Inspection on 29/08/06 for Earlfield Lodge

This inspection was carried out on 29th August 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 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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Earlfield Lodge 29 Trewartha Park Weston Super Mare North Somerset BS23 2RR Lead Inspector Catherine Hill Key Unannounced Inspection 29th August 006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Earlfield Lodge DS0000008040.V296210.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.V296210.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 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.V296210.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. 21st December 2005 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.V296210.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over three visits by two inspectors, spending a total of 26½ hours in the home. The visits were spaced several weeks apart and the first two were unannounced. During these visits, inspectors spoke with 24 of the residents, 7 of the staff, and 2 school pupils on work experience. Inspectors also spoke with 4 visitors and several external professionals associated with the home. Most of the first visit was spent talking with residents and looking at the environment. Approximately a third of the second visit was spent talking with residents. The rest was spent looking at the homes records. During the final visit, the medication system was reviewed. On completion of the inspection process, the service provider was given feedback on the inspection process. The inspectors sampled a number of residents records. They looked in depth at a range of records associated with 4 of the residents whom they met during this inspection. Eight immediate requirements were issued to the provider. These concerned the environment, infection control, and health & safety issues. What the service does well: Residents felt that the range of activities meets their needs well. Some interesting and unusual activities are laid on, including a weekly Tai Chi session, and there are lots of outings. There is no charge for basic toiletries, activities and outings - these are all included in the basic fee. The home has an exceptionally tolerant and accepting culture: residents are treated very much as individuals, and evidently feel able to be themselves. Residents were very positive about their lives at the home. Comments included They cant do enough for you, the girls really look after us and you can have a laugh with the staff”. One person said I have been so happy here. Visiting arrangements are flexible: one person said we can have visitors whenever we want. Theyre very good about that. The home’s routines are generally very flexible: residents comments included I get up when I want. If I dont feel like it I dont have to. Residents felt that the food is very good and that they are offered plenty of choice. Several people made comments to the inspectors such as the food is wonderful. Menus are balanced and flexible. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 6 The environment is very comfortable, well suited to residents needs and maintained to a good standard. What has improved since the last inspection? What they could do better: A number of issues identified by CSCI at the inspection of 21 December 2005 had not been addressed by the first visit of the current inspection. These were put right before the second visit of the current inspection. Where a timescale has been set for compliance, a programme for achieving it needs to be produced and followed. Routines need to be more flexible in some regards. The staff team is well motivated, but the service needs to become more person-centred than taskoriented. The tolerant culture of the home will help the team to bring its approach up-to-date with current good practice. Residents needs must be re-assessed when they change. Care plans need to be clearer about what staff should be doing to meet each persons needs, and should reflect individual residents wishes and feelings. Risk assessments need to be drawn up where individual people are at particular risk. The medications policy needs to cover the disposal of medicines. Some aspects of the environment require attention: • some fire doors • call bells • infection control • safe storage of dangerous chemicals • regular testing and servicing of all lifting equipment. Staff must have regular basic training. Some improvements were recommended to the staff recruitment system. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 7 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.V296210.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.V296210.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, Quality outcomes in this area are good. Residents get plenty of information about the home prior to deciding to move in. The home gathers enough information about prospective residents to be reasonably sure of being able to offer them a good service. EVIDENCE: The pre-admission assessment is in the form of a detailed checklist, so that staff doing the assessment are able to have a less formal conversation with the person yet still gather a lot of information. This assessment begins by asking about the persons preferences and interests, only moving on to their care needs once their personhood has been established. The home does not make any charge for extras: newspapers, toiletries, activities and outings are all included within the fee. The inspector recommended that the home reviews its contract because it only asks for one weeks notice. The provider confirmed that fee levels are in line with those paid by North Somerset Social Services. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 10 The home has a clear Statement of Purpose and a Service Users Guide, which was revised in August this year. These documents are really informative, and give people a clear idea of what they can expect from the home. A note is kept on residents care records of the date that revised copies of the Service User’s Guide are given to them. The home does not provide intermediate care. Earlfield Lodge DS0000008040.V296210.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality outcomes in this area are adequate. Residents health care needs are being well met, with the support of the district nursing team. Care plans give a clear indication of the persons progress but need to make clearer exactly what staff should be doing to meet their needs. The homes culture is generally respectful and accepting, but further work needs to be done to ensure that attitudes, practices and routines are person-centred rather than task-oriented. EVIDENCE: Care plans and residents files information were generally well organized and very clear. However, many of the action plans were actually a note of the aim rather than a clear list of the actions required to meet that aim. For example, one persons action plan was to make their room easy to move around in but there was no guidance to staff about what exactly they should do to make the room easy for that particular person to move around in. Conversation with staff showed that they have a good understanding of what is required of them, but written care plans do not always clearly reflect what staff are actually doing. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 12 It was a requirement of the last inspection that care plans are updated when residents needs change, and that a meaningful review of the care plan must be carried out at least once a month. The records showed that there has been a real improvement in this area: care plans had been promptly updated following any significant changes, and the records of reviews showed that staff are carefully considering significant issues. Some people have become so frail now that they require nursing care. At present, the district nursing team are regularly visiting the home to oversee these peoples care. These residents needs must be reassessed and kept under continuous review to ensure that they are being satisfactorily met in this environment. It was a requirement of the last inspection that specific risks to individual residents are assessed. The care plans now identify areas of possible concern but risk assessments have not yet been drawn up. The consultant is currently liaising with the Falls Team of the Primary Care Trust on drawing up action plans and risk assessments. It was a requirement of the last inspection that consent is obtained for the use of bed rails. Since then, a bedrail policy has been introduced, and relatives sign a copy of this. However, even if the relative were in a position to give consent on the resident’s behalf, the policy does not actually constitute a disclaimer. Where a resident is unable to give consent, other advocates such as their relatives and GP need to be involved in drawing up a written risk assessment, which clearly shows why the decision to use bed rails has been judged to be in the persons best interest. Where a resident can give consent themselves, a proper disclaimer should be signed, rather than simply a copy of the home’s policy. The daily notes sampled tended to be rather repetitive in some regards. For example, one persons notes repeatedly said, came to dining room for all meals. This did reflect one aspect of that persons care plan, but there was no reflection in the daily notes of how the person’s other identified needs were being met. The inspector suggested that these records would be more useful if they showed how each aspect of the care plan is being addressed on a day-today basis. It was a requirement of the last inspection that nursing interventions must only be carried out with the knowledge and approval of the community nursing team. The inspector discussed with Mr Butcher and the consultant the restrictions imposed on the home by the Care Standards Act 2000, regarding employed staff giving nursing care in a home that is not registered for such. Certain specialized types of care can be given under the direction of external health care professionals, when those professionals retain responsibility for the care tasks being carried out. However, the home may not use its staff who also happen to be qualified nurses to give nursing care to the residents. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 13 It was a recommendation at the last inspection that residents wishes and preferences regarding daily living should be recorded more explicitly in the care records. Many of the residents the inspectors spoke with did not know what was on their records nor whether they were able to look at them. Conversation with staff showed that there were generally aware of residents individual preferences, but these are still not formally recorded. The inspector and senior staff discussed how these might usefully be incorporated into the written records. The home has up-to-date and reasonable policies and procedures on the administration and storage of medication. However, these procedures do not cover the disposal of unused medication. A member of staff told the inspector that they thought there was such a procedure, but did not produce it. A serious issue came to light: one resident’s medication had been hidden in their food when they refused to take it. Mr Butcher said that he had made this decision in conjunction with the persons GP, but there was no record of this. Residents have the right to refuse treatment. If there is good cause for questioning a persons ability to make this decision, their GP must be asked to arrange a proper assessment of their mental competence. Medications must never be crushed or hidden without first exploring all other reasonable possibilities. If all relevant people involved in the person’s care agree that this is the best option, the supplying pharmacist must be consulted to ensure that it is safe to tamper with these medications in this way. The decision of all relevant professionals needs to be carefully documented. Mr Butcher said that practice will conform to this standard from now on. Medications stock being kept in the home was clearly recorded. All medication was properly signed in, and countersigned by additional members of staff. The home keeps a record of any medicines returned to the supplying pharmacist for disposal. The medications stock book is used for this, in conjunction with a smaller spiral-bound notebook. When carers use any prescribed medication they write this into the notebook. Between the notebook and the medication stock book, it is possible to audit medication used against medication still held at any given time. However, this is quite a complicated system, so the inspector recommended that the home keeps one book for recording medication in and out. He also recommended that this book has fixed pages to reduce the likelihood of pages falling out or being removed. There is separate documentation for service users who administer their own medication. The inspector could find no risk assessments relating to the ability of service users to administer their own medication. Medications Administration Records were in good order with no unexplained gaps. Controlled Drugs Administration Records were countersigned by an additional member of staff, and kept separately, in keeping with good practice guidelines. The inspector checked some of the medications against the records Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 14 and found that the amounts tallied. During the inspection, two staff members administered medication in line with the good practice guidelines. Two of the staff confirmed to the inspector that this is the normal practice. Staff take medications to whichever room the resident is in, and then return to sign the record. Staff confirmed that medications are never left with residents but that they wait with the person until they have taken their tablets. Observations during the inspection indicated that staff are mindful of service users dignity while giving them personal care. Staff took care to close bathroom doors and discreetly took people away from communal areas to be changed privately. When residents became uncooperative about receiving care, staff remained calm and reassured the person; if this didnt work, staff left the person alone, saying that they would come back later. Staff tried to give people a choice where possible. Staff generally spoke to service users respectfully: the inspectors noted that, while they were all kindly, sometimes the staff tone came across as condescending. This was particularly noticeable in the way people with dementia were addressed, but a small proportion of other residents’ comments indicated that some people feel that staff do not always treat them courteously. Some people said that staff often say “In a minute” when residents ask for help, but do not always come back quickly: people felt that this is not because staff are rushed, but happens particularly when they are taking breaks. The consultant is introducing topics for discussion to staff meetings and short training courses, which will look at attitude and the impact that it can have on residents quality of life. It may also be worth reviewing staff break times and how many staff take a break simultaneously. There is a notice on the bathroom wall near the lounge in the ‘care wing that lists residents names and the type of incontinence pads each person needs. Making this sort of information public is a breach of residents confidentiality and does not promote their dignity. Earlfield Lodge DS0000008040.V296210.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality outcomes in this area are good. There is an exceptionally good range of activities and outings, all of which are provided free of extra charge. While staff made efforts to offer choices, some aspects of the routines are rather inflexible. Residents benefit from menus that offer plenty of choice, and are balanced and interesting. EVIDENCE: Residents told the inspector that the home has a range of activities including exercise, music sessions, religious activities and frequent coach trips, and that they felt the programme of activities meets their needs. Several residents said they choose not to make use of the activities available. The two school pupils who are on work experience in the home play Scrabble, do jigsaws, or simply sit and chat with the residents, and it is evident that their input is adding a lot to the homes lively atmosphere and the residents quality of life. One of the inspectors sat in on two of the organized activity groups. The first was a Tai Chi session, which is provided every week. Residents were encouraged to perform a range of seated and standing exercises, depending on their ability. Residents found the sessions stimulating and enjoyable. The comments that residents made to inspectors were generally very positive. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 16 Only a few people made any negative comments, and these may not have been a reflection on the homes efforts to please. Other people made comments such as They cant do enough for you, and the girls really look after us. One person said I have been so happy here. Another person said that staff have a bit of fun with them, and you can have a laugh with the staff. Comments from a number of sources indicated that the general attitude of staff is kindly and respectful. Residents feedback regarding visiting arrangements was also positive: one person said we can have visitors whenever we want. Theyre very good about that and another gave the example of a visitor who needs to come quite late in the day but is always made welcome. Residents comments indicated that they find the home’s routines generally very flexible: one person said I get up when I want. If I dont feel like it I dont have to and another said we can get up when we want and go where we want. However, one person told the inspectors that they get up at 7:30 a.m. because that is when staff bring them a cup of tea, and also because this gives the person time to get dressed ready for breakfast in the dining room. A couple of people told the inspectors that it is possible to have breakfast in their bedrooms, but only if they are ill. Another person told the inspector that they get dressed for breakfast, but on bath day they then get undressed again for their bath and a change of clothes. Inspectors suggested that residents are reminded that they can have breakfast in their rooms if they prefer. It is recommended that all care routines are reviewed to ensure that they revolve around residents needs and preferences, and not around the needs of the staff team to achieve a set number of tasks by a certain time of day. Comments from staff and residents, plus the homes bath list, showed that each resident is offered a bath once a week. This is supported by strip washes, so each person is able to keep clean. Although routines are generally reasonably flexible, bath arrangements need to be a lot more flexible, and those residents who would prefer a bath or shower more often must be offered this choice. Some of the personal care charts showed that residents are only having baths, hair washes, body washes, and bed linen changes every nine days or so. It was evident that this is not the case, and that personal care is in fact being offered a lot more regularly, so inspectors suggested that the staff in charge of each shift monitor that these records are being properly completed. Residents said that the meals are very good: menus are varied and portions are of a good size. People felt that, if they had particular dietary requirements, the home would cope with this. One person said the food is wonderful. Copies of the menus are kept in the dining room. The cook the inspector spoke with said that she goes to the dining room after each main meal to get Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 17 residents comments and suggestions. Staff take the tea menu round every day to ask about each persons preferences. This is done while the residents are eating their lunch in the dining room. This probably saves staff quite a lot of time, but could be confusing for the residents, especially as staff are also asking them which of the two deserts they want at their lunchtime meal. Inspectors recommended that this practice is reviewed with the residents. There are three choices at teatime, but the meal records show that in practice people can ask for other things if they prefer. Lunchtime menus are based on the record of residents likes and dislikes that is kept in the kitchen. Meal records showed that plenty of choice is provided: for example, there are five different types of fish dish on a Friday, plus an alternative for people who do not like fish. Desserts are almost always home-made. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 18 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 outcomes in this area are adequate. The home has an open culture in which residents comments are listened to and taken seriously. However, the service is not yet as person-centred as it should be, and many of the staff have not had abuse awareness training. EVIDENCE: None of the service users was aware of the home’s complaints procedure, although they understood their rights within the home. A useful flow chart of the home’s complaints procedure is included in the Service Users Guide, a copy of which is given out to each resident every time it is updated. This was last revised in August this year, and copies given to all residents. Inspectors asked many of the residents they met about what happens if they have a complaint. Most people had not had any cause for complaint, but those who had all said that they had felt able to tell the owner-manager, and that he had listened. Many residents said their first port of call, if they were at all unhappy, would be the staff in charge on the day, or Mr Butcher if it was serious. People felt that Mr Butcher would deal with the situation appropriately. No complaints had been received by the CSCI. The home has recorded one complaint in the past four years, in July this year. The record includes the action that will be taken to address it. This is greatly outweighed by the appreciation file that is kept with cards and letters of thanks. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 19 There are clear and straightforward abuse and whistle-blowing procedures. However, most of the staff have not had abuse awareness training. Given the size of this service and the fact that practice currently tends to centre around routines and tasks, rather than around the residents as individuals, it is particularly important that all staff are aware of the small ways in which abusive practices can creep in. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 20 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, 26 Quality outcomes in this area are adequate. The environment is pleasant and well-suited to residents needs, but improvements are not always carried out promptly and a consistent improvement in infection-control practices still needs to be achieved. EVIDENCE: Although Earlfield Lodge is a big home, the arrangement of rooms helps to reduce the impact this has on residents. Rooms are in wings, each with its own communal lounge. Residents may choose whether to remain in their wing, or join other residents. Three separate dining rooms allow for meals to be taken in quieter surroundings. A passenger lift offers easy access to all areas of the home. There are attractive gardens at the front and to the rear of the home. The small quadrangle garden at the back of the home has been newly landscaped and looks very pretty. The standard of the furniture and decoration is good. Communal rooms are Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 21 welcoming and comfortable. Each of the inspectors spoke with maintenance staff, who described a programme of regular maintenance within the building. Some of the woodwork was being repainted during this inspection. Residents with high needs are transferred to the ‘care wing’ (after consultation with them and their relatives). The fixtures and fittings in this wing are perhaps less homely than the rest of the building. This wing has a particularly good range of mobility aids, and patient hoists. There are extensive grab rails throughout the home, particularly in the bathrooms, toilets and corridors. Mr Butcher hopes to extend the conservatory in the near future to provide a larger lounge and dining room area for the residents, and to create a staff base nearer to the high-dependency wing of the home. The home’s policy is to give couples two bedrooms: even if the couple elects to share a bedroom, this gives them a second room to use as a private lounge. Although none of the bedrooms in the care wing have ensuite facilities, most other bedrooms do. Mr Butcher hopes to convert some of the current staff accommodation into new rooms for residents: this will not increase the number of residents accommodated, but will create larger bedrooms and the opportunity to add more ensuites. Residents told the inspector that they were able to bring items from their own households when they moved in, as long as they would fit in the rooms without creating a hazard. Many of the residents the inspectors met had a key for their own rooms. It was a requirement of the previous inspection that areas of specific risk to individual residents are assessed. These areas are now being identified on care plans, and staff are starting to draw up risk assessments. It was a requirement of the last inspection that residents are able to access the alarm call in their own room, unless a risk assessment indicates otherwise. This had not been acted on by the time of the current inspection. Only a few of the bedrooms seen had call bell extensions so that residents can call staff independently from their beds or chairs. It was a requirement of the last inspection that window restrictors are fitted on all upper level windows. This had not been done by the first day of this inspection, but window restrictors had been fitted throughout by the time of the second visit. The large window in the staff bedroom appeared to be hanging on by one hinge at the time of the first visit but had been repaired by the time of the second. The bathroom near bedroom 5D has a cupboard with a light switch and air vent switch, the design of which could be dangerous if staff use these with wet hands. The switch had been replaced with a safer design by the time of the second visit. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 22 The carpet on the fire exit staircase that leads past staff flat 25a was a trip hazard but had been replaced by the time of the second visit. The ground floor fire door at the back of the premises near the car park is rotten at the bottom, and needs replacing or repairing. The fire door on the top floor sticks on the carpet. This door leads to a second fire door, which was swollen and difficult to open. Fire doors must be able to open without obstruction at all times. The second fire door was locked and bolted, and had a separate key fastened to the frame of the door. Given the level of independence of many residents, this should be risk assessed, perhaps as part of the homes overall Fire Risk Assessment. The home has sufficient toilet, washing and bathing facilities, although several of the toilets on the ground floor do not have a wash hand