Inspection on 22/08/07 for Cleveland Lodge

This inspection was carried out on 22nd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Cleveland Lodge 17/08/09

Cleveland Lodge 18/07/06

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 Sally Walker Unannounced Inspection 09:15 22 August 2007 nd 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.V340201.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.V340201.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.V340201.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th July 2006 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 4 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. Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 22nd August 2007 between 9.15am and 6.20pm. Mr Foreman was present during the inspection. Five residents and five staff were spoken with. A tour of the building was made. The care records, medication records, staffing records, menus and risk assessments were inspected. As part of the inspection process, survey forms were sent to the home to gain the views of residents, their representatives, staff and healthcare professionals. Comments can be found in the relevant parts of this report. 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? Action has been taken to ensure that all pre-admission assessments are dated and show the source of the different information. Care plans now give clear guidance about managing behaviours and medication to be administered at specific times. Staff are recording factual observations and no inappropriate language was seen in reports. Bathing risk assessments identified that residents were never left alone when bathing. In addition the home’s policy that residents are never to be left alone was posted in each bathroom. Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 6 Staff pay detailed attention to residents grooming, making sure that clothing is clean and matching. The supplying pharmacist now provides medication that had to be cut in half to reduce the risk of staff administering the wrong dose by cutting it themselves. A member of staff has been appointed to organise and provide regular activities. Care staff say they are now more confident providing activities at other times. A range of resources has been purchased for these activities. The menus provided more home cooked dishes rather than pre-frozen meals. Fresh vegetables were provided twice a week. The home still provides frozen vegetables for the rest of the week. Bedrooms had been numbered and photographs or artwork displayed so that residents could find where they lived. The home was cleaned to a good standard including those areas not always visible. All staff engaged with residents. Those staff who were seen to have a poor attitude to residents at the last inspection had left employment. Food was being stored in accordance with food hygiene requirements. The kitchen was cleaned to a good standard. Action had been taken to address all of the requirements and recommendations from the last inspection of July 2006. 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. The summary of this inspection report can be made available in other formats on request. Cleveland Lodge DS0000066527.V340201.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.V340201.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 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 potential residents care needs are assessed in detail before a place is offered. Other services involved in the treatment of residents are engaged so that residents will have continuity of care and healthcare. The home does not provide intermediate care. EVIDENCE: Either Mrs Mason or Mr Foreman carried out the detailed pre-admission assessments to establish whether the home could meet potential residents care and support needs. Information was gained from as many sources as possible and this was recorded on the assessment document. The assessments identified potential residents interests as well as their care and medical needs. Care management assessments were obtained on every occasion if potential residents were funded by a local authority. Mr Foreman Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 9 said that they could not take emergency admissions. Residents and their families were encouraged to visit the home before admission. All residents had an initial months trial to establish whether the placement was suitable. Any healthcare needs were set up with the local district nursing or community psychiatric services before admission. This meant residents had continuity of treatments. Action had been taken to address the recommendation that pre-admission assessments were signed and dated with an indication of the source of the information gained. Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans give details of all residents care and support needs with guidance to staff on how they are to be met. None of the residents managed their own medication. Systems were in place to ensure safe administration of medication. Staff upheld residents’ privacy and dignity. EVIDENCE: All residents had a care plan with detailed guidance on how to meet needs. Care plans were regularly reviewed each month and separate reports were made each month on the individual’s progress. These reports showed a good picture of how the care was being provided and monitored. Care plans identified where a healthcare professional had given a diagnosis of dementia and additional conditions. Action had been taken to meet the requirement that clear guidance was documented in care plans regarding how residents needs were to be met, particularly with regard to managing behaviours and medication to be taken at specific times. Some care plans had been agreed Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 11 and signed by the funding agency. If behaviours were identified, a separate chart was kept for monitoring purposes and information for the healthcare professional involved with their care. One resident had a separate care plan with specific guidance