CARE HOMES FOR OLDER PEOPLE
Foxley Lodge 24-26 Foxley Hill Road Purley Surrey CR8 2HB Lead Inspector
Alison Ford Key Unannounced Inspection 14th August 2007 11:30 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.V347269.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.V347269.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.V347269.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. 7th November 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.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.V347269.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first key inspection visit as part of the inspection process for the year 2007/2008 and was unannounced. 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. There have also been conversations with residents, their relatives and members of staff. Prior to this visit, the homes manager had submitted an Annual Quality Assurance Assessment. 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. On the day of the visit there were 19 residents living in the home. In addition to the manager, three care staff were on duty, supported by a cook, and another staff member undertaking cleaning duties. During the visit, a partial tour of the premises was undertaken; a sample of care plans were assessed, documentation relating to health and safety was seen, staff members, several of the residents and one relative, who was visiting, were spoken with. Some time was also spent observing residents and staff as they participated in the daily routine of the home. Since the last key inspection one issue was investigated under the local authority adult protection procedures. Allegations regarding the home were found to be unsubstantiated and concerns regarding communication and recording have now been addressed. What the service does well:
The home continues to demonstrate that it is able to meet the needs of its residents all of whom are frail and experiencing varying stages of dementia. The home is very homely in style and residents all appear well cared for and happy and on the morning of the inspection several were enjoying a musical
Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 6 session and playing a game with care staff. They are all very alert and show an interest in anyone who visits the home even though communication for them is often difficult. The routine use of sedative medication is discouraged. Those able to express an opinion said that “it was a nice place to live in” and “people were very kind to them”. Others, who were not able to communicate, showed signs of positive wellbeing in the ways in which they behaved and interacted with staff and other residents. They enjoy well balanced meals and several said how nice they found the meals that were served to them. Pre-admission assessments are exceptionally detailed to ensure that residents healthcare needs can be met and form the basis for care planning, taking into account residents’