Inspection on 02/06/08 for Earlfield Lodge

This inspection was carried out on 2nd June 2008.

CSCI found this care home to be providing an Adequate service.

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

Earlfield Lodge 09/07/07

Earlfield Lodge 29/08/06

Earlfield Lodge 21/12/05

Earlfield Lodge 05/07/05

Earlfield Lodge 08/11/04

Earlfield Lodge 10/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Earlfield Lodge 29 Trewartha Park Weston Super Mare North Somerset BS23 2RR Lead Inspector Melanie Edwards Unannounced Inspection 09:15 2 and 3rd June 2008 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 Earlfield Lodge DS0000008040.V360542.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. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Earlfield Lodge Address 29 Trewartha Park Weston Super Mare North Somerset BS23 2RR 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) 01934 417934 01934 622491 earlfieldcare@btopenworld.com Mr Gerald William Butcher Mr Gerald William Butcher Care Home 65 Category(ies) of Old age, not falling within any other category registration, with number (65) of places Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 65 persons aged 65 years and over requiring personal care only May accommodate two named `older person` aged 53 years or above. This condition is specific to the named individuals and ceases when that person leaves or reaches the age of 65. 9th July 2007 Date of last inspection Brief Description of the Service: Earlfield Lodge offers personal care to older people over the age of 65. Mr Butcher has owned the home for many years and is also the registered manager. The home is situated in a quiet residential area on the hillside of WestonSuper-Mare. Over the years the accommodation has been altered and refurbished. It now offers 57 single rooms, and 4 that may be shared. The majority of these rooms have en suite facilities. Residents have access to a number of lounges and dining rooms, as well as a small cinema and private chapel. The gardens are attractively laid out, and offer a range of quiet places to sit. Mr Butcher takes residents on regular trips out in the home’s minibus. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection was carried out over two days by two inspectors. Both visits were unannounced. Sue Fuller, our pharmacist inspector, inspected the handling of medication in the Home. We met forty-one of the fifty-six residents living at the Home. We also met a number of visitors. We met Mr Butcher who is the owner as well as the registered manager. We also met four deputy managers who take responsibility for different aspects of the day to day running of the Home .We spoke to seven care assistants and one of the cooks. We talked with them about roles, responsibilities, training needs, and how they assist residents. We saw staff helping residents with their needs. We saw the lunchtime meals being served. We looked at a selection of records relating to the running and management of the Home. These included six care plans, six assessment records, training records, staff duty records, supervision records, accident records, fire records, and menus. We saw most of the environment and the only parts that were not checked were a small number of bedrooms. The Home was operating within the required conditions of registration set down by the Commission. The conditions of registration detail the type of care and the needs of residents, and the numbers of residents who may stay at the Home. What the service does well: Staff try hard to meet residents needs and often support them very well. Residents and visitors made a range of comments including, ‘ I love it here ’, ` there’s always laughter ’, and ‘I like it here the staff are very friendly ’. Residents’ meals are of a good variety and quality. Meals are nutritionally well balanced and well presented. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 6 Residents take part in a range of social and therapeutic activities. This helps residents to enjoy a good quality of life at the Home. There has been a good emphasis placed on improving staff training, and making sure staff do a range of training to better understand residents’ needs. What has improved since the last inspection? What they could do better: Make sure that all residents care plans show what actions must be taken to meet the persons range of needs Care plans and assessment records must be reviewed on a consistently regular basis. This is to demonstrate residents needs can still be met. If regular medication is not given a reason must be recorded. This is to show that medicines are given safely. If the dose is variable a record should be made of the amount given so that it is clear how much medicine has been needed. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 7 Guidance should be available for staff on the use of medicines that have been prescribed to be used When required. This is to make sure that they are always used appropriately. Do not employ any staff until they have at least had a ‘ POVA 1st ’ check .The staff can only then commence work with direct staff supervision, and after consultation, and agreement from us. All staff must also have a completed Criminal Records Check carried out on them. All staff involved in caring for residents must be regularly supervised in their work and practise. The staff team should revisit information in the Homes induction programme book. This refers to staff referring to residents by the name or endearment that the resident themselves would like to be known by. 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. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 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 Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are given the information that they need to help them make informed choices about the Home. Residents have their needs met and their needs assessed. Residents are not provided with intermediate care at the Home. EVIDENCE: We read a copy of the service users guide and the statement of purpose to see what sort of information is available about the Home for residents. