Inspection on 11/02/09 for Fenland Lodge

This inspection was carried out on 11th February 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fenland Lodge 07/01/10

Fenland Lodge 12/08/09

Fenland Lodge 11/06/08

Fenland Lodge 28/11/07

Fenland Lodge 28/06/07

Fenland Lodge 02/02/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Fenland Lodge Soham Road Stuntney, Ely Cambridgeshire CB7 5TR Lead Inspector Elaine Boismier Key Unannounced Inspection 11th February 2009 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 Fenland Lodge DS0000067620.V373913.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. Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fenland Lodge Address Soham Road Stuntney, Ely Cambridgeshire CB7 5TR 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) 01353 668971 01353 772734 fleuropeancare@aol.com European Care (Central) Limited Margaret Ann Smedley Care Home 49 Category(ies) of Dementia - over 65 years of age (49), Old age, registration, with number not falling within any other category (49) of places Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th June 2008 Brief Description of the Service: Fenland Lodge is owned by European Care and is situated between Ely and Stuntney. The home is registered to provide care to 49 elderly people, all of whom may have dementia. There are 45 single occupancy bedrooms and two shared rooms. All have en-suite facilities. The weekly fees range from £347 to £600. Additional costs include those for hairdressing, private chiropody and toiletries. A copy of the inspection report is available on request from the home or via or website at www.csci.org.uk Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This summary includes information about the home since our last key unannounced inspection, in June 2008. 30th October 2008 Following our inspection, in June 2008, a requirement was made for there to be a sufficient number of staff on duty. In October 2008 we received information that there was an insufficient number of staff on duty at all times. As a result of this information on the 30th October 2008 we carried out a random unannounced inspection to assess if the home was providing a sufficient number of staff to meet the individual needs of the residents. We found evidence that, during the weekdays there was a sufficient number of staff on duty but not at the weekends. We considered there remained a breach of the associated regulation, regulation 18(1) and we made a new, more specific requirement for the home to comply with this Regulation. The timescale for compliance was to be by the 11th November 2008. We also reported that We expressed our concerns that Fenland Lodge might be operated on behalf of the staff, as their work requirements were taken in to consideration over and above the needs of the residents currently living at Fenland Lodge. At our October 2008 inspection the Manager was unclear if her registration, as the Manager of Fenland Lodge, was active. In our inspection report we clarified that indeed the Managers registration was active and therefore retained the legal responsibilities of a registered person. 19th November 2008 Following our inspection in June 2008 we made a requirement for care plans to detail all the needs of residents and state how staff should meet these needs to ensure there is a consistent approach. Care plans must be written as soon as the information is available to ensure that staff are aware of the needs of new residents. The timescale for this requirement was the 1st August 2008. On the 19th November 2008 we attended a safeguarding meeting during which we received information that the care plans did not meet this requirement and Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 6 therefore there remained a breach of Regulation 15. We agreed to extend the timescale to that of 27th February 2009. 6th December 2008 On the 6th December 2008, a Saturday, a random unannounced inspection took place and we assessed that there had been an improvement in the numbers of staff on duty, at all times. We considered that the requirement we made at our previous inspection, of the 30th October 2008, had been met. 15th December 2008 We attended a safeguarding meeting and we received information that there had been a failure of the home to report a safeguarding incident that had occurred in October 2008. (Protection of Vulnerable Adults or POVA is now known as safeguarding). We also heard that there remained deficiencies in the standard of care planning although the home was receiving support, from the Community Mental Health Trust, to improve this standard. 10th February 2009 On the 10th February 2009 we attended a reconvened safeguarding meeting. During this meeting we heard, from the home, that there had been progress made in the majority of the residents care plans. We also heard that the registered Manager was receiving additional support from her manager to improve areas such as staff training, staff recruitment and quality assurance. 11th February 2009 We, The Commission for Social Care Inspection (CSCI), carried out this key unannounced inspection, by two Inspectors between 10:00 and 15:30, taking 5.5 hours to complete. We looked around the premises, spoke with some of the staff and watched how they worked. We also spoke with the Registered Manager and some of the residents and their guests and examined documentation. We case tracked two residents: we spoke with them, watched what they were doing, noticed how they were and compared our observations with their care records. Before the inspection we received some surveys back from residents, visitors and staff. We also received an Annual Quality Assurance Assessment (AQAA) that was completed by the Manager. We also looked at information that we have received about the home, since our last inspection, in June 2008. For the purpose of this inspection people who live at the home are referred to as people, person resident or residents. Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: People’s dignity must be valued at all times. We have made no requirement on this occasion as we expect the home to take action to address this issue. More timely action should be taken to ensure the high number of complaints is reduced. The environment of the home could be more homely and we expect this to be considered by the registered persons, rather than we make a requirement. Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 8 There could be improved environmental methods, such as signs, to help people know where they are, in the home and where they want to go. We have made no requirement about this as we expect the home to consider this, as part of good practice. Staff training in medication and assisting people with their food should be considered. We have made no requirement, on this occasion, as we expect the home to take action about this issue. The staff training records could be improved by being up to date. We have made no requirement about this as we expect the home to consider this, as part of good practice. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 9 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 Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 Quality in this outcome area is excellent. There is an excellent system in place to ensure that the home can meet the needs of any person who moves in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the four residents surveys said that the person had received enough information to help them decide if it was the right place for them to live, before they moved in. During a telephone discussion with the Manager, in January 2009 and receiving an email from her, it was clear that the home had carried out an assessment of a persons needs before they were admitted to the home. We examined two people’s care records and we found detailed preadmission assessments including assessments of their health and personal care needs; their likes and dislikes; their interests and their life and social histories. Both of Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 11 these assessments had been signed by the prospective resident, indicating that they had been part of the pre-admission assessment process. Discussion with the staff, including the Manager, indicated that the home would only admit people that the home is able to safely meet their needs. Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. People are safer due to the improved standards of care planning; their health and care needs are generally well supported and met although their dignity is sometimes not valued. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was made for the care plans to improve to meet the Standard and comply with the regulation. During a safeguarding meeting we agreed to extend the timescale for this requirement to be met by the 27th February 2009 (see also the summary part of this inspection report). Currently there is work in progress in improving the standard of the care plan documentation, with currently 25 residents’ files that have been subjected to such improvements. We case tracked two people and we looked at their care plans, one of which had been subject to the current review process. Comparing these care plans with each other the evidence indicated that there has been considerable Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 13 improvement in the standard of these care records. We found, as part of our case tracking, that the reviewed care plan accurately reflected the health and social care needs of the person; it provided details of the person’s likes and dislikes; information that had been obtained from their pre-admission assessment was transferred to their care plans and the care plans had been signed by the person. We spoke with these residents and their guests and it was confirmed that there had been active consultation in drawing up their care plans. There were risk assessments for falls, moving and handling and the development of pressure sores and these risk assessments were actively reviewed each month. There was clear guidance for the staff in how a person might present any challenging behaviour; what might cause such behaviour and what the staff were to do to reduce this. This requirement has been met and we expect the home to continue, and sustain, these improvements in the care planning records. Guests told us that they were very satisfied with the standard of care their relative received, including the standard of their personal care. We were told that they had chosen Fenland Lodge, for their relative to live in, after visiting 7-8 other care homes. Fenland Lodge was chosen because the home was friendly and happy and this had a direct and positive effect on their relative’s mental health; they were coming out of their room to integrate with the other people living there, which was a change in the person’s previous behaviour of choosing to be reclusive. A resident told us that they were ‘Very satisfied’ with the care that they received. We saw that the people were well dressed and their hair and nails were clean. From the discussion with the staff and examination of the residents’ care files, belonging to those people we case tracked, we saw that the home accesses health care professionals such as community psychiatric nurses, occupational therapists, dental services, general practitioners and district nurses, one of whom was visiting the home whilst we were there. The care records, that we saw, indicated that the person was weighed each month and their weight was stable. All of the four residents surveys said that the person always or usually received the care, including medical care, and support when the person needed it. All of the four surveys from relatives said that the home met the needs of Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 14 their relatives. One of these surveys said They go that extra mile in all circumstances. A Pharmacist inspector examined the practices and procedures for the safe handling and recording of