

CARE HOMES FOR OLDER PEOPLE Cleveland Lodge Cleveland Lodge Church Lane Figheldean Salisbury Wiltshire SP4 8JL Lead Inspector Ms Sally Walker Unannounced Inspection 09:05 18th July 2006 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 Cleveland Lodge DS0000066527.V298366.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. Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cleveland Lodge Address Cleveland Lodge Church Lane Figheldean Salisbury Wiltshire SP4 8JL 01980 670584 F/P01980 670584 clevelandlodge@dementiacarehome.freeserve.co .uk Cleveland Lodge Ltd 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 James Foreman Care Home 29 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (29) of places Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th October 2005 Brief Description of the Service: Cleveland Lodge is a private care home registered to provide care and accommodation to 29 older people with dementia. The home has been extended to provide extra accommodation. The property is a former Victorian vicarage situated in the small village of Figheldean near Amesbury. The home is accessed via a private drive and has large enclosed gardens for residents’ safety. The residents’ accommodation is all single bedrooms to the first and ground floors accessed via a passenger lift or staircase. There are two sitting rooms and two dining rooms, one in each of the newer and older parts of the building. The staffing rota provided for a minimum of a senior carer leading the shift of 3 carers during the waking day. At night there are 2 waking night staff with Mr Foreman or his wife carrying out the sleeping in duty from their adjacent house. Since the last inspection the owners have registered as a Limited Company. Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.05 am and 5.45pm. Mr and Mrs Foreman were present during the inspection. Mrs Brenda Mason who is the Responsible Individual and works at the home was on a day off. The care records, staff records, medication, accident log and fire logbook were inspected. A tour of the building was made. Six residents were spoken with and 3 staff. One relative wrote to the inspector to say that their mother often told them of the kindness they were shown and that the food was wonderful. They said that staff did a marvellous job. One of the district nurses telephoned to say that they were happy with the care provided and that the carers did a good job. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 6 The menu had been changed and offered a traditional range of meals suited to the tastes of older people. Although much of the provision is stored frozen, there was a large quantity of fresh fruit in the storeroom. The general cleanliness of the building had improved but there were some areas not always visible, which were in need of immediate attention; the undersides of toilet surrounds and bath hoists and the kitchen floor. Following an inspection of the building by the Environmental Health Officer regarding risk of falls and trips, surfaces had been levelled, steps removed and levelled and steps to the outside rimmed with coloured strips to increase their visibility. The home has also reviewed and revised its environmental risk assessments. The conservatory had been lined with a coating to reduce the heat and glare. What they could do better: 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. Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Efforts are made to ensure that prospective residents care needs can be met with assessments done by the home and information gained from placing agencies. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Most of the time the home was able to carry out pre-admission assessments with prospective residents. Mrs Mason carried out the majority of the assessments and decides whether the home can meet needs. Where these residents were not from the locality there was evidence of care management assessments from the placing authorities. Some of the home’s own assessments were not signed or dated and did not show the source of the information given that people with dementia may not always be able to express their care needs. One relative said that their mother’s admission to the home had been positive. Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 9 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 & 10 Care plans were very comprehensive in detailing residents care needs but guidance to staff was variable and did not always give specific guidance to staff on their interventions. Consequently daily reports reported on basic care provision rather than the complex interventions observed in caring for people with dementia. Residents’ health care needs were met. None of the residents were assessed as being able to administer their own medication due to their diagnosis of dementia. Personal care was delivered in private but a small number of staff did not necessarily always respond to residents in a respectful manner. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Care plans were kept separately from the daily report. Care staff report to the senior staff who then write the daily record. As a matter of good practice it was noted that a quick guide list of those residents who were assessed as high nutritional risk was placed at the beginning of the daily reports. Some of the residents were seen to be given food supplement drinks throughout the day. Fluid charts were in place identifying specific amounts in millilitres but there was not always a total for the day recorded to monitor whether residents had had sufficient intake. One of the staff said that they regularly gave residents drinks throughout the day especially in the hot weather. There was good Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 10 guidance on managing swallowing difficulties with a liquidised diet or food supplements. The mouth care sponges found uncovered in the freezer at the last inspection had been removed. Residents were weighed on admission and regularly thereafter. Risk assessments were carried out on all aspects of residents care needs, for example, falling, bathing, pressure damage, moving and handling, smoking and nutrition. However the inspector advised that bathing assessments must state whether some residents were able to bath alone, or never to be left alone in the bath. There was much evidence of assessment