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 10 Each resident is given their own copy of the guide so they have information about life in the Home. The statement of purpose and the service users guide include information about the service residents can expect, the qualifications of the staff employed, and the accommodation. The philosophy of the Home and how the service aim to meet residents needs is also included. The complaints procedure is in each service users guide so residents know how to complain about the service. There is a website about the Home that contains a range of helpful information about the service, for people to find out more about the Home. We read six residents assessment records to see how well needs are being assessed. The assessment records were adequately detailed. They showed the residents range of physical, mental and social personal care needs had been assessed. What needs to be done to help each resident had been written in the assessment records. However the assessment records we read were not being regularly reviewed and updated. Assessment records need to be regularly reviewed as this information forms the basis for deciding what sort of care and support residents will need. We talked to one of the managers about how residents’ needs are assessed. They explained that the Home has introduced a key worker system and a member of staff will take specific responsibility for writing residents assessments and accompanying care plan. They also explained that the managers had been training and helping other staff to be able to understand how to write residents assessment records. The Home does not provide intermediate care for residents. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of residents care plans appear to demonstrate how needs are met. However care plans are not being reviewed regularly to make sure they remain current. Residents’ health needs are met. Medicines are looked after safely in the home. Improvements are needed to some records so that it is always clear how medicines have been given. Residents feel satisfied with how the staff treat them, and they feel they are treated respectfully. However residents would benefit further from staff reviewing how they address the residents. EVIDENCE: We read six residents care plans to see how they are helped with their needs. We found the care plans to be adequately informative and they showed how to meet the nursing needs of the person. The care plans set out what actions Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 12 staff must follow to assist the resident to meet their needs. However we saw that there were gaps of time on the care plans of two and three months when they had not been formally reviewed or updated. Residents care plans must be regularly reviewed to show that their needs can still be met. We saw a written health record in each resident care files. These record when residents see a doctor, optician, dentist and chiropodist and what treatment may be required. There was information in the daily records that demonstrated staff monitor and observe residents and call a doctor if concerned. Residents are registered with local GP surgeries. Community nurses also support them with their health. This helps to shows how residents’ health care needs are met. We were sent a survey form back from a G.P, and the Doctor said in the form that they were satisfied by the overall standard of care residents receive. The pharmacist inspector looked at the handling of medicines in the home. Improvements have been made to the medication system used in the home. A monthly blister pack system is now used which means that staff can check the label and sign for each medicine they give. This reduces the risk of mistakes being made. Two people living in the home look after all their own medicines and a number of other people look after and self-administer their own inhaler and creams. A policy and risk assessment is in place for the people looking after all their own medicines, to make sure this is safe, and this should be used for everyone selfadministering any medicines. Records need to be kept of when any medicines received into the home are passed on to someone living in the home to look after themselves. This is so that there is a clear audit trail for all medicines in the home. Ample storage is available for keeping medicines securely, a medicine fridge is also used. Records showed that medicines needing extra security are looked after safely. Medicine trolleys are used to store the monthly blister packs and other current medicines. This means that they can be moved around the home safely and staff can give the medicines from the original labelled pack supplied by the pharmacy. We saw staff giving the lunchtime medicines to some of the people living in the home. Two people are involved in this process to reduce the risk of errors. On some occasions the person signing the medicines administration record sheet could not see who the medicine was given to, this could increase the risk of medicines being given to the wrong person. Action should be taken to address this. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 13 The pharmacy provides printed medicines administration record sheets each month. In some cases the sheets have had to be written by hand. Handwritten additions should be signed, dated and also checked by a second member of staff to reduce the risks of mistakes being made. In the main part of the home the records had been filled in fully with very few gaps seen. Blister packs also showed that medicines had been given as recorded. It was not always possible to check that medicines supplied in standard packs had been given correctly, particularly if they had been supplied in a previous month. It is recommended that action be taken to allow these medicines to be audited. In the extra care wing more gaps were seen in the administration records. Some medicines recorded in the Controlled Drugs register had not been recorded as being given on the person’s administration record sheet. The record for one person’s nasal spray had been signed once a day instead of twice a day on many occasions and the person concerned commented that staff sometimes forget to give it. If regular medicines are not given