Inspection on 10/08/06 for Eighton Lodge Residential Care Home

This inspection was carried out on 10th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Eighton Lodge Residential Care... 21/08/07

Eighton Lodge Residential Care... 15/12/05

Eighton Lodge Residential Care... 05/07/05

Eighton Lodge Residential Care... 01/02/05

Eighton Lodge Residential Care... 02/09/04

Eighton Lodge Residential Care... 25/02/04

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The Highlands

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Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

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

CARE HOMES FOR OLDER PEOPLE Eighton Lodge Residential Care Home Low Eighton Gateshead Tyne & Wear NE9 7UB Lead Inspector Miss Andrea Goodall Key Unannounced Inspection 10th & 18th August 2006 9:30 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 Eighton Lodge Residential Care Home DS0000007380.V304180.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. Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eighton Lodge Residential Care Home Address Low Eighton Gateshead Tyne & Wear NE9 7UB 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) 0191 410 3665 0191 492 1006 Wellburn Care Homes Limited Kelly Sarah Watt Care Home 45 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (45), of places Physical disability over 65 years of age (5), Sensory Impairment over 65 years of age (2) Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th December 2005 Brief Description of the Service: Eighton Lodge is a large home in Low Eighton set back from the road in its own extensive grounds. It is a listed building of historical interest and is directly opposite the Angel of the North, which can be seen from many of the bedrooms. The home currently provides personal care for up to 45 older people, some of whom may have dementia care needs and a smaller number who may have physical needs. The home does not provide nursing care. There are bedrooms on both floors of accommodation, which are served by a central passenger lift. There is level access into the home from the driveway, and around the ground floor where the communal lounges and bathrooms are sited. The home is located on a main bus route, and it is a couple of miles to the nearest local facilities. Over the past 18 months the home has been extended. The additional premises will allow for a slight increase in number of places (up to 47 places), all but one shared rooms have been reduced to single occupancy, and a further bathing facility has been provided. The extension has been carried out sympathetically and is indistinguishable from the original house. Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 2 days, and the home had very short notice about the first visit. Much of the time was spent talking with residents, visitors and staff to get their views of the service. The Inspectors joined residents for a lunchtime meal to assess the catering service in 2 different dining areas. The new and upgraded areas of the premises were examined. Time was also spent talking with the Manager about the progress of the service, looking at care records, staff records, medication systems, and health & safety records. Comment cards for residents and their relatives were sent out well in advance of the inspection. Five comments cards were received from residents and 10 comment cards were received from relatives. All were generally satisfied with the service, and any written comments are included in this report. There have been no formal complaints about the service since the last inspection. Two concerns were raised by relatives about the disruption to residents due to building works. However these were well managed by the home staff. One further concern was raised by a relative about not being informed of an incident. This matter has also been addressed by the home. What the service does well: There is good information for resident about the home to help them make an informed decision about moving here. There is also good information in each bedroom about the service, menus and activities that residents can read at any time. The home provides a good range of social events and activities for residents to choose if they want to take part. There are frequent local trips out and entertainment. Residents are supported to go out into the local community and to maintain links with relatives by telephone or visits. The quality of meals is very good and residents are also offered drinks and snacks throughout the day. Staff were very respectful and courteous in their support of the people who live here. Residents and relatives had many positive comments about the home. One relative said, My (relative) is well looked after and (their) increasingly frail state is treated with care and concern by all staff members. The home has a very warm and welcoming atmosphere. The Owner makes sure that there are always fresh flowers in the home. The building is well Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 6 maintained. The furnishings are of good quality and bedrooms are decorated to a good standard. The gardens are extensive and very well maintained. Staff have good opportunities for training that helps them to do their jobs. There are sufficient staff on duty to support the number of people who are currently living here. The home is well managed, and there are frequent checks by the Owner to make sure the good standard is kept up. Residents are asked for comments and suggestions about the service they receive. Their comments are used to continually make improvements to the service. What has improved since the last inspection? What they could do better: The home is registered to provide care for people with a visual impairment so it should have information about its service in a suitable format for them, such as on cassette tape. This is outstanding from the last inspection. All assessment documents should be fully completed so that staff know what each person needs assistance with, especially moving & assisting. Some care plans still needs to show whether residents or their relatives were involved in the plan. It would be better if the home kept a daily record of everyones wellbeing, and if the monthly evaluations gave details of what has actually been achieved. The home must get advice from health care professionals for individual needs, for example the Falls Team for residents who are at risk of falls. The home must make sure that residents are offered their prescribed medication at all the right dosage times, including when a resident is out of the building. Staff must use the right way to record when a resident has not wanted and an as and when required medication. Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 7 At the time of this visit there were a small number of premises issues that needed attention, including: uneven flooring in the first floor corridor; existing en-suites are not fitted with door locks; the plug to the ground floor bathroom is not fixed to the bath; the lock to the continence equipment store cupboard is ineffective; and signage is missing from some doors, such as toilets and the hairdressing room. Also plans for one bathroom to be made usable by residents should now go ahead so that residents have this choice. The home should have a copy of the proof of identity of each member of staff, and a declaration by them of their physical and mental fitness to do their job. The hot water temperature of the showers needs to be checked to make sure that they are safe for use by the people who live here. 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. Eighton Lodge Residential Care Home DS0000007380.V304180.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 Eighton Lodge Residential Care Home DS0000007380.V304180.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): 3 & 4 (standard 6 does not apply to this home) Quality in this area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents only move to this home following an assessment of their needs, but some assessment records are not fully completed so do not show the full support needs of potential residents. Resident get good information so that they know that the home will meet their needs, but information that is in a suitable format for those residents with a visual impairment had not yet been given to them. EVIDENCE: The needs of all potential new residents are assessed prior to them making a decision about moving to this home. Most residents have first been assessed by a Care Manager of the Social Services Department, and copies of those assessment documents are placed in the residents care file. The home also carries out an assessment to ensure that a persons needs can be met at Eighton Lodge. An assessment document is used to check peoples care needs including emotional, physical and mental health. The potential Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 10 resident is also invited to spend a full day at the home so that their support needs can be checked. If it is determined that the home can provide the necessary care, the Manager writes formally to the potential resident confirming this. However, in a sample examined, several areas of the assessment documents were not fully completed, and were not signed by the assessor. In some cases moving & assisting assessments had not been carried out even though the potential residents had mobility needs. In this way it could not be demonstrated that the full range of a potential residents support needs had been assessed. The home is pro-active in acknowledging when a residents needs have changed so much that the home can no longer provide the required support. It is good practice that the home requests re-assessments by Social Services Department of residents whose dependency level can only be met by a nursing care service. The home is registered to provide up to 14 places for older people with dementia care needs, 5 places for people with a physical disability and 2 places for people with a significant sensory impairment. At this time all those places are filled, so the home cannot admit any more people with those needs at this time. All but 4 staff, including housekeeping and catering staff, have completed a 12-week training course Positive Dementia Care. This means that all staff are better equipped to support people with dementia care needs. All staff have regular training in moving & assisting so that they know how to support people with their mobility needs. There are 2 people who live at the home who have significant visual impairments. The home now has information about the service on a CD but at the time of this inspection the residents had not been given this information or the equipment to play it on. (By the end of the inspection CD players had been obtained for those residents.) At this time there is no specialist equipment to support the orientation of people with a visual impairment around the home. Advice was given about specialist support in this area. Eighton Lodge Residential Care Home DS0000007380.V304180.