Inspection on 02/02/07 for Fenland Lodge

This inspection was carried out on 2nd February 2007.

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

Fenland Lodge 07/01/10

Fenland Lodge 12/08/09

Fenland Lodge 11/02/09

Fenland Lodge 11/06/08

Fenland Lodge 28/11/07

Fenland Lodge 28/06/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Fenland Lodge Soham Road Stuntney, Ely Cambridgeshire CB7 5TR Lead Inspector Joanne Pawson Unannounced Inspection 2nd February 2007 11:30 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 Fenland Lodge DS0000067620.V329178.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.V329178.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 668971 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.V329178.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration:N/A Date of last inspection 18th December 2006 Brief Description of the Service: Fenland Lodge is registered to provide care to 49 elderly people (all of which may have dementia). European Care owns the home. The home is situated between Ely and Stuntney. There are 45 bedrooms for single occupancy and two shared rooms. All bedrooms have en-suite facilities. The weekly fees are £540. The inspection report is available in the front entrance area. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted by two inspectors on the 2nd February 2007 between 11.30am and 6.30pm. Methods used for the inspection included speaking to the manager, staff and residents, observation of care, reading documentation and a tour of the home. A shorter unannounced inspection was carried out at the home on the 18th December 2006 in response to a complaint received about the care being provided at the home. As a result of that inspection eight requirements and one recommendation were made. (A copy of the full report for the inspection in December can be obtained by contacting the Commission). Six of the requirements made at the previous inspection had not been fully met at the time of the inspection. What the service does well: What has improved since the last inspection? During the last inspection it was found that a service user was becoming distressed because she did not have any clothes in her wardrobe that she could change into. However during this inspection it was found that she has several changes of clothes to choose from in her wardrobe. Several members of staff were observed showing empathy and warmth to the residents they were working with. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate Service users needs are assessed before moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user has an assessment by a care manager or a member of the management team before moving into the home. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. Staff do not have all the information they need to fully meet the service users needs. The administration of medication is inconsistent and could lead to residents not receiving the right medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Several care plans were inspected. Although the care plans had been updated since the previous inspection all of the care plans inspected had either inaccurate information, information missing or staff were not following the procedures that had been written for the particular resident. The inspector observed two members of staff putting a moving and handling belt around a resident and then lifting her from a lounge chair to her Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 10 wheelchair. The resident made no attempt to weight bear. The residents care plan stated that she was a moving and handling risk code red and should be hoisted at all times. If staff do not follow the correct moving and handling procedure they could injure a resident or themselves. Another resident was observed being helped to cut her food up and having verbal prompts from various members of staff. However her care plan stated that she could eat independently. One resident had cellulitis on her legs, her care plan was not clear if staff should take any action or if it was just the responsibility of the district nurses. Two members of care staff spoken to both stated that they cared for the resident in different ways and no district nurse notes could be found for the particular resident. The manager confirmed that the district nurse was visiting the resident regularly. Care plans should ensure that care staff work in a consistent manner with the residents. One resident had a large bruise on his left hand. There was no record of the bruise in his wound assessment part of the care plan. The manager had not been made aware of the bruise by any members of staff. The bruise looked like it was beginning to fade so it was unlikely that it had just happened. The resident did not know how he had got the bruise. Care must be taken to observe any bruises or wounds and a record made so if necessary it can be investigated. The administration of medication was observed. Although it was a great improvement since the last inspection it was noted that the medication trolley was left open and unattended when helping residents with their medication. The medication administration charts were inspected and were found to have several inaccuracies and omissions for signing for the administration of medication. No creams or lotions had been signed for. The member of staff on duty who was responsible for the administration of medication stated that it was the homes policy not to sign for creams and lotions. This could lead to creams not being applied. One weekly medication had not been administered for two consecutive weeks. Staff were not clear what to do if a resident refused a once weekly medication. A policy needs to be put in place stating whether the medication is then offered the next day or not offered again until the following week. The number of signatures in the medication administration sheets and the number of tablets remaining did not reflect each other. Therefore it seemed that medication was been signed as administered when it hadn’t been. Incorrect codes were used on the administration of medication sheets. The controlled drugs register was recorded in a loose-leaf folder. This is not acceptable. Controlled drugs should be recorded in a bound book so that pages cannot be removed. One member of staff stated that she had worked in previous homes where aqueous cream had been used so had brought some in for a resident to use. All medication including creams and ointments should be on the recommendation of a GP. An immediate requirement was issued at the time of the inspection stating that there must be immediate accurate administration and recording of all Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 11 medication. Failure to comply with this could lead to the commission taking legal action. Two service users spoken to stated that they felt their privacy and dignity was promoted. One service user stated that the majority of staff knocked on her door before entering. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 12 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 poor Residents are not given the support they need at mealtimes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activities were not looked at in detail during this inspection although those residents spoken to stated that they had enough things to occupy their time. Staff were seen offering the residents some choices. One member of staff stated that she offered most of the residents the choice of what they would like to wear however she did choose for some of them. All residents should be encouraged to make choices for themselves. A 45-minute period over lunchtime was observed. The chef speaks to each resident and asks them what they would like out of the choices for lunch. It would be better practice to have the food in hot trolleys so that residents can make a choice of what they would like by looking at the food on offer. Also if residents would like second helpings the food should be available rather than staff having to leave the dining area and go to the kitchen. The menu is on a Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 13 chalkboard in the dining areas, this may be difficult to see for any of the residents with visual impairments or dementia. The Inspector suggested that pictures of the food being offered could also be used. Five different members of staff assisted one resident during her lunch. None of the staff sat down on a chair next to her although one member of staff did kneel on the floor so they were at the same level. One member of staff was assisting two residents with their food at the same time. Staff should only assist one resident at a time. If there are not enough staff on to help each person then the rota should be changed to accommodate the needs of the residents or lunch time could be staggered so that not all residents eat at the same time. One carer picked up a chip from a residents plate in her fingers and tried to put it into the resident’s mouth but she refused. Staff should use the appropriate utensils when assisting residents to eat. One resident was struggling with her food for 20 minutes before a member of staff asked her if she would like her food cut up the resident replied ‘that would be nice’ however she struggled for another 25 minutes to eat the food without any assistance form staff. Although residents should be encouraged to be as independent as possible this needs to be kept under constant review and the appropriate support offered when needed to ensure that residents are getting the help they need to eat. One resident walked over to the trolley and picked up a second dessert. A member of staff took it off her and asked her to sit down. If a resident cannot have a second dessert due to health reasons then this should be explained and a healthy alternative should be offered. One resident ate a little food when she was encouraged by a member of staff. However when the member of staff walked off to help other residents she stopped eating. At the end of lunch her plate was removed as the carer assumed she did not want her food. Had the carer stayed with the resident she may with encouragement and the appropriate support have eaten more of her food. The main meal on the day of the inspection was Fish and Chips. No evidence of any condiments being offered was seen. Staff were seen ‘speaking over’ residents and making comments such as ‘she plays with her food that one’ and ‘aren’t you a clever girl’. Staff should talk with the residents and use the appropriate terms. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 14 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 poor Not all staff are aware of the correct procedures to be followed to help protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the residents spoken to stated that they would complain to a member of staff if they were not happy with anything in the home. The home has a detailed complaints procedure. One member of staff had attended training in the protection of vulnerable adults however when she was asked by an inspector what she would do if she saw a member of staff slapping a resident she stated she would tell them it was wrong and if they done it again she would report them to the manager. This is not acceptable and any suspected abuse should be reported immediately to the manager. The manager must ensure that all staff are aware of the whistle blowing policy and adult protection procedures. The details of two complaints have been made available to the commission. An unannounced inspection was carried out on 18th December 2006 to investigate the complaints. The inspection resulted in eight requirements and one Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 15 recommendation. A full report of the inspection can be obtained by contacting the local CSCI office. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 16 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): 19,20,21,23,24,25,26 Quality in this outcome area is adequate The majority of the home is well maintained and safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The entrance to the home is welcoming and has several sofas that are regularly used by the residents. There are lots of similar looking corridors that could be confusing for the residents. The manager plans to make some changes to make the environment more accessible for service users with dementia. The majority of the home was clean and well maintained with no offensive odours. There was two areas of wall that looked like they had drinks spilt down the paintwork and had not been cleaned. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 17 There is plaster missing from the wall in the main lounge and some areas that need painting. Evidence was seen of residents bringing in their own possessions to personalise their bedrooms. Resident’s bedrooms look clean and comfortable. There are stair gates on a number of bedroom doors but this is to keep other people out and has been agreed by the residents and their families. There are toilets close to bedrooms and communal areas. One of the toilets has a sliding lock on it which may not be accessible by the residents and if it was used it could not be opened from the outside in an emergency. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 18 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): 27,29,30 Quality in this outcome area is poor. Although staff have a wealth of experience and knowledge about the residents some staff were seen to be working in a task orientated way rather than being aware of the individuals needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Due to the location of the home there has been difficulties with recruiting from the local area. The home is purchasing a minibus so that they can provide transport for staff to get to and from work. The staff rota was not a true reflection of what staff were working on the day of the inspection. The staff rota may need changing to ensure that there are appropriate numbers of staff available at peak times such as meal times. Several staff had obviously built warm and caring relationships with the residents and were seen talking to and gently encouraging residents to come to the table for lunch. When lunchtime was observed some staff were seen to follow institutional practices such as talking over residents, lack of choices, assisting two residents to eat at once and working in a task orientated manner. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 19 Although staff have received moving and handling training they were not following the correct procedures as detailed in the training or the individuals care plan. Some of the staff members did not seem to understand the importance of the individual care plans and sharing the information they have about the residents so that all staff are working in a consistent manner with the residents. One member of staff stated that she had attended the Alzheimer’s Society training on working with people with dementia but hadn’t changed her practice as a result as she was doing it all anyway. The staff recruitment files were tracked for three members of staff. There were no interview notes for one member of staff. There was no evidence that a negative reference had been investigated either with the person supplying the reference or the member of staff. The dates of employment on one application were not detailed enough and it was impossible to tell if there had been any a gaps in their previous employment. Staff have received various training such as moving and handling, food hygiene and first aid. As well as the mandatory training all staff will be taking part in more detailed training on how they should work with people with dementia. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 20 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): 31,32,33,34,35,37,38 Quality in this outcome area is poor. Systems need to be put in place so that the management team can regularly audit the quality of care being provided and take appropriate action. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspection has found that there are a number of concerns that the management team should have been aware of and taking appropriate action. Regular audits and observations need to take place to ensure staff are following policies and procedures in all parts of their job. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 21 There were no minutes available for residents and families meetings since April 2006 although the manager stated that a meeting had been held in September 2006. Residents and relatives questionnaires were sent out in December and the results showed that the satisfaction levels with the care provided had decreased since the previous questionnaire. An action plan has been produced to increase the quality of care provided. The home has also received letters of thanks for the care provided. The small amount of money held on behalf of three residents and the records were checked and found to be accurate. Not all risk assessments had been completed. Staff must ensure that they follow risk assessments for example following moving and handling guidance. The staff rota did not accurately the hours worked by all of the staff. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 3 3 X 3 3 3 2 STAFFING Standard No Score 27 1 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 X 2 1 Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement The registered person must after consultation with the service user provide a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The care plan must be kept under review. Failure to comply with this requirement could lead to the Commission taking legal action. Timescale for action 10/03/07 2 OP8 13(5) 3. OP9 13(2) All staff must be aware of and 10/03/07 follow the correct procedures when moving and handling service users to ensure their safety. 02/02/07 All staff must accurately administer medication as stated on the individual medication sheets and accurately record that this has been done or any reason why it was not possible to administer the medication. This will ensure that all service users receive the correct medication. An immediate requirement was issued for this at the time of the inspection. DS0000067620.V329178.R01.S.doc Version 5.2 Page 24 Fenland Lodge 4. 5. OP14 OP15 12(2) 16(i) 6. 7. OP26 OP27 23(2)(d) 18(1)(a) Service users must be helped to exercise choice and control over their lives. The registered person must ensure that staff support service users with their meals when necessary. All areas of the home must be kept clean. There must be enough staff available at meal times to ensure that residents can have one-toone staff attention when needed. Gaps in employment should be explored and recorded at interview. An accurate copy of the duty roster of persons working at the home must be kept. The registered person must ensure that unnecessary risks to the health and safety of service user are identified and so far as possible eliminated. Risk assessments must be reviewed regularly and updated when necessary. 10/03/07 10/03/07 10/03/07 10/03/07 8. OP29 9. 10. OP37 OP38 19(1)(b)(i ) Schedule 2 17(2) Schedule 4 13(4)(c) 10/03/07 10/03/07 10/03/07 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. Refer to Standard OP29 Good Practice Recommendations Interview notes should be kept on file. Fenland Lodge DS0000067620.V329178.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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.V329178.R01.S.doc Version 5.2 Page 26 - 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. 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