a reason must always be written on the medicines administration record sheet and codes are available for this. Throughout the home, medicines which had a variable dose of one to two (e.g. Paracetamol) had no indication of how many staff had given. So it was not possible to tell how much medicine had been given or to audit the stock. If the dose of medicine varies, the amount given must be recorded. One person had two medicines prescribed to be given When required but there was no guidance available for staff either on the medicines administration record sheet or in the person’s care plan about what these medicines should be used for. This could mean that medicines are given inappropriately. Records showed that both medicines had been given one day during the month but the records did not show why this was. Staff have been given training from the pharmacy about the use of the new system and this helps to make sure the system is used correctly an people health is protected. We saw staff knocking on bedroom doors before entering them and assisting residents in a polite and respectful manner. This helps demonstrates that staff respect privacy. All of the residents that we met told us staff are helpful, kind and caring, when they help them with their needs. The residents also spoke positively about the attitude of the staff. Examples of comments made by residents included, ` it’s a good home ’, ‘ the girls (the staff) are very good ’, ‘ the staff are excellent they do what I want ’, and ‘ they will do anything for you ’. However we noticed that during both days of the inspection a significant number of staff referred to residents as ‘ love ’, ‘ sweetie’, and ‘ darling ’. Visitors were also Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 14 spoken to in this way .We discussed this with Mr Butcher and the managers. We advised it could be useful for the staff team to revisit information in the Homes induction programme book. In this it clearly advises that staff should refer to residents by the name or endearment that the resident themselves would like to be known by. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 15 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. Residents take part in a variety of social and therapeutic activities. Residents are given good opportunities to exercise choice and control in their daily lives Residents are provided with a well-balanced diet. Residents are able to keep close contact with family and friends if they so wish. EVIDENCE: Residents’ benefit from being able to take part in a range of activities put on by a recently recruited activities coordinator who works for five days a week. There is a copy of the monthly timetable of social activities planned to take place on display in the Home. This helps to ensure residents are aware of current activities taking place. Activities that are planned for the near further include, a drive to look at the sea, arts and crafts sessions, games, a visit from a therapeutic dog, musical afternoons, and gentle exercise classes. Many residents told us that Mr Butcher very regularly takes them out for drives in the Home’s own minibus. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 16 On the first day of the inspection a film show took place and a number of residents were observed watching the film. Residents spoke positively about this activity. On the second day the ‘PAT’ dog, who comes to the Home from a charity for residents to enjoy, came for a visit. Residents told us how much they liked the regular visits from the dog. A small group of residents also took part in a Tai Chi lesson on the second day of the inspection .We were told that these lessons have benefited those residents with their balance and mobility There is also a library with a range of books for residents to read. We saw a number of residents have visits with their family and friends during the inspection. Visitors said that the staff are welcoming and friendly. Residents were also observed having lunch with their visitors. The Home has a relaxed and flexible visiting policy this benefits residents as this means they can keep in contact with family and friends. We were told by a number of the residents that they are able to choose what time they get up and what time they go to bed. Residents also told us that they are consulted about the meal options in the Home, and their likes and dislikes. There has also been a residents committee introduced, and a regular in house newsletter set up .A copy of the most recent newsletter was looked at, and in it there is a request for residents to give their views about the Home and the service. These are all really good ways for residents to exercise choices and have some autonomy in their daily lives. A portion of the lunchtime meal was sampled with a small group of residents on both days of the inspection. On the first day the meal was a choice of roast turkey or boiled ham, or omelettes with potatoes, and three cooked fresh vegetables followed by choices of deserts. On the second day the meal was shepherds pie, or an alternative, again with three fresh cooked vegetables. Both meals were tasty, well cooked and well presented. All of the residents that we spoke to commented very positively about the food served at the Home. We also checked the residents menu to find out if residents are consistently provided with a well balanced diet .The meal options seen were nutritionally well balanced and varied. There are choices available each day, and staff ask residents what they wish to eat each day. Special diets are also catered for and there are a variety of special meals provided for residents who need them. Earlfield Lodge DS0000008040.V360542.