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 in this area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents needs are set out in a care plan, but some care records are not fully completed, so the support given is not demonstrated. Residents health care needs are met by community health care services. Residents medication is managed by staff but on one occasion the home failed to ensure that residents received the treatments that they have been prescribed. Residents feel that they are treated with respect. EVIDENCE: The home has a clear protocol for care planning. Assessment records are used to identify the appropriate goals and needs of each resident and these are set out in an individual plan of care. The goals/needs are evaluated on a monthly basis, or sooner if there is a significant change. The care plans are wellordered, and easy to follow. However of the sample examined some assessments were not completed so those needs were not included within the care plan. Some new needs were identified in daily records but not included in care plans e.g. one resident has Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 12 had input of a dietician for their poor appetite and nutritional needs, but this did not form a new care plan goal. Some care plans are very detailed and clearly guide staff in how to support a resident with their specific needs. Others are not sufficiently detailed and so staff could not provide consistent responses, which could be confusing for residents. For example, for residents who can become agitated their care plans state give reassurance, but this could mean different things to different staff. Most evaluation records provide a good indication of what support was necessary over the past month. However some simply stated, care plan working well. This does not demonstrate all the good care practices carried out by the home. Daily reports, which support the care plans, are not currently completed on a daily basis so there can be long gaps with no indication of a persons wellbeing. For example, one person had sustained an injury following an accident but there were no further daily reports for 16 days. Instead the staff have been recording pertinent care information in a bound communications book, which includes details of all residents care. This can compromise confidentiality and data protection, and could also lead to incidents or events being recorded twice, which is unnecessary duplication. One care plan advised the wrong support. The resident has had a number of falls and the care plan intervention directed staff to place a chair against her bed to prevent her from falling out of bed. This could be construed as restraint and could exacerbate the risk of injury if the resident tried to climb over the chair. A referral had not been made to the Falls Assessor for their expert advice. (Following the inspection, the chair was removed and a referral made to the Falls Assessor.) In all other care plans of the sample examined, it was clear that the home did make referrals to community health services on behalf of residents when necessary including GPs, district nurses, opticians, chiropodists, dental services, dieticians CPN. In between the 2 inspection visits all residents were supported to spend a day outside the home at a nearby community facility whilst essential electrical maintenance works were carried out at Eighton Lodge. However the Inspector was most concerned to find that the medication of only 2 residents was taken to the community facility for the residents lunchtime dose. Several other residents are also prescribed medication for lunchtime, but these were not made available to them for that dosage time, or for anytime during their absence from the home. The missed medications included GTN (taken at the onset of angina attacks), inhalers (for the relief of asthmatic attacks) and pain-relieving medication. Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 13 Only a prescribing medical practitioner can decide whether a medication need not be taken. However the home had not contacted the respective GPs for advice. In this way the home withheld residents medication from them. The Manager stated that she had been uncertain about the security of the medication outside the home. However, the home had not contacted the pharmacist for advice about transporting medication. The MARs (records of administration of medication) show that staff are using 2 different ways of recording whether a resident has chosen to have and as and when required medication. Some staff are marking the record /, some are writing R. Neither of these is correct, and further advice was given about this. It was clear from observations and discussions with residents and their visitors that the people who live here are treated with respect and courtesy by staff. Staff were seen to be very sensitive in their care and support of all residents. There were many positive comments from relatives about the sensitivity and care shown by all staff towards each resident. For example, one relative stated, My (relative) is well looked after and (their) increasingly frail state is treated with care and concern by all staff members. Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents are enabled to follow their own lifestyle and that the home satisfies their social, recreational and cultural interests. Residents are supported to maintain contact with their family and friends and to take part in the local community. Residents are enabled to make their own choices and decisions. Residents can choose from very good quality, varied meals that support their nutritional health and well-being. EVIDENCE: Discussions with residents and staff indicated that residents can continue to lead their own preferred lifestyle at the home. Residents confirmed that they can get up and go to bed when they wants. There is good freedom of movement around the home and residents can use a range of lounge areas for socialising. Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 15 Some residents have a key to their bedroom, and several residents enjoy spending part of their day in the privacy of their own rooms. Since the last inspection those residents who cannot manage a key to their own bedrooms are now able to access their own room without having to seek staff support (unless they need physical assistance). The home provides a good range of activities and residents stated that they enjoy several social events and trips out. It is very good practice that a printed monthly itinerary of social events is provided in each bedroom for residents to refer to at anytime. Two care staff have a small number of supernumerary hours to plan and provide activities. There are also several visiting entertainers and therapists. For example on the day of this inspection a reflexologist visited in the morning to provide massages for some residents, 10 residents were going to out to a local community facility for a coffee afternoon, and a singer was also booked for the afternoon entertainment. Residents commented positively on a number of regular weekly trips out such as visits to a senior citizens club, visit to a local garden centre, and to a local community centre. The home also provides a day care service to a small number of local people. One relative wrote, My (relative) attends for day care twice a week which (they) enjoy very much and it helps me a great deal as a carer. Residents spoken to said that their relatives could visit them at any time in the home and this was observed on the day of the inspection. Good contact is maintained with relatives and with the local facilities so that residents still feel that they are part of the local community. It was clear from discussions and observations that residents are encouraged to make their own choices. Residents are able to choose what personal possessions to bring to the home, what to eat at mealtimes and how to spend their day. There is a good range of choices at each mealtime. Residents are asked what they would like just prior to the meal so that they can make an informed decision. Everyone commented favourably on the quality of the meals provided in the home, all describing the chefs as very good. Throughout the inspection visits residents were offered drinks and snacks in between meals. As well as the main dining room, there is now seating for around 12 people to dine in one lounge. The Inspectors joined residents in both dining areas for a lunchtime meal. The quality of the meals and presentation was very good, the tables were suitably set, and residents were able to help themselves to tea, milk and sugar. In one dining area some people needed extra assistance with their meal. This was provided with great sensitivity and care, and at an unhurried pace so that Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 16 those residents were able to enjoy their dining experience. In the main dining room residents had to wait some time for their meal as these were individual served by the chef. As a result some residents with confusional needs kept leaving their table and wandering off, so had to be constantly brought back by staff. There are sufficient staff on hand to help to plate-up meals for a quicker service to table, and advice was offered about this to the Manager. The kitchen is well stocked and clean. Temperature records of meals served are in place except for breakfast meals even where these contain high protein foods. Fridge and freezer temperature records were not being recorded on a daily basis. Eighton Lodge Residential Care Home DS0000007380.V304180.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents and their representatives have information about how to make a complaint and are confident to do so. Staff training and protocols are in place to protect residents from abuse. EVIDENCE: The home provides residents with a Service Users Guide, which includes details of how to make a complaint. The Service Users Guide is kept in each bedroom so that residents have immediate access to it at anytime. The information about how to make a complaint has also been voiced onto CD for residents with a visual impairment and this is now to be made available to them. All of the residents responses to comment cards and most of the relatives responses to comment cards indicated that they are aware of the complaints procedure. This was confirmed during discussions with residents and their visitors, and several residents said that they would feel confident to discuss any concerns with the management staff. There have been no formal complaints about the service since the last inspection. Two concerns were raised by relatives about the disruption to residents due to building works. However these were well managed by the home staff. One further concern was raised by a relative about not being informed of an incident. This matter has also been addressed by the home. Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 18 As with all adult service agencies in Gateshead, Eighton Lodge has adopted the local POVA (Protection of Vulnerable Adults) policy and procedures. These are robust procedures for dealing with suspected abuse. All except newest staff have had training in the POVA procedures. All management staff need to be fully aware of their own role as lead officers when receiving alerts from staff about suspected abuse. Eighton Lodge Residential Care Home DS0000007380.V304180.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 & 26. Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home provides a safe, comfortable and warm place to live. The accommodation is of a very good standard, is well-maintained and has been further improved by extensive alterations. There are now more bathrooms, but these all need to be usable by the people who live here. Bedrooms are comfortable and personalised by residents, so that they all have an individual look. The home is a clean, pleasant and hygienic. EVIDENCE: Eighton Lodge has been a registered care home for several years. It has a long history of providing a good standard of accommodation. Over the past 18 months the Owner, Wellburn Care Homes Limited, has made some significant extensions and alterations to the premises in order to upgrade existing facilities even further. Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 20 The works have also resulted in an increase in the number of places from 45 to 47. The upgrades have included: extra showering facilities; access to two more outdoor sitting areas; increased lounge and sitting space; increased number of single rooms; and increased number of bedrooms with private en-suite facilities. Several residents commented positively on the changes to the home, especially now having their own private en-suite facility. One resident described how they had lived at other homes in the past but was immediately very satisfied with this home, and even more so following the changes. The quality of the accommodation is very good. All bedrooms are different in shape and style, and residents are encouraged to bring in their own possessions. As a result each bedroom has a very personal and individualised feel. The home is also set in its own grounds and residents benefit from access to a well-maintained spacious garden. At the time of this visit there were a small number of premises issues that require attention, including: uneven flooring in the first floor corridor; existing en-suites are not fitted with door locks; the plug to the ground floor bathroom is not fixed to the bath; the lock to the continence equipment store cupboard is ineffective; and signage is missing from some doors, such as toilets and the hairdressing room. There are now 5 potential bathing facilities in the home, including 3 bathrooms and 2 shower rooms. However one of the bathrooms remains unusable at this time, and so limits residents actual choice of bathrooms. The Manager stated that there are plans for this bathroom to be upgraded. At this time it was being used to store 2 cleaning trolleys, which could have presented a tripping hazard for residents. (These were moved to another storeroom by the end of the inspection.) The home has an extremely small laundry room due to the limitations of the layout of the building. In discussions, most residents confirmed that they are satisfied with the laundry service. A smaller number of people indicated that there were occasional mishaps, such as items being temporarily lost. However one relative wrote in a comment card stated that there were continuous problems with laundry going missing. This is an area for the Manager to monitor. All areas of the home examined during these visits were very clean, pleasant and hygienic. Most staff, except new starters, have completed Infection Control training. An Area Manager of the organisation carries out rigorous monthly checks of the home, including its cleanliness, and this supports the on-going good standard of hygiene in this home. Eighton Lodge Residential Care Home DS0000007380.V304180.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The numbers and skills of the staff team meet current residents needs. Residents are protected by the homes recruitment practices. Staff are trained and competent to do their jobs. EVIDENCE: Staffing levels remain the same, that is 5 care staff on duty throughout the day and evening, and 3 care staff on waking duty during the night. (This does not include the Managers hours to attend to the many managerial and administrative tasks in managing a home.) These staffing levels currently meet the needs of the 36 people who live here. However these will need to be reviewed in light of the increase in number of places and continuing increase in dependency levels of residents. Current staffing levels would not be sufficient for the 47 residential care places and 6 day care places that the home is to provide. Since the last inspection there has been an improvement in the number of staff with NVQ care qualifications. Of the 28 care staff, 17 have either achieved or are engaged in training towards NVQ level 2 in care. In this way it is planned that more than half the staff team will have a professional care qualification to support them in their care of the people who live here. Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 22 There have been a small number of changes to the staff team. The homes recruitment and selection processes include police checks, references and other clearances. A small number of staff personnel files were examined, and these were generally in good order. However there were no recorded declarations of mental and physical health by applicant staff, and there were no copies of formal identification such as passport or birth certificates. All new staff receive suitable Induction training in line with Skills for Care standards. All staff who took part in discussions stated that they have good opportunities for training, and training records confirmed this. Records show that all staff have training in statutory health and safety matters. Eighton Lodge Residential Care Home DS0000007380.V304180.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents benefit from living in a well managed home. . Residents views are used to run the home in their best interests. Residents financial interests are safeguarded, but the record style cannot ensure confidentiality. The health & safety of residents is promoted. EVIDENCE: The Registered Manager has many years experience at a senior level within the home. She has attained a number of care and management qualifications, including NVQ 4 in Management, and in Care. In this way she demonstrates her capability and commitment to professional development. Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 24 The Manager is supported and supervised by an Area Manager, and there are clear lines of accountability within the organisation. The Area Manager carries out frequent visits to the home, including a monthly audit of the service. The organisation has a comprehensive quality assurance system that includes a number of audits of the homes practices, and also includes the views of residents. During visits by the Area Manager the views of residents and relatives are sought to ensure their satisfaction, or otherwise, with the service provided by this home. It is evident from those reports that suggestions and comments made by those residents who take part do influence the practices in the home. There are also Residents Meetings every couple of months for residents to voice their ideas, comments and suggestions. It was clear from the minutes of these meetings that there is a good attendance. Residents and their representatives also have a chance to comment on the service they receive at care reviews every 6 months. In these ways, the home endeavours to run in the best interests of the people who live here. Satisfaction questionnaires have also recently been designed for gaining residents views. The questions are appropriate and will allow the residents to suggest what might improve the service. However the method of scoring does not fit the style of questions, so is rather confusing. Residents are encouraged to continue to manage their own finances wherever they can, and currently around 9 people still look after their monies. The home helps many of the remainder of residents to securely store small amounts of personal allowance. The records of how this is managed were well detailed and up to date. However there is still only one record book to record the transactions of those monies. In this way individual residents cannot view their own records confidentially if they wish to do so. The Manager confirmed that there are plans to change this system to individual records. There is maintenance staff to carry out routine maintenance checks and address any minor repairs. A health & safety audit is carried out to the premises each month to check that the home remains a safe environment for the people who live here. Water temperature checks are carried out to ensure that hot water to washbasins and baths is at a safe temperature for residents to use. However these checks have not included the 2 new shower facilities. Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 25 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 2 3 X 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 12(4)b & 22(6) Requirement The home must now provide the service information on CD (with CD player) to those residents with a visual impairment, and seek specialist advice about orientation and support for those residents. All relevant assessment records for care plans must be fully completed, including moving & assisting assessments. (Previous timescale of 01/03/06 not met.) The home must continue to seek the involvement of residents and/or representative in care planning or record why this not possible. (Previous timescales of 01/11/05 and 01/04/06 not met.) The home must seek the advice of appropriate health care clinicians regarding the prevention of falls by a resident; and the home must not employ any method of restraint to prevent the movement of a resident. All residents prescribed medication must be available to DS0000007380.V304180.R01.S.doc Timescale for action 01/11/06 2. OP7 15 01/10/06 3. OP7 15 01/11/06 4. OP8 12(1)a, 13(4) & 13(7) 01/10/06 5. OP9 12(1)a, 13(2) 01/10/06 Eighton Lodge Residential Care Home Version 5.2 Page 27 6. OP9 13(2) 7. OP19 23(2) 8. OP29 19, Schedule 2 (1) & (6) 9. OP38 23(2)j them at every dosage time, even during their absence from the home. The home must not withhold prescribed medication from residents, unless directed by the prescribing medical practitioner. Staff must record in the correct manner when an as and when required (PRN) medication has not been taken. The minor premises issues must be addressed, as outlined in this report; and the planned proposal to upgrade the small bathroom must be put into effect. The personnel details of all staff employed by the home must include proof of the persons identity, and evidence (or signed declaration) that the person is physically and mentally fit for the purposes of work. Hot water temperatures of showers must be tested on a weekly basis to ensure a safe maximum temperature of 41°C. 01/10/06 01/12/06 01/11/06 01/11/06 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. Refer to Standard OP7 Good Practice Recommendations Consideration should be given to keeping daily reports on a daily basis in order to maintain an up-to-date record of each residents well-being, and avoiding unnecessary duplication in the communication book. Evaluation records should describe the support provided and/or residents achievements towards each of their goals. A review of mealtime arrangements should continue to be carried out to ensure that residents are served in a timely DS0000007380.V304180.R01.S.doc Version 5.2 Page 28 2. 3. OP7 OP15 Eighton Lodge Residential Care Home 4. OP15 5. 6. 7. 8. 9. 10. OP18 OP26 OP27 OP28 OP33 OP35 manner, so that people with dementia care needs do not become unsettled by a long wait for their meals. Records of the cooked temperatures of meals served to residents should include high-protein cooked breakfasts foods; and records of fridge/freezer temperatures should be recorded on a daily basis. The Manager and Deputy Manager should be aware of their specific role within POVA procedures so that they can deal with any reports of suspected abuse. The Manager should monitor the quality of laundry practices to ensure that residents and their relatives are satisfied with the service. The Owner should consider staffing proposals for the increase in number of places and potential dependency levels of potential residents. Staff should continue to pursue NVQ training to ensure that at least 50 of the team achieves NVQ level 2 in care. Consideration could be given to changing the style of scoring on Residents Satisfaction Questionnaire to fit the style of questions. There should be individual records in respect of monies held for each resident. Eighton Lodge Residential Care Home DS0000007380.V304180.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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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