Inspection on 22/08/07 for Florence Lodge

This inspection was carried out on 22nd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Florence Lodge 14/12/09

Florence Lodge 06/11/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Florence Lodge 23-25 Florence Road Boscombe Bournemouth Dorset BH5 1HJ Lead Inspector Marjorie Richards Key Unannounced Inspection 22nd August 2007 10:15 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 Florence Lodge DS0000067048.V348316.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. Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Florence Lodge Address 23-25 Florence Road Boscombe Bournemouth Dorset BH5 1HJ 01202 397094 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) johnhardy12@btconnect.com Florence Lodge Healthcare Ltd Mr John Anthony Hardy Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the refurbishment plan be completed within the agreed time frame of two years. Within the total of 25 places, two service users may be accommodated within Florence Lodge over the age of 50. Mr Hardy must complete an NVQ Level 4 in management and care by August 2007. Evidence of successful completion must be forwarded to the Commission. 6th November 2006 Date of last inspection Brief Description of the Service: Florence Lodge is a care home providing personal care and accommodation for up to twenty-five older people. The registered provider is Florence Lodge Healthcare Ltd and the registered manager is Mr John Hardy. The provider also employs the services of a management company to give additional support services to the home. Florence Lodge is situated in a quiet residential area of Boscombe, within a few minutes level walking distance of the bustling Boscombe shopping centre. The main shopping centre of Bournemouth is less than two miles away and Bournemouth Travel Interchange (trains and coaches) is situated about a mile from the home. Local amenities include a wide range of shops, cafes and restaurants and a weekly street market, as well as places of worship, doctors surgeries, a library, parks and gardens etc. There is a car parking area to the front of the home and further car parking is available for visitors on surrounding roads. It is approximately five minutes level walk to the bus station, where buses provide a service to all areas of Bournemouth, Christchurch, Poole and beyond. The home is situated approximately half a mile from the seafront at Boscombe. Florence Lodge is a large, detached property formed by linking two adjoining properties at ground floor level. The property was originally used as a hotel and then converted for use as a care home. Resident accommodation is arranged over two floors. The upper floors are not linked, so residents on one side of the home have a choice of a staircase or stairlift to aid access between the floors, but the other side may only be accessed by means of the stairs. There are twenty-two bedrooms, including three double rooms, but all are currently let as single bedrooms. Twenty rooms have en suite facilities, including baths or showers in twelve of these. The home has two communal lounges and two dining rooms. There are Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 5 sufficient bathrooms and W.C.’s to meet the needs of residents. There is a garden to the rear of the home, which is laid mainly to lawn with shrubs and mature trees and is accessible to residents. Garden furniture is available. Twenty-four hour care is provided. Laundering of personal clothing is carried out on the premises. All meals are prepared and cooked within the home. A choice of menu is offered and a variety of alternatives are available to suit individual taste and preference at mealtimes. Special diets can be catered for. Some social activities and also entertainments are arranged to provide stimulation and interest for residents. The fees for the home, as confirmed to the Commission for Social Care Inspection (CSCI) at the time of inspection, range from £268 - £721 per week. Additional charges include hairdressing, chiropody, dry cleaning, toiletries and newspapers. The Office of Fair Trading has published a report highlighting important issues for many older people when choosing a care home, e.g., contracts and information about fees and services. The CSCI has responded to this report and further information can be obtained from the following website: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choosing a care home .aspx A copy of the home’s inspection report is available to anyone wishing to read it in the Information Rack in the entrance hall. A copy of the Office of Fair Trading report, “Fair Terms for Care” is also displayed. Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 9 hours on the 19th June 2007. The main purpose of this unannounced inspection was to review all of the key National Minimum Standards, check that the residents living in the home were safe and properly cared for and to look at progress in meeting the requirements and recommendations made following the previous inspection. On the day of inspection, twenty-two residents were accommodated. A tour of the premises took place and records and related documentation were examined, including the care records for three residents. Time was spent observing the daily routine during the inspection, as well as talking with residents and the staff on duty. Discussion also took place with Mr Hardy, the registered manager. Mr Graham Thomas (on behalf of Florence Lodge Healthcare Ltd) made himself available for most of the inspection and this was appreciated. The Annual Quality Assurance Assessment (AQAA) form had been completed by Mr Hardy and provided to the Commission for Social Care Inspection in advance of the inspection. Recent legislation has made it a legal requirement for all registered services for adults to complete an AQAA every year. The completed assessment is one of the ways in which the Commission for Social Care Inspection will assess how well the service is delivering good outcomes for the people using it. For the purposes of this report, people who live at Florence Lodge are referred to as residents as this is the term generally used within the care home. The Inspector was made to feel welcome in the home throughout the inspection. What the service does well: Florence Lodge provides a clean and well-maintained home where the personal, health and social care needs of residents are met. The residents describe the home as a very relaxed and friendly place to live where the staff are helpful and supportive. Residents commented, I am very pleased I found this place. I like it here.” I would have to give this place 10/10 in every way. This place isn’t bad, you get used to it. I think they do their best for us. The staff treat residents with respect and provide encouragement for them to pursue their own lifestyles, wherever possible, and to make choices about their daily lives. Activities are available for those residents who wish to participate. Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 7 Residents said, “I join in with the activities if I feel like it. We dont have to do it if we dont want to. I like to go out for a walk sometimes.” I enjoy everything they have on offer here, there is something for everyone I would say. Residents are supported to maintain contact with family and friends, enabling people living in the home to continue to enjoy relationships that are meaningful to them. Residents say that their visitors are made welcome. Residents are able to choose where to take their meals. All residents spoken with were very positive about the quality of the meals provided. Residents commented, The food is very good. I think we have lovely meals. It tastes even better when you dont have to cook it yourself. We have very good cooks, so the food is excellent. Dinner today was lovely, roast turkey and stuffing. I thought Christmas had come early! Florence Lodge is clean and free from unpleasant odours. A full-time laundry assistant is employed and residents say the laundry service is good. Residents commented, They do all the washing and ironing very quickly. It comes back before you know it. They keep everything spic and span.” Residents and staff agree that Florence Lodge is a good place in which to live and work. A wide-ranging training programme supports staff to ensure they have the skills they need to carry out their work. Residents say, The people here seem very pleasant. If I ring my bell, they come very quickly and never seem to mind.” Everyone is very kind to me. The staff are very good on the whole. Staff say that they like working at Florence Lodge and feel valued. They commented, I think this is a good place to work. We have a lot of training to help us do our jobs well.” The manager likes to have things done properly, so he can be strict but he is very fair.” “This place is very well run and very homely. It might not be the poshest place, but the people here think of it as home. What has improved since the last inspection? Two requirements were made at the last inspection and both have been met. Improvements have been made to care planning and the dispensing of medicines. There have been further improvements to the environment and corridors have been redecorated. Eight bedrooms have now been refurbished, including redecoration, new carpets and curtains, new bed and bedroom furniture. A new alarm call system has been fitted throughout the home and call times are monitored to ensure a prompt response. A new fire alarm system has also been installed to help ensure the safety of the home in the event of fire. Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 8 Recommendations made during the last inspection, regarding heating in the ground floor bathroom and handrails at the top of the staircase nearest the dining room, have been implemented. Mr Hardy has now attained the Registered Managers Award. 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. Florence Lodge DS0000067048.V348316.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 Florence Lodge DS0000067048.V348316.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 and 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to Florence Lodge. Information provided about Florence Lodge and a thorough admissions procedure allows prospective residents to make informed decisions about admission to the home and ensures that only those whose needs can be met are offered places there. EVIDENCE: Florence Lodge has an equal opportunities policy for residents. This following statement is also included in the Service Users Guide: • Residents will not be discriminated against or receive less favourable consideration of the grounds of race, gender, sexual orientation, marital status, age, disability, language ability, literacy or religion. Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 11 The Statement of Purpose and Service User Guide are well laid out, easy to read and contain a variety of information about Florence Lodge and its facilities. These documents give a good indication of what a resident can expect from the home and are given to prospective residents and/or their representatives when they are at the point of selecting a care home. A copy is also available in each residents bedroom within the home. In addition, an Information Rack is available in the entrance hall. This contains the Service User Guide and Statement of Purpose, which are regularly updated to include current information about fees. A copy of the latest inspection report, details of services available in the home, (such as hairdressing, chiropody etc,) an activities programme, sample menus, details of terms and conditions and information about local advocacy services are also displayed. The results of the annual quality assurance survey are also available for anyone to read. Individual care records are kept for each resident and two of these were examined for recently admitted residents. They showed that, prior to moving to the home, care needs had been assessed by the homes manager, Mr Hardy. Mr Hardy says that, wherever possible, he always visits prospective residents prior to making a decision as to whether the home is able to meet their needs. A comprehensive form has been developed for this purpose, providing detailed information about each resident’s specific health needs. Prospective residents and their relatives or representatives are invited to visit Florence Lodge to look around, perhaps enjoy a meal, meet with the manager, staff and other residents and ask any questions before making a decision about whether or not to move in. A letter of confirmation is then written to the prospective resident so that they may feel assured their care needs can be met. Copies of such letters were evidenced during the inspection. Florence Lodge DS0000067048.V348316.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Florence Lodge. Residents are treated with respect and their personal care needs are met, with the home also ensuring they have access to a range of healthcare services to meet all assessed needs. EVIDENCE: Following admission to the home, further assessments are carried out and a care plan is drawn up, identifying the needs of each resident and how staff are to meet these needs. Care planning documentation is comprehensive. It includes questions about how the resident likes to be addressed, their wishes regarding the gender of staff caring for them, preferred form of address, religion, ethnicity and spoken language. The care plans for three residents were examined. They inform how care is to be delivered to meet residents’ personal, social and healthcare needs. Detailed Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 13 assessments, including general and specific risks are recorded. Corresponding care plans have been produced outlining how these risks are to be minimised. Subsequent meetings, observation and discussions with the three residents concerned demonstrate that care is being delivered as detailed in the care plans. Mr Hardy says that, wherever possible, care plans are agreed and signed by the resident themselves, or, if this is not possible, by a relative or representative. This was evidenced on the care plans examined. All care plans are regularly reviewed and updated as necessary to reflect any changing needs. Some residents could not remember if they have been involved in reviewing care plans where changes are necessary and it was not always easy to evidence this from the documentation. Detailed daily records are written by staff to evidence the care being provided. Members of staff are able to demonstrate that they have a good knowledge of residents’ individual care needs Good daily records are written by both day and night staff to evidence the care being provided. These show that residents have access to General Practitioners, district nurses, dentists, chiropodists, opticians etc and attend hospital appointments as necessary. This was also confirmed in discussion with residents and staff. The home has systems in place for managing medicines. Only senior staff deal with medication and they first have to undertake a course of related training. Medicines are stored securely, to ensure the protection of residents. A Monitored Dosage System is in use. A member of staff was observed giving out medicines to residents and samples of the cassettes were checked to confirm that the quantity left agreed with the Medicine Administration Records (MAR) charts, to ensure that medicines had been administered correctly, as prescribed. The member of staff was knowledgeable about individual residents and their medicines. Staff were observed knocking at bedroom doors and offering personal care discreetly. Staff interact with residents in a friendly and relaxed manner. It was clear from the time spent with residents that they feel comfortable and at ease with staff and appreciated their gentle and caring approach. Staff were seen throughout the inspection to be treating residents with courtesy and kindness, with due regard for dignity and respect. Residents commented, I am very pleased I found this place. I like it here.” I think I am a bother sometimes, but they tell me I am not, which is reassuring. I think I am looked after very well here, everybody is very nice. I would have to give this place 10/10 in every way. This place isn’t bad, you get used to it. I think they do their best for us. Residents confirm that they are able to go to their own bedrooms whenever they wish, thereby offering an opportunity to be on their own or allowing privacy for any visitors or personal care needs. Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 14 Florence Lodge DS0000067048.V348316.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Florence Lodge. The home is flexible in its approach to the provision of activities and meals, enabling residents to retain control over their lives as much as possible. EVIDENCE: Basic information about the social, cultural and religious needs of people moving into the home is recorded in assessments and care plans. Residents, their relatives or representatives are then invited to complete “Life Histories,” giving information about each resident’s personal history, hobbies and interests etc. Most of these have now been completed. Such information is sometimes used for reminiscence purposes and will also help to ensure that activities are tailored to meet individual needs and wishes. Florence Lodge has a regular newsletter, keeping everyone in touch with what is happening within the home, residents’ birthdays etc. Activities are available and the August activities diary is displayed around the home. During the month, residents may participate in armchair exercises, games, a beach walk, a visit to Bournemouth, manicures, garden games, visits to the local Boscombe Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 16 market, home cinema, reminiscence, a trip to Boscombe tea room, local shopping and bingo. During the morning of the inspection, a group of residents were observed sitting in the lounge taking part in gentle armchair exercises. Residents later commented that they felt this was good fun and an enjoyable social occasion. Discussion with residents during this inspection shows that they enjoy the activities being provided. Comments include, “We do exercises sometimes, that’s a bit of fun. I wish we did more singing, I enjoy that.” “I join in with the activities if I feel like it. We dont have to do it if we dont want to. I like to go out for a walk sometimes.” “They play lots of music, which is nice but there is never any classical music, which would be nicer still.” There is something on most days and I take part in most things. It is nice to be able to go out and I wish I could do it more often. It is very pleasant to just sit outside sometimes. I enjoy everything they have on offer here, there is something for everyone I would say. Arrangements are made for clergy to visit individual residents upon request. Two residents like to attend worship at a local church. An interdenominational Christian service is held within the home every month. Mr Hardy says that visitors are welcome to visit the home at any time. Residents and staff confirm that visiting times at Florence Lodge are unrestricted. Residents records and the visitors book demonstrate contact with family and friends as well as visits by professionals. Several residents are able to go out alone and others with staff or relatives. A telephone is always available to residents so they may make or receive calls from family and friends. Residents are able to have their own telephones installed in their bedrooms if they wish, at their own expense. As far as possible, residents are encouraged to choose their own lifestyle within the home and make choices about how they wish to live. Residents confirm that they can spend their time as they please. For example decisions to sit in the entrance hall reading the newspapers, sit in the garden, go out for a walk, remain in their bedrooms or go to bed early or late, are respected by staff. Residents are able to bring their own possessions into the home to personalise their bedrooms and this was witnessed in many of the rooms viewed during the inspection. Residents are encouraged to make choices, e.g., about what to wear and what to eat or drink. Residents confirmed that their individual preferences and routines are respected. I dont think I could be in a better place, if I couldnt be in my own home. Everyone here is very friendly not like some places where you feel you have to be on your best behaviour all of the time. Here you can relax and just be yourself. “What I really like about this place is the attitude of the people in charge. They say they want us to do as we please and be happy and I think they mean it.” Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 17 Lunch on the day of inspection was roast turkey and stuffing or cauliflower cheese, with creamed potatoes, cabbage, carrots and peas, followed by semolina, or bananas or prunes in custard. A range of alternatives, such as salads, jacket potatoes with a variety of toppings, omelettes and soups, is always available to suit individual taste and preference. One resident will not eat any other vegetable except peas and the home accommodates this wish. Residents may choose where to eat their meals and mealtimes can be flexible to fit in with care needs, appointments etc. Special diets are catered for. Discreet staff assistance is available for those who need help with their food in the smaller dining room. One resident commented, I am very slow and feel embarrassed, so I prefer to eat away from the main dining room. The cook demonstrated a good knowledge of residents’ dietary needs, as well as likes and dislikes. She visits residents during the morning to explain the menu and ask what they would like for their lunch. She then visits residents again during the afternoon to see what they would like for their evening meal. The menu is displayed in both dining rooms. The home has ample supplies of frozen, tinned and dry foods available and fresh fruit and vegetables are delivered twice weekly. Mealtimes are unhurried and residents had plenty of time to sit and enjoy their lunch on the day of inspection. During the evening meal, one resident was joined by her relative and they were able to enjoy a meal together. The following comments were received from residents: The food is very good. I think we have lovely meals. It tastes even better when you dont have to cook it yourself. I enjoy most of the meals here. We can always have something else if we dont like what is on the menu, they are very obliging. We have very good cooks, so the food is excellent. Good plain English food is what I like. Thats what we have here. I enjoy the roasts best. The food is good. It is freshly cooked and we have lots of vegetables, which I enjoy. Dinner today was lovely, roast turkey and stuffing. I thought Christmas had come early! Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Florence Lodge. The systems in place provide residents with the confidence that their complaints will be listened to and acted upon and they are protected from possible abuse. EVIDENCE: The home has a complaints policy and procedure that is included in the Service User Guide provided to all residents in their bedrooms. A copy of the complaints procedure is displayed in the home and is also available to visitors in the Information Rack in the entrance hall. Mr Hardy says that two complaints have been received by the home since the last inspection. Examination of the complaints record shows that these have been dealt with appropriately. However, the complaints record itself is not very structured. Although information is available, it does not clearly set out the progress of the complaint from receipt, through investigation, the outcome and any subsequent action taken as a result. Residents expressed confidence that they would be listened to and appropriate action taken if they raised any concerns. Residents commented, You can always talk to him (manager) about anything at any time, hes good like that. If there is a problem, he deals with it straight away. The man in the office is very good (pointing to manager) and if something goes wrong I would tell him. I lost something and he found it for me. If something wasnt right, I would Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 19 go down to the office and tell the manager. He always sorts things out for me. The home has an Adult Protection policy in place to protect residents from possible abuse. This makes reference to the Department of Health No Secrets guidance, which is also available to staff. All staff have received Adult Protection training, to ensure a proper response to any suspicion or allegation of abuse and further updates are already booked for later in 2007. Two safeguarding adults referrals have been received since the last inspection. These were investigated by Bournemouth Borough Council social services and appropriate action taken. Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Florence Lodge. Florence Lodge provides residents with comfortable, clean, “homely” and wellmaintained surroundings in which to live. Environmental standards will further improve when the planned refurbishment is completed. EVIDENCE: Inspection of the premises confirms that routine maintenance is being carried out. Detailed maintenance records are kept and prompt attention is paid to any minor defects and repairs whenever necessary. Plans are being submitted for major improvements to the home, including a refurbishment of existing facilities. It is intended to completely refurbish the dining rooms, including the replacement of all the existing dining furniture. The kitchen has units and worktops that are becoming very worn. The kitchen will also be fully refurbished as part of the improvement programme. Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 21 Some improvements have already taken place. Corridors have been redecorated. Eight bedrooms have been refurbished, including redecoration, new carpets and curtains, new bed and bedroom furniture. A new alarm call system has been fitted throughout the home and call times are monitored to ensure a prompt response. A new fire alarm system has also been installed to help ensure the safety of the home in the event of fire. Recommendations made during the last inspection, regarding heating in the ground floor bathroom and handrails at the top of the staircase nearest the dining room, have been implemented. The two lounges are situated on the ground floor and provide comfortable communal space. One is used as a quiet room and is furnished with a threepiece suite. An electric organ, games and books are provided with a selection of magazines available on the coffee table. In addition, there is a small sitting area in the entrance hallway where some residents like to sit and watch the comings and goings. The two dining rooms are also situated on the ground floor, close to the main lounge. They currently contain a variety of different tables and chairs, but new dining furniture is planned as part of the refurbishment. These communal areas are well used throughout the day. The home has a garden to the rear of the property, which is accessible to residents. There is a patio with a colourful display of potted plants, small flowerbeds and a lawned area surrounded by mature trees and shrubs. Garden furniture is available and some residents were observed during the inspection sitting outside and enjoying the sunshine. A tour of the building confirms that bedrooms are comfortably furnished and personalised to varying degrees. All except two bedrooms have ensuite facilities, some with WC and wash hand basin and others with a bath or shower. Residents spoken with said that their bedrooms suited their needs. Residents commented, I love my room, I think I have the best one in the whole place.” My room is more than adequate for my needs.” I like my room and I prefer to stay here, but I go downstairs sometimes. The home is clean and there are no unpleasant smells, making life within the home more pleasurable. A full-time laundry assistant is employed and residents say the laundry service is good. Residents commented, They do all the washing and ironing very quickly. It comes back before you know it. This is a huge place to keep clean. I think they do a grand job. I am glad I havent got to do it. They keep everything spic and span.” Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Florence Lodge. Florence Lodge has a well-trained workforce in place and the provider has agreed to increase staffing levels to ensure that there are always sufficient staff on duty to meet the needs of residents. However, occasional shortfalls in recruitment practice have the potential to place residents at risk from staff being employed without full checks being carried out. EVIDENCE: On the 08.00 14.00 18.00 20.00 day of inspection the following care staff were on duty: - 14.00 3 care assistants - 18.00 3 care assistants - 20.00 2 care assistants - 08.00 2 wakeful night care assistants. In addition, the home employs cooks, cleaning and laundry staff. Examination of the staffing roster, feedback from those living in the home and observation during the day of inspection demonstrated there is a sufficient number and skill mix of staff to meet the current needs of residents. However, between 18.00 and 20.00, there are only two care staff on duty. The AQAA completed by Mr Hardy states that five residents now need two staff to assist Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 23 them. This potentially leaves no other staff available to provide care for the remaining residents and deal with other tasks if only two staff are on duty. This was discussed with Mr Hardy and Mr Thomas. Mr Thomas gave an undertaking that staffing levels would be increased immediately to three staff from 08.00 and 20.00 and this would be kept under review to ensure the needs of residents are met. Relationships between staff and residents were directly and indirectly observed throughout the course of the inspection. Staff were seen to be responding to residents appropriately and working to protect their need for privacy and dignity. Staff demonstrate a friendly, relaxed and caring approach when dealing with residents. Residents commented, The people here seem very pleasant. If I ring my bell, they come very quickly and never seem to mind.” I think staff do a difficult job. Most of them are very good. Everyone is very kind to me. The staff are very good on the whole. The home employs a total of seventeen care staff and is working to achieve the recommended target of at least 50 trained members of care staff with National Vocational Qualification (NVQ) level 2, to ensure residents at Florence Lodge are in safe hands. Two members of staff have now attained NVQ level 2. Five members of staff have NVQ level 3 (or equivalent) and three more are currently studying for NVQ level 3. Mr Hardy is hoping to encourage further staff to undertake NVQ training. An equal opportunities policy underpins the employment practice of the home. The records for two staff members were examined and found to contain essential information including an application form, an enhanced Criminal Records Bureau disclosure, photograph, evidence of identity and of induction training. Since taking up his appointment as manager, Mr Hardy has made improvements to the recruitment process and the file for the most recent employee also contains an interview assessment form, interview notes, a health declaration and detailed employment history. However, on one file a work colleague, rather than the last employer had provided the reference. Mr Hardy agreed to take immediate action to rectify this. All new staff receive induction training. This includes a shorter introduction to the home followed by a six-week induction, which is now based on the Skills for Care Common Induction Standards. (Mr Hardy is also slowly working through these Common Induction Standards with all of the remaining staff to ensure they have the skills and knowledge necessary to fulfil their roles within the home.) Mr Hardy carries out a regular audit of staff training and produces an overview document, which clearly identifies the training achieved by all staff in the home and where further input is needed. Further updates are also arranged to Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 24 ensure all staff receive appropriate training in moving and handling, infection control, fire safety, first aid, Protection of Vulnerable Adults, basic food hygiene and health and safety. Copies of training certificates are being retained to provide evidence that staff receive a minimum of three paid days training per year. Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 25 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Florence Lodge. The management arrangements at Florence Lodge and the quality assurance system now in place, helps to ensure that the residents live in a home that is well managed and the service provided meets their needs. EVIDENCE: Mr Hardy was registered with the Commission as manager of Florence Lodge in August 2006. He has experience in caring for older persons and has recently attained the Registered Manager’s Award. Since taking up his post as manager, Mr Hardy has made a number of changes at Florence Lodge, including the implementation of new formats for pre-admission assessment and care planning, improved recruitment procedures and the introduction of Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 26 formal supervision for staff. He remains enthusiastic about his work and says he receives good support from the registered provider, Florence Lodge Healthcare Ltd, as well as from residents and staff in the home. Florence Lodge has a “homely” and welcoming atmosphere, which is beneficial to residents, staff and visitors alike. Working relationships between management, staff and residents were directly and indirectly observed throughout the course of the inspection. They appear open and friendly, contributing to the relaxed atmosphere, which is beneficial to all in the home. Mr Hardy has a good rapport with residents, visitors and members of staff and this was demonstrated during the inspection. Several residents stopped at the office door to have a chat with Mr Hardy. One commented, “I enjoy having a chat with the manager now and then. I like to keep him on his toes! He has a good sense of humour so we can share a joke together.” Staff say that they like working at Florence Lodge and feel valued. They commented, I think this is a good place to work. We have a lot of training to help us do our jobs well.” The manager likes to have things done properly, so he can be strict but he is very fair.” “The manager is very good. He has a very laid-back and relaxed style but he gets things done.” “This place is very well run and very homely. It might not be the poshest place, but the people here think of it as home. The manager is very good. He keeps us all on our toes, but does it in a very pleasant way.” Annual Quality Assurance questionnaires are distributed to residents, staff, relatives and other visitors to obtain their views about the home. The last survey was completed in November 2006 and the results can be viewed in the Information Rack in the entrance hall. Responses are now being received for the 2007 survey and some of these were viewed during the inspection. Comments include: Residents. I have been looked after very well. Staff. We work with no pressure. The management is understanding of staff feelings. We get a lot of opportunities to learn new things. Florence Lodge is a very caring, friendly home. A very happy home. Relatives. Very friendly. A lovely, friendly environment. The staff are welcoming and pleasant always. Mr Hardy carries out regular audits within the home, including weekly medication audits. He is about to introduce more frequent auditing of care plans. Policies and procedures are reviewed to ensure best practice. Mr Hardy confirms that, in order to protect residents it is the policy of the home wherever possible not to have any involvement in their personal Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 27 finances. Therefore those residents who are unable to handle their own affairs, or choose not to, have a relative or other representative to deal with their finances etc. The home pays for services such as chiropody and hairdressing and this amount is then invoiced to residents, relatives or representatives for payment each month. The home is currently holding a small amount of money for one resident, at the request of the relative. Receipts are retained for any purchases. From touring the premises, looking at records and discussions with staff and residents, it is evident that measures are in place to promote the health and safety of residents, e.g. equipment, such as the stairlift, gas appliances, hoists and portable electrical appliances are regularly serviced and maintained. An electrical certificate for the property has recently been renewed. All substances that could be potentially hazardous to health are handled and stored safely. Staff have received first aid and moving and handling training and further updates are planned. Examination of the fire records shows that appropriate procedures are in place to ensure the safety of residents and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is arranged. Routine checks are carried out at appropriate intervals and staff confirm this. Staff fire training, including induction training for new staff, is taking place and fire drills are arranged so that staff are fully aware of the action to take in the event of a fire. Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 28 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 4 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 2 17 X 18 3 2 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 18(1)(a) Requirement The registered person must ensure that sufficient staff are employed to meet the needs of residents at all times. The registered person must ensure that staff are only recruited after robust checks have been fully completed. Timescale for action 01/10/07 2 OP29 19 01/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP16 Good Practice Recommendations It is recommended that the involvement of residents (or their relatives or representatives) in reviewing changes to care plans should be more fully documented. It is recommended that the content of the complaints log should be more structured, clearly setting out the nature of the complaint, the subsequent investigation, the outcome and any action taken as a result. It is recommended that a refurbishment plan be prepared, detailing proposed improvements and giving timescales. A copy should be forwarded to the Commission. DS0000067048.V348316.R01.S.doc Version 5.2 Page 30 3 OP19 Florence Lodge 4 OP28 It is recommended that a minimum of 50 of care staff achieve NVQ level 2 training. Florence Lodge DS0000067048.V348316.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. 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