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents can be confident that complaints about the service are listened to and acted upon wherever possible. Staff training and in house procedures only partly help to ‘safeguard’ residents from abuse. EVIDENCE: There are copies of the complaints procedure in the reception area. The procedure includes the name of the Commission for Social Care Inspection for anyone who wishes to contact us. How to contact Mr Butcher is also explained if people wish to contact him directly to make a complaint. Mr Butcher also lives on the premises and residents told us that they see him daily. The residents we met told us they would make a complaint to Mr Butcher, one of the managers or staff. They said they felt the staff take their concerns very seriously and are interested in their concerns and complaints. This helps to demonstrate the Home welcomes and responds positively to complaints. We looked at the complaints record to see how well complaints are dealt with. There had been two complaints received since the last inspection. Both complaints related to the service that residents receive, and had been thoroughly investigated by a deputy manager. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 18 The majority of the staff team have now done training to ensure they are up to date in their understanding of the principles of safeguarding residents from abuse. However we were very concerned to find that a new member of staff had just started working in the Home who did not have a CRB (Criminal Records Bureau) check or a ‘POVA 1st ’ (Protection of Vulnerable Adults) check. We were also concerned because the member of staff was left sitting in a lounge with residents without any form of direct supervision. We expressed our strong concerns to Mr Butcher and one of the deputy managers during the inspection. Earlfield Lodge DS0000008040.V360542.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): 19,21,24,25,26.Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home is generally suitable for residents to live in. Residents live in an environment that is clean and satisfactorily maintained. EVIDENCE: Parts of this section have been quoted from the last inspection report, as it is still applicable Earfield Lodge is an older property that is in fact three large houses converted into one building. The Home is near to private houses and a short distance from the town of Weston Super mare. This helps ensure residents can be a part of the community. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 20 The Home is set in its own grounds. The garden was satisfactorily maintained and there are patio seats and a secure garden where residents can sit and walk safely. We saw residents spend time in the garden area. The residents that we saw looked very comfortable and relaxed in the surroundings. Bedrooms have been personalised to reflect the tastes of residents with photographs, mementos and small items of furniture. The standard of furniture and fittings is satisfactory. Domestic staff were observed working hard cleaning the Home, and we found the environment to be clean and tidy in all of the areas that we saw. Residents bedrooms are grouped in wings of up to half a dozen rooms. There are toilets, bathrooms, and lounges within easy reach of each group of bedrooms. This arrangement helps to create a sense of living in a smaller community within this very large home. The Home is considering creating an extra dining room upstairs so that residents can eat together in smaller groups closer to their own rooms. Since the last inspection, the extra care wing has been refurbished, and upgraded. The fixtures and fittings are very domestic, and of a very good standard. There are hot water temperature regulators fitted to all hot water outlets to which residents have access, and these are routinely tested. Radiators are fitted with low surface temperature covers. Windows are restricted, and this all helps to make the environment safer for the residents. Earlfield Lodge DS0000008040.V360542.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are well protected by good staffing levels, and by staff who do a good range of training. However, not all police checks are being carried out and this leaves a significant gap in residents protection. EVIDENCE: We looked at the staff duty record for two weeks of May and June 2008 to see if residents benefit from a sufficient number of staff to meet their needs. There is a minimum of ten care staff on duty in the morning, and at least five care staff on duty in the afternoon. There are also extra care staff who work shorter shifts above these numbers each day. There are three waking staff on duty each night. There are a number of the managers on duty each shift. There are also cooks, kitchen assistants, dining assistants, and cleaners employed by the Home. However we did not check the numbers of these staff. We were told some very positive comments about the staff, examples of comments from residents included, ‘the staff are very friendly, ’ ‘you can get attached to some of the staff, ’and ‘I am very happy here I think that everybody is marvellous ’. We checked four staff employment files to find out if the Home carry out safe employment practises before they take on new staff. As we have already referred to, we saw one staff member had started work prior to a satisfactory Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 22 ‘POVA 1st’ check being received. However the four files that we did see had two written professional references taken up for all new staff prior to offering work with the Home. The staff do sign to declare they have not committed a criminal offence prior to employment. The four staffs files did include a completed CRB check and a ‘ POVA 1st ’ Check before commencing employment. These checks are a further safeguard for vulnerable residents. We observed some of the staff communicate with residents in a very skilled way. However some of the staff, seemed to be less skilled in the ways that they spoke to the residents .For example we observed one care assistant sensitively assist one of the residents, and go to get them a mid morning snack. While they were doing this a another member of staff told the resident that it was not yet lunch time, and perhaps they would like to go back to their room rather then sit at the dining room table .The resident seemed very confused by the two very different staff responses. We reminded staff that residents can chose to sit where they like as long as they are safe. This was discussed with the staff at the time. We saw good evidence in the training files that there is a varied range of inhouse training taking place on a range of subjects relevant to residents and their needs. The staff also told us that they can do a variety of training run by external trainers or in-house, and distance learning courses. Earlfield Lodge DS0000008040.V360542.