medication. The home has good written policies and procedures for the safe use of medicines for staff to follow. Medicines are stored securely for the protection of residents and the home has purchased some new cabinets that permit medication in stock to be well controlled. Records are kept when medicines are received into the home, when they are given to residents and when they are disposed of. These records were compared to the medicines in stock and apart from a few minor discrepancies they were in good order, provide a clear audit trail of medicines in use and demonstrate that people receive the medicines prescribed for them. We found one case where the special instruction for a medicine for two people was not followed. This would normally result in a requirement being made but it was remedied during the inspection. People are allowed to manage their own medicines if they wish and are provided with a lockable cabinet in their rooms to store them safely. Medicines are only administered to people by designated staff but their training is basic and could be more in depth. There should also be an assessment that staff are competent to perform this task safely. We expect this to be managed by the home as a matter of good practice. We saw the majority of the staff interact with the residents in a caring and sensitive manner. Visitors told us that the staff were very good and valued their relative’s dignity. We saw, however, two incidents where the dignity of two residents was not valued. Firstly one resident was seen to have a cream applied to her nose during lunchtime while sitting at the dining table and when other people where still eating their meal. Secondly, during the lunchtime, we saw a member of staff without speaking, turn a resident’s plate around on the table, whilst the person was eating their lunch from it. Following on from this, the same member of the staff approached the (same) resident and held the resident’s left hand that was holding a fork with food on it. The member of staff told the resident that there was too much food on their fork, whilst tipping the food, off the fork on to the plate, by manoeuvring the resident’s hand. This interaction was carried out in a manner that could have been more sensitive and kinder. We spoke with this member of the staff and we were informed that their training, in assisting the people at meal times, had taken place some years ago (see Standard 30 of this report). We have made no requirement, on this occasion, as we expect the home to take action, to ensure people’s dignity is valued at all times. Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. People have the opportunities to live a good quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On a notice board, in the main reception area, we saw photographs of some of the residents taking part in activities, including celebrating Guy Fawkes’ Night and Christmas. The home has a full time Activities Co-ordinator, who works every alternate weekend. Examination of people’s care records and discussion with one of these people, indicated that the residents’ have access to a range of activities including trips out, pursuing their own hobbies and interests and taking part in in-house activities. Two of the four residents surveys said that the home always provided suitable activities whereas the two remaining surveys said that sometimes such activities were provided. One of the staff surveys said the home could be better to Provide more in house activities i.e. gentle exercise, more group activities. We saw the minutes of the last residents’ meeting, held on the 8th Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 16 January 2009, and this included people’s wishes about what they would like to see happen, with regards to activities. We saw some of the residents receive their guests and we were told by some of the visitors that they could visit their relative at any time. One of the residents said that they sometimes went out, of the home, with their family. All of the four relatives surveys said that the home supported their relative to live the life they choose. We saw some of the people were allowed to stay in their bed if they wanted to. Bedrooms were complemented with people’s photographs, ornaments and objects, of a personal interest, such as soft toys and doll houses. All of the four residents surveys said that the person liked their meals and those people we spoke with said that the food was good, plenty of it, there was always a choice and it was well presented in the way it was served. On the day that we were at the home, there was a main choice of shepherds’ pie or omelette and the choice of menu was clearly displayed on a chalkboard, in one of the dining rooms where we observed part of the lunchtime experience. People had also a choice of what to drink- either water or orange juice. For those people who needed help with their food this was done in a sensitive and encouraging way as the staff sat down with the resident on a 1:1 basis and encouraged them to be as independent as possible. Encouragement was given for a person who was reluctant to eat. (See also Standard 10 of this report). Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. People have not always been listened to and they have sometimes been placed at risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the four residents surveys said that the person knew who to speak to if they were unhappy about something and all of these surveys, and the four surveys from relatives, said the person would know how to make a complaint. The relatives surveys said that the person was satisfied with the homes response to any concerns that had been raised. The four residents surveys told us that the staff listened to what the person said to them and acted on what they had been told. All of the residents and visitors said that they would go the Registered Manager, if they were unhappy about something. The three surveys from staff said that the person knew what to do if any person had concerns about the home and a member of the staff told us what they would do should any person tell them about a concern or complaint they might have, about the home. The AQAA, on page 25, told us that within the last 12 months the home has received 23 complaints, which is of a high number. However the AQAA told us Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 18 that none of these complaints had been proven. Earlier the AQAA, page 11, told us We have very few complaints... although we found this was not the case. We discussed this information with the Manager and we looked at the record of complaints. Since our last inspection, in June 2008, the home has received a total of 34 complaints, which is a high number and the majority of these were with regards to the environment, with particular regard to the heating of the home, including hot water. Should action have been taken, to meet the requirement within the given timescale of the 1st August 2008, the high number of such complaints might not have occurred. Although we saw that complaints were responded to, the complaints about the heating and hot water were not effectively resolved, in a timely manner, until the installation of a new heating system, in 2009. On the day after our inspection we discussed this issue, with a representative of the Registered Company, who agreed with our findings. Since the last inspection we have attended three safeguarding meetings and information about these are detailed in the summary part of this inspection report. During one of these meetings we were informed that the home had failed to follow correct reporting procedures following an incident between two residents. We discussed this with the Manager who considered that the home has an increased awareness of reporting such safeguarding incidents. During one of the safeguarding meetings we were informed that an incident of abuse against a resident, by another resident, could have been prevented, should there have been closer supervision of the staff. Since this event we have found evidence, during our subsequent inspections, that there is a member of staff present, in this area, at all times, when there are residents there. The staff we spoke with gave satisfactory responses, to our questions, of what they would do if they became aware of an incident of abuse against any of the residents. Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21 & 26 Quality in this outcome area is good. People live in a clean and well-maintained home that could be more homely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the tour of the premises we saw that people, when the weather is good, have access to internal and well–maintained courtyards that have raised flower and herb gardens and garden furniture. The AQAA told us All flooring to the bedrooms have now been replaced. We noted however that the flooring in those areas we visited, including lounges and bedrooms, gave a ‘clinical’ feel to the home, as there were no carpeted areas. Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 20 The home has a number of corridors and these varied with the type of ornaments and objects, such as ‘fiddle boards’. However we noted that there was no written or pictorial signage to tell people where they were or where they needed to go. Given that Fenland Lodge provides care for some people with dementia, environmental orientation aids, for these people, could be improved. The Manager explained that a representative, of the registered company, had considered this, 7 to 8 months ago, but there had been no progress in this area. This is an area that needs to be improved upon although we have made no requirement as we expect action to be taken in a more timely and responsive manner. A requirement was made, following our inspection in June 2008, that said There must be an adequate supply of hot water to the residents’ ensuite bathrooms. This will ensure that residents can wash their hands or have a bath in their ensuite if they choose to. The timescale for this requirement to be met was by the 1st August 2008. We understood from the Manager, during the safeguarding meeting held in December 2008, that the home was being fitted with a new boiler. We were told that the heating system required considerable work but is now fully functioning. We tested the hot water, accessed in one of the resident’s hand wash basins, and we found that warm water was available within 20 seconds of the tap being turned on; this is an improvement since our inspection in June 2008. Although the requirement was not met within the timescale of the 1st August 2008 (and we received no request to extend this timescale) this requirement has now been met. Records for the hot water temperatures were seen and these were satisfactory as hot water is being delivered at safe and comfortable temperatures. All of the four residents surveys said that the home was always or usually clean and fresh. One of the surveys said As soon as you walk in the front door the place smells nice. We found the home was clean and smelled fresh with no offensive odours. Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 & 30 Quality in this outcome area is good. People are cared for by a sufficient number of staff who are wellrecruited and generally well trained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since our inspection, in December 2008, the improvement in the staffing numbers has been sustained. We spoke with the staff, the Manager and residents and their visitors and evidence indicated that there is a sufficient number of staff on duty, including at weekends. We saw people receiving individualised care and attention in a generally unhurried manner. The four residents surveys that the staff were available when the person needed them and the three staff surveys said that this was generally the case. One of the staff surveys said If one or two staff members call in sick, every effort is made to ensure that there are enough staff to meet individual needs of all people