Inspection on 12/08/08 for Foxley Lodge

This inspection was carried out on 12th August 2008.

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

Foxley Lodge 11/08/09

Foxley Lodge 14/08/07

Foxley Lodge 07/11/06

Foxley Lodge 11/05/06

Foxley Lodge 20/01/06

Foxley Lodge 03/08/05

Foxley Lodge 16/02/05

Foxley Lodge 01/04/04

Similar services:

Clovelly House Residential Home Ltd

Cherry Orchard Nursing Home

Coppermill Care Centre

Fountains Care Centre (The)

Eleanor Palmer Trust Home

Elmstead House

Bridgeside Lodge Care Centre

Dalemead

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Foxley Lodge 24-26 Foxley Hill Road Purley Surrey CR8 2HB Lead Inspector Wendy Owen Key Unannounced Inspection 12th August 2008 16.30 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.V369059.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 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.V369059.R01.S.doc Version 5.2 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. 14th August 2007 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. Each resident has their own bedroom, and access to spacious communal areas including two lounges, a 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 previously extended to provide two single, en-suite bedrooms and two toilets. The home 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 £400.60 to £460.00 and at the time of this inspection. Additional charges may be payable for some extras but would be discussed prior to admission. Copies of the homes Statement Of Purpose, Service User Guide and the latest inspection report may be obtained from the home. Inspection reports can also be downloaded from the Commission for Social Care Inspection website. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate outcomes. This was the key inspection visit that was unannounced and took place over three days. When writing the report consideration has also been given to other information gathered throughout the year such as, records of accidents and complaints and other documentation required to be kept by the home. Prior to this visit, the homes manager had submitted an Annual Quality Assurance Assessment (AQAA). This document is now a legal requirement, which gives Registered Providers and their managers the opportunity to tell us how well they consider they are meeting the needs of the people who use their services and of any changes that they have planned for the future. One of the days we spent a couple of hours observing the tea-time meal and medication practices. The second day was spent viewing records; speaking to staff and the deputy manager and touring the home. We had to pay a third visit when the manager returned from annual leave to access records that were not available at other times. We also sent out surveys to people living in the home and received seven completed in response. We also received three from relatives. During the course of the year we has also visited on two other occasions and have included the outcome of these visits in this report. What the service does well: The home is very homely in style and residents all appear relaxed and well cared for. Pre-admission assessments are undertaken and are very detailed to ensure that residents healthcare needs can be met and form the basis for care planning. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 6 The home demonstrates that it is able to meet the needs of its, often frail residents, all of whom are experiencing varying stages of dementia. Some of the comments we received in the feedback include, Foxley Lodge “provides a caring environment where individuals are treated with care and compassion and treated as a family.” The way people behaved, the way they communicated and interacted with staff showed signs that they experience positive wellbeing. They enjoy well -balanced meals and people, in the main, found the food to be enjoyable. A number of staff have worked in the home for a few years providing continuity, stability and familiarity for residents which is important for people with dementia. “I have always found the staff to be kind and helpful and on the whole X always seems content” one person responded in a survey. Staff training remains organised and staff are provided with good opportunities to keep their knowledge and expertise up to date. The owner/manager has been running the home for many years and shows a sound knowledge of the residents and in meeting the needs of older people who have dementia. Robust recruitment procedures are in place to ensure that residents are cared for and protected from people who should not be working there. What has improved since the last inspection? The manager/provider has worked hard to make the changes required at the last key inspection. There has been some improvement in the signage around the home to make it easier for people to find their way around. The patio door has been alarmed making it a safer environment for those who wander and may be at risk outside of the home. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 7 It is also positive that he has had some success in receiving surveys from people about the service to enable him t find out about the experiences of people living in the home and to improve the care provided. What they could do better: Generally people experience a reasonable standard of care. Their overall experiences would be further improved by ensuring staff have the information in care plans and risk assessments to be able to take the appropriate action in meeting their individual needs. The healthcare of people must also be improved by more robust medication practices and by making sure appropriate action is taken where people suffer injuries after incidents or falls and by ensuring those with healthcare needs have good access to healthcare professionals in timely fashion. People living in the home appeared relaxed and content in their familiar environment. However, their well-being could be further improved by looking at ways in which staff could increase provision of activities and opportunities for stimulation and interaction. This is also true of reporting possible adult protection issues where people have suffered unexplained injuries and such incidents have not been referred to the responsible agency to decide on whether these should be investigated. The manager and staff understanding of these procedures must be improved and would show that the manager/provider is open and transparent and looking to keep people safe. An action plan must be provided on how areas of the home are to be improved to provide a well-maintained, comfortable and homely environment for those living there. These issues also reflect in the lack of contact with the Commission where we have not been notified of incidents/ events that affect the well-being of people living in the home. Whilst a requirement has not been made in this report this aspect of the management of the home is being monitored. Generally staff receive a good standard of training, although there are gaps in some of the core training and their updates that must be addressed so that people’s safety can be assured. Whilst the manager has invaluable experience of caring for the people living there demands on his time means that monitoring the systems, procedures Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 8 and practices is not as robust as it could be to ensure a consistent service is provided. This is also reflected in the management of the home in his absence and the individual’s knowledge of complaints recently where a person in charge of the home had not been made aware of the processes and if a complaint had arisen this may not have been dealt with effectively and appropriately. It is positive to note that serious attempts have been Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 7 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is information available to people who wish to use the service to help them decide if the home will suit them. The people who use this service have their needs assessed prior to admission to ensure that the home can meet them. This home does not offer intermediate care; standard 6 is not applicable. EVIDENCE: There is both a Statement of Purpose available for the home which is given to potential residents or their representatives. A Service User Guide is given to residents at the time of admission. This had been amended since the last inspection to provide much of the information required. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 11 Information from the surveys showed that six of the seven received information about the service and we received comments such as “ We were given open access to the home and all info we requested” “We contacted the home and the move for X was quick but was handled very well by the home.” “We were invited to view the home before making a decision which we found to be extremely helpful.” We viewed the pre-admission records relating to two people who were recently admitted to the home and found the information particularly detailed and informative. We found that there was good information and assessments received from the Care Manager/Social Worker and assessment undertaken by the manager. Before any admission is arranged the manager receives written information from the social worker and a psychiatric assessment regarding the mental health issues caused by dementia. There is evidence that the resident or their relative or representative is also asked to contribute to the process. Documentation includes a questionnaire to establish any personal and dietary preferences of the new resident and information regarding their social history. 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. This information ensures that as far as it is possible the home can be confident that it can provide a suitable place for the person to live in and that they will be happy there. We do have some concerns about how they are able to provide care and support to some people with mental health issues and may pose a risk to other people living in the home. In particular where a resident was admitted prior to the manager going on annual leave with assessments detailing issues that staff and temporary management may not be aware of or able to manager appropriately or that is best for the individual or others living there. Contracts from the six surveys five stated they had received a contract a number of surveys were completed by relatives on behalf of their family member One relative wrote-“Yogi was very helpful in explaining contract terms and very amenable to our particular situation.” We did not view the contracts as part of this inspection. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 12 We did note that the pre-admission process included recording of people’s property checks to ensure possessions were safeguarded. Standard 6 is not applicable. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff do not have the full information or ensure appropriate action is taken to assure people who use the service that their needs will be met. Medication policies and procedures are in place although practices need to be more consistent and robust to protect people. People are treated with respect and dignity and in a way, which safeguards their privacy. EVIDENCE: Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 14 A recent unannounced inspection in June was undertaken as a result of an anonymous complaint. We found at this inspection that there was a need to improve the practices where people have accidents and injuries to ensure they receive the required treatment to make sure they are safe ands well. We noted people had injuries that had not been treated by health professionals particularly crucial with head injuries. At that inspection we had a brief look at three care plans and found them to be comprehensive but not specific or person centred and that risk assessments had been competed but not updated to reflect the current situation. We also found that there were some areas requiring improvement in the keeping of records for prescribed medication. A number of requirements were made relating to these areas. During this inspection we also viewed care plans, risk assessments and other information and records in relation to people living there. When we looked at four care plans we found, once again, that they were comprehensive covering a number of areas of need for the individual. Whilst they covered a number of areas the information they gave on how care should be provided in detail. For example: how many staff to support people with personal care, do they like a bath or shower and if so how often. We also found, in some areas, such as religion it states, in some cases, “not interested”. More importantly there were some key areas missed such as health issues. One person, who is a diabetic, there was no detail on the care plan, for instance, how their health care needs are to be met the role of the DN and staff in management of this. There is the need to ensure regular eye checks or chiropody. Nor did it state on diet the need for a diabetic diet etc. In another case the individuals’ assessment stated hypertension and some mental health problems but the care plan did not consider these details nor did it give details of how staff could ensure a balanced mental health. Instead it stated, “can contact CPN”. There was no information on signs and symptoms to look for relapse or how to manage behaviours. This was also true of a third care plan viewed. These are areas where there have been some issues over the last few weeks which needed appropriate interventions recorded for staff to act upon. In another case daily records showed the individual to be wandering and restless at night with some difficult behaviours being presented. The care plan did not detail this. Statements such as “Independence-encourage independence as far as possible in all areas of daily living tasks. Communication-encourage verbal communication. Memory-confused and disorientated” do not show what a person’s needs are or how staff can support them. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 15 We also noted that some people were prescribed “as required” medication but the care plans had not detailed the guidance on this aspect of care. They also need to be more person centred and provide information on how their cultural needs can be met. Care plans are there to give staff information on how a person’s whole needs are to be met and this needs to be more detailed and contain specific information in many cases. Whilst looking at the daily records we found little evidence of any record of two of the three people having a bath or shower. This may be due to a recording oversight or it may mean that people have not had this personal care. The surveys returned provided positive feedback about the service. All responded by saying that staff listen and act on what they say and that staff are available when they are needed. Our observations during the time spent in the home showed that staff are generally kind, considerate and had a good understanding of people’s needs. People appeared to be groomed and dressed quite well for the time of year. In response to our question “What do they do well?” One person wrote that, Foxley Lodge “provides a caring environment where individuals are treated with care and compassion and treated as a family.” We also observed staff practices during two of the days and found staff to be kind, caring and sensitive to peoples’ needs and that people were dressed appropriately for the weather and generally well groomed. Staff demonstrated how they respect individuals through the way they spoke to them and ensuring personal care was undertaken in private. There was some evidence of assessments relating to risk of falls and moving and handling assessments. Once again these were basic in information provided. Looking at healthcare records there was evidence of access to some NHS healthcare and optical and chiropody for some. However, there was little evidence of District Nurse involvement in ensuring the healthcare of the individual with diabetes and, as said previously, the access to healthcare where people suffer injuries and require first aid treatment. When we asked people using the service “do you receive the medical support you need” all six said “always”. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 16 “I can confirm that X receives their medication ad has been seen by their GP at the home when necessary.” “Good response this year with regard to X’s vomiting. X was taken to hospital-and had an operation……” “this all took place at breath taking speed.” We remain concerned about the action staff are taking when people have accidents resulting in injuries. On looking at two accidents in detail where people had suffered head injuries, including cuts and bruising to the head we found that there is little evidence of the treatment by health professionals with accident reports stating, for example, bruising to eye but no action taken. The accident reporting procedure states that, “appropriate assistance should be summoned eg first aid, ambulance. Notify our inspectorate immediately. Act to prevent re-occurrence.” It appears that staff are not following these guidelines and that there is a