Inspection on 28/07/05 for Forest Lodge Care Home

This inspection was carried out on 28th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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 02/05/06

Forest Lodge Care Home 28/11/05

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 28 July 2005 10:00 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 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 C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 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 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 0167 0115 942 2582 Mr Riaz Khan Mr Riaz Khan Care home 28 Category(ies) of A Alcohol depend past/present, x 1 registration, with number OP Old age, x 28 of places Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one client aged 55 years of age with Alcohol Dependency 2. Staff to receive additional training to meet needs of service users with alcohol dependency. Date of last inspection 10 January 2005 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. 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. The home overlooks the Forest recreation ground and is also close to the Arboretum Park. There is an external patio area and ample car parking. A sloped entrance provides access for wheelchair users and a stair lift is available to access the first floor. Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by two inspectors during one day and was unannounced. Service users gave their views and some were seen in their own rooms. Three care staff were also consulted. The owner / manager, deputy and administrator were all present during the day and contributed information. Since the last inspection on 10th January 2005, a short additional visit was made to this service on 19th April 2005 in response to concerns raised when a service user allegedly had untreated pressure sores when admitted to hospital from Forest Lodge. The care of two others potentially at risk of developing sores was inspected at that time. It was found that appropriate action was taken to address the risks and none had any current sores, though some recommendations for good practise were made. This is reported under Standards 7 and 8 in this report and the outcome of that visit is available on request. The main focus of this inspection has been on the standards relating to specific health and social care needs and the areas that were identified for action and development at previous inspections of this service. What the service does well: What has improved since the last inspection? Care planning is gradually improving and staff receive clear verbal instructions about how to meet needs. Employment contracts have been issued to all staff since the last inspection. A full inspection of the premises was not made on this occasion, but plans to install a passenger lift have been approved and the premises will be assessed at the next inspection of this service. Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 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 standard(s) 3 Pre-admission assessment of needs is seen as essential. EVIDENCE: There was a social work assessment on each of the five service users’ files examined. There were also some further assessments previously done by senior staff at the home. A recently admitted service user said that a visit was arranged to the home and information exchanged to establish if needs would be met there. Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 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 standard(s) 7, 8 and 10 Care plans are in place and set out how needs are to be met by staff, but more care needs to be taken with reviewing and updating of the plans to ensure all needs are met. Healthcare needs are met by liaison with external health professionals. Service users feel respected by care staff. EVIDENCE: Care plans of five service users were examined and some clear instructions for staff were found. Some staff said they never see the care plans, but get their instructions directly from the manager, deputy or senior care staff. On further questioning it is clear that what is in some care plans has been effectively passed on verbally. There was some indication that plans were reviewed on a monthly basis, but for the majority no change was recorded and there was considerable use of ditto marks, even for signatures. It is strongly recommended that this practice cease and that service users or representatives are fully involved in reviewing their care. There were some errors in the recording of events on one care plan and for two service users there was a need to replace outdated plans with clear up to date information. For example, one service user is no longer incontinent and for another service user the method for taking food and medication has changed. Staff on duty were, though, aware of the up to date situations. Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 10 Health care needs were identified and met, where necessary, by the district nursing team. Visits from nurses and General Practitioners were recorded in running records or in the care plan review notes. Care plans addressed action required to identify, prevent and treat pressure sores and staff were able to describe the changes in skin condition that they were looking out for. Since an inspector’s visit in April 2005, a chart for recording turning one service user was started, but staff have discontinued using this and it is again recommended as good practice. There was information about opticians and chiropody services provided, both in care plans and on the questionnaire completed by the administrator. Service users spoken with were happy with the personal care they receive and said that they felt respected by all staff. Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 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 standard(s) 15 Service users enjoy their food and have their meals in comfortable settings. EVIDENCE: The menu was written on a board in the main dining room. Service users said that they always enjoy the meals served and are given plenty to eat. There is always a vegetarian “Asian” meal on offer as well as traditional English food and alternatives are prepared for those who do not want what is on the menu. During inspection most were eating in the main dining room, but some were served in the conservatory and others in the lounge or own rooms. Some were given discreet assistance with eating and one relative was assisting. Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 17 and 18 Relatives protect service users’ rights to some extent, but information is not given about advocacy services. Staff are aware of the need to safeguard service users from abuse, but updated procedures are not available and some financial records are not clear. EVIDENCE: There was some evidence on files that legal and financial matters are dealt with by relatives and solicitors in some cases, but service users have not received information about available advocacy services and this should be contained in the Service User Guide. Some staff have received some awareness training regarding adult abuse and staff stated they would inform the manager or deputy if they were alerted to any possible abuse or had any concerns. A copy of the Nottinghamshire Committee protection of Vulnerable Adults policy and procedures was available at the home, but not the amendments and, as at the last inspection, it is recommended that the owner / manager and anyone left in charge of the home keep up to date with amendments and attend free training available on the use of those procedures. Details can be found at www.nottsadultprotection.org. Some small financial matters are dealt with on behalf of service users, but there are no appropriate records of this. See comments under Standard 35. Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 13 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 standard(s) None of these standards was fully assessed on this inspection. EVIDENCE: Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 A small staff group cover all shifts, providing adequate staffing to meet the needs of current service users, but this is not clear from the rota. Service users are not fully protected by recruitment practices, as some staff have been employed at the care home prior to appropriate checks being carried out. EVIDENCE: The staffing rota shows at least three care staff on duty between 8am and 3pm, two between 3pm and 10pm with two on nights. Those on night duty are both wakeful. Roles are not clear on the current rota. The registered owner/manager reported that he undertakes care duties in addition to management, particularly during the late afternoon and evening, but it is not made clear when he is part of the care team. An additional staff member is on duty in the mornings for domestic duties, but again the role is not clear on the rota. Service users commented that staff attend to their needs and that there always seem to be enough staff. Care staff confirmed this and said that the manager is usually available to assist until 6 or 7pm, but that two staff normally manage well as most people are fairly independent. Staffing records show that, for three current staff on duty, no application for an enhanced check through the Criminal Records Bureau (CRB) was made and insufficient references were obtained. For one of these staff members, employed since the last inspection, there was no reference from an appropriate independent person or previous employer. Though the person was known to an existing staff member, this is not sufficient to ensure service users are protected and the registered provider was required to immediately make applications to CRB and obtain further references. Until the outcome of these checks staff must be closely supervised and no future staff must be employed Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 15 prior to undertaking fresh CRB checks or appropriate checks of the Protection of Vulnerable Adults list (PoVA first checks) and obtaining at least two satisfactory references. The registered provider must obtain relevant information and documents on all existing staff and ensure Criminal Records Bureau checks are undertaken and satisfactory references are obtained on any future staff prior to employment. Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 and 37 Financial interests are not completely safeguarded. Some records are well maintained, but some relevant information is missing relating to staff. EVIDENCE: Since the last inspection a policy and procedure has been drawn up with respect to service users’ money and valuables. Currently no cash or valuables are held on behalf of service users, but the owner / manager makes some payments for services and items and then receives money from relatives at a later date. Some receipts were seen, but written records have not been maintained in accordance with the policy. As already reported under Standard 29, some staff records did not contain CRB checks and some references were missing. Other records were well maintained and held securely. There were some records of accidents in the home, but the record book in use is not an up to date issue and it is recommended that a new one be obtained to be fully compliant with the Data Protection Act (1998). Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 2 2 x x x x 2 x 2 x Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 18 Yes 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 OP 29 Regulation 19(1) Schedule 2 Requirement The manager must ensure applications are made for Criminal Records Bureau checks on all staff and obtain full and appropriate references. The previous target date of 28th February 2005 was not met. Ensure those staff for whom the outcome of CRB checks has not been received are closely supervised and that no new staff are employed prior to undertaking fresh CRB checks or appropriate PoVA first checks and obtaining at least two satisfactory references. Ensure written records are kept of all cash transactions on behalf of service users. All records relating to staff as detailed in schedules 2 and 4 of the Care Homes Regulations must be held in respect of each member of staff. Timescale for action Immediate. Collect information and submit application s by 5th August 2005. Immediate 28th July 2005 2. OP 29 19(1) Schedule 2 3. 4. OP 35 OP 37 13(6) Schedule 4.9 19(1) Schedules 2 and 4 30th sepember 2005 30th September 2005 Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 19 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 OP 7 OP 7 OP 8 OP !7 OP 18 Good Practice Recommendations Undertake more thorough monthly reviews of care plans, updating or replacing the action plans where necessary to reflect changing needs and clarify how they are to be met. Draw up and review care plans with the involvement of the service user or representative ensuring action is agreed and signed by them. Record turning and other preventative care given with the completion of charts. Include details of local advocacy services in the Service Users’ Guide. It is recommended that the manager keep up to date with amendments in the Nottinghamshire Protection of Vulnerable Adults policy and procedure and that he, and anyone left in charge at the home, attend free training available on the use of those procedures. Details can be found at www.nottsadultprotection.org. Clarify roles of staff on the staffing rota. Obtain an accident record book that is fully compliant with the Data Protection Act 1998. 6. 7. OP 27 OP 27 Forest Lodge Care Home C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 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 C53 C03 S2198 Forest Lodge V239652 280705 Stage 4.doc Version 1.40 Page 21 - 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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