on managing their behaviours. Any risks had been assessed with clear guidance on minimising those risks. For example, one resident who had been identified as having a risk of malnutrition had a specific care plan with regard to diet. They were given nutritional supplements and records were kept of their fluid intake. One resident who was identified as being at risk of developing pressure sores had pressure relieving equipment in place and guidance in their care plan. All residents had their risk of falls regularly assessed. Residents were regularly weighed and weights monitored. Any significant weight loss was referred to their GP. Moving and handling assessment were in place. Action had been taken to address the recommendation that fluid intake charts gave a total each day for monitoring purposes. One of the senior staff said that fluid charts were only used if residents were at risk. All of the current residents were able to drink independently. Residents were seen to be given hot and cold drinks throughout the day. Some of the residents were given whole milk flavoured drinks in addition to tea or coffee during the day. Food supplement drinks had also been prescribed by some residents’ GPs. Action had been taken to address the recommendation that the care plans were kept with the daily reports for staff reference. Action had been taken to meet the recommendation that staff were aware of appropriate language to use in written records. There was a summary of each resident’s care and support needs accompanying their daily records. Care plans identified which name each resident liked to be called by. Action had been taken to address the requirement that bathing risk assessments identified whether residents could be left alone in the bath or whether they could never be left. This was identified in care plans and a policy displayed on bathroom doors stating that residents were never left alone whilst bathing. Action had been taken to meet the requirement that staff pay proper attention to residents being well groomed. All of the residents seen were well groomed, with cleaning clothing. All of the women had had their hair done recently. Staff had paid attention to ensuring that items of clothing matched. Continence accidents were managed immediately. Shaving or personal care requirements were identified in care plans. Some female residents were asked about whether they had been asked their views on receiving intimate personal care from male staff. One resident said they did not mind and that they had been given a bath by a man. The home writes to relatives informing them that both male and female staff are employed. They are asked if this is an issue for their family member. It was advised that the home must develop a gender working policy for the giving of Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 12 intimate personal care. Residents must also be asked their preferences and these must be recorded in their care plans. The recommendation that the home should consult with visiting healthcare professionals to arrange suitable times for treatments to be carried out, not when residents were having meals, was now not relevant. Mr Foreman said that the district nursing service had appointed permanent staff who visited regularly at suitable times to treat their patients. Those residents who had a diagnosis of diabetes had a management care plan. It was clear in each plan whether diet or medication was prescribed for the individual. Senior staff had each been trained by the district nurse to carry out blood glucose monitoring tests with residents who were diagnosed with diabetes. This had recently been updated by the district nurse. One of the senior staff said that the district nurse also wrote a care management plan for each resident with diabetes. One of the senior staff said that the district nurse had given staff training in the Primary Care Trust’s system for alerting when concerns were noted. This was described as an ‘early warning system’. The arrangements for the administration and control of medication was explained by one of the senior staff. All residents are assessed as to whether they can administer their own medication. None of the current residents administered their own medication. Only senior staff or those staff who had worked at the home for a long time could administer medication. All staff were trained in administration by Mrs Foreman who regularly assessed their continued competence. The system was overseen by Mrs Mason or Mrs Foreman who ordered repeat prescriptions and checked medication as it was delivered by the pharmacist. The medication administration records were properly recorded. Any changes were witnessed, signed and dated. Specific indications with regard to administration were recorded in those residents’ care plans. Examples included: medication administered via a body patch, medication to only be taken when required or medication only taken once a week. Injections given by the community psychiatric nurse were identified in those residents’ care plans. Data sheets supplied with medication were kept with medication administration records. An up to date British Notional Formulary, published by the British Medical Association and the Royal Pharmaceutical Society was available for staff information about medication. The pharmacist from the local Primary Care Trust had recently undertaken an inspection of the medication arrangements. Action had been taken to address the recommendation to request that the supplying pharmacist cut any tablets as needed to reduce any risk of staff cutting the wrong dose. All tablets requiring this were supplied already cut in the monitored dosage packs. Two GPs responded to survey forms. Both said yes to the question whether the home communicates clearly and works in partnership with them. Both said Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 13 yes to the question on whether there was always a senior member of staff to confer with. Both said that they were able to see their patients in private. Both said that staff demonstrated a clear understanding of residents’ care needs. One GP said yes to the question as to whether any specialist advice they gave was incorporated into the resident’s care plan. Both GPs said yes to the question whether residents’ medication was appropriately managed. Both said yes to the question whether management took appropriate decisions when they could no longer manage a resident’s care needs. Neither GP had received complaints about the home. Both GPs said they were satisfied with the overall care provided to their patients. Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Efforts are made to find out about residents interests before they come to the home. Employing a member of staff to organise and provide activities has started to improve the quality of residents’ social lives. Residents’ contact with relatives is encouraged. Those residents who have a degree of capacity have some control over their day to day lives. The quality of the meals provided is improving. EVIDENCE: Residents generally relied on staff for direction about what to do and where to spend their day. Some residents had chosen to spend some time during the day in their bedrooms. Other residents were spending time in the grounds, particularly those residents who smoked. Patio furniture and an awning had been put out for residents to use the garden. Some residents chose to walk around the home engaging with staff on the way. None of these residents appeared to be distressed or looking to leave the building. There was little evidence in the daily reports of how staff were encouraging residents with decision making or expressing choice. Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 15 A number of the residents smoked and this was detailed in their care plans. One resident said that they went to the office at specific times of the day to get their cigarettes so that they were not smoked all at once. It was advised that in addition to the written notice for times for cigarettes, a visual chart and clock would perhaps aid those residents knowing when they could have their next cigarette. It was noted that those residents who smoked were not denied cigarettes at the given times. Those residents who continued to ask for their cigarettes were given a cup of tea. Action had been taken to address the recommendation that the activities programme was developed to provide specific activities to outcomes for people with dementia, realistic achievements and different attention spans. Action had been taken to address the good practice recommendation that a member of staff with specific responsibility was appointed. This member of staff provided 2 hours activities each day, Monday to Friday. They talked about their ideas for different activities. They talked about a barbeque that had taken place in June, a tea party earlier in the year, flower arranging, dancing, keep fit and a cake baking session. Staff still provided some activities. Some staff said they felt more enthusiastic an confident in providing activities now that a member of staff organised the programme. Staff joined in with some of the group work and they said they had more of an idea of things to do. A stock of materials, games, quizzes and music had been purchased for activities. The activities organiser said they had been able to purchase whatever they had wanted. The programme included marking significant events on the calendar throughout the year, for example, an Easter party. Some residents were growing tomatoes and cucumbers in a small green house. Some of the residents’ artwork was displayed around the building. There were also photographs of residents involved in activities. Mr Foreman had obtained money from the Government Grant available to care homes for older people, to purchase 2 mobile sensory activities units and for some raised beds in the garden for residents to grow flowers or vegetables. Mr Foreman said he took some residents out shopping. Another resident went with him to the recycling centre. One resident had been to the local church with a member of staff to play the organ by special arrangement. One of the residents said they wanted to go out more particularly in the afternoons. They said they did not want to go far, just a walk around the garden or to the village. Each resident had an activities care plan. The pre-admission assessments identified residents’ interests. Visitors were encouraged and some residents said they liked to go out with family. Mr Foreman reported that relatives are made aware of the local Alzheimers Society self help group. Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 16 In a survey form filled out with staff help a resident said “Feels she spend to much time on her own.” One resident spoken with said that they had chosen to spend the morning in their bedroom. A raffle at a recent barbeque had raised money for activities. Action had been taken to address the recommendation that the variety and range of meals should be reviewed taking into consideration guidance published by the Alzheimers Society on food and nutrition for people with dementia. The three week menus had been revised to provide more ‘home cooked’ meals with the addition of more fresh fruit and fresh vegetables, twice a week, rather than frozen. Mr Foreman said that he mainly used local suppliers. He went on to say that he had taken advice from a dietician and that food supplements were prescribed for some residents who had difficulty in maintaining their diet. There was a stock of snacks and crisps for residents to have when they liked. One of the staff was preparing a fresh fruit salad as the inspector went into the kitchen at the start of the inspection. The chef had been taken ill that day and one of the staff was preparing the midday meal. They said they had previous experience as a chef with the army. One of the staff said in a survey form: “I think maybe more variety of food for those who understand what they are having to eat.” A relative said: “Very pleased with food & amount he gets.” All of the residents spoken with who could comment said that they enjoyed the food. One of the residents said they liked the new menu and that now the meals were ‘lovely’. They went on to say how they enjoyed the salads. At lunchtime residents were served meals according to their appetite. The meal of roast chicken with two fresh vegetables and potato was well presented with good portions of meat. All the pastry cakes were made at the home. Meat was sourced locally. Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to support residents’ relatives to complain about the service. Staff are confident in using the local Safeguarding Adults procedure for reporting any allegations of abuse. EVIDENCE: The home has a complaints procedure that was given to residents’ representatives on admission. The home keeps a log of any complaints together with records of investigations and outcomes to complainants. One of the residents said that they would “tell them what’s wrong” when asked about how to make a complaint. A relative in a survey form said: “But no complaints need to be made. Knows [they] can talk to managers/carers at any time.” During the inspection one of the residents told the inspector about an item of their possessions that had gone missing the day before. Further investigation showed that Mr Foreman was aware of the loss and was dealing with the resident’s complaint. Staff were asked about the procedure for reporting allegations of abuse. They said they would report through management. They were also aware of the Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 18 direct reporting route to the local Safeguarding Adults Unit. All staff had been given a copy of the local procedure booklet. Staff said that there was a form they filled out to document allegations. Staff had been trained in the local Safeguarding Adults procedure. Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mr Foreman continues to improve the quality of the environment for residents. Significant improvements have been made to the cleanliness of the home. EVIDENCE: Residents’ accommodation is all single bedrooms some with ensuite toilets and wash hand basins. Rooms had been personalised and were clean, light and airy. Residents’ bedrooms had been numbered and some had photographs or paintings on the door to enable some residents to identify their individual bedrooms. There were no unpleasant odours detected at any time during the inspection. Mr Foreman said he was replacing some of the vanity units in the bedrooms. It has been agreed, in a separate letter to Mr Foreman, that his plans to establish a hairdressing room in one of the bathrooms. There are sufficient bathrooms in each area of the home to meet the National Minimum Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 20 Standards. However works must not be carried out whilst the bedroom adjacent to this bathroom remains occupied as this resident is used to having this bathroom available to them. Significant efforts had been made to meet the requirement that all areas of the home were kept cleaned to infection control standards, including those areas not necessarily visible. The laundry was clean and well ordered. Clothing was sorted and washed according to temperature guides. Prepared laundry was put in named baskets ready to be returned to residents. There were proper arrangements for dealing with soiled or infected laundry. Disposable gloves and aprons were available. A member of staff said in relation to improvements: “Have a laundry worker so that the 2 night staff could spend more time caring for the service users instead of washing ironing and returning laundry to the rooms. The laundry room is quite separate and leaves I carer to look after 29 vulnerable people at a time (Many are up at night).” Staff said “it is kept very clean and tidy most of the time. Also there are always plenty of aprons gloves and anti-bacterial gels available.” It was advised that the continence book should be kept securely and not left in the sitting room. Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is generally good. This judgement has been made using available evidence including a visit to this service. Staffing levels have been increased in the afternoons to meet the needs of residents. Staff have good access to training. A robust recruitment process is in place. EVIDENCE: The care staffing rota provided for 4 care staff and a senior carer in the mornings and three care staff and a senior until 7.30pm. The staffing levels had been increased during the afternoon and early evenings to support the residents increased needs during this time. At night there were 2 waking night staff and either Mr or Mrs Foreman carrying out the sleeping in duty from their own accommodation nearby. A member of staff had come in to cover the carer who was doing the cooking. In addition to the care staff there were 2 cleaners. Staff are provided with taxis, paid for by the home, to come into work and go home at the change of each shift. Action had been taken to address the requirement that some staff considered how their attitude affects the residents. Staff were seen to engage with residents throughout the inspection. Staff also responded immediately to Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 22 those residents who sought assurance or wanted items, unlike what had been witnessed at the previous inspection. Staff went about their work in a quiet manner. As part of the inspection process survey forms were sent to the home requesting comments from staff. One staff said: “Staff turnover tends to be very high – due to army personnel – clients challenging behaviour – I feel staff need to be more informed of this on application.” Another staff said “Over the time I have worked there the home has made many improvements – environmental and activities (one to one and group).” Another staff said: “A person to start before 7.30am to work alongside night staff. Help people up and help with washing dressing and showering.” Another member of staff said: “Good constant supply of drinks build up milky, during