Inspection on 06/11/06 for Florence Lodge

This inspection was carried out on 6th November 2006.

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 22/08/07

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 09:45 6th November 2006 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 DS0000067048.V317549.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. DS0000067048.V317549.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 DS0000067048.V317549.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 by August 2007. Evidence of successful completion must be forwarded to the Commission. First inspection, new registration in May 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 provide additional support 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 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 DS0000067048.V317549.R01.S.doc Version 5.2 Page 5 dining rooms. There are 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 £256 - £445 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_c hoosing a care home .aspx Once published, a copy of the home’s first inspection report will be made available to anyone wishing to read it and included in the Information File in the entrance hall. DS0000067048.V317549.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Florence Lodge underwent a change of ownership on 5th May 2006, when Florence Lodge Healthcare Ltd took control. Mr Graham Thomas made himself available for the majority of the inspection, on behalf of Florence Lodge Healthcare Ltd and this was appreciated. This unannounced inspection took place over 8.5 hours on the 6th November 2006. The main purpose of this initial inspection since the change of ownership 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 with the planned refurbishment. On the day of inspection, 20 residents were accommodated. A tour of the premises took place and records and related documentation were examined, including the care records for three residents. These three residents were “case tracked” and documentation relating to them examined, for example regarding Standards 3, 7, 8 and 9 and the residents also spoken with to gain their views. Additional information was provided to the Commission in the Pre-inspection Questionnaire, completed in advance of the inspection by the manager. Time was spent observing the interaction between residents and staff, as well as talking with a total of eleven residents. The daily routine was also observed during the inspection. Discussion took place with Mr John Hardy, the registered manager and members of staff on duty. 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 very welcome in the home throughout the visit. What the service does well: When a person moves into the home a thorough assessment of needs is carried out. A letter is then written to the prospective resident confirming that the home is able to meet their needs. Residents’ health, personal and social care needs are supported by detailed plans of individual care. Health care needs are well met, with evidence of good support from community health professionals. DS0000067048.V317549.R01.S.doc Version 5.2 Page 7 Residents say that they enjoy living at Florence Lodge. They say that they are well cared for and their privacy is respected. Residents commented, I think I am fortunate to be in a place like this. You hear stories about dreadful goings-on in some places, but I am well looked after here.” It is nice to find a place where old age is respected.” I choose to go to my room sometimes. I like to be on my own for part of the day, but I enjoy company sometimes. My room is my castle. The lifestyle of those living in the home offers varied individual and shared social opportunities, which reflect people’s interests and preferences. Residents are also supported to maintain contact with family and friends and to make choices and enjoy an independent lifestyle. Residents confirmed that their individual preferences and routines are respected. “What I like about this place is that you can do what you like. There is no one breathing down your neck saying you must do this or you must do that.” Everyone here is so friendly. It feels like home now. Residents enjoy a varied, nutritious and appealing diet, in surroundings of their choice and at times which are convenient to them. Only positive comments were received from residents: The food is excellent. The cook is lovely; she comes to ask ‘How is your appetite today?’ and to see what I would like to eat. We can have just about anything we want really. The food is much better than it used to be. We have far more choices now. The food is good and plentiful.” The food is very good. If you dont like the choices on the menu, they will give you something else. Residents spoken to say that they feel able to raise any issues of concern. If I was worried about anything, I would tell the staff or even speak to the manager. Hes all right, you can talk to him.” I once had a problem, but it was soon sorted out. The home has a comprehensive Adult Protection policy in place and staff have received training to ensure residents are protected from possible abuse. Residents live in comfortable surroundings and have access to pleasant communal areas, including gardens. These communal areas are well used by residents. Facilities are provided where residents and visitors can make themselves a drink of tea or coffee at any time. Bedrooms are generally well equipped, comfortably furnished and individually personalised to suit their occupants. A resident said, We have everything we need here, my room is very pleasant.” The home is clean and there are no unpleasant odours, ensuring that residents live in a pleasant environment. A full-time laundry assistant is employed and residents felt the laundry service was good. Residents commented, We have a good laundry service and nothing gets lost now. Everything is spotlessly clean here.” DS0000067048.V317549.R01.S.doc Version 5.2 Page 8 The home employs sufficient staff to meet the current needs of residents and to ensure their safety and comfort. Staff showed a warm and caring approach when dealing with residents. Residents commented, I did not feel too well the other day and the girls did everything