Inspection on 02/05/06 for Forest Lodge Care Home

This inspection was carried out on 2nd May 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

Forest Lodge Care Home 21/05/08

Forest Lodge Care Home 12/12/07

Forest Lodge Care Home 21/05/07

Forest Lodge Care Home 28/11/05

Forest Lodge Care Home 28/07/05

Forest Lodge Care Home 10/01/05

Forest Lodge Care Home 30/07/04

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

CARE HOMES FOR OLDER PEOPLE Forest Lodge Care Home 20 Forest Road East Nottingham NG1 4HH Lead Inspector Meryl Bailey Unannounced Inspection 11:50 2nd May 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 Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 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. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Forest Lodge Care Home Address 20 Forest Road East Nottingham NG1 4HH 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) 0115 978 0617 0115 942 2582 Mr Riaz Khan Mr Riaz Khan Care Home 28 Category(ies) of Past or present alcohol dependence (1), Old registration, with number age, not falling within any other category (28) of places Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To admit one client aged 55 years of age with Alcohol Dependency. Staff to receive additional training to meet needs of service users with alcohol dependency To continue care of one service user aged 61 years as identified in application number 19353 dated 19/03/05 28th November 2005 Date of last inspection Brief Description of the Service: Forest Lodge provides care for a maximum of 28 older people in a large, detached house within one mile of the city centre and close to the tram route. The home overlooks the Forest recreation ground and is also close to the Arboretum Park. Staff are multi-lingual and current service users are from various cultural backgrounds. Accommodation is arranged over two floors and includes four bedrooms with en-suite toilets. Other rooms are mainly single with two double rooms available. In addition to the two lounges and a dining room there is also a conservatory offering a choice of communal space. There is an external patio area and ample car parking. A sloped entrance provides access for wheelchair users and a passenger lift is available to access the first floor. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information from people who use services aswell as staff and providers. Records of information received since the last inspection have been used together with an unannounced inspection visit to the home, which lasted just over six hours. Discussions were held with residents and staff about their views of the service provided. Further discussions were held with the owner / manager, deputy and administrator, who were present throughout the day and contributed information. A sample of care records were examined to assess how care is planned. There was also a tour of the building and some direct observation of care practices. There were 23 service users in residence. Their origins included Asian, White British, and Jamaican. What the service does well: What has improved since the last inspection? What they could do better: Overall the written plans of care gave some clear guidance about what actions staff should take to meet needs, but one person clearly had an identified need that was not addressed in the written plan. The manager must ensure all needs are met and direct staff to record (on charts) the care and attention given to prevent the development of pressure sores. One service user receives all food and medication via a “peg” and this must also be carefully recorded. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 6 There are some activities taking place in the afternoons, but these are not clearly planned with service users. The manager should provide a clear plan of activities available each day on a notice board and in a suitable format. The complaints procedure needs to be clarified to state clearly who will deal with complaints and how long the process will take. Another improvement would be for handrails to be fitted to assist people using the steps near the entrance to the home. 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. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. The needs of all prospective service users are assessed prior to arranging admission. EVIDENCE: There was a social work assessment on each of the four service users’ files examined. There were also some further assessments completed by senior staff at the home. Information had been sought from relatives, aswell as service users themselves to establish if needs could be met within Forest Lodge. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. Care plans are in place, but not all identified needs are addressed and therefore there is a risk that some needs may not be met. Medication is well organised, but the lack of records of prescribed food substitutes could give rise to error. Healthcare needs are generally met by liaison with external health professionals. Service users feel respected by care staff. EVIDENCE: Care plans of four service users were examined and some clear instructions for staff were found. For three of the four there were individual plans for each of the identified needs. The fourth was cared for in bed and assessed as at risk of developing pressure sores, but there was no plan to address this and no charts completed to show the attention given. The manager agreed these would be in place by the following day. Generally, risk assessments were incorporated in the plans for falls, behaviour and eating. There were daily records of significant events, including contacts with medical professionals, though for three of the four nothing significant had been recorded since the Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 10 beginning of March 2006. Each plan had, though, been reviewed on a monthly basis to 12th April 2006. All medication was stored in a locked cupboard. Each service user’s medication was contained within an individual box clearly labelled with name. No controlled drugs were currently held. The deputy manager stated that all staff responsible for administering medication attended a two-day training course in March 2006, but were still awaiting their certificates. Two staff spoken with confirmed their attendance for this training. Records showed that procedures for recording prescribed medication were being followed. However, there were no records of prescribed “peg” feeds being given to one person. Staff confirmed they had received training in administering “peg” feeds from hospital staff. Service users spoken with were very appreciative of the care they received, mentioning staff by name and stating clearly the respect shown by all staff. Descriptions of staff included “very polite” and “always very helpful”. Staff were observed knocking on doors before entering and speaking with respect for individual wishes. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. There are various activities available, but these are not all planned with service users. Relationships are maintained with family, friends and the local communities. Service users exercise some choice in their daily lives. A choice of food is available and meals are taken in comfortable settings. EVIDENCE: There was still no written plan of activities, but staff and service users reported that there were occasional outings and some activities such as dominoes and cards during the afternoons. Some were seen playing dominoes in the dining room. Some service users said they had been assisted on shopping trips and walks. This was confirmed by staff, who said they took people for walks if the weather was good and if they had time. Two service users went out without staff each day for a walk and to buy a paper. The deputy said she regularly took some service users to the local market by tram. Some service users enjoyed Crocheting and reading books with large print. Several service users chose to sit in the main lounge for the majority of the day and watched television or had a doze. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 12 The names of visitors to the home were recorded and this showed regular visits from families and some friends of service users. One relative, who visits each day, was spoken with and was satisfied with the service provided. Two service users attended a day centre on some days. Service users described their typical days at Forest Lodge and were satisfied with their routines. They could choose when to get up and when to go to bed. The menu was written on a board in the main dining room. Service users said that they always enjoyed the meals served and were given plenty to eat. There was chicken curry, vegetable curry or sausages and vegetables for lunch. A cooked meal was also available at tea time. Service users could choose where to eat their meals. The main dining room was spacious and a dining table was also set up in the conservatory. Some ate in their own rooms. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The complaints procedure displayed needs to be amended to clarify the process for relatives, aswell as for service users. Staff actively protect service users from harm, though current records are insufficient to support actions taken to care and protect service users. EVIDENCE: There had been one written complaint received at the service and this involved an allegation of neglect with respect to one service user who had left the home. At the time of this inspection the matter was being appropriately dealt with through the home’s complaints procedure and by the Social Services Department through protection procedures (Safeguarding Adults). The complaints procedure displayed in the home did not clarify the name or contact arrangements for the owner / manager, though Mr Khan is available within the home on most days. Also, the procedure should state the stages and timescales for the complaints process. A more appropriate complaints procedure was issued with the service user guide. As reported under Standard 8 there were no records regarding actions taken to avoid pressure sores for one current service user, though staff verbally reported the attention given. Staff had received some training in protecting vulnerable adults from abuse and the manager was aware of the local protection procedures. Lockable facilities are available in bedrooms and all doors are lockable. Some service users look after their own small amounts of cash otherwise relatives manage financial affairs. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 and 26 Quality in this outcome area is good. The environment is appropriate with some good facilities, but some furnishing could be improved and external handrails would improve accessibility. Most areas are clean and hygienic, but further odour control is needed. EVIDENCE: All communal areas, bathrooms and some bedrooms were seen. Since the last inspection the passenger lift has become fully operational and several rooms and corridors had been redecorated. Also, bathrooms had been tiled. The parking area was completed and flowerbeds were being planted. There were, though some external steps without handrails. A slope was also provided, though the handrail for this was in need of adjustment in level to ensure it meets the needs of service users. All areas were generally clean and well maintained, though some bedrooms required further odour control and the doors of some newly purchased wardrobes needed attention. Service users spoken with were very satisfied with the rooms provided. Just two women were sharing and a curtain screen was provided aswell as two washbasins Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 15 within the room. There were four bedrooms with ensuite facilities and one service user demonstrated that there was ample space for wheelchair users in one of these rooms. The chairs in the main lounge were identical, vinyl covered armchairs, which were easy to clean. There were more comfortable, fabric covered armchairs in the rear lounge and in other rooms . Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. Service users are satisfied that the number of staff, who are well trained in care practice, meets their needs. Specific training has been given, though records of this are incomplete. Recruitment practise is appropriate to protect vulnerable adults. EVIDENCE: The staffing rota available was not clear and was rewritten during the inspection visit. It then showed that there were at least three care staff on duty between 8am and 6pm with two during the evening until 10pm and a further two on nights. Those on night duty were both wakeful. The registered owner/manager reported that he undertakes care duties in addition to management, particularly during the late afternoon until 6pm. An additional staff member is on duty in the mornings for domestic duties. Service users commented that staff attend to their needs and that there always seemed to be enough staff. There were call buttons in bedrooms and service users said they never had to wait long. Care staff spoken with said that the manager assisted with care and that during the evening there were enough staff as many of the service users were independent in getting ready for bed. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 17 Four of the care staff had recently completed a National Vocational Qualification at level 2 in care practices. Others had already obtained this qualification and the deputy had almost completed level 3. There was evidence of other appropriate training in training records of some staff, but these records had not been updated and there was also no recorded evidence of some induction training (see under regulation 37 regarding records). There was evidence of staff having been checked through the Criminal Records Bureau and two references were present for each member of staff. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is good. The home is run by an experienced provider / manager, who continues to develop management skills. Records are not all kept up to date. Health and safety are generally promoted within the environment. EVIDENCE: The owner of Forest Lodge is also the registered manager. He had almost completed training at level 4 of the National Vocational Qualification. There had previously been an attempt to use questionnaires to seek service users’ and relatives’ views about the quality of the service. This had not been repeated since the previous inspection and should now be planned and carried out. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 19 No cash or valuables were held on behalf of service users and the owner / manager no longer made any payments for chiropody and hairdressing on behalf of any service users. Therefore, there was no need for any written records to be maintained as required at previous inspections. The administrator carried out a great deal of work on records under the direction of the manager. Staffing records were available, but training records had not been updated and there had been no 1:1 supervision meetings with staff for almost one year. Since the last inspection, original Criminal Records Bureau documentation had been obtained. Staff reported having had some training in the safe working practices and the deputy said that refresher training in safe moving and handling was planned for 20th June 2006. A hoist was seen available, but not currently used to move any service user. During the tour of the premises all areas within the building appeared free from hazard apart from, as reported under standard 19, there were some external steps without handrails. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 X 3 X X 3 X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 3 Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP7 OP8 Regulation 15(1) 17 Requirement The registered person must ensure care plans address all identified needs and risks. The registered person must ensure staff record on charts or otherwise the care and attention given to prevent the development of pressure sores. The registered person must ensure staff record “peg feeds” given. The registered person must ensure staffing records are all kept up to date including records of training. Timescale for action 03/05/06 03/05/06 3. OP9 13(2), 17 03/05/06 4. OP37 17, Sch 4.6 31/05/06 Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 22 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. 4. 5. Refer to Standard OP12 OP16 OP19 OP26 OP33 Good Practice Recommendations Provide service users with a clear plan of suitable activities available each day. Display a clear complaints procedure detailing contact details and giving timescales. Fit handrails where there are external steps and raise the handrail for the slope. Control the odour in bedrooms affected. Develop a quality monitoring system based on seeking the views of service users and relatives. Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Forest Lodge Care Home DS0000002198.V290725.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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