Inspection on 07/06/07 for Crowborough Lodge

This inspection was carried out on 7th June 2007.

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 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

Crowborough Lodge 13/07/06

Crowborough Lodge 19/12/05

Crowborough Lodge 18/05/05

Crowborough Lodge 05/10/04

Crowborough Lodge 01/06/04

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

CARE HOMES FOR OLDER PEOPLE Crowborough Lodge 2 Crowborough Road Saltdean East Sussex BN2 8EA Lead Inspector Jo Griffiths Key Unannounced Inspection 7th June 2007 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Crowborough Lodge DS0000037605.V342899.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. Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crowborough Lodge Address 2 Crowborough Road Saltdean East Sussex BN2 8EA 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) 01273 302614 Evans Care Ltd Mrs Bernadette Mary Weller Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - (OP) The maximum number of service users to be accommodated is 31. Date of last inspection 13th July 2006 Brief Description of the Service: Crowborough Lodge provides care and accommodation for older people. Since the last inspection the owner has extended the building and varied the registration of the home to change the number of people that can be accommodated in the home from twenty-three to thirty-one older people. The home is a large detached house with sea views and is situated in a quiet residential area off the A259 main south coast road in Saltdean. Local transport, shops and other amenities are located close by. Accommodation is provided on three floors. There are four shared bedrooms and twenty-three single bedrooms. Some bedrooms have ensuite facilities. Communal areas consist of two lounge areas, a dining area, a sunroom, a smoking room and a small garden area to the rear of the building. The current fees range from £415.00 to £465.00. Additional charges are made for hairdressing, chiropody and newspapers. Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection carried out under the CSCI “Inspecting for Better Lives” programme of inspection. The inspection visit was unannounced. The manager and the owner were at the home at the time of the inspection. Time was spent with the Manager reviewing the key documentation, inspecting the premises and gaining feedback on developments in the home since the last inspection. During the afternoon time was spent talking with the people that live in the home about the care they receive. Indirect observation of the support people were receiving throughout the day was also used to form a judgement of the service provided. Surveys were sent to relatives, people living in the home and health professionals to gather their views of the home as part of the inspection process. The feedback was positive overall and comments included “I would have no problems recommending this home to any elderly person.” “When the decoration works are finished this will be the best rest home in the area.” “I would like to see more activities. An outing more often would be good.” “The service is very proactive and individuals needs are met effectively.” What the service does well: What has improved since the last inspection? The environment has been improved to provide more modern facilities for people. It is planned that this will continue this year to provide more ensuite facilities. Staff have updated their medication training so that people in the home are better protected by safe practices. A handrail has been added to the hallway Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 6 and the infection control policy is being reviewed. Staff have started training in Dementia. The Manager has updated much of the documentation used in the home to make it easier and clearer for staff to follow. 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. Crowborough Lodge DS0000037605.V342899.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 Crowborough Lodge DS0000037605.V342899.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): Standards 1, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with information to help them make an informed decision about using the service. Each person has a full assessment of their needs before they move in to ensure they can be appropriately met. People have the opportunity to visit the service and assess the quality before moving in. EVIDENCE: The owner has updated the Statement of Purpose and Service User Guide to reflect the recent change to the number of people that can be accommodated in the home. Training has been provided to staff to ensure they are skilled to meet the needs of the people living at the home. Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 9 Before a person moves into the home the Manager visits them to carry out an assessment of their needs to ensure the home will be able to meet their needs. Once the person moves into the home another, more detailed assessment is completed to establish their support needs and the care plan is developed. Before moving to the home people can visit for the day or can come for a period of respite. When they arrive they can bring family to help them settle in. People that have recently moved to the home confirmed that this was the practice. Crowborough Lodge DS0000037605.V342899.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): Standards 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have a care plan that ensures their personal, social, emotional and health care needs are met. They are supported to manage their medication in a safe way. Staff treat the people living at the home with respect and support them to maintain their dignity. EVIDENCE: People have a care plan that addresses how their assessed needs will be met. The care plans are easy to follow and reviewed monthly. Individuals would further benefit from more detailed instruction for staff on how to meet the person’s personal care. Where possible people have signed their own care plans and the Manager gave evidence of how people are encouraged to be involved in writing the plans. The care plans include a section to record information about the person’s interests, key events in their lives and things that are important to them. This Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 11 gives staff a picture of the whole person and allows them to talk to the person about things that matter to them. Staff are instructed, through the care plan, to listen to people’s views and to consult with them about their care. This is very good practice and demonstrates that the Manager has a good understanding of person centred care. People spoken with said that they felt they were getting the support they needed and that their needs were being met. Records evidenced that the care plans are being consistently followed and reviewed as people needs have changed. The GP and other healthcare professionals meet individuals’ health care needs. The