they could to make me feel better. I am happy to be here. It is lovely here, we are so well looked after.” The staff are a very good crowd. They really seem to take an interest in what they do.” The staff, on the whole, are excellent; very caring and considerate. The staff are very pleasant and helpful. They have patience with me when Im slow. Robust employment and recruiting procedures are in place to ensure the protection of residents when employing new staff. An ongoing programme of training is provided, so that staff will have the skills necessary to meet the needs of residents. Florence Lodge has a “homely” and welcoming atmosphere, which is beneficial to residents, staff and visitors alike. During the inspection, the manager demonstrated effective management skills in the organisation of the daily routine in the home and a good rapport was observed between residents, staff and management. Residents said, I think the manager is making a good job of running the home. We have had lots of improvements since he took over. The manager is very good. He comes to see us all every day for a chat, which is very nice I think.” Staff commented, “I enjoy working here. We have staff from many countries, but we are all working well together for the residents.” “The manager is very good. He wants us all to do our best for the residents.” The home has no involvement in the finances of residents. Those who are unable or do not wish to undertake this responsibility for themselves, have nominated relatives or other representatives to do this on their behalf. What has improved since the last inspection? What they could do better: New and detailed care planning documentation has been introduced. However, examination of care plans showed that not all had been regularly reviewed. This should take place at least monthly and care plans be updated as necessary to reflect any changing needs. DS0000067048.V317549.R01.S.doc Version 5.2 Page 9 Medicine Administration Records (MAR) charts were examined and it was found that the homes policy regarding the administration and recording of medicines had not been followed in one instance where a resident had refused a medicine. A programme of refurbishment has been implemented. However, until this can be fully achieved, it is recommended that the ground floor bathroom be provided with suitable additional or replacement heating, to ensure the warmth and comfort of residents. It is further recommended that the two small handrails at the top of the staircase (near dining room) be replaced with something more substantial and easier to grip. Only one member of staff has currently achieved National Vocational Qualification (NVQ) level 2, and five more are currently studying for NVQ level 3. Mr Thomas says that eight members of overseas staff have qualifications in their own countries that are the equivalent of NVQ level 3, but at present, there is no documentary evidence available to support this. 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. DS0000067048.V317549.R01.S.doc Version 5.2 Page 10 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 DS0000067048.V317549.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to Florence Lodge. Pre-admission assessments are carried out so residents are assured that only those whose needs can be met are offered places there. The home confirms in writing with prospective residents that their needs can be met. EVIDENCE: Clear pre-admission assessment information has been recorded for two residents who have recently moved into Florence Lodge. Mr Hardy says that 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. Some of the assessments examined had a few gaps in the information provided. Mr Hardy explained that occasionally it had not been possible to acquire certain details. Where it is not possible to obtain particular DS0000067048.V317549.R01.S.doc Version 5.2 Page 12 information, it is suggested that this be identified on the form and a brief explanation given. 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 on file. The information contained in pre-admission assessments and also any assessments supplied by Social Services, is then used to help draw up a detailed plan of care. DS0000067048.V317549.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to Florence Lodge. Florence Lodge has a good care planning system in place, which ensures that staff have the information they need to meet the needs of residents. However, care plans are not always regularly reviewed, to ensure they are updated as necessary. Health care needs are well met, with evidence of good support from community health professionals. The home has procedures in place for managing residents’ medication. However, these are not always followed, to ensure the safety of residents. Residents are treated respectfully and care is offered in a way that protects their right to privacy and dignity. DS0000067048.V317549.R01.S.doc Version 5.2 Page 14 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. To aid correct identification, each record contains a recent photograph of the resident. 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, religion, ethnicity and language. Care plans for three residents were examined. They inform how care is to be delivered to meet residents’ personal, social and healthcare needs. Detailed 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. Care plans give personalised information to assist staff in ensuring good quality care. For example, ….Likes to attend local church.” ….Enjoys weak tea.” 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. Residents commented, I could recommended this place to anyone.” I feel I am looked after very well here.” Examination of care plans showed that not all had been regularly reviewed. This should take place at least monthly and care plans be updated as necessary to reflect any changing 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 later 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. 