of all aspects of residents’ care and medical need but not all care plans had clear guidance for staff in meeting those needs. There was good guidance for communicating with a resident who was deafened and referral to their GP for a new hearing aid. But another resident who had no speech had very little guidance on how to communicate with them or how they would make their needs known to staff, for example, whether they were in pain, needed a drink or wanted staff intervention. There was clear guidance to staff on sanctions on alcohol due to residents’ type of diagnosis of dementia. Another resident with a visual impairment had a very detailed care plan on how their bedroom must be kept set out so they could move around it at their ease. Yet there was no guidance about keeping them informed of what was happening from day to day, or how staff should approach the resident. This resident said that they had to ask staff about various different events including the weather or what was for the next meal. One resident was identified as only sleeping for short periods during the night. The daily report stated that they had been found in another resident’s bed but there was no strategy for dealing with this in the care plan, or whether the reasons for this had been investigated. Another resident had good details of their sleeping patterns and how the night staff were to support them with this. Where residents had been assessed as at risk of developing pressure damage, it was not clear from their care plan whether pressure-relieving equipment was in place, although mattresses and chair cushions were seen in bedrooms and in use in sitting rooms. Another resident was described as having “difficult behaviours” but there was no guidance to staff on how to manage these behaviours although a incident log was being kept and the resident was having their care reviewed by the community psychiatric nurse. There was no specific guidance to staff when residents were identified at risk of suicide or self-harm. The inspector advised consideration of some of the language used in residents’ files, for example, “co-operative”, “un-cooperative”, “moody”, “bad tempered” and “violent and aggressive”. The inspector was of the view that the daily reports did not always reflect the complex care needs of residents or relate to the explicit guidance that staff were required to report upon. Discussion were held about the possibility of placing the care plan with the daily report so that they were more readily accessible to staff as they reported upon residents needs. Also consideration of the benefits of staff reporting directly into the records, their interventions, monitoring and observations of residents. One resident had not had their fingernails cleaned or their teeth. Another resident had very long fingernails. The inspector spoke to one resident who, at the last inspection, Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 11 said that their foot hurt and was found to be in urgent need of chiropody. They confirmed that their feet did not hurt this time. The district nurse came at lunch time to give an invasive procedure to one resident who clearly did not want to go to their bedroom when other residents were being asked to go to lunch. The home is advised to negotiate with the district nurses a more convenient time for the resident to receive this treatment. A district nurse from one of the surgeries said that they were happy with the care provided. It was evident from the records that any healthcare concerns were promptly referred to the relevant professional. One resident was asking staff for cups of tea, cigarettes and tissues during the day. Their care plan had little guidance to staff on how to meet these needs which may have resulted in the disengaged attitude of staff noted in the Staffing Section of this report. Only senior staff or those staff who had worked at the home for some time and had more experience administered medications. One of the seniors explained the process from ordering to administration and reviewing with the GPs. They said that all staff had completed the supplying pharmacist’s distance learning pack and some had also covered medication as part of the NVQ. There was an advertisement on the notice board in the medication store for further medication training opportunities in September 2006. Mrs Foreman monitored staff’s continued competence in administering medication and would also provide in house training. Any changes to medication following a GP visit would be recorded appropriately on the medication administration record and entered into a separate log for staff to read at handover. If a consultant or community psychiatric nurse had changed medication this would be confirmed in writing by them. None of the residents had been assessed as being able to administer their own medication due to a diagnosis of dementia. One resident’s medication administration record stated that they had a particular tablet at a critical time in the morning. Their care plan gave no information as to the rationale for this, only to give ‘at the allotted time’. It was clear from talking to senior staff that they were familiar with the reasons that this medication was prescribed including the specific time guidance and this detail should be recorded in the care plan. There was, however clear guidance on the administration of paracetamol which would be given when required. The home kept all the data sheets for the prescribed medication and it was clear that the senior staff were well informed of purpose these medications together with any side effects. No controlled medication was being administered. None of the eye drops stored in the fridge were marked as to when they were opened. One of the senior staff said that all these medications were destroyed each month and new ones provided so that residents would not be given depleted strength eye medications. It was noted that the home had a tablet cutter and one of the staff said that this month the pharmacy had not cut the tablet as they normally did. The inspector advised that the home should Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 12 request this to be done by the pharmacy in future in order to reduce the risk of staff cutting the wrong dose. Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 13 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, 14 & 15 Most residents have to rely on staff to stimulate their interests and how they spend their day. An activities programme is mainly delivered by staff. Residents choice and control over their lives is restricted by their reliance on staff. Residents enjoyed the food but there is a reliance on frozen products. The Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Most residents relied on staff for direction throughout the day. Some residents were able to choose how they spent their day. Residents were not restricted in access to any part of the home or grounds. Most residents had social histories gained from families. There was a file kept of each resident’s involvement in activities with a list of 25 potential activities for staff to provide. There was also guidance from the Alzheimers Society on the proper provision of relevant activities for residents. Activities recorded as having taken place recently included: hand massage, ball games, entertainer (no reference to what kind of event), gardening, darts, exercises and word games. The list included hairdressing and chiropody, which are more personal care interventions rather than an activity. It was not possible to establish from these records whether they took place every day or whether gaps in the record indicated that a resident had not wanted to join in with an activity. A person had come to the home at 10.00am to give an exercise class and staff were encouraging residents to join in the chair exercises. Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 14 Mr Foreman said that trips out had been arranged in the past but that residents had been disorientated or upset on return to the home so they had not been resumed. He went on to say that he had tried to take some residents out in his car when he was doing errands or shopping but this had not worked either. He said that residents often went out with families for a meal, to their family’s home or for a drive. The recommendation that consideration should be given to developing the activities programme to provide specific activities geared to outcomes for people with dementia, with realistic achievements and consideration of different attention spans and the appointment of a person responsible for activities had been actioned in part. Although no activities person had been appointed and staff were expected to provide the majority of the activities as well as care, some people had been engaged to provide an exercise class and what was described as ‘entertainer’. A clergyman and a group of people from one of the local churches were providing a service in one of the sitting rooms. One of the care leaders said that other denominations came once a month to provide services or communion to some residents in their own bedrooms. Those residents who smoked had their cigarettes rationed by staff. One of these residents said they were happy with the arrangement to help them stretch their finances and said that staff never refused them a cigarette. The recommendation that consideration should be given to revising the range and variety of dishes in the home’s menu together with the new chef, taking into consideration the guidance from the Alzheimers Society on food and nutrition for people with dementia had been actioned in part. The menu, operating over 3 weeks, has changed and provided a range of traditional foods suited to the tastes of older people. There was no choice but a hot meal was served at night. Some of the dishes were pre-prepared frozen dishes, for example, fish cakes. Whilst research shows that frozen foods are not diminished in nutritional value, the inspector was surprised to find that frozen vegetables were being served during the time of year when fresh produce would be readily available. Most of the ‘fresh’ ingredients were stored frozen and there appeared to be very little made on the premises; some pastry and puddings. However the residents did appear to be enjoying the lunch and there was a large number of bananas, oranges, apples and pears in the store cupboard. Mr Foreman showed the inspector the stock of frozen dishes for those residents with diabetes. All of those residents who were spoken with said they enjoyed the food. Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 15 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 & 18 Systems are in place for residents and their families to make comments and complaints about the service. Some staff were aware of and had regular training in the Vulnerable Adults policy and procedure. However some staff need to be aware of their attitude when working with residents. The Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home had a complaints procedure which had been made available to relatives. Mr Foreman said that questionnaires were sent to relatives each year when they were notified of an annual fee increase. Information was also sent about how to make comments on the service. Mrs Mason was in the process of collating the information received and changes would be made as necessary. Staff had been trained in abuse awareness and one of the staff was able to tell the inspector what action they would take if they noted that residents were vulnerable to abuse, either from colleagues, families or indeed any other person. They were aware of the local vulnerable adults policy and procedure and said that all new staff were made aware of the policy on induction. However some staff needed to be made aware of less obvious actions described in the Staffing Section, which still are considered abusive behaviours to residents. Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 16 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): 19 & 26 Residents live in a comfortable, well-maintained environment and much effort has been made in this area. Whilst no unpleasant odours were detected, some areas not always visible were not cleaned to a good standard. Advice from the Environmental Health Officer with regard to reducing falls had been actioned. Some food storage in the kitchen was not in line with guidance. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Residents’ bedrooms were personalised and were provided with new furniture and matching linen and towels. The bedrooms appeared comfortable light and airy and no unpleasant odours were detected during the inspection. Staff were in the process of making beds and it was noted that one bedroom had soiled bedding left on the floor rather than in a storage bin or taken directly to the laundry. Mr Foreman removed the filing cabinet used to store the district nurses dressings from one of the sitting rooms during the inspection. The requirement that all areas of the home, including those which are not necessarily visible, were kept clean taking into consideration guidance on Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 17 infection control had been actioned in part. Whilst general standards of cleanliness had improved, there were still some areas in need of consideration, for example, the undersides of raised toilet seats, toilet bowls, bath hoists and the kitchen floor. A chair on wheels in one of the bathrooms was rusty underneath. Protective clothing and gloves were available to staff. Different colour coded cleaning equipment was used for different parts of the home to reduce cross contamination. As a result of a recent Environmental Health Officer’s visit to assess the home’s risk assessments with regard to falls, trips and accidents, Mrs Mason had updated the homes risk assessments. The ventilation in the kitchen was also to be improved as a result of this visit together with all food handlers completing food hygiene certificates and having new overalls. The paintwork in the kitchen would also be redone. Sloping floors and steps in the middle of a throughway had been levelled and replaced with new flooring. Steps to exits had been edged in lighter colours to reduce trips and falls. It was noted that at 4.00pm there were 4 lunches and 2 puddings left on the counter top in the kitchen. Mr Foreman said that these should have either been returned to the fridge or discarded, particularly on this hot day. There were also 5 puddings left uncovered in the fridge where other items were covered and dated. Mr Foreman said he would take this up with the chef. The conservatory was being coated with a reflective surface to reduce the heat and glare. The fire logbook was being regularly maintained with records of all the tests, checks and services of equipment and instruction to staff. However the home needs to record discharges of the emergency lighting batteries in accordance with the timescales set by the Chief Fire Officer. Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29 & 30 Residents were supported by sufficient numbers of care and ancillary staff. Staff have good access to training albeit, in house. Recruitment is robust. Despite this some staff’s attitude to residents on this occasion was poor. Residents, 1 relative and a district nurse made positive comments about staff. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The staffing rota showed 5 care staff including a senior during the morning and 4 care staff including a senior for the afternoon and evening. There were 2 waking night staff and either Mr or Mrs Foreman sleeping in their own accommodation within easy access of the home. Domestic staff were employed to carry out cleaning and laundry duties. At previous inspections staff were seen to positively engage with residents. However, the inspector was concerned about most of the morning staff’s attitude to one resident who was asking for cups of tea, cigarettes and tissues at various times during the day. Staff were seen to ignore the resident and walk past, at another time, admittedly during staff tea break, they continued to talk to each other over the resident; the resident eventually got up and walked away. Two staff said “in a minute” to this resident. Another resident was ignored by a staff member who continued their conversation with another staff. Only the senior carer engaged every time with this resident and gave them what they were asking for each time, or sat with them as they drank their tea. Two staff were heard shouting at each other across the sitting room about answering a ring to the front door. One of these staff asked a resident whether they wanted to go to the toilet; this could be heard by all present in the sitting room. Another resident who Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 19 was trying to get from a sitting position in their chair in the sitting room to the dining room managed to get upright to use their frame but was blocked by a chair placed in their way by a member of staff who was about to clean the floor. The member of staff did not appear to notice that the resident was moving to the dining room. Another member of staff then noticed the resident’s predicament and removed the chair. Two staff had come into 2 different residents’ bedrooms when the inspector was talking to them without knocking on the doors and waiting to be invited in. The three senior staff had NVQ Level 3 and two of them had Level 4 with the other about to commence the award. All staff are encouraged to undertake NVQs. A robust recruitment procedure was in place with potential staff having to complete an application form, declare any convictions and attend an interview. The home kept all the documents and information as required by regulation. None of the recently appointed staff had commenced duties without a POVAfirst check and Criminal Records Bureau certificate applied for. The visiting hairdresser and chiropodist had also been subject to Criminal Records Bureau checks as they had unsupervised access to residents. New staff were inducted and ‘shadowed’ a more experienced member of staff for the first couple of shifts on duty. Mrs Foreman carries out most of the staff training and staff had access to a good range of relevant training. Training included moving and handling, first aid, food hygiene, dementia awareness, abuse awareness, One staff told the inspector of their previous experience in care settings, they said they had had a good induction into the home, shadowing Mrs Foreman. They said they had done a large amount of relevant training since working at the home. They said that staff meetings were regularly held and they could contribute to the agenda. They said that they had regular supervision. They also said that all the staff worked well together and got on. Those residents with whom the inspector could communicate made very positive comments about the staff. A relative and a district nurse also made positive comments. Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 20 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): 31, 33, 35, 36 & 38 This is a family business and each member has different areas of responsibility as well as management of care. The home is run in the best interests of residents. The home takes no responsibility for residents’ finances. Staff are made aware of safe working practices. The home has a history of actioning requirements and recommendations. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Mr Foreman is the registered manager in this family business. His responsibility is the day-to-day running of the home and Mrs Mason is the Responsible Individual but manages the care. Mrs Foreman is the training manager and works in the home. Mr Foreman has had over 20 years experience of both working in and running care homes. Although Mrs Mason is a nurse she does not provide any nursing input into the home. The home has a history of always actioning any requirements or recommendations. Staff were regularly supervised by management and records kept on file. Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 21 There were a number of questionnaires on file sent to relatives to comment on various aspects of the service. None of the forms were dated so it was not possible to establish whether they were recent. Mr Foreman telephoned Mrs Mason who said that the forms had been sent out in May 2006 and that she was in the process of collating the information as part of the home’s quality assurance system and would make any necessary changes where issues were raised. Mr Foreman said that they did not hold any money or valuables on residents’ behalf but encouraged families or solicitors to be responsible for residents’ finances. Where any resident had no family, the local authority managed their money on a court of protection. Mr Foreman said he paid for any items purchased by residents, for example, hairdressing, chiropody or cigarettes, and invoiced the person holding each residents money at the end of the month and this system worked well. Those residents with whom the inspector could communicate made positive comments about the home. One said they did not need looking after but that it was nice to know that someone was there to give them a bath. Another resident explained how staff supported them with getting up and bathing. They said all the staff were lovely. The accident records were audited each month by the providers. Records were varied with some good detail of what was witnessed but others poorly documented when not witnessed, for example, “found on floor”. Environmental risk assessments had been updated following advice from the Environmental Health Officer after their inspection of the safety of the environment in terms of risk of falls and trips. Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 22 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X 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 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 23 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 OP26 Regulation 23(2)(d) Requirement The registered person must ensure that all areas of the home, including those which are not necessarily visible, are kept clean taking into consideration guidance on infection control. (In progress but toilet surrounds and underneath hoist seats still need some attention). The registered person must ensure that clear guidance is documented in care plans as to how each residents assessed needs are to be met, for example, managing behaviours or any medication prescribed to be taken at specific times. The person registered must ensure that bathing risk assessments identify whether residents can bathe alone or whether they must never be left in the bath alone The registered person must ensure that staff pay proper attention to residents being well groomed. The registered person must ensure that some staff consider DS0000066527.V298366.R01.S.doc Timescale for action 18/07/06 2 OP7 15(1) 18/07/06 3 OP7 13(4)(b)& (c) 18/07/06 4 OP8 12(1)(a) 18/07/06 5 OP36 12(5)(b) 18/07/06 Cleveland Lodge Version 5.2 Page 24 6 OP38 16(2)(j) how their attitude affects the residents and could undermine the personal and professional relationships with residents. The registered person must ensure that food storage complies with food hygiene safety guidance. 18/07/06 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 OP12 Good Practice Recommendations The person registered should consider developing the activities programme to provide specific activities geared to outcomes for people with dementia with regard to realistic achievements and taking into consideration different attention spans. The appointment of a member of staff with specific responsibility for this provision is a good practice recommendation. (In progress but care staff still providing the majority of the activities) The person registered should consider reviewing and revising the range and variety of dishes in the home’s menu with the residents and the new chef, taking into consideration the good practice guidance published by the Alzheimers Society on food and nutrition for people with dementia. (A change of menu but most of the ingredients still pre-prepared and high quantities of frozen vegetables, even in summer). The person registered should ensure that pre-admission assessments are signed and dated and an indication should be given as to the source of the information. The registered person should ensure that fluid intake charts give a total each day in order to assess whether sufficient has been taken. The registered person should consider keeping the care plans with each daily report for staff reference. The registered person should ensure that staff are aware of appropriate language to use in written records. The person registered should consult with visiting DS0000066527.V298366.R01.S.doc Version 5.2 Page 25 2 OP15 3 4 5 6 7 OP3 OP7 OP7 OP37 OP8 Cleveland Lodge 8 OP9 healthcare professionals to arrange suitable times for treatments to be carried out when residents are not having meals. The registered person should request of the supplying pharmacist to cut tablets where required rather than staff who risk cutting the wrong dose. Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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 Cleveland Lodge DS0000066527.V298366.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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