home has developed a good working relationship with the district nurses who visit the home regularly. Records showed good recording of people’s health needs and a quick response to any changes in their well being. People living in the home said that they can always see a doctor quickly if the need to. Only trained staff that have been assessed as competent administer medication. All staff have recently updated their medication training and good practice issues have been identified in supervision sessions. Plastic pots have been purchased since the last inspection to avoid the need for staff to handle tablets when dispensing them. The policy for the administration of medication in the home should be dated to show when it was last reviewed. Staff were seen to talk to the people living at the home in a respectful and patient way. People spoken with told the inspector that the staff are all very kind and treat them well. One person said “Nothing is too much trouble for the staff, they always carry out their jobs with a smile.” Feedback in the surveys provided further evidence to support that staff treat the people that use the service with respect. Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People enjoy the activities that are available but would like more. They are supported to maintain contact with their friends and family. People are supported to make their own decisions and these are respected. People living at the home enjoy a varied and balanced diet. EVIDENCE: There are some organised activities in the home for two days per week. This includes quizzes and a trip to the pub. There is also a monthly church service held in the home. Recently the home have organised a sunflower growing contest for people to join. The Manager has identified the need for more activities to be provided and is planning to consult with the people living at the home about their preferences. It is also planned that a board displaying the activities available will be put up in a communal area to allow people to choose if they wish to participate. People spoken with confirmed that more activities would be beneficial and felt Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 13 that the Manager had listened to them about this. They were happy that this was going to be developed. People living at the home can receive visitors when they wish to and can choose to see them in one of the lounges or their own rooms. There is a payphone in the hallway and a cordless phone for people to make private calls. People spoken with said they enjoyed going for short walks in the area and would like to be able to do that more often. People living in the home are encouraged to make choices and decisions for themselves. They are supported to manage their own personal money where they wish to and decorate and furnish their rooms with their own belongings. A new resident said she was able to bring all her furniture and belongings. Those spoken with said they can choose when to get up, go to bed, have a bath and have a cup of tea. There are some routines in the home but people said these are flexible and that they can ask for anything they want outside of the set times. The Manager is planning to develop an orientation board to as a reminder for people about the date and key calendar events. There is a four-week menu in the home that provides two choices per meal. People are asked what they would like for their meal the following day. If they do not want the offered choices alternatives can be provided. People with specific dietary needs have their needs assessed, met and kept under review. Everyone spoken with praised the meals and said they were happy with the choices. A couple of people commented that the cups of teas are not always very hot and the inspector also noted this. The manager said she would look into this issue. The menu is displayed in the dining room but it is not situated in a position that people can easily see and it would benefit the people living at the home if it was in a larger print. Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home know how to make a complaint if they need to and can be confident that they would be listened to. People in the home are safeguarded from abuse. EVIDENCE: There is a clear complaints procedure in place. It would benefit the people living at the home if the complaints procedure was produced in a user-friendly format and displayed within the home for people to easily access. There is a suggestions box in the home although people do not routinely use this. There have been no complaints received by or about the home. People that live at the home said they felt they could talk to the Manager if they had any concerns about the care they were receiving. All staff are required to undergo a Criminal Records check before they are employed and this includes a check against the POVA (Protection of Vulnerable Adults) register. All staff have training in safeguarding adults and the Manager works alongside staff on duty to monitor their practice. Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 23 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at the home benefit from a spacious and comfortable environment. They will further benefit from the completion of the decoration works to the new part of the building and development of the outside areas. The home is clean and safe. EVIDENCE: Since the last inspection the home has been extended to accommodate an additional 8 people. There are 8 new single ensuite bedrooms and an additional lounge. The new part of the home is very modern. In the existing part of the home there is a lounge, large conservatory, dining room and smoking room. It is planned that everyone living in the home will be encouraged to use all areas of the home including the existing and new Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 16 facilities. A handrail has been fitted to the hallway to support people with mobility difficulties. There is still some work being finished to the décor of the new part of the home. Risk assessments are in place for the decorating and remaining building works. There have been some disturbances of noise from the building works but the Manager has tried to limit this by offering people the chance to move away from the source of noise. The rear garden is not yet accessible to the residents. This will be worked on across the summer but the front garden is accessible. It is also planned that some of the existing bedrooms will be upgraded this year to include ensuite facilities. All areas of the home are clean and well maintained, but the Manager must ensure there are no infection risks from people’s bars of soap being left in bathrooms. All the people spoken with are happy with their bedrooms and feel they meet their needs. There are two lifts in the home to enable people to access all floors. The Manager needs to assess the risk of a bathroom door that opens out onto a stairway in the new part of the building. Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 17 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): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are supported by sufficient numbers of trained staff. They are safeguarded by the homes procedures for recruiting staff. They would benefit from more staff obtaining their NVQ award. EVIDENCE: Rotas show that sufficient numbers of staff are employed to meet the needs of the people living at the home. When new people are admitted to the extended part of the building the numbers of staff on duty will increase. People spoken with said that there are always staff around to help them when they need it and that staff can be called using the call bells in each room. Staff undertake an induction when they join the home. The Manager is advised to refer to the “Skills for Care” website for advice on induction standards. Training has been completed or planned for all staff in the areas they require to safely carry out their roles. The Manager must ensure that the records of staff training are clear and evidence when staff have completed the required training courses. Staff are currently completing a training course in Dementia care. Some staff have completed an NVQ and it is planned that more staff will commence in September. This will increase the numbers of qualified staff to 50 . Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 18 The recruitment procedure for new staff is robust and safeguards the people living at the home. All staff are formally interviewed and at least two references are taken up. The owner also follows up written references with a telephone call to verify the reference where possible. Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 19 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): Standards 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from there being a competent and approachable Manager. The home is run in their best interests and they are safeguarded by the homes policies and record keeping. People in the home would benefit from staff being supervised more frequently. They are supported to maintain their finances safely and their health and welfare are promoted and protected. EVIDENCE: The Manager has achieved the NVQ level 4 in management and the Registered Managers Award. She attends training courses as needed to keep up to date Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 20 with best practice. The Manager has a good understanding of person centred care and spends time each day talking with the people living at the home to ensure they are happy with the service. People spoken with said they felt they could talk to the Manager about any concerns and the staff said they felt well supported. The owner is at the home several days a week and meets regularly with the Manager to discuss issues in the home. Surveys are sent to relatives once a year to gather their views and issues raised are responded to quickly. In response to a request a newsletter has been published to share news about the home. The owner is advised to publish the results of any quality assurance exercise for the people living in the home to see. Residents meetings have been recently reinstated to allow people living at the home the opportunity to make suggestions for improvement and have a say in the running of the home. People are supported to maintain their own finances and have a lockable space in their own rooms for personal items. If people wish to they can ask the home to hold money or valuables for them. Where this occurs clear records were seen to be in place. Staff supervision has taken place, but not regularly. An increase in the supervision of staff would ensure that people are supported by staff that are up to date and have their practice monitored. The home has clear policies and procedures in place and these are discussed with staff at induction, supervision and team meetings. The Manager should ensure that policies show the date they were last reviewed. It is recommended that staff record the time they make their entries on each person’s daily notes to provide a clearer audit trail of the care provided. Health and Safety checks are made each week and servicing of equipment is up to date. Risk assessments have been completed for the general environment but also any specific risks for individuals. The Manager must ensure that any risks from the bathroom door in the new part of the building are assessed as this opens onto the top of a stairway and could present a risk to staff or people in the home. Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 21 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 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 3 3 Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 22 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 OP12 Regulation 16(2)(n) Requirement The registered person must ensure that the people living in the home are consulted on the activities they would like have available to them. A programme of activities based on people’s interests must be provided to ensure they are appropriately occupied. The complaints procedure must be produced in a format that is accessible to the people living in the home so that know how to make a complaint if they need to. The registered person must ensure that risks of infection in are minimised to maintain the health of the people living at the home. The registered person must ensure that all risks in the general environment are assessed and minimised to protect the people living at the home. DS0000037605.V342899.R01.S.doc Timescale for action 27/07/07 2 OP16 22(2)(6) 27/07/07 3 OP26 16(2)(j) 30/06/07 4 OP38 13(4)(a) 30/06/07 Crowborough Lodge Version 5.2 Page 23 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 OP7 Good Practice Recommendations It is recommended that more detail be included in the care plans that direct staff on how to support people with their personal care needs. It is recommended that the menu be produced in a larger print and positioned in a place that people can easily access in the home. It is also recommended that the Manager ensure staff provide people with hot drinks to their preferred taste. 3 OP30 It is recommended that the skills for care induction standards be included as part of the staff induction. It is recommended that a training matrix be used to clearly evidence staff training. 4 5 OP28 It is recommended that at least 50 of staff complete their NVQ award. It is recommended that the results of the annual quality assurance exercise be published for people in the home to see. It is recommended that staff have a supervision session at least every two months and that this is recorded. It is recommended that all policies are dated to show when they were last reviewed. 2 OP15 OP33 6 7 OP36 OP37 Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Crowborough Lodge DS0000037605.V342899.R01.S.doc Version 5.2 Page 25 - 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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