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): 31,33,35,36,37,38.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ live in a Home that is run in their best interests. Residents and their family and friends are supported to raise concerns to the management of the Home. Staff are not being regularly supervised in relation to the work they carry out in the Home. EVIDENCE: Mr Gerald Butcher is the registered manager and owner. He has run the Home for many years. He is supported in his work by four managers who take responsibility for overseeing, and managing different aspects of the running of the Home. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 24 The staff reported that staff meetings are held regularly. A sample of recent minutes were looked at that demonstrated staff are consulted, and their opinions are listened to by the managers. A residents committee has been sent up, involving residents and relatives .The committee discuss and make suggestions about daily life in the Home. The Home has its own format for monitoring the quality of the care and the overall service. We did not look at the paperwork that is used to audit the Home on this inspection. However we discussed at length with one of the managers their aims and objectives for driving up further the standards in the Home. Care staff told us that the managers and senior staff are supportive and helpful. However there has been a lack of consistent regular supervision sessions to assist them in their work and in better understanding the needs of residents. When we looked at a sample of supervision records, these showed staff supervision sessions have not been taking place regularly over the last three to six months. This section of the report has been quoted from the last inspection report as it still applies: ‘The home only holds residents money for safekeeping if there is no one else able to do this. Cash and record totals are kept separately. Records are very basic but clear. Both cash amounts exceeded the amounts shown in the records: Mr Butcher explained that he always rounds these sums up, as he dislikes coppers. The records checked in depth confirmed other evidence that the home tends to pay for many of the ‘ extras ’ on residents behalf.’ The maintenance man and one of the managers do health and safety audits of the whole environment regularly. We saw a copy of the document that is used to carry out the audit. This was informative and aimed to address health and safety areas through the Home. We looked at a selection of recent accident forms to find out what action is taken after residents have an accident. The accident records showed the managers review in detail the nature of the accidents and what may have caused it. They also monitor all follow up action taken by staff to assist the resident involved in the accident over a period of days after the event. Staff do training in health and safety matters including first aid, food hygiene training and moving and handling practises. This should help protect residents’ health and safety if staff are knowledgeable and well trained in these health and safety principles and practices. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 25 The kitchen was tidy and organised when viewed. There were up to date daily records being kept of the fridges and freezer temperatures. This information is necessary to demonstrate the fridges and freezer is working properly and foods are being kept at a safe temperature. The cooks check the temperatures of all high-risk foods before serving the food to residents. This is necessary to ensure the food has been cooked to a safe temperature for residents to eat. There were also dairy products, cooked meats, and cooked food stored in the fridge that had been covered and dated. This is done for these foods so they are used within a safe timescale. We checked the fire logbook records, and these showed fire alarm tests are being carried out. There are also fire drills carried out on a regular basis to help protect the health and safety of residents and staff. Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 2 3 X 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 3 3 Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15.1 Requirement The identified residents care plans must show what actions must be taken to meet their range of needs. Care plans and assessment records must be reviewed on a consistently regular basis. This is to demonstrate the resident’s needs are met. Medication must be given as prescribed by the doctor. If regular medication is not given a reason must be recorded. If the dose is variable the amount given must be recorded. Guidance must be available for staff on the use of medicines prescribed When required, to make sure that they are always used appropriately. Staff must have at least had a POVA 1st Check before employment .The staff must only commence work with direct staff supervision, and after consolation and agreement from us . DS0000008040.V360542.R01.S.doc Timescale for action 15/06/08 2. OP7 15.2(b) 03/07/08 3. OP9 13.2 15/06/08 4 OP9 13.2 15/06/08 3 OP29 19.1 04/06/08 Earlfield Lodge Version 5.2 Page 28 4 OP36 18.2 All staff involved in caring for residents must be regularly supervised. 03/07/08 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 OP10 OP9 Good Practice Recommendations Residents should be called by the name or endearment that they themselves would like to be known by. Staff review medicines administration procedures to ensure that the person signing the medicines administration record sheet can always see that medicines have been to the correct person. Handwritten additions to the medicines administration record sheet should be signed, dated and also checked by a second member of staff to reduce the risks of mistakes being made. 3 OP9 Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Earlfield Lodge DS0000008040.V360542.R01.S.doc Version 5.2 Page 30 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!