Inspection on 01/06/06 for Deer Lodge

This inspection was carried out on 1st June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Deer Lodge 02/10/07

Deer Lodge 09/11/05

Deer Lodge 18/05/05

Deer Lodge 10/01/05

Deer Lodge 29/06/04

Deer Lodge 05/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Deer Lodge 22 Sandy Lane Teddington Middlesex TW11 0DR Lead Inspector Sharon Newman Unannounced Inspection 7th June 2006 07:50 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 Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 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. Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Deer Lodge Address 22 Sandy Lane Teddington Middlesex TW11 0DR 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) 020 8943 3013 Mr S N Patel Care Home 14 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (14) of places Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2005 Brief Description of the Service: Deer Lodge is registered to provide residential care to fourteen older people. The home is a three storey building situated on a main road running along the boundary of Bushy Park close to local amenities in both Kingston and Teddington. Accommodation is provided on the ground and first floors. A large, well-kept garden is situated to the rear of the property and there is a patio area with seating, lawns and a variety of mature trees and shrubs. As the home is opposite Bushy Park, a small number of bedrooms have fine views across the nearby parkland. Fees for private clients range from £600 to £670 per week. Fees for residents placed by social services range from £550 to £570 per week. Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days. Two regulation inspectors visited on 7th June 2006 and a pharmacy inspector visited on 14th June 2006, the findings of his inspection are included in this report. Records examined at this inspection included care planning documentation, health and safety information and staff files. A tour was also taken of the premises. There were fourteen residents living at the home on the day of the visit and many were spoken to. Relatives who were visiting the home at the time of inspection were also spoken to and the feedback from them was very good. Surveys for residents, relatives and health/social care professionals were left at the home to be given to those individuals who wished to complete them. Three surveys were returned from health/social care professionals, nine from relatives and five from residents. Again, this feedback was largely favourable. The inspection team were made to feel welcome by the staff who demonstrated a helpful and professional attitude throughout the inspection visit. Many improvements have taken place since the last inspection report and the inspection team noted that the manager and deputy manager have worked hard to achieve this. Good feedback was received from relatives and residents about the home. One resident said ‘it is very friendly here’. Another reported ‘I have lots of friends here.’ A relative commented that their family member said to them ‘this is a nice place, isn’t it?’ Another said that their relative is ‘very well cared for and has settled well’ at the home. One said that their relative is ‘safe and well looked after.’ What the service does well: Staff continue to have a good rapport with residents and were seen to interact well with them and showed kindness and respect when talking to them. The cook also interacts well with residents and was seen to speak to them individually to inform them of the lunch on offer. Staff sit down to eat meals with residents creating a pleasant atmosphere. The acting manager and deputy manager remain enthusiastic about their roles and have a conscientious attitude to their work. They both work well together and offer each other support. There is a large beautifully maintained garden and relatives and residents commented about how lovely it is. One relative said that ‘the garden is delightful.’ Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 6 The home is clean and homely with a relaxed and friendly atmosphere. The home has arrangements for the safe storage, recording, administration and disposal of medication. There are good risk assessments and auditing arrangements in place. Medication is given correctly and all staff giving medication are trained. What has improved since the last inspection? What they could do better: Although the care plans and risk assessments have improved attention still needs to be paid to ensuring all information including risk assessments are upto-date. This will help to ensure that resident’s needs are met. The pharmacy inspector identified that labelling of medication needs to be improved to prevent confusion about what medication is in a container. Also Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 7 record keeping needs to be improved on the Medication Administration Records to ensure there are no blank entries. The leaking bath and the ceiling beneath this leak need to be repaired. This was discussed with the deputy manager who said that they are addressing this issue. Freezer temperatures need to be maintained within safe limits to ensure that residents are not laced at risk. The five yearly electrical check still needs to be obtained to ensure the safety of the premises. Also as reported in the previous inspection report water temperatures in the home must not exceed 43 degrees centigrade. The water in the home should be stored at 60 degrees centigrade, distributed at 50 degrees centigrade and only thermostatically lowered to 43 degrees centigrade at the actual outlet. The manager needs to register with the Commission for Social Care Inspection and this was discussed with the manager and deputy manager at the time of inspection. 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. Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1. 2. 3. 