the day. Good communication with walky talky. Activities daily events entertainments plenty of training courses good carers.” One staff said: “I feel unhappy that service users who are up very early (their choice) once washed and dressed have to be left alone whilst the 2 night staff work their way through the rest of the home getting people up. Given that the home is on 2 floors and many people need 2 carers to be got up it is not possible to be supervising them all. We really need a third person from around 6 – 6.30am.” These comments were shared with Mr Foreman. A robust recruitment process was in place. All potential staff fill out an application form, attend an interview and all the information and documents were in place before staff commenced duties. No staff started working without checks on the Protection of Vulnerable Adults list or a Criminal Records Bureau certificate applied for. All new staff have a period of induction with records kept. One of the senior staff told the inspector about their recent training which included a moving and handling update, first aid, safe use of chemicals, trips and falling, Safeguarding Adults, dementia, medication and diabetes. Another staff described their induction into their role. Mrs Foreman is the home’s training manager and provides regular training in relevant subjects. Seven staff had NVQ Level 2 and eight staff had Level 3. Three of the senior staff had NVQ Level 4. Other recent training had included moving and handling, first aid, food hygiene, medication and falls prevention. Sixteen staff had undertaken training in dementia care. There was a list of when core training was needed to be updated for each staff. This included a training plan for the rest of the year. Regular staff meetings were held with minutes kept. Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has been run as a family concern for many years. The home is run in the best interests of the residents. The home does not hold any cash on residents’ behalf. Staff benefit from regular supervision. Residents and staff’s health and safety is considered although not always recorded thoroughly. EVIDENCE: Mr Foreman is the registered manager and he and his sister Mrs Mason take joint responsibility for the day to day running of the home in this family business. Mrs Foreman is the training manager. She also works in the home. Mr Foreman said that they keep themselves up to date with current good practice with attending seminars and trade shows. Mrs Foreman holds the Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 24 Registered Managers Award. She is also considering attending training in supervision, appraisal and dementia mapping. Action had been taken to address the requirement that food storage complies with the food hygiene safety guidance. The kitchen was seen to be well ordered with no food left on surfaces. The food kept in the fridge was covered as appropriate. Records showed that all staff had regular supervision. One member of staff in a survey form said “[Supervision] always recorded but not always planned”. One staff said that they had supervision every three months. The home sent questionnaires each year to residents or their representatives for responses about the quality of the service provided. Comments are collated and action taken on any suggestions. The home set out its plans in the Annual Quality Assurance Assessment returned to the Commission as required. The home does not provide a safekeeping service for residents’ cash. Mr Foreman said that the home would pay for any items that residents bought, for example, hairdressing services, clothing or toiletries and the person acting on the resident’s behalf would be invoiced each month. The local Environmental Health Department had carried out an assessment of the home’s risk of ‘slips and trips’. The home had carried out their own assessment of some of the other risk to the environmental and tasks. The inspector advised that other risks should be assessed, for example, taking residents out in the vehicle or for walks in the community. It was clear from discussions with Mr Foreman that informal consideration had been given and action taken to reduce risks associated with a range of activities that residents and staff were involved in. However there were no records as evidence. Mr Foreman said he regularly walked round the building noting any maintenance or safety hazards. He then made arrangements immediately to remedy the fault. Staff were regularly training in moving and handling, food hygiene, fire safety, first aid and infection control. Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 25 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 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.V340201.R01.S.doc Version 5.2 Page 26 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 OP10 Regulation 12(2),(3) &(4)(b) Requirement The person registered must provide a policy with regard to the giving of intimate personal care by staff of a different gender for the protection of residents and staff. Timescale for action 31/10/07 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 2 Refer to Standard OP37 OP14 Good Practice Recommendations Consideration should be given to more confidential storage of the continence record. Consideration should be given to providing, in addition to the written timetable, a visual chart or prompt, or clock so that residents who smoked may know when their next allocated cigarette was due. Consideration should be given to building upon the current progress in improving activities with more visits in the locality when requested by residents. Consideration should be given to building upon current progress in providing more fresh ingredients in the meals DS0000066527.V340201.R01.S.doc Version 5.2 Page 27 3 4 OP13 OP15 Cleveland Lodge provided. Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Cleveland Lodge DS0000066527.V340201.R01.S.doc Version 5.2 Page 29 - 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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