CARE HOMES FOR OLDER PEOPLE
Foxley Lodge 24-26 Foxley Hill Road Purley Surrey CR8 2HB Lead Inspector
Claire Taylor Key Unannounced Inspection 11:00 11th & 31st 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 Foxley Lodge DS0000025783.V292888.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. Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Foxley Lodge Address 24-26 Foxley Hill Road Purley Surrey CR8 2HB 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) 020 8668 4135 020 8668 4135 yabhee@btinternet .com Mr Yogindrananth Abhee Mrs Devika Abhee Mr Yogindrananth Abhee Care Home 22 Category(ies) of Dementia - over 65 years of age (22) registration, with number of places Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A variation has been granted to allow a maximum of three service users aged between 60 and 65 in the Dementia (DE) category to be admitted from time to time. 20th January 2006 Date of last inspection Brief Description of the Service: Foxley Lodge is registered to provide care and accommodation to elderly residents with a diagnosis of dementia. With the exception of one double, each resident has their own bedroom, and access to spacious communal areas including two lounges, dining room and large garden with both paved and lawn areas. There are adequate toilet and bathroom facilities to meet the needs of the current resident group. The building was also extended to provide two single, en-suite bedrooms and two toilets. The house is situated in Purley, and well placed for road and rail links, and access to the local supermarket. It is also within reasonably easy reach of the centre of Croydon. Fees charged range from £400.00 to £450.00 and were accurate at the time of this inspection. Additional charges may be payable for some extras but would be discussed prior to admission. Foxley Lodge DS0000025783.V292888.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 upon findings from two unannounced inspections that took place on two separate occasions. During the first visit the manager/owner Mr Abhee was not in the home and some records were not accessible as they are kept locked in the office. A second visit was therefore carried out so that the necessary records related to the last inspection could be checked. Inspection time was spent talking to the residents and staff, two visiting relatives and the manager /owner Mr Abhee. A brief walk round the premises took place and various records were checked. The total time spent in the home was seven and a half hours with both visits carried out during a lunchtime and early afternoon. All of those standards considered by The Commission to be key to the inspection process were assessed. The Commission received one complaint from a relative prior to this inspection. Regulations that have not been met in relation to the concerns raised are included in this report. All those who contributed to the inspection process are thanked for their time and assistance. What the service does well: What has improved since the last inspection?
Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 6 As required at the last inspection, individual risk assessments for locking residents’ doors have been put in place as well as a locked door policy for the kitchen. Information seen in the care plans now identifies why some individual residents are unable to have keys. More garden furniture has been provided which residents commented favourably about. The home now arranges for newspapers to be delivered and one resident was pleased that they now received their daily paper on time each morning. Training for staff has included courses on understanding mental illness and report writing. A planned training programme is in place for staff to attend relevant courses throughout the forthcoming year. Accidents and incidents are recorded in more detail and improvements have been made concerning the legal reporting of events to the Commission. e.g. concerning deaths, falls and/ or admissions to hospital. In response to the last inspection, the owner has devised an annual quality assurance plan for the home although this now needs to be implemented. What they could do better:
Following this inspection there has been a slight increase in the number of areas that need attention. Although risk assessments covering key areas such as fall prevention are in place, they need to be more detailed to reflect the individual mobility needs of a resident. Medication practices were in most areas well organised although there were some errors concerning the administration of medication for one resident. Night staff therefore need medication training as such shortfalls may put a resident’s health at risk. Further improvements are needed concerning the home’s overall policy on management of aggression. Such details are needed to ensure that the resident’s needs can be fully met and also further minimise the risk of injury to other residents, staff and visitors. As the home is registered for people with dementia, there must be specific policies and guidance on managing potential challenging incidents and unpredictable behaviour shown by some residents. The manager must reintroduce such policies to all staff. Risk plans and specific guidelines must also be developed for those residents who may become verbally and/ or physically aggressive towards others. Two hygiene issues were identified concerning the environment. Due to the continued unpleasant odour and despite extensive cleaning, the manager acknowledged that the hall carpet by the downstairs toilet now needs replacing. The clinical waste bin was overfull. The manager must therefore arrange for a larger storage facility to meet the residents’ needs and regular collection day with the supplying contractor. A programme of maintenance and refurbishment is still needed to demonstrate that repairs and upkeep of the premises are undertaken. Staff still need further training on abuse awareness and adult protection as organised by the Croydon local authority. It is acknowledged that there is a waiting list for local authority training and the manager must therefore arrange in house training as an interim measure. Surveys and questionnaires have yet to be offered to the residents, their relatives and other relevant stakeholders. The opinions and views of people who use the service are important as they can influence and contribute to the
Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 7 home’s operation. Now outstanding, this must therefore be addressed as a matter of priority. One recommendation from the August 2005 inspection highlighted a lack of community-based activities for the residents. This is now made a requirement as some individuals again commented that they would like to go out on trips more often. The manager stated he plans to obtain a seven-seated vehicle for the home. More care staff need to obtain the NVQ2 qualification to meet the required standard of 50 of care staff trained in the home. The previous timescale for compliance was still applicable at the time of this inspection and evidence seen that six staff have been enrolled on an NVQ course. Six good practice areas for the manager/owner to consider are outlined as follows. Repeated from the last inspection is that the resident, wherever capable, and/or relative/ representative should sign in agreement with the care plan. It would be better if healthcare records and correspondence relating to each resident’s needs were documented separately. To further ensure that safe practice is maximised, residents’ medicine charts and medication supplies should be audited on a regular basis. A designated activities coordinator should be allocated within the staff team so that residents are provided with structured activity sessions and entertainment. Given that the home is owned and managed by the same person, an independent agency could visit the home annually to carry out an internal audit on the quality assurance systems. Finally, the provider should undertake a regular audit of accident and incident records to identify if any patterns or trends are forming e.g. recurrent falls. 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. Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 8 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 Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 9 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 and 4. Standard 6 is not applicable to this home as it does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. Residents’ needs are assessed prior to admission to ensure that the home can meet their needs and that staff are aware of how to support them. EVIDENCE: Since the last January 2006 inspection there have been no new admissions to Foxley Lodge. Mr Abhee reported that the home had one vacancy following the recent death of one resident. The needs assessments for five residents were sampled and information was available to staff to ensure they could meet their social, emotional and care needs. Before any visit is arranged the manager receives written information from the social worker and a psychiatric assessment regarding the mental health issues caused by dementia. The manager/ owner undertakes the pre-admission assessment that is usually completed with the resident, his/her relative or representative and the other relevant professional associated with the referral. Written admission
Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 10 documentation includes a questionnaire to establish any personal preferences of the new resident. Such information gathered about a resident’s family history is particularly useful to staff when engaging with residents, particularly those with dementia. A copy of the care management assessment was also held on each file. An admission assessment about the person includes their medical and social history background and details of specific care areas such as nutrition, skin care, medication and mobility. Specific cultural needs are identified. Examples seen included details about skin care for residents of a black / Asian ethnic background. Contact is also encouraged to ensure that relatives, who may view the home on behalf of prospective residents, are satisfied that their specific needs can be met. Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 11 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. This judgement has been made using all the available evidence including a site visit to the service. Care planning is well organised and regular informal reviews ensure that staff are aware of each residents’ current needs. Residents are able to access care from additional services so that their healthcare needs continue to be met. Effective support is provided within a risk management framework although some individual plans need further development to fully safeguard individuals from potential harm. Overall, the arrangements for the management of resident’s medicines are appropriate but some improvements are needed to further maximise safe practice and ensure that residents are not put at risk. EVIDENCE: Eight care plans were sampled during the inspection. Previous inspections required the home to improve upon the care planning process and record keeping related to residents care. The manager has taken action to ensure that individual plans are kept up to date and reflect the assessed needs and desired outcomes of planned care for residents. Monthly reviews were taking place and any changed needs were clearly documented in the residents care plans. For
Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 12 one person, staff had noted some change in their mood and temperament. The care plan had been amended to identify that the resident required specific reassurance to alleviate their emotional concerns. In another care plan, one resident’s psychological needs had changed significantly resulting in increased episodes of agitation and incidents of aggression. Records showed that the manager and staff had taken appropriate action to address these changed needs. The psychiatric consultant had undertaken a medication review and a meeting was held with the person’s care manager. As a consequence the resident was later admitted to another health service facility for further assessment. Some further improvements are needed however concerning the home’s overall policy on management of aggression and guidance on dealing with challenging incidents. A requirement has been set for this under “complaints and protection” standards. Some guidance had been added to the care plan on how to manage this resident’s unpredictable behaviour but there was no specific risk plan or guidelines for staff to follow. Such details are needed to ensure that the resident’s needs can be fully met and also further minimise the risk of injury to other residents, staff and visitors. Other minor shortfalls regarding risk plans were identified during this inspection. Risk assessments covering key areas such as fall prevention are in place although some improvements are needed. Risk plans need to be expanded upon and more detailed to reflect individual mobility needs. Staff must have more detailed information about residents’ mobility needs so that appropriate interventions and support can be given. Each risk assessment must specify the risk; possible consequences of the risk; and action required to minimise it. Other risk assessments were in need of review and this must also be addressed. Residents and relatives are involved in the care planning process although, wherever possible, residents and/or their representatives should sign in agreement with the plan as some had still not been completed. The recommendation is therefore repeated from the last inspection. Residents are in regular contact with General Practitioners, District Nurses and other health care professionals as required. E.g. hospital clinics, chiropody and optician. In addition, a visiting CPN or Consultant Psychiatrist monitors the care and mental health needs to ensure that residents continue receiving the correct treatment or medication. Clearly, this assists in maximising each resident’s health and well being. Entries related to healthcare appointments are recorded in each resident’s progress notes although it would be good practice if healthcare records were written separately. Nutritional records were in place such as monthly weight charts for residents and dietary guidelines for two individuals who have diabetes. Medication practices were in most areas well organised although there were some errors concerning the administration of medication for one resident. Medicines are stored securely in a locked trolley that is kept in the dining area. The home uses a monitored dosage system with most medication being delivered in blister packs by the dispensing pharmacist from “Boots”. Records for the receipt, return and disposal of medication were in good order. To ensure that the correct treatment regime is followed and based upon their needs, the G.P. reviews residents’ medication regularly.
Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 13 For one resident, diabetic medication prescribed to be taken once at night had not been given for the previous two evenings but the administration record was signed as given. Such shortfalls in the administration of medication may put a resident’s health at risk. The manager advised that the resident concerned often goes out for the day and returns quite late at night. None of the night staff are trained to administer medication and Mr Abhee stated that staff would call him to the home if the need arose. This arrangement is not adequate and night staff must achieve accredited medication training. A requirement was therefore set. Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 14 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 and 15 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. Routines of daily living are made flexible and activities are provided however, they could be increased to provide more interest and stimulation for residents. Residents are assisted to maintain contact with family and friends and visitors are welcomed to the home. Meals are nutritiously balanced and offer a healthy and varied diet for the people who live there. EVIDENCE: Care plans included details of the residents’ social needs and preferred lifestyles. Activities for residents are mostly offered during the mornings and include bingo, skittles, music/ dance, quizzes and gentle exercise sessions. Records are kept of the activities that residents take part in although some notes indicated a lack of stimulation for some individuals. It would be better if the manager allocated one or two staff to take responsibility for organising activities in the home. I.e. as role of activities coordinator. A previous recommendation was that the manager should explore ways that the home could facilitate more community-based activities. Some individual residents again commented that they would like to get out more often. The owner agreed that there was a lack of community activities and advised that he plans
Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 15 to obtain a seven seated vehicle. This is outstanding from the August 2005 inspection and is therefore now made a requirement. Residents’ religious needs and beliefs are catered for and some individuals confirmed that they participate in a weekly communion service at the home. Monthly meetings are also held for residents to discuss issues. As previously suggested, the home has arranged for newspapers to be delivered at a regular time to suit individual residents. One resident said they were pleased that they now received their paper on time each morning. Some other residents said they look forward to a weekly visit from the hairdresser. Two relatives were visiting the home during the inspection. Both gave complimentary views about the way things are run and that staff are friendly and welcoming. The home has a visitors’ policy and one on maintaining contact between residents, their friends and families. Adequate areas are available for people to meet in private. There was a varied and adequate stock of food provisions in the kitchen that would indicate residents are provided with a balanced and nutritious diet. The daily menu is displayed on a large notice board in the dining room and staff ask residents each day for their choices. The cook confirmed that alternatives to the main meals could be provided and gave examples where special dietary needs such as soft diet are catered for. Two residents enjoy curry and their preferences were included on the menus. Several comments regarding the food were received with one stating ‘the food is good’. Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 16 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): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to the service. A satisfactory complaints procedure is in place to ensure that the views of residents, their families and friends are listened to and acted upon. The home’s practices generally safeguard residents although some policies must be improved upon to maximise protection for people living and working in the home. EVIDENCE: A copy of the home’s complaints procedure is displayed in the hall. Residents said they would speak to the manager if they were unhappy about something. One complaint was recorded in the home’s logbook and clearly identified what action the manager had taken. There had been one unresolved concern raised by a relative with the Commission since the last inspection. Regulations that have not been met in relation to the concerns raised are included in this report. As discussed earlier in the report, there had been increased episodes of agitation and incidents of aggression concerning one resident. Although the manager and staff had taken action to address these changed needs, the home’s policies on dealing with residents’ physical and /or verbal aggression needs improving. The policy did not make reference to incidents involving staff or visitors meaning that there was a lack of guidance on what to do in the event of an incident of aggression. In addition, it was not clear how the home would address the safety of other residents during such an event. Given that the home is registered for people with dementia, there must be specific policies
Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 17 and guidance for staff on managing potential challenging incidents. All other policies and procedures relating to residents’ protection were clearly written and up to date. i.e. on recognition and prevention of abuse, staff recruitment and safeguarding residents financial affairs. In the last twelve months two strategy meetings have been held under the auspices of Adult Protection; one on the 19 July 2005 and the second on the 16 January 2006. Both were organised by the care management team from the placing authority. There were no significant findings reported to the Commission which indicates that both matters were resolved satisfactorily. Staff still need to receive further training on abuse awareness and adult protection as organised by the local Croydon authority. It is acknowledged that there is a waiting list for local authority training and the manager must therefore arrange in house training as an interim measure. Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 18 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, 20 and 26 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. Generally, the home is clean, and pleasantly decorated so that residents live in a well-maintained environment. One hygiene issue remains however concerning the carpet by the downstairs toilet. Improvements are also needed with clinical waste disposal to ensure that infection control is maximised. EVIDENCE: The interior of the home generally presents as clean and pleasantly decorated. The majority of residents tend to sit in the two lounge areas although some individuals said they like to spend time in the garden depending on weather conditions. Positively, more furniture has been provided in the garden since the last inspection. At the January 2006 inspection, one hygiene issue was identified concerning the hall carpet by the downstairs toilet. Due to the continued unpleasant odour and despite extensive cleaning, the manager agreed that the flooring was now in need of replacement. Incontinence aids are used by some residents and are disposed of in an appropriate clinical waste
Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 19 facility to the rear of the house. The bin appeared overfull however and indicated it was inadequately sized to meet the residents’ needs. The manager must therefore arrange for a larger storage facility and regular collection day with the supplying clinical waste contractor. Aside from these issues, the home appeared clean, tidy and in a good state of repair with appropriate systems in place to control the spread of infection. A written plan for the home’s overall maintenance and redecoration programme still needs be developed further. This must identify how the home maintains the upkeep of the building and show any planned improvements for the fabric of the premises. The former requirement is therefore repeated. Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 20 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. This judgement has been made using all the available evidence including a site visit to the service. There is a well-established staff team who understand the needs of the elderly people living there. Improved training for staff has resulted in a more skilled workforce to meet the residents’ needs although more staff still need to achieve the NVQ level 2 qualification. Robust recruitment procedures are in place to ensure that residents are cared for and protected. EVIDENCE: Duty rotas seen indicated that sufficient staffing levels are maintained for the current resident group with three staff on each shift and two on waking nights. Ancillary staff include a contracted cook and part time cleaner. Positively, the staff remain largely unchanged with only one new staff being appointed since the last inspection. The manager advised that the home was fully established without vacancy during this inspection. Residents commented positively about several long-standing care staff. One staff was interviewed and discussed their orientation to the home. They were able to correctly describe what to do if they suspected that a resident had been abused. Four staff files were checked, including one for the newest staff who joined in December 2005. All necessary checks had been obtained prior to their employment showing that the home continues to vet staff correctly for their suitability to work with vulnerable adults. The induction process for new staff includes in house training relevant to the needs of the residents. Sampled files contained good evidence that staff
Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 21 have undergone relevant training. E.g. moving and handling; food hygiene; first aid; fire; elder care and dementia training. Training for staff since the last inspection has included courses on understanding mental illness and report writing. A planned training programme is in place for staff to attend relevant courses throughout the forthcoming year. Evidence was seen that six staff have been enrolled on an NVQ 2 course. Progress will be checked during the course of future inspections, as the home still needs to meet the required standard for numbers of trained NVQ staff. Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 22 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. This judgement has been made using all the available evidence including a site visit to the service. Limited progress has been made by the home to establish a quality assurance system to show how they intend to make positive changes and monitor quality of care. Based on residents’ views, the home must therefore develop its quality monitoring systems further. The home’s financial procedures are thorough and protect the interests of the residents. The manager has valid experience, qualifications and demonstrates good management practice to continue to run the home in the best interests of the residents. Health and safety practices ensure that residents live in a safe environment and the welfare of residents and staff is protected. Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 23 EVIDENCE: The registered manager / provider has attained an appropriate management qualification and has valuable experience in residential care. Mr Abhee has a vast experience in caring for those with dementia or memory impairment and also owns a nursing home in Swindon. He continues to run the home and advised that he is still trying to recruit a manager. Staff spoke positively about the owner’s leadership style and felt the team works well together. Two relatives at the home during inspection also said they were happy with the way the home is run. In response to the last inspection, the owner has devised an annual quality assurance plan for the home. Although some quality monitoring resources are in place, surveys and questionnaires have yet to be offered to the residents, their relatives and other relevant stakeholders. This must be addressed as a priority so that their views can be assessed and used to underpin the home’s quality assurance system. The opinions and views of people who use the service are important as they can influence and contribute to the home’s operation. Mr Abhee agreed to send out questionnaires within the next month. Given that the home is owned and managed by the same person, it would be good practice if an independent agency visited the home annually to carry out an internal quality audit. The manager keeps records, including evidencing receipts for monies spent on behalf of one resident. Aside from two who have social services as their appointee, all other residents had relatives to handle their financial affairs. A sample of health and safety practices and procedures were checked including fire records, accidents and incident records, staff training, risk assessments and infection control which were all satisfactory. The regulatory records were also checked with no requirements outstanding from either the fire or Environmental Health departments. Records showed that the home’s last fire drill was held in May 2006. Accidents and incidents are recorded in detail and improvements have been made concerning the reporting of events to the Commission. e.g. deaths, falls and/ or admissions to hospital. As good practice, the provider should undertake a regular audit of accident/ incident records to identify if any patterns or trends are forming. As required at the last inspection, individual risk assessments for locking residents’ doors have been put in place as well as a locked door policy for the kitchen. Information seen in the care plans now identifies why some individual residents are unable to have keys. Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 24 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 3 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 X X X X X 2 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 2 X 3 X X 3 Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(4)(5) Requirement Risk assessments need to be written in more detail to further safeguard residents’ welfare, particularly regarding the prevention of falls. A risk assessment and specific guidelines must be developed for those residents who may become verbally and/ or physically aggressive towards others. Night staff must receive accredited training in the safe handling and administration of medication. The manager must offer more community-based activities for residents that are in meeting with their needs and preferences. The home’s policies on dealing with residents’ verbal and / or physical aggression must be revised as outlined in this report. The manager must reintroduce such policies to all staff and provide clear guidance for them on the management of incidents
DS0000025783.V292888.R01.S.doc Timescale for action 31/07/06 2. OP7 13(4)(5) 31/07/06 3. OP9 18(1)(a&c ) 01/09/06 4. OP12 12(1-3) 16(2) (m & n) 31/08/06 5. OP18 12(1a) 13(4c)(6) 31/08/06 6. OP18 13(6) 18(1c i) 31/08/06 Foxley Lodge Version 5.1 Page 26 7. OP33 24 of aggression. Quality Assurance systems need to be further developed. The provider must seek the views of residents, their family members / representatives and other interested parties to ensure that the home is meeting its aims, objectives and stated purpose. Results of these surveys must be made available in the home. (Outstanding from inspection January 2006 although it is acknowledged that the manager has written a plan for implementing a QA system) A programme of maintenance and refurbishment should be put in place to demonstrate that repairs and upkeep of the building are undertaken. (Partially addressed within previous timescale of 28/02/06. Plan needs more detail however to identify timescales for work completion) 31/08/06 8. OP19 23(2 b,d) 31/07/06 9. OP18 13(6) 18(1 c (i)) Staff need to receive further 30/09/06 training on abuse awareness and adult protection. I.e. as organised by the local Croydon authority. (It is acknowledged that there is a waiting list for local authority training. The manager must therefore arrange in house training as an interim measure) Due to an unpleasant odour, the 31/08/06 manager must replace the carpet area by the downstairs toilet. Clinical waste must be stored 31/08/06 appropriately and disposed of on a more regular basis.
DS0000025783.V292888.R01.S.doc Version 5.1 Page 27 10. 11. OP26 OP26 16(2 k) 16(2 k) Foxley Lodge 12. OP28 19(5 b) More care staff need to obtain the NVQ2 qualification to meet the required standard of 50 of care staff trained in the home. (Repeated- Timescale for compliance still applicable at time of inspection. Evidence seen that six staff have been enrolled on NVQ 2 course.) 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The manager should ensure that the resident, wherever capable, and/or relative/ representative signs their care plan. (Repeated from January 2006 inspection) Records and correspondence relating to each resident’s healthcare needs should be documented separately. Residents’ medicine charts and medication supplies should be audited on a regular basis to ensure that safe practice is maximised. A designated activities coordinator should be allocated within the staff team so that residents are provided with structured activity sessions and entertainment. Given that the home is owned and managed by the same person, it would be good practice if an independent agency visited the home annually to carry out an internal quality audit. The provider should undertake a regular audit of accident records to identify if any patterns or trends are forming e.g. recurrent falls. 2. 3. OP8 OP9 4. OP12 5. OP33 6. OP38 Foxley Lodge DS0000025783.V292888.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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