basin. These facilities are all in reasonable condition and are fitted with suitable patient hoists. The plumber was in the process of fitting hot water temperature regulators during this inspection, and told the inspectors that regulators have been fitted on all baths and showers, and almost all handbasins. The plumber has also been asked to routinely test these regulators. It was a requirement at the last inspection that working locks are fitted to toilet doors, and the inspector found that all toilets and bathrooms now have working safety locks. Radiators have low surface temperature covers. To move between the two houses that comprise the home, people must either go through the kitchen or the chapel, each of which involves using a short flight of stairs. Inspectors were concerned that the stairlift seat creates an obstacle on the quite narrow chapel stairs. Mr Butcher confirmed that, although residents use this route quite frequently, they are usually accompanied by staff. However, he undertook to investigate the possibility of fitting a seat clip to ensure that the seat is kept as out of the way as possible. There are a number of small boxes mounted on the walls around the home. Mr Butcher said that these are speakers, which were once in all the rooms but are now no longer in use. It is recommended that these are removed so that residents and their visitors can feel assured of their privacy. The premises were generally clean, hygienic and free from offensive odours. However, as at the previous inspection, there are some concerns about infection-control. Dirty laundry had been tied in pillowcases and left on the floor on various landings. Some bathrooms and toilets had paper towels simply placed on the windowsill rather than in a dispenser, and in one shower room incontinence pads were stored uncovered on the windowsill. Communal nail-brushes and toiletries - including bars of soap and toothbrushes - were in many of the bathrooms. Apart from the possibility of cross-infection, the use of communal toiletries does not promote residents dignity and individuality. In three of the bathrooms there were what appeared to be communal Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 23 disposable razors, which had evidently been used. Communal razors carry a significant risk of cross-infection. Following the first visit, Mr Butcher confirmed in writing that incontinence pads are now properly stored, that laundry is now being collected from residents rooms in a suitable container, and that all communal hand wash facilities now have paper towel dispensers fitted nearby. At present, staff are washing up by hand, relying on a mix of Miltons and washing-up liquid to manage the risk of cross-infection. Inspectors commented that this is not an effective use of staff time, and recommended that the provider consider acquiring an industrial dishwasher. Mr Butcher confirmed that he is already considering this. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 24 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 outcomes in this area are adequate. Effective staffing practices promote residents safety and well-being. However, there are occasions when there are not enough staff on duty, and care needs to be taken to ensure that all pre-employment checks are satisfactorily carried out. EVIDENCE: A senior member of staff is rostered on each shift. As a minimum, there are 4 care staff on each shift, but in the mornings there are usually 6 or 7. There are usually 4 cleaners rostered each day, 3 dining room assistants, a laundry person, and 2 cooks. One day each week, 3 cooks are rostered so that one person is able to do some deep-cleaning of the kitchen. There are 3 staff on duty at night. While staffing levels are generally good, 4 care staff is not adequate for the numbers and level of need of the residents, particularly given the layout of the building. There is an effective system in place for ensuring that staff recruitment complies with good practice. The staff files seen showed that this generally works well but is not completely foolproof, because one of the files had no record of references ever being received. The administrator immediately sent further reference requests to the named referees. The inspector reminded the provider that staff must not start work in the home until all pre-employment checks have been satisfactorily completed. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 25 Prospective staff are required to fill in an application form which asks for a reasonable depth of information. From the files sampled, it was evident that some staff had given two friends’ names as referees but had been asked at interview for the name of an employer instead. The inspector recommended that the application form is amended to request at least one reference from the current or most recent employer. This will also help to ensure that the persons current employment does not remain hidden. Although the application form of one staff member included a five-year gap in employment immediately prior to their previous job, there was no evidence that the reason for this was explored at interview, nor why the persons current employer was not approach for a reference. Any gaps in employment should be thoroughly explored as part of the home demonstrating it is making every reasonable effort to employ only people who are fit for the job. The disciplinary procedure is very clear. Staff receive an induction and foundation training soon after joining the team. Some staff did a dementia course and a manual handling course a few months ago. One of the senior staff did a course recently on care planning, and some of the staff attended a Stroke study day. Some staff told the inspector that abuse awareness training is being organized but they were not sure when this would be. Staff training records showed that in general a good range of training opportunities is being offered but not all staff are having statutory training, such as abuse awareness and manual handling. The inspector suggested that a master list is kept of all the staff and the dates of all the courses they have attended, as this will help the staff planning future training to see what statutory training is required. Nine of the twenty-seven care staff hold an NVQ 2. Two staff are undertaking NVQ 3. Three staff are doing a three-month infection control course and a similar medication course. Two of the cleaners have taken NVQ 1 in cleaning. Most of the senior staff have worked at the home for a number of years. Many of the staff whom the inspector spoke with were really enthusiastic about their jobs, and evidently have a strong commitment to making residents lives as enjoyable as possible. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 26 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, 32, 33, 36, 38 Quality outcomes in this area are good. The home has a very friendly atmosphere and people generally feel happy to be there. Some aspects of health and safety have improved recently, but there was a lack of evidence that other aspects are being properly monitored. EVIDENCE: Mr Butcher has been the registered owner-manager for some years. He has recently appointed a trained nurse to act as a consultant on the business, regarding both residents care needs and quality assurance. Many of the staff with whom the inspectors spoke said they really like working at this home. People felt part of the team, well supported, and get a lot of job satisfaction. Some staff said that Mr Butcher often helps them out if they are busy. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 27 The consultant has set up a programme of quarterly staff meetings specifically to look at health and safety issues. Carers meetings are now being held weekly. She is looking at inviting external health care professionals to give talks at some of these meetings as part of the staff training programme. Staff who have been on training may give a presentation to the rest of the team at these meetings. She is also setting up a service users Forum with residents and relatives. Inspectors gained a strong impression that staff thoroughly enjoy working at this home, and there is a real sense of being a team. Newer staff said they had immediately felt welcomed and included, and many people gave examples of how team members help each other out. Inspectors observations during this inspection supported this: domestic staff paused to talk with residents as they went by, and undertook to pass messages on to other staff. A record is kept of the date of each one-to-one staff supervision session, and staff confirmed that these sessions are happening and feel supportive. However, no other record is kept of these sessions. It may be very useful to staff as well as to the employer to have a record of these. The recently employed consultant is looking at redesigning the whole appraisal system. Most residents told the inspector that they handle their own financial affairs. The owner only acts as Appointee for one person. Not all fire extinguishers had been tested by the contractor in December 2005. Mr Butcher confirmed that there is a location list of fire extinguishers that would have been used by the contractor during his check. The next inspection is due within four months, and Mr Butcher said that he would raise this matter with the contractor who carries out that check. Inspectors advised the provider following the first visit that all hazardous chemicals must be stored in line with COSHH (Control Of Substances Hazardous to Health) Regulations. Hazardous chemicals were still not all being appropriately stored by the second visit of this inspection. Comments from some of the people the inspectors spoke with indicated that there is some poor manual handling practice. To protect the safety of both residents and staff, manual handling practice must comply with current guidelines. Action must be taken immediately towards identifying and providing the necessary equipment to enable this, and a schedule of staff training must be arranged. Mr Butcher has asked an occupational therapist to give advice. None of the home’s hoists and baths had stickers indicating that they have been regularly checked. Maintenance records for this type of equipment showed that the passenger lifts have been regularly serviced, but contained no Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 28 evidence that other equipment has been. One of the inspectors spoke with Mr Butcher about this, who said that if the receipts were not in the folder they were probably not there. He was unable to provide them during the course of this inspection. Inspectors concluded that the lifting equipment and baths at the home has not been serviced as required by LOLER (Lifting Operations and Lifting Equipment Regulations). This may well have an impact on moving and handling practice, and affect the safety of both residents and staff. One resident’s description of how staff move her indicated that manual handling practice does not always comply with current guidelines. One of the professionals contacted by inspectors said they had seen examples of poor manual handling practice, which could have caused injury to the staff involved and the person on the receiving end. Thirteen of the staff have a current first aid certificate, and the home keeps an accident book. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 29 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 2 Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 30 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. 2. Standard OP7 OP7 Regulation 15 13 Requirement Care plans must show what needs to be done, when, and by whom to meet residents needs. Areas of specific risk must be assessed. Consent must be obtained for the use of bedrails. This requirement was first made on 21/12/05. Residents assessments of needs 28/12/06 must be kept under review and revised as necessary. This is with particular reference to those very frail people who are currently receiving intensive support from the community nursing team. The homes written medications 28/12/06 policy must cover the disposal of medicines. Written risk assessments must be drawn up in respect of those residents who self-medicate. The registered person must so far as practicable enable service users to make decisions about DS0000008040.V296210.R01.S.doc Timescale for action 28/09/06 28/12/06 3. OP8 14 4. OP9 13 5. OP9 12, 13 07/11/06 Earlfield Lodge Version 5.2 Page 31 the care they receive. The registered person must also ensure that no service user is subject to physical restraint unless this is the only practicable means of securing their welfare and there are exceptional circumstances. In this event, the registered person must record those circumstances and the nature of the restraint used. This refers to the incident where medicines were crushed and hidden in a residents food. the registered person must ensure that the home is conducted in a way which respects the privacy and dignity of service users. This refers to the practice of displaying confidential information about residents continence on a notice in one of the bathrooms. The service provided must take into account the wishes and feelings of service users. This is with particular regard to the flexibility of bath-time arrangements. Staff must have abuse awareness training. Fire doors must be in good condition and able to open without obstruction at all times. Residents must be able to access an alarm call in their own room, unless risk assessment dictates otherwise. This risk assessment must be documented. This requirement was first made on 21/12/05. Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 32 6. OP10 12 07/11/06 7. OP12 12 07/12/06 8. 9. 10. OP18 OP19 OP22 13 23 23(2) 07/02/07 07/11/06 28/12/06 11. OP26 13 Suitable arrangements must be made to prevent infection, toxic conditions and the spread of infection at the care home. This is with regard to the use of communal razors and toiletries. The registered person must ensure that at all times staffing levels are appropriate for the health and welfare of service users. The registered person must ensure that staff receive training appropriate to the work they are to perform. A programme of staff training needs to be drawn up to address this. All parts of the home to which service users have access must be kept free from hazards as far as reasonably practicable. This is with reference to the storage of hazardous chemicals. The registered manager must ensure safe moving and handling practices. All hoists and lifting equipment must be serviced in accordance with LOLER regulations. 07/11/06 12. OP27 18 07/11/06 13. OP30 18 07/12/06 14. OP38 13 07/11/06 15. 16. OP38 OP38 13 13 07/01/07 07/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP2 OP9 Good Practice Recommendations The residents contract should be reviewed because it only asks for one weeks notice. The system for recording medicines in and out of the home DS0000008040.V296210.R01.S.doc Version 5.2 Page 33 Earlfield Lodge 2. OP12 should be simplified. Residents’ wishes and preferences regarding daily living should be recorded more explicitly in the care records. This recommendation was first made on 21/12/05. All care routines should be reviewed to ensure that they revolve around residents needs and preferences. The practice of asking residents about their tea-time menu preferences while they are eating their lunch should be reviewed with the residents as it could be confusing. The fire door which is kept locked and bolted, and has a separate key fastened to the frame of the door, should be risk assessed, perhaps as part of the homes overall Fire Risk Assessment. The speaker boxes around the home should be removed so that residents and their visitors can feel assured of their privacy. Consideration should be given to acquiring an industrial dishwasher, rather than staff washing up by hand. At least one reference from the current or most recent employer should be requested. Any gaps in employment should be thoroughly explored as part of the home demonstrating it is making every reasonable effort to employ only people who are fit for the job. A written record should be kept of each individual staff supervision session. 3. 4. 5. OP12 OP12 OP19 6. 7. 8. OP19 OP26 OP29 9. OP36 Earlfield Lodge DS0000008040.V296210.R01.S.doc Version 5.2 Page 34 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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