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Good information is available to help residents decide if this home can meet their needs. Assessments of need are in place for all residents which helps detailed care plans to develop from this documentation. Intermediate care is not offered at this home. EVIDENCE: A Statement of Purpose is available which has now been updated to include the size of all the bedrooms at the home. Service Users Guides are in place and can be found in the resident’s bedrooms. These were seen to be in large print to help enable the residents to read them more clearly. All residents had pre-admission assessments in place and residents’ files contained evidence of review at six weeks and six months where appropriate. Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 10 All residents except one had contracts in place and they had not all been signed and dated. However it is noted that the resident who did not have a contract had moved in only two weeks previously. A resident said ‘I like it here, the staff are really friendly.’ A relative commented ‘this home is well-run and all the staff are caring and helpful, it is always spotlessly clean.’ Two relatives said that ‘the facilities, the service and the care and kindness of the staff are excellent.’ They also reported that the prepared food is very tasty and they liked their family members’ room. Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 11 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Resident’s health needs are met and they are treated with respect by staff. Minor omissions in record keeping and inappropriate labelling of medication were found. These did not put the health or welfare of residents at immediate risk. EVIDENCE: Four residents’ care plans were examined and they contained detailed information regarding individual personal care and how staff should deliver the care. There was also good information about residents’ preferences in terms of daily routines such as rising in the morning and retiring to bed. The care plans were observed to address maintaining a safe environment, mobility, medical history, medication, communication, continence, mental state, diet, social needs and family, religion, wishes following death. Although some were signed by the residents or their representative not all had done so. Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 12 Goals and action plans to achieve these were in place. For example one care plan identified a resident’s wish to attend church and there was evidence that this has been achieved. A separate file was in place for each individual and this contained a dependency rating, Waterlow assessment, health needs assessment, manual handling assessment and risk assessments. Appropriate risk assessments were in place for issues including: falls, bed rail equipment and residents holding keys to their room. Most of these had evidence of regular review but some still needed review as they were dated August 2005. The risk assessments were signed by member of staff but not the resident/representative. These should demonstrate the involvement of the residents or their relatives to indicate that their wishes have been taken into account and that they are aware of any risks. One resident had their increasing needs documented in their care plan. Appropriate food was seen to be prepared for them and they were encouraged in a caring manner by a staff member. There was also evidence that a health care professional had visited to assess their needs. Evidence was seen in care plans of appropriate referrals to health and social care professionals. A relative reported that if any health problems arise they are always contacted. All current records relating to receipt, storage, administration and disposal of current medication were examined. Last months records were also seen. The acting manager, and one staff member was interviewed. A sample of the current medication in stock was compared to the current records and medication not supplied in compliance aids was counted and compared to the records. This was to check that medication was being given as directed. All the medication in stock agreed with the list of medications on the administration records. Each resident has a medication profile detailing discontinuations and alterations to medication as well as any allergies. These corresponded with the current medication administration records. Most medication is given from compliance aid that is dispensed and labelled by the pharmacist. There is a risk assessment for this method of administration. Appropriate arrangements are in place to enable staff to identify individual medication and check if medication has been given or not. Other risk assessments were seen detailing the storage and administration of medication that showed that staff were aware of the issue around medication handling. The compliance aids were also labelled with the other items for each resident that were supplied in a separate container. This could cause confusion about what is in the container. The administration records clearly identify where each medication is. Two other items had no label with directions for administration Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 13 and one item was labelled to be given as directed. Directions for administration are available on the copy of the prescription and in the medication profile. The receipt of one resident’s medication had not been recorded the previous month. The receipt of all current medication had been recorded. One resident had two missing entries on their administration record. From the medication in stock the correct medication had been given. All other current administration records had been completed. The amount of medication currently in stock agreed with the records. This indicated that medication had been given to the resident as prescribed unless otherwise recorded. Staff have all received training in medication handling. An audit of the records and stocks of medication is done every two weeks. All medication was stored securely and in the correct conditions. The controlled drug cupboard does not comply with the Misuse of Drug (Safe custody) Regulations. This has no impact on the health or welfare of residents. Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 the service. Activity provision is good and residents are encouraged to participate in activities. They are also encouraged to maintain contact with family and friends. Relatives are made to feel welcome at this home. Residents are offered a choice of nutritious meals in a pleasant, homely setting. EVIDENCE: One relative said that they visit fortnightly and that they are always made welcome. They reported that they were very pleased with the care given to their relative. They said the staff are good and that they know their family members’ needs well. Breakfast was seen to be eaten in a quiet and relaxed atmosphere. Residents were observed to have breakfast when they wished and were seen to come for breakfast at times that suited them. Some residents said they like to have a lie in and then a late breakfast. The cook knew each resident’s likes and dislikes and spoke to residents politely. Tea and coffee pots and condiments were brought to the table so that residents could serve themselves. Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 15 Residents were seen to go into the garden to eat their lunch in the gazebo and staff went to a lot of effort to ensure that all those who wanted to were taken outside. Staff ate lunch with the residents and this helped to create a homely atmosphere. Those residents who did not wish to go outside had their choice respected. Staff were observed to assist those who required help with eating and drinking. This was done in an appropriate and caring manner, with staff sitting by those residents and offering gentle persuasion to those with poor appetites. Several residents pointed out that they were often offered the choice of eating in the garden in good weather and that they enjoyed this. The cook was seen to discuss the menu with the residents. She reported that she talks the residents through the next day’s menu with each resident to check what they would like. Residents were seen to be offered a choice of two hot food options for lunch. Many of the residents talked favourably about the food and said they enjoyed their meals. One resident commented that they found the fried chicken difficult to eat and there was ‘a lot of lamb which does not always agree with me.’ Appropriate music was playing for the residents whilst they ate breakfast and they were asked what they wanted to listen to. Also, fresh flowers had been placed in vases around the lounge area creating a pleasant atmosphere. Newspapers were seen to be given out to those residents who wish to read them. Staff were seen to have a caring attitude towards the residents. A relative commented that the hairdresser visits their family member fortnightly and they were ‘very impressed’ with the care at the home. Some residents were taken out to a local day centre for tea and cake on the day of inspection. There were opportunities for residents to take place in a variety of activities such as armchair exercises and snakes and ladders played on a large board. An entertainer arrived and sang a range of popular songs for the residents in the afternoon. He interacted well with the residents who all seemed to really enjoy the experience. Residents meetings are held, however there has been only one recorded this year and residents would benefit from these being held more regularly to help ensure that their views are taken into account regarding life at the home. An issue discussed at the last meeting concerned ensuring that there were times of the day when the television would be switched off. This is to allow residents to read, rest or engage in other activities. It was agreed by the residents that the television would be switched on after 2pm to allow those who wished to watch TV to do so. Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 16 Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. 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 the service. Staff have now received adequate information/ training on recognising and reporting abuse. Complaints are now fully recorded so it is clear what action has been taken to prevent bad practice and also allows this information to be audited. EVIDENCE: There is a clear and open complaints procedure in place at the home and a full record of complaints is kept which allows this information to be audited. An organisational abuse policy is in place at the home and the home has adopted the London Borough of Richmond Protection of Vulnerable Adults Policy and Procedure. A whistle blowing policy was seen to be available in the home. Staff members spoken to demonstrated a very good knowledge of abuse awareness and the importance of whistle blowing procedures in preventing bad practice. The amount of falls recorded has decreased since the last inspection visit. Five falls were documented for the last six months. There is evidence that falls are monitored monthly and an Occupational Therapy Assessment of the home has taken place to help identify and minimise areas of risk. Risk assessments are in Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 18 place where residents identified as at high risk of falls, but some needed review. (See previous section on health and personal care). Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19. 21. 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents continue to live in a homely and attractive environment with access to a beautiful and well-maintained garden. The bedrooms are well personalised and comfortable. The home is clean and hygienic. EVIDENCE: The lounge/dining area was comfortable and bright and had a pleasant atmosphere. Pictures, ornaments and bookcases helped the area appear more homely. However as reported in the previous inspection report, there is limited communal space available at the home. There is no alternative quiet room and residents must use their bedrooms if they wish to see visitors privately. A relative also commented on this issue and one health/social care professional said ‘the home feels quite small and cramped’ at times, however they stressed this was their only criticism. Another relative said I feel that the home needs a quiet room. Ideally a small extension at the rear would answer this need. The present arrangement with the TV constantly on after 2pm for Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 20 those few residents who wish to view is unsatisfactory for those residents who find it too intrusive.’ The manager reported that the registered provider had looked into the possibility of extending the home, but this has not yet been possible. One relative suggested that the dining room and hallway would benefit from updating in terms of décor. However, they also pointed out that the front and rear of the house is kept well and that ‘the flowers look lovely on arrival.’ The large garden is very attractive and well maintained and a large gazebo has been erected to allow the residents to have lunch outside. An assessment of the environment by an Occupational Therapist has now been carried out. This was to help ensure that appropriate action has been taken by the home to minimise the risk of residents falling. A new ‘reconditioned’ stair lift has been installed at the home. The bedrooms seen at this inspection visit were comfortable, personalised to individual taste and well decorated. However one bedroom was seen to have water stains on the ceiling and the deputy manager said that the bath upstairs was leaking. She reported that they were addressing this problem. The bath and ceiling will need to be repaired. The home was clean, tidy and hygienic on the day of inspection. A resident commented that ‘the home is always spotlessly clean and always smells fresh.’ Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27. 28. 29. 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staff are enthusiastic and caring and have a good knowledge of resident’s needs. Staff training has improved at the home and this can help staff to meet the needs of the residents. EVIDENCE: Residents and relatives made very positive comments about the staff. One relative said that the staff were ‘very approachable.’ Another said the ‘staff are caring and nothing is too much trouble for them.’ The deputy manager said that care staff are no longer required to carry out cleaning duties and cleaning staff are employed for this role. She reported that this meant that care staff could dedicate themselves to these duties. A cook is employed by the home specifically for this cooking role. The deputy manager said that there are currently two care staff vacancies and the home has arranged interviews for prospective staff members. Five staff files were examined and found to contain all information including two references, application forms, contracts and proof of identity to help ensure the safety of the residents. All contained evidence of Criminal Records Bureau disclosure except one, however this file did contain a Protection of Vulnerable Adults check. The management were aware that one Criminal Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 22 Records Bureau check was outstanding and stated that this has been applied for. This check was promptly forwarded to the Commission for Social Care Inspection following the inspection. However, only one staff file contained evidence of a formal induction to their role. All staff files should contain evidence of induction to demonstrate that staff are aware of health and safety procedures and have received training in the homes’ procedures. Previously staff were required to pay for some training, however, the inspection team were informed that this is no longer the case as the home had realised that this was a factor that affected the recruitment of staff. A staff member commented that they thought this was a positive step. Training records were clear and well-kept and indicated that staff are up-todate with mandatory training such as fire safety, moving and handling, first aid and food hygiene. Staff have also received training in communications and report writing and are encouraged to undertake their NVQ training. One staff member said they had attended much training since starting, including manual handling, food hygiene, health and safety, fire and the protection of vulnerable adults. They reported that they had completed the NVQ Level 1 and had been informed that they will start NVQ Level 2 later in 2006. They reported that the morale at the home is good and that management are approachable and supportive. They stated they have regular supervision, which they found useful, and that they attend team meetings regularly. Another staff member reported that they had attended training in dementia care, moving and handling, food hygiene, medication, abuse awareness and continence care. They said that they felt ‘happy and supported’ at the home and received regular one-to-one supervision. Another stated that they had received training in abuse awareness, moving and handling, health and safety and dementia care. They reported that they ‘really enjoyed’ working at the home. Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31. 33. 35. 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is still no registered manager in place at the home. However, there has been an improvement in the running of the home and the both the acting manager and deputy manager are enthusiastic and conscientious. Policies and procedures, and the majority of records including care plans, complaints and accident details are all well kept. All files were seen to be organised and information is easy to obtain. Staff are adequately supervised on a one-to-one basis. EVIDENCE: The home still does not have a manager that is registered with the Commission for Social Care Inspection (CSCI). This requirement remains outstanding from the previous inspection report. Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 24 Both the acting manager and deputy manager displayed a very conscientious and professional attitude to their work and demonstrated a caring manner to the residents. Relatives, residents and staff spoke highly of both of them. A relative reported that both managers were ‘wonderful.’ A staff member said that the ‘managers are nice and supportive.’ The acting manager reported that she felt ‘well-supported’ by the registered provider. As stated in the previous inspection report consideration should be given to allowing staff to have access to E-mail services and internet. This will enable them to access information quickly and efficiently, keep up-to-date with current research in health and social care and allow for good communication with other services and health and social care bodies. Most of the policies and procedures have been recently updated at the home. Records kept at the home are up-to-date and well organised. Staff supervision now takes place more regularly which helps to ensure that staff have the direction and support to carry out their roles. Although some staff meetings are taking place, it was discussed with the manager and deputy manager that more regular staff meetings should take place to ensure good communication within the home. All residents’ money is kept separately and the Registered Provider carries out random checks in this area when he carries out his monthly visit to the home in line with Regulation 26 of the Care Homes Regulations 2001. The deputy manager reported that an issue still remains outstanding regarding water temperatures at the home. However, she had documentation to demonstrate that the home is trying to solve this problem and ensure that all water temperatures remain within safe limits. This requirement remains outstanding from the last inspection. Water temperatures must not exceed 43 degrees centigrade. The water in the home should be stored at 60 degrees centigrade, distributed at 50 degrees centigrade and only thermostatically lowered to 43 degrees centigrade at the actual outlet. The kitchen water temperature is 43 degrees centigrade and there is no dishwasher. Consideration should be given to the purchase of a dishwasher to ensure crockery is washed at the correct temperatures to meet health and safety requirements. Records seen regarding legionella and portable appliance testing were in order on the day of inspection, however an up-to-date five yearly electrical check needs to be obtained and this remains outstanding from the previous inspection report. Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 25 Fridge and freezer temperatures were seen to be in order apart from one freezer where temperatures were recorded at –11, -12 and -13 degrees centigrade. This freezer must be repaired/replaced to ensure residents are not placed at risk. Regular fire drills are carried out and fully recorded and it was noted that recommendations are made after each fire drill to help ensure that this procedure is carried out safely. Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 26 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 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 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 2 X 3 X 3 X X 2 Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 27 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 OP2 Regulation 5(b)(c) Requirement Timescale for action 01/07/06 2. OP7 The registered person must ensure that all service users have contracts/terms and conditions in place. 12(1The registered person must 3)15(1&2) ensure: (a-d) 1. That service users plans are reviewed regularly or when a change in need occurs. (Previous timescale of 01/01/06 not met). 2. That they contain sufficient information to ensure that service users needs are met 01/07/06 3. OP8 13(4)(6)1 5 4. OP9 13(2) 5. OP9 13 (2) The registered person must ensure that service users and/or their relatives are given the opportunity to participate in the development of their risk assessments to indicate their agreement. The registered person must ensure that the receipt and administration of all medication is recorded accurately. The registered person must DS0000017363.V294064.R01.S.doc 01/07/06 01/07/06 01/07/06 Page 28 Deer Lodge Version 5.1 6. OP21 23 7. OP31 9(1)12(1a &b) ensure that items of medication are appropriately labelled. The registered person must ensure that the bath in the first floor bathroom and the bedroom ceiling beneath this room are repaired. The registered person must submit an application for a Registered Manager to the CSCI. (Previous timescales of 01/09/05 and 01/12/05 not met). The registered person must ensure that: 1. The water system in place at the home meets health and safety requirements. It should store water at 60 degrees centigrade, distribute it at 50 degrees centigrade and then it should be thermostatically lowered to 43 degrees centigrade at the outlets. (Previous timescales of 01/07/05 and 01/02/05 not met). 2. The tap water in the kitchen is of sufficient temperature to prevent infection and that it meets Health and Safety Requirements. (Previous timescale of 01/07/05/and 01/02/05 not met). The registered person must ensure that a Five Yearly electrical installation check certificate is available for inspection at the home. (Previous timescale of 01/01/06 not met). The registered person must ensure that the temperatures of the freezers remain within acceptable limits. 01/08/06 01/09/06 8. OP38 12(1a)13( 4) 01/08/06 9. OP38 13 (4) 01/08/06 10. OP38 13 (4) 01/07/06 Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 29 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 OP9 OP31 Good Practice Recommendations It is recommended that controlled drugs are stored in a cupboard that complies with the appropriate legislation. Consideration should be given to having access to E-mail services or internet. This will enable them to access information quickly and efficiently and allow for good communication with other services and health and social care bodies. Consideration should be given to the purchase of a dishwasher to ensure crockery is washed at suitable temperatures. 3. OP38 Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Deer Lodge DS0000017363.V294064.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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