lack of monitoring to ensure appropriate action is taken. We are taken further enforcement action regarding these issues to ensure people are kept safe in the home. The written feedback from six service users, completed with the help of family members, showed them to be generally happy with the quality of care. We received some comments that reflected the majority view…………….. “Yogi always rings and let me know what is happening.” We looked at the medication practices and records. On the first day, during the tea visit, we observed the deputy manager who had been “employed” to cover the manager’s absence, administering medication. The deputy manager dispensed and administered medication, signing the records themselves. However, in two cases, they gave one medication and one cream to another care staff to administer and signed the records themselves. An immediate requirement was made to stop this practice and the manager was reminded that if they dispense they must administer the medication and sign the records. We also noted that a member of staff was given a cream to administer a female resident to ensure their dignity was respected. However, the deputy manager signed the record where the staff administering the cream should have done so. Medication records were in place and had been printed by the chemist unless a new resident had been admitted. They generally had photographs of the individuals but not all records detailed allergies or where none were known this had not been recorded. Any hand written medications had been signed with two signatures. There was a list detailing staff authorised to administer medication along with the initials used on signing the medication records. This had not included the member of staff who administered the cream. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 17 We noted where medication was to be given “as required” there was no guidance for staff as to when it should be administered. For example, haloperidol and glyceryl trinitrate were both prescribed PRN but no guidance recorded or a care plan developed for this area. This was particularly pertinent in respect of the haloperidol as the person was administered this one night to reduce agitation and the following hours an ambulance called and the person admitted to hospital. The ambulance crew asked the question about the amount of haloperidol administered as they were concerned about this aspect. There may or may not have been a link with the medication but this is not clear. Where creams were prescribed the records also needed guidance as to how and where they should be administered. Some medication that remained over from one month to the next had not been recorded as being carried forward. It would also be beneficial to record on boxes when the medication commenced to be taken from this box. For example one person had 300 quitipine in stock but there was no evidence on the medication record of how much came in and how much was carried forward each month. Some individuals are prescribed temazpam. This medication is kept in the medication trolley rather than in controlled drugs (CD) cupboard. In light of recent changes the deputy manager was made aware of the need for a CD cupboard that meets the regulations to be fitted within 3 months. The medication had been recorded appropriately in a bound book and medication record. We noticed from the records that the medication had been recorded as received in the exact date ad the medication had run out for that person. However, the label showed a date some time previous to that. We remind the manager that the records must show the date the medication comes into the home rather than the date they are commenced. Good practice would allow for the recording the date started on the box as stated previously. When checking the records against the stock these were found to be correct. The medication policy stated all medications except liquids are blister packed by Boots. However, not all medications are suitable for placing in blister packs. We would suggest this be reviewed. The policy generally covers the areas required, although for some the information could be elaborated on and follow the current guidance provided by the Commission. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 7 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service enjoy flexible routines to enable them to choose how they wish to spend their days. There is limited evidence of people enjoying a variety of activities or interaction to provide interest and stimulation during their daily lives. Their friends and visitors are always welcome to visit the home. People are provided with a varied and healthy diet, although there continues to be limited choices at meal times. EVIDENCE: Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 19 On observing practice and viewing care plans we found that there was very little information on people’s preferred routines such as getting up or going to bed, how they like to spend their days and minimal information about social interests or preferred activities etc. This was reflected in feedback from some of the surveys undertaken by the manager earlier on in the year and also reflected in one of the surveys returned to the Commission, where a relative stated, “Activities could be better”. Some people told us that there were games to play but there was very little evidence of any external activities, except where people are taken out by family and there was no evidence of any form of entertainment provided. On the second day during the afternoon we observed very little interaction, stimulation or activity. Staff were busy with tasks, although when they did speak to people they were very kind and caring and we could see how positive this was for the