who use the service. We noted, however, that some of the staff, including the Manager, are working in excess of their contracted hours; one member of the staff was unable to tell us if they had opted out of the European Working Time Directive. We were told that some of these staff are feeling tired and we discussed our findings with the Manager. Such long periods of working (we were quoted up to 60 hours per week although the staff roster did not always corroborate this) pose a risk Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 22 to the health and safety of the residents. The Manager agreed with our concerns. There has been an improvement in the standard of the staff roster, since our inspection in December 2008. This legal document contained the full names of the staff and the title of their role. According to the AQAA the home employs 30 care staff of which 16 have an National Vocational Qualification (NVQ) level 2 or above in care i.e. 53.3 with 43 of care staff working towards this desirable qualification. However there was a discrepancy in the AQAA as it said elsewhere that the home employed 20 care staff. We asked the Manager for clarification and we were told that there are 25 care staff, to include bank staff, and 12 of these 25 members of staff have the NVQ level 2, or equivalent in care i.e. 48 . Two of the staff files were seen and information about the person, including written references, proof of identification, employment history and POVA (protection of vulnerable adults) 1st and criminal records bureau checks had been applied for, before the candidate was allowed to work at the home. All of the three staff surveys said that they had the right support, experience and knowledge to meet the different needs of the resident. All of the four relatives surveys said that the care staff always had the right skills and experience, to look after the people properly. All of the three staff surveys said that their induction training programme covered everything very well for the person to do their job and that they had received ongoing and up to date, relevant training. Examination of two of the staff supervision records and speaking with some of the staff, including the Manager, indicated that the staff have opportunities to attend ongoing and up to date training to include care of the person with dementia. Within Standards 9 (medication) and 10 (privacy and dignity) of this report we have identified two areas where the training of the staff could improve. Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38 Quality in this outcome area is good. People benefit from living in a safe home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following our inspection, on the 30th October 2008, due to the Registered Manager being unsure if she remained registered with us, we confirmed, in writing, that she remained registered with the CSCI and therefore retained the legal responsibilities of a registered person. Although there is no deputy manager the Registered Manager is well supported by a team of care and ancillary staff. One of the staff surveys said that the person was Very proud to work under Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 24 Margaret as she put (sic) in 110 . A relatives survey said The Fenland Lodge is such a well run home and ...and there is a very happy feel to it and visitors to the home endorsed this view. We heard, from some of the other staff, that the current style of leadership of the home provides a level of support and confidence that could be more robust. We discussed these less than positive views with the Registered Manager, who agreed that this might be the case but she felt, with the support from her newly appointed line manager, the management style of Fenland Lodge, under her leadership, would improve. We saw that monthly reports had been written, following visits by a representative of the registered company. These reports included audits of records, medication, staff and health and safety of the premises. The Manager stated that surveys are sent to residents and relatives bi-annually, from the registered company although we were not presented with any collated results of such surveys. Residents attend meetings and minutes of these are recorded; the last of which was held on the 8th January 2009. The minutes recorded people’s views and requests and what action is to be taken, such as offering activities that the residents have requested. Two of the people we case tracked have their monies kept by the home and we counted the amounts. We found that the amounts generally reconciled with the record of the balances (one person was in credit by 1p). Two of the staff supervision files were examined and evidence suggests that the supervision sessions are held on a 1:1 basis, each month and training attended is recorded and training needs are identified. According to the AQAA 100 of catering staff and 50 of care staff have attended training in safe food handling and 15 members of staff have attended infection control training. The AQAA told us that service checks are in date for hoists, fire fighting and fire detection equipment and portable (electrical) equipment (PATs). We saw that PATs were next due in May 2009; fire alarms and emergency lighting checks had been carried out weekly and each month respectively. The staff told us, and confirmed in the staff supervision records, that they had attended training in fire safety and moving and handling, although the staff training matrix was not up to date. We expect the home to take action to improve this standard of record keeping. Fenland Lodge DS0000067620.V373913.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 3 x 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 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 1 17 x 18 2 3 x 3 x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 3 x 3 Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fenland Lodge DS0000067620.V373913.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!