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. Those MAR charts examined were generally well maintained, but a gap was noted on one. This was discussed with the member of staff concerned, who explained that the resident had refused the medicine. DS0000067048.V317549.R01.S.doc Version 5.2 Page 15 Where a resident refuses a medicine, this must always be recorded appropriately on the MAR chart. Staff were seen to knock at bedroom doors and to offer personal care discreetly. Staff interact with residents in a friendly and caring manner. It was clear from the time spent with residents that they feel comfortable and at ease with staff and appreciated their gentle approach. Staff were seen throughout the inspection to be treating service users with courtesy and kindness, with due regard for dignity and respect. Residents commented, I think I am fortunate to be in a place like this. You hear stories about dreadful goings-on in some places, but I am well looked after here.” I am settling in here very well. They do their best to keep us all happy. It is nice to find a place where old age is respected. 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. Residents commented, I choose to go to my room sometimes. I like to be on my own for part of the day, but I enjoy company sometimes. My room is my castle. DS0000067048.V317549.R01.S.doc Version 5.2 Page 16 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. A range of activities and entertainment provides variation and interest for residents. The home is currently gathering information about residents social, cultural, religious and recreational interests, to ensure their needs and expectations are fully met. Residents are supported to maintain contact with family and friends and the wider community and to choose their own lifestyle within the home, where their individual preferences and routines are respected. Florence Lodge serves a balanced and varied selection of food that meets residents’ tastes and special dietary needs in surroundings of their choice and at times which are convenient to them. 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 and staff are currently being invited to be involved in the preparation of “Life Histories,” giving information about each resident’s DS0000067048.V317549.R01.S.doc Version 5.2 Page 17 personal history, hobbies and interests etc. Such information will help to ensure that activities can be tailored to meet individual needs and wishes. Activities are available in the home, including gentle armchair exercises, quizzes, relaxation to music, ball games, hoopla and skittles, sing-a-longs and bingo. Entertainment is arranged at least weekly. A clothes party is arranged approximately every six months. During the morning of the inspection, a group of residents were sitting in the lounge taking part in gentle armchair exercises and during the afternoon they enjoyed armchair ball games. These were social occasions, with plenty laughter and conversation going on as well. Discussion with residents during this inspection shows that they enjoy the activities being provided. Comments include, “They have activities here if you want to join in. I like the exercises, they are good for a laugh.” “I enjoy the entertainers that come here. I like to join in with the singing.” “The activities are quite enjoyable.” Arrangements are made for clergy to visit individual residents upon request. Two residents like to attend worship at the local church. The arrangements for Christmas are well in hand, including a buffet party for residents and their relatives. A local school choir will be visiting to sing carols. Mr Hardy will be encouraging residents to participate in putting up seasonal decorations around the home. He has been given a budget for the provision of new decorations, Christmas trees and lights etc. A few residents have also expressed a wish to make some festive paper chains. Father Christmas will be visiting Florence Lodge on Christmas Day to give out presents to the residents. 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. Two residents have their own telephones installed in their bedrooms. 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 confirmed that their decisions to spend their time as they pleased, for example sitting in the entrance hall reading the newspapers or spend time in their bedrooms, or going 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. “What I like about this place is that you can do what you like. There is no one breathing down your neck saying DS0000067048.V317549.R01.S.doc Version 5.2 Page 18 you must do this or you must do that.” Everyone here is so friendly. It feels like home now. Lunch on the day of inspection was pork steak or vegetable burger, with mashed potatoes, broccoli and runner beans, followed by apple sponge and custard or pineapple and cream. A range of alternatives, such as jacket potatoes with a variety of toppings, omelettes and soups, is always available to suit individual taste and preference. One resident chooses to only eat peas as a vegetable 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 and discreet staff assistance is available for those who need help with their food. The cook demonstrated a good knowledge of residents’ dietary needs, 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. A new menu has recently been introduced after consultation with residents. This is displayed in both dining rooms. The cook demonstrated that she had ample supplies of fresh, frozen, tinned and dry foods available. Mealtimes are unhurried and residents had plenty of time to sit and enjoy their lunch on the day of inspection. It is intended to refurbish the dining rooms in due course, including the replacement of all the existing dining furniture. The following comments were received from residents: The food is excellent. The cook is lovely; she comes to ask ‘How is your appetite today?’ and to see what I would like to eat. We can have just about anything we want really. The food is not bad, not bad at all. The food is excellent. I would give it 10 out of 10. The food is much better than it used to be. We have far more choices now. The food is good and plentiful.” The food is very good. If you dont like the choices on the menu, they will give you something else. The food is really very good. We have a good cook and I enjoy my meals. DS0000067048.V317549.R01.S.doc Version 5.2 Page 19 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. A system is in place for dealing with any complaints. Residents are confident that complaints would be listened to and dealt with appropriately. The home has a comprehensive Adult Protection policy in place to ensure residents 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 policy is also available to visitors in the Information File in the entrance hall. The complaints record shows that no complaints have been received by the home since registration in May. Discussion with residents demonstrates they feel able to voice a complaint if necessary and their concerns are taken seriously, and acted upon. Comments include: The care here is very good, there is nothing to complain about.” I have no complaints, none at all.” If I was worried about anything, I would tell the staff or even speak to the manager. Hes all right, you can talk to him.” I once had a problem, but it was soon sorted out. DS0000067048.V317549.R01.S.doc Version 5.2 Page 20 The home has a comprehensive Adult Protection policy in place to protect residents from possible abuse. This makes reference to the Department of Health No Secrets document, which is also available to staff. Staff sign to show they have read and understood the policy. All except two staff have now received Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. Training is booked for the remaining two new staff later in November. The staff on duty confirmed that they had benefited from training in the Protection Of Vulnerable Adults. DS0000067048.V317549.R01.S.doc Version 5.2 Page 21 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 this service. Residents live in comfortable surroundings where standards are constantly improving. A refurbishment programme is in progress which will further enhance the home environment. Residents have access to pleasant communal areas, including gardens. Bedrooms are comfortably furnished and individually personalised to suit their occupants. Florence Lodge is clean and there are no unpleasant odours, ensuring that residents live in a pleasant environment. DS0000067048.V317549.R01.S.doc Version 5.2 Page 22 EVIDENCE: Inspection of the premises confirms that routine maintenance is being carried out. Plans are being prepared for major improvements to the home, including a refurbishment of existing facilities. Detailed maintenance records are kept and prompt attention is paid to any minor defects and repairs whenever necessary. Some improvements have already taken place. These include new curtains and chairs in the lounge, redecoration and new carpets in the lower hallway, entrance area, lounge and small dining room. Two bedrooms have also been decorated and one has new furniture in place. A new alarm call system has been fitted throughout the home and call times are monitored to ensure a prompt response. A complete refurbishment of bathrooms is planned. However, until this can be achieved, it is recommended that the ground floor bathroom be provided with suitable additional or replacement heating, to ensure the comfort of residents. It is further recommended that the two small handrails at the top of the staircase (near dining room) be replaced with something more substantial and easier to grip. 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. Garden furniture is available. A tour of the building confirmed 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 sit and look out of my window when the sun is shining and I am in Heaven.” We have everything we need here, my room is very pleasant.” 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 felt the laundry service was good. DS0000067048.V317549.R01.S.doc Version 5.2 Page 23 An infection control policy is in place, but most staff have yet to complete training in infection control. Evidence was seen to confirm that training is booked to take place later in November. The home has suitable facilities and procedures in respect of the disposal of clinical waste. Residents commented, We have a good laundry service and nothing gets lost now. Everything is spotlessly clean here.” DS0000067048.V317549.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs sufficient staff to meet the current needs of residents and to ensure their safety and comfort. The home is working towards the recommended ratio of 50 NVQ level 2 trained staff, to help ensure residents are in safe hands. Robust employment and recruiting procedures are in place to ensure the protection of residents. Staff are provided with suitable training, so they will have the skills necessary to meet the assessed needs of residents. EVIDENCE: Examination of the staffing roster, feedback from those living in the home and observation throughout the inspection demonstrated there was a sufficient number and skill mix of staff to meet the current needs of residents. 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 DS0000067048.V317549.R01.S.doc Version 5.2 Page 25 dignity. Staff showed a friendly, relaxed and caring approach when dealing with residents. Residents commented, I did not feel too well the other day and the girls did everything they could to make me feel better. I am happy to be here. The staff are all marvellous, very kind and helpful. The care here is excellent. It is lovely here, we are so well looked after.” The staff are a very good crowd. They really seem to take an interest in what they do.” I am settling in here very well. They do their best to keep us all happy. The staff, on the whole, are excellent; very caring and considerate. The staff are very pleasant and helpful. They have patience with me when Im slow. The home is working to achieve the 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. One member of staff has now attained NVQ level 2. Five members of staff are currently studying for NVQ level 3. Mr Hardy is hoping to encourage further staff to undertake NVQ training. Mr Thomas says that eight members of overseas staff have qualifications in their own countries that are the equivalent of NVQ level 3. At present, there is no documentary evidence available to support this. The records of two recently employed staff members were examined and found to contain all essential information including an application form, an interview assessment, an enhanced Criminal Records Bureau disclosure, evidence of identity and of induction training. An equal opportunities policy underpins the employment practice of the home. The manager takes staff training seriously as a means of improving the standard of care provided and ensuring residents safety. 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 currently working through these Common Induction Standards with all of his staff to ensure they have the skills and knowledge necessary to fulfil their roles within the home. An audit of staff training has been carried out and an overview document produced which clearly identifies the training achieved by all staff in the home and where further input is needed. Further training is being arranged to ensure all staff receive appropriate training in moving and handling, fire safety, first aid, Protection of Vulnerable Adults, basic food hygiene and health and safety. Infection control training has also been arranged in November 2006. It is hoped that all staff will have completed essential and mandatory training by the end of 2006. Copies of training certificates are being retained to provide evidence that staff receive a minimum of three paid days training per year. DS0000067048.V317549.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. 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. Mr Hardy demonstrates a good knowledge of the operation of the care home and the needs of its residents. Florence Lodge carries out regular audits to review its performance. The home has implemented a quality assurance system to ensure that residents remain satisfied with all aspects of the home. Residents are assured of sound management of their financial interests. Florence Lodge works to ensure the general health, safety and welfare of residents. The premises and equipment are properly maintained in good condition and subject to ongoing improvements to ensure the comfort and safety of all in the home. DS0000067048.V317549.R01.S.doc Version 5.2 Page 27 EVIDENCE: Mr Hardy took the post of manager at Florence Lodge in February 2006. He was present at the last inspection of Florence Lodge in March 2006, which contained a number of requirements and recommendations. He was working towards achieving these when the home changed hands and Florence Lodge Healthcare Ltd took control in May 2006. Mr Hardy was registered as manager with the Commission in August 2006. Mr Hardy has experience in caring for older persons and is currently studying for 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 formal supervision for staff. Mr Hardy presents as a very enthusiastic person, who is passionate about his work. He says he receives good support from the registered provider, Florence Lodge Healthcare Ltd, as well as from residents and staff in the home. It is clear from this inspection that Mr. Hardy has worked hard to achieve a number of improvements throughout the home. A little more work is now needed to ensure that the documentary evidence is available to support all that has been achieved, especially in pre-admission assessment and care planning review. Florence Lodge has a “homely” and welcoming atmosphere, which is beneficial to residents, staff and visitors alike. Mr Hardy has a good rapport with residents, visitors and members of staff. This was demonstrated throughout the inspection, with residents stopping at the office door to have a chat with the manager and discuss any concerns etc. Residents commented, I think the manager is making a good job of running the home. We have had lots of improvements since he took over. Everyone here is very friendly, from the bosses down. They all stop and speak to me.” The manager is very good. He comes to see us all every day for a chat, which is very nice I think.” Staff commented, “I enjoy working here. We have staff from many countries, but we are all working well together for the residents.” “This is a good place to work.” “The manager is very good. He wants us all to do our best for the residents.” Quality Assurance questionnaires have been distributed to residents, staff, relatives and other visitors to obtain their views about the home. Responses are now being received and these will be collated and made available for all to see in the Information File in the entrance hall. Regular audits also take place within the home and policies and procedures are reviewed to ensure best practice. DS0000067048.V317549.R01.S.doc Version 5.2 Page 28 Mr Hardy confirms that, in order to protect residents it is the policy of the home not to have any involvement in their personal 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. 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 is in place. (N.B. The document seen shows it is due for renewal in January 2007. When this is renewed, a copy of the new certificate should be forwarded to the Commission.) All substances that could be potentially hazardous to health are handled and stored safely. The majority of staff have received first aid and moving and handling training and further training is 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. DS0000067048.V317549.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X 3 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 3 X 3 X 3 X X 3 DS0000067048.V317549.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? N/A 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 14(2)(a) and 15(2)(b) 13 Requirement All aspects of each resident s health, personal and social care needs must be recorded and regularly reviewed. The registered person must ensure that the policy for the recording, handling and safe administration of medicines is always fully implemented by staff. Timescale for action 01/02/07 2 OP9 01/02/07 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 3 Refer to Standard OP19 OP19 OP28 Good Practice Recommendations It is recommended that suitable additional heating be provided in the ground floor bathroom It is recommended that the two small handrails at the top of the staircase be replaced with something more substantial and easy to grip. It is recommended that a minimum of 50 of care staff achieve NVQ level 2 training. DS0000067048.V317549.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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