individual. People did appear to be relaxed, happy and comfortable in their surroundings showing sings of positive well-being. At the last inspection we required an improvement in the signage around the home. We noted some “pictures” on bedroom and bathrooms doors to assist people with finding their way around. We visited the home on three occasions and had the opportunity to observe a number of mealtimes. The manager has asked for information from relatives or the residents about individuals’ likes and dislikes and has kept a copy of this. Each day staff record on the white board in the dining room what the choices are at each mealtime ie breakfast, lunch and tea-time. Each time we visited the breakfast choices were weetabix, cornflakes, porridge and tea and toast. However, on each occasion we found no evidence of porridge in the home. There were choices for lunch and tea, although on three occasions we noted that only onje of the choices had been provided. For example for tea on first day there was a choice of tuna bake or assorted sandwiches. However, only ham sandwiches had been made. We did note that staff were willing to make someone a jam sandwich when they were asked. On the second occasion there was a choice of sausages or curry and, once again only sausages, had been provided. On the third time at tea there was choice of sandwiches or macaroni cheese and once again only sandwiches had been provided. We noted from records that on occasions different meals had been provided, although this was only occasionally. The system for offering the choices and ensuring people are aware that they are able to choose “one or the other” and Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 20 that it is not an “either or” would perhaps show a variety provided at mealtimes. We also noted that one person wanted sugar in their tea because it tasted “awful” but staff refused because they were diabetic. Perhaps sweeteners could be purchased. There was little other evidence of low sugar products and desserts and during one tea- time meal there was a choice of fruit cocktail or angel delight. The person with diabetes was provided with one of these choices, neither of which were low sugar or contained sweeteners. In fact the fruit cocktail contained syrup which has a high percentage of sugar. The staff have complied with the requirement to record the food provided to people and there is some evidence that some people are offered choices. However this must be greatly improved to ensure that al people are aware of the choices for the day and are provided with that choice. Whilst we observed the mealtimes we noted that there was little assistance in the form of adopted cutlery or crockery People did appear to be relaxed and enjoy their food and staff were on hand to replenish teacups and offer more sandwiches etc. Returned surveys confirmed this with six of the seven saying they “always” enjoyed the food with one saying “usually”. Once again a survey undertaken by the manager earlier this year showed some people felt the quality of food could be improved. We looked at how food is stored and found some issues and therefore we made an immediate requirement to store food safely. This was addressed by the timescale with food now stored more safely and therefore risks to people minimised. There is still some further work to be done to make the storage area safer such as ensuring the vent in the cellar wall, that leads to the outside, is covered to minimise the risks from any pets entering the area. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service benefit from a complaints procedure that ensures that their views listened to and acted upon. Whilst policies and procedures are in place to safeguard residents these are not put into practice to ensure people are fully protected. EVIDENCE: A copy of the home’s complaints procedure is displayed in the hall although as reported in previous inspections most of the people living there would probably not have the ability to understand or access the procedure. We also reminded the deputy manager that the Commission address should be amended in light of recent changes in the Commission. The returned surveys- when asked, “Do you know who to speak to if you are not happy.” All seven said yes. They also said they knew how to make a complaint. This evidence should be considered in the light of most of the residents surveys were completed by their family member. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 22 One relative wrote, “I’ve never had any need to but would not hesitate to raise it with the manager with whom I have a good relationships.” We could not view the complaints book during our first visit, as the deputy manager in charge of the home was not able to locate it. He was not fully aware of the complaints process or his role in ensuring complaints were dealt with in the manager’s absence. However he is a reasonable and approachable and caring person who the staff and relatives would be able to raise concerns if they needed to. The manager must remember that it is his responsibility to ensure those left in charge of the home in his absence are aware of the systems and processes in place including what to do if someone raises a concern. The AQAA and discussions with the manager on his return showed there have been no complaints in the last twelve months. Abuse procedures are in place with guidance to staff to note for signs of abuse and to report to manager immediately. It states the manager will review accident book, injuries, untoward incidents etc for signs of abuse and that he will look at other symptoms and refer the allegation to the adult protection unit. There have not been any referrals or investigations over the last twelve months however, the recent history shows that there are concerns about how accidents or incidents are managed and that the home does not always refer possible abuse on to the required authority eg where there incidents between service users, unexplained bruising or other injuries. Referring on would demonstrate an open and transparent approach by the manager/provider and ensure these. This is a repeated requirement and further failure to comply may result in the Commission taking enforcement action. There is evidence that staff have received training and two staff spoken to had a reasonable understanding of what they would do. However, there is a need to ensure that this knowledge is put into practice to fully safeguard vulnerable people living in the home. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in an environment, which is clean and generally safe and comfortable for them. EVIDENCE: A tour of the home showed that the doors to bedrooms all locked and only a few people have keys to their room. There was no evidence that any discussions had taken place about this and detailed on the individuals’ care plans. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 24 We noted that the home is decorated and furbished in a homely and comfortable way, although there are a number of areas that would benefit from improvement. The en—suite in room 2 was in a poor state; the ground floor bathroom is also in need of refurbishment; one of the pedestals and hand basins in one of the rooms needs to be fixed securely; the carpet in the hallway appeared quite stained, although was actually new there is a need to ensure all bathrooms can be used by the residents and therefore fitted with either a bath seat or hoist. We also noted that there were no plugs in the bathrooms on the first and second floor and staff on duty were not aware of where they were. On the manager’s return he said that they are hidden away because he has had a number of flooding incidents. However, if staff are not aware of their location then these rooms cannot be used. Alarm calls were located throughout the home and hand-washing facilities were also available for staff to use. We also noted that the rear patio doors had been alarmed as required at the last inspection. On reading the communication book we found there was a problem with the hot water supply on 12/08/08 for a few days and one part of the home was without hot water. Staff confirmed this. We did not receive any communication on this as required under regulation 37. This issue had en resolved by the end of the week. When asked “Is the home fresh and clean?” Six said “always” and one said “usually”. One relative wrote “X said their room is hoovered everyday and we observe that the home is clean.” However, comments have been made previously about the risk of cross infection through poor food storage. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service benefit from an established staff team who generally had suitable training to help them understand their needs. Recruitment procedures are in place, although further improvements could be made to ensure that residents are protected from people who should not be working with them. EVIDENCE: Mr Abhee, the manager works long days as part of the care team and managing the home. There are sufficient staff numbers and of different job roles to ensure people are adequately cared for. It is positive that a number of staff have worked in the home for a few years providing continuity, stability and familiarity for residents which is important for people with dementia. However, an increase in staffing levels to enable an increase in the opportunity for activities and stimulation would benefit people and improve their overall well-being. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 26 The deputy manager on duty during the inspection visits was not a permanent employee but had been “recruited” to the task to manage the home whilst the manager was away. During discussions we found that he had a sound knowledge of caring for individuals in residential care, although he had a lack of knowledge about the policies and procedures relating to this home. An example of this is that he could not locate a number of records such as the complaints log nor had he been given access to some of the files such as staff records etc nor was he fully conversant with need to notify the Commission of incidents under Regulation 37. We also spoke to member of staff who is new to the home. She told us she had applied for the job and been interviewed by Mr Abhee and that she could not start until her criminal records bureau check and references had been obtained and was satisfactory. She also told us of the induction process and that she was shown around the home and had a number of things explained to her. She was also given a “booklet” that she had to complete. We discussed a number of procedures and she had a basic knowledge of what to do in an emergency and when accidents occur and knew to refer such incidents to more senior staff. Considering the short time she had been n the home and the fact that the manager has been away since her first day she had a satisfactory knowledge of abuse and what to do if she felt there were such incidents. We looked at the individual’s staff file and found it to contain an application form; health questionnaire; birth certificate; passport; POVA check and two references although not from the last employer. The manager explained that they had tried to do so but had no response. This must be recorded as part of the evidence and would assure us they have taken reasonable steps to obtain thee required checks. There was no record of an initial induction ie on first day etc or orientation. The manager showed us a record used previously that related to staff induction and was no longer used due to the induction booklet. We thought this to be useful record and would support any other induction provided ensuring the person has guidance on all aspects of care. There was good evidence of staff training provided, although there were some gaps, specifically in the updating of staff in core training such as moving and handling and fire procedures and particularly for the new member of staff recently started. Also ancillary staff need to be included in core training such as moving and handling. It is important that this training be provided as soon as possible to ensure people being cared for are safe. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 27 It is positive to note that some staff have had training in mental health, dementia and challenging behaviour. We received some positive feedback about the care provided by staff and these included: “All staff seem nice and helpful” “I have always found the staff to be kind and helpful and on the whole X always seems content.” We found these comments to be a reflection of our observations during the time spent in the home. The staff have a good attitude and approach and it is clear residents are relaxed in their presence and so the home has the basis to provide a good standard of care. Improvements in the areas detailed in this report, which the home has a capacity to do, are needed to reach and maintain a good quality of care. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has the experience and qualifications to run the home, although there is a need for regular monitoring of systems and practices to ensure the service provided provides a consistent level of care to people living there. Health and safety practices ensure that they live in a safe environment and their welfare is protected. EVIDENCE: Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 29 Mr Abhee is the manager/provider working five days each week at the home as manager and part of the care team often working long days. He also owns another home which he has a registered manager. He is a qualified nurse in Learning Disability and has a degree in Health and Social care. This gives him the experience to manage the home which he has done for a number of years. There were two deputy managers in charge whilst he was taking his annual leave. During the inspection we spent some time with one of these. He told us that he “covers” the home whilst Mr Abhee is away and the last time he worked in the home was a “few years ago”. During the first two days of the inspection the deputy manager was not able access all records or unable to locate others and was unaware of some of some of the processes. The manager needs to ensure full induction for those in charge of the home, in particular, where they have not had much contact with the home. People must also be aware of the current systems and practices to enable them to deal with issues whilst the manager is away so there is continuity and people are kept safe. We saw evidence of residents’ meetings taking place and would suggest that the minutes also record the action to e taken by staff as a result of issues raised. For example, one resident would like a bath everyday bit this was not evidenced in care plan or any action taken by staff. We found no evidence of external audits or the involvement of an external agency in reviewing the service, as required at the last inspection. Such as system would show an openness to involve others in the way the service is run and what improvements could be made as well as supporting the home’s current systems. We have amended this to a recommendation in light of the Providers improvements in other areas of quality assurance. He has recently (March 2008) undertaken a review of the service which consisted of sending out surveys to residents and relatives. The responses were generally positive, although some commented on the need for more activities and stimulation, the way in which complaints are handled and the quality of the food. Comments on responses included, “ I think x is cared for very well and all X needs met.” “Staff-good; care-good and personal care –good.” One person surveyed wrote “ “…it is nice to find a caring friendly owner and such willing staff wanting to help. It really is lovely to find “Foxley Lodge” Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 30 where clients are treated with respect and compassion-are clean and well dressed and there is always a lovely smell of lunch coming from the kitchenvery different from my friends previous home.” The survey results need to be collated to give overall outcome with a report completed, along with action for any improvements detailed. Such reviews give the manager an opportunity to make improvements that would improve the experiences of people living in the home ensuring it meets their needs. Mr Abhee told us that it is difficult to manage a home and be part of the care team and that it is difficult to be objective when you are part of the care team. It is also difficult to monitor the procedures and practices as closely as he would like to as the report shows in relation to the monitoring of practices when accidents /incidents occur and in the care planning and risk assessment process. It is because of this that is he currently looking to recruit a manager for the home to enable him to oversee the two homes that he owns. Such a move may enable home to have a clearer view of his role as a Provider, how best to improve the service and to keep up with regulations, standard and good practice and furthermore will give him the capacity to maintain a consistently good service. We have asked that we be kept informed of such developments and changes as required by the statutory notifications process. We sampled some of the service agreements relating to the equipment and services used. These were found to be generally satisfactory ensuring the safety and well-being of the people living there. We would however remind the manager that all equipment used to lift people must be serviced and tested at six monthly intervals to ensure they are safe for people to use. The previous standards have commented on the training provided and the need to ensure all staff have core training such as fire and moving and handling and this is regularly updated. The systems in place for the management of personal monies are satisfactory meaning people’s monies are kept safe. One of the main issues recurring from the inspection in June 2008 relates to the home’s need to notify the Commission of events affecting the well being of residents under regulation 37 and the action taken by staff where accidents occur. During the course of the inspection we had to remind the deputy manager of this and also found that there were incidents previously that we had not been told about. Since the last inspection and prior to writing this report there has been some improvement in this the notificationa and so we have removed this requirement. However, any further failure to let us know about these events may result in further enforcement action. We also advised Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 31 the manager/provider for him and his staff to familiarise themselves with the Commission’s guidance statutory notifications to ensure they are fully aware of the events we need to be contacted about. We are however, taking further enforcement action regarding the treatment of people where they have sustained injuries as a result of an accident or incident. People are kept safe in the home by ensuring there is satisfactory insurance in place and that the registration is accurate and reflects the current situation. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 32 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 3 x 3 2 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 2 X X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 X 2 3 Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 33 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 YA7 Regulation 15 Requirement Timescale for action 01/12/08 2 OP8 13 3 OP8 13 (1)(b) 4 OP8 17(1)(a) Schedule 3 (3)(j) Care plans must provide information about the health, social and personal care needs of people living in the home in such details to enable individual care needs to be met. Risk assessments must be 01/12/08 developed where risks have been identified and include in detail the interventions required by staff to minimise the risks. Where residents have had 01/12/08 accidents and have been injured further appropriate action must be taken to ensure they are examined and treated (where required) by a health professional. Timescale of 01/07/08 has expired. All accidents and incidents must 01/12/08 be recorded and give details of the action taken including where medical treatment was required. The records must show who was in charge of the home and the name of the person supervising the person. Timescale of 01/07/08 has DS0000025783.V369059.R01.S.doc Version 5.2 Page 34 Foxley Lodge 4 OP9 13 5 OP9 13 6 OP9 13 7 OP12 12 8. OP18 13(6) 9 OP19 23 10 11 OP19 OP19 23 23 expired. All medication being received into the home must have accurate records of the date, number and signature of the person responsible for receiving the medication. Medication records must detail the full of the administration guidance in relation to all prescribed medication including the medication prescribed, “as required” and “as directed”. To ensure staff administer the medication safely without detriment to the individual’s health. To ensure safe storage Temazapam must be stored in a cupboard that meets the requirements for the storage of controlled drugs. The manager must look at ways in which the provision of activities and interactions can be improved so that people living in the home enjoy a stimulating environment and positive wellbeing. There must be sound systems in place to ensure vulnerable people are protected from abuse, including monitoring of practice where incidents occur. Timescale of 01/07/08 has expired. An action plan of work to be completed in improving the home must be sent to the Commission to ensure people enjoy a safe and comfortable environment in which to live. The vent in the cellar must be covered so as to ensure food stored in the area is safe. The ground floor bathroom must be redecorated and refurbished to provide people with a DS0000025783.V369059.R01.S.doc 01/11/08 01/11/08 01/01/09 01/01/09 01/12/08 01/12/08 01/11/08 01/02/09 Foxley Lodge Version 5.2 Page 35 12 OP33 23 13 OP30 18 14 OP33 24 comfortable place to receive personal care. A report must be completed on 01/04/09 any review undertaken detailing the outcome and actions to improve the service for people living there. All staff must receive core 01/11/08 training which is updated regularly ensuring staff are safe and competent to provide care to people living in the home. The manager/Provider must 01/11/08 implement systems for monitoring procedures and practices so that a consistent quality of care is provided. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP9 OP15 Good Practice Recommendations The date prescribed medication is commenced should be recorded on the medication container. Medication procedures should be amended to ensure they are accurate. There should be food choices available at each mealtime and food provided appropriate to the individual’s diet. Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Foxley Lodge DS0000025783.V369059.R01.S.doc Version 5.2 Page 37 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!