Inspection on 21/12/05 for Earlfield Lodge

This inspection was carried out on 21st December 2005.

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 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 02/06/08

Earlfield Lodge 09/07/07

Earlfield Lodge 29/08/06

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Earlfield Lodge 29 Trewartha Park Weston Super Mare North Somerset BS23 2RR Lead Inspector Alison Murray Unannounced Inspection 21st December 2005 09:30 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.V268864.R01.S.doc Version 5.0 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.V268864.R01.S.doc Version 5.0 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 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.V268864.R01.S.doc Version 5.0 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. 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. He is the registered manager. The home is situated in a quiet residential area on the hillside of Weston Super Mare. Over the years the accommodation has been revised and refurbished. It now offers 57 single rooms, and 4, which may be shared. The majority of these rooms have en suite facilities. Residents have access to a number of lounge 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 minibus. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. Two inspectors spent at total of 15 hours in the home. During this time they spoke to 13 of the 43 residents individually, and chatted with many others in the communal areas of the home. Staff were not consulted formally, but observed as they went about their work. Mrs Bowers, the care manager, was on sick leave when the inspection took place. Detailed conversations were held with Mr Butcher, to offer feedback on the inspection findings, and discuss future plans for the home. What the service does well: What has improved since the last inspection? Mr Butcher is keen to ensure that the home ‘moves with the times’. He has identified that the care needs of residents admitted to the home are increasing. He has appointed a registered nurse, to act as a consultant, and oversee the care delivery. He must ensure that nursing interventions are only carried out with the knowledge and approval of the community nursing team. Mr Butcher hopes to revise the senior management structure of the home over the coming months. He is currently consulting staff about these proposed changes. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 6 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. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 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 Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5. Standard 6 does not apply Prospective residents are encouraged to look around Earlfield Lodge before admission. Their needs are effectively assessed. EVIDENCE: One recently admitted resident said that when she needed to move into a care home, friends suggested that she look at Earlfield Lodge. She and her family visited the home, and met staff before she made a decision to stay there. She said that during this visit, she discussed her care needs with the staff. This lady commented that she was made to feel very welcome, and had settled well. She felt confident that staff had the skills and knowledge to give her the assistance she required. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Residents feel that they receive a good standard of care. They get on well with the staff. Care records demonstrate a person centred approach, but are not effectively updated to reflect residents’ changing needs. Some nursing interventions are outside the home’s registration category. Medication systems were of serious concern. Medicines are not securely stored, or accurately recorded. EVIDENCE: Residents consulted during the inspection said they were very happy with the standard of care provided at Earlfield Lodge. There was evidence of a good rapport between staff and residents. One person said ‘they care about me, not just for me’. Another resident was unwell, and had remained in bed. She looked comfortable. It was apparent that close attention had been paid to her personal care. Both staff and residents said that they appreciated the advice of a registered nurse employed on a consultancy basis. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 10 Care records for a total of 7 residents were reviewed. Care plans were in place for some areas of assessed need. Those seen demonstrated a good person centred approach to care. Staff had signed the care plans most months, to confirm that a review had taken place. In some cases, entries in the progress notes suggested that although needs had changed from month to month, care plans had not been updated to reflect this. Comments made in progress notes and district nurse records indicated that one resident had pressure sores. She did not have a specific care plan to guide staff in the treatment of these wounds, and prevention of further tissue breakdown. A trained nurse, employed on a consultancy basis at Earlfield Lodge had made entries in the district nursing records. It appeared that she, rather than the district nurse had ordered a new type of dressings for this resident. Several of the residents had rails fitted to their beds. These were not recorded in the care records, and there was no evidence to confirm that permission had been sought for their use. Serious concerns were raised about medication procedures in the home. Prescription only medicines were left out on the manager’s desk. The door to this office was wedged open. It was not possible to follow an audit trail of medicines received into the home, administered to residents or returned to the pharmacy. Entries on several medicine administration records had been amended using correcting fluid. There was a large stock of ‘homely remedies’. A number of these were not included in the home’s list of approved ‘homely remedies. One bottle of cough medicine was found to be well past its ‘sell by’ date. These shortfalls were discussed with Mr Butcher. It was agreed that the CSCI Pharmacist be asked to contact the home, to arrange a suitable date to carry out a full inspection of medicine systems in the home. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 11 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 and 15 Residents are offered the opportunity to participate in a wide range of activities. The standard of food provided is good. Residents enjoy the meals provided. EVIDENCE: Residents said that they were able to arrange their day as they saw fit. The home has a good range of communal lounges and dining rooms. It was clear that groups of residents chose to meet at certain times. One lady was keen to say how much she enjoyed the planned activities. On the morning of the inspection, a group of residents took part in a Tai Chi exercise class. Several people commented how much they enjoyed this. Others said that they liked to sit in the home’s chapel, and ‘let the world go by’. Mr Butcher regularly takes groups of residents out in the home mini bus. Although it was evident that staff knew residents individual likes and dislikes, this was not specifically recorded in the care records. All those consulted said that family and friends were actively encouraged to visit. During the inspection, there was a steady stream of visitors to the home. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 12 Staff, residents and visitors all praised the standard of meals provided in the home. The meal served during the inspection looked and smelt appetising. Residents said that the chef takes the time to get to know individual preferences, and ensure they are included in the menu. Food items stored for the forthcoming Christmas celebrations confirmed a commitment to quality produce. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 13 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 The complaint procedure in the home is satisfactory. EVIDENCE: All those consulted said that they would have no hesitation raising concerns with Mr Butcher, or Mrs Bowers. The home has a book, in which to record complaints made. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 14 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, 20, 21, 22, 23, 24, 25 and 26 An ongoing programme of refurbishment and redecoration helps to ensure that residents and their visitors are comfortable at Earlfield Lodge. Further attention to locks on toilet doors, and the use of communal toiletries is needed to promote individual privacy and dignity. Concerns were raised about infection control procedures in the home. There was evidence of poor practice that places residents and staff at risk. EVIDENCE: Although Earlfield Lodge is a big home, staff have worked hard to reduce the impact this has on residents. Rooms are informally arranged in wings, each with its own communal lounge. Residents are able to choose whether to remain in their wing, or join other residents. A passenger lift offers easy access to all areas of the home. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 15 There was evidence of an ongoing programme of refurbishment and redecoration. Staff said that Mr Butcher was always making improvements. Work was underway to redecorate the corridors. The standard of the furniture and decoration is good. The communal rooms are attractively decorated. Residents with high needs are transferred to the ‘care wing’ (after consultation with them and their relatives). The fixtures and fittings in the ‘care wing’ are perhaps less homely than the rest of the building. Nevertheless, it was clear from conversations with residents and their relatives that they were comfortable and happy. This wing has a good range of mobility aids, and patient hoists. Several of the windows on the upper floors were open. These were not fitted with opening restrictors. One room in particular, had a window at chair height. The door to this room was propped open, and the window itself was open wide. All of the bedrooms were fitted with alarm call panels. None of those in the care wing had accessible handsets to allow residents to call for assistance. Whilst it is possible that many of these residents would be unable to use the handsets, this was not documented in the care records. Communal bathrooms were fitted with suitable patient hoists. The door to one of the communal toilets in the care wing did not shut properly. There was no lock fitted to this door. Inside the toilet, was a cupboard housing the lift mechanism. Although the cupboard door was fitted with a bolt, a resident sitting on the toilet could easily open this. Several of the toilets on the ground floor were not fitted with wash hand basins. Concerns were raised about infection control procedures in the home. There were communal toiletries, including disposable razors and bars of soap, in all the bathrooms. A number of the showerheads seen were very dirty. In one bedroom, the end of a night catheter bag was left uncovered. A mop stored in a sluice area was heavily soiled. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 16 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 Staffing levels meet the needs of the current residents. EVIDENCE: All the residents and relatives consulted said that the staffing levels are appropriate. There were 43 residents in the home. Staff said that they were kept busy, but that they were actively encouraged to spend time chatting with the residents. Duty rotas showed a high level of staff sickness. Mr Butcher said that a number of staff were recovering from surgery, and were due back early in the New Year. A number of staff were working in excess of 48 hours per week. They were clear that they were happy to do this to help out, on a shortterm basis. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 17 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): 34 and 35 Financial procedures are sound. Accurate records are kept in respect of residents’ finances. EVIDENCE: Although occupancy levels have been lower over recent months, there was no evidence to suggest problems with the financial viability of the business. Mr Butcher keeps money for a small number of residents. He keeps a record of all transactions carried out on their behalf. The records kept in relation to one resident were reviewed. These corresponded with the money held in the safe for that resident. Fire safety procedures were not formally reviewed. In the conservatory area, fire door exit signs were confusing. They would benefit from review. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 2 2 3 3 2 2 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 3 X X X Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 15(1)(2) Requirement Care plans must be regularly updated to reflect residents’ changing needs. Meaningful reviews must be carried out at least once a month Areas of specific risk must be assessed. Consent must be obtained for the use of bedrails. Nursing interventions must only be carried out with the knowledge and approval of the community nursing team. Medicines must be securely stored at all times. An immediate requirement notice was issued. Correcting fluid must not be used on medicine administration records. There must be a clear audit trail of medicines received into the home, administered to residents, or returned to the pharmacy. Working locks must be fitted to toilet doors. Residents must be able to access an alarm call in their own room, unless risk assessment dictates DS0000008040.V268864.R01.S.doc Timescale for action 21/12/05 2 OP7 13(7)(8) 21/02/06 3 OP8 18 21/12/05 4 OP9 13(2) 21/12/05 5 6 OP9 OP9 17 13(2) 21/12/05 21/12/05 7 8 OP21 OP22 23(2) 23(2) 21/01/05 21/02/06 Earlfield Lodge Version 5.0 Page 20 9 OP25 13(4) 10 11 OP26 OP26 13(3) 13(4) otherwise. This risk assessment must be documented. Opening restrictors must be fitted to upper floor windows, prioritising those which pose the greatest risk to residents. Communal toiletries must not be used. All staff must attend infection control training 21/06/06 21/12/05 21/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP9 OP12 OP21 OP38 Good Practice Recommendations A medicine administration policy and procedures specific to Earlfield Lodge should be developed. Residents’ wishes and preferences regarding daily living should be recorded more explicitly in the care records. Consideration should be given to fitting all toilet areas with a wash hand basin. Fire exit signage should be reviewed. Earlfield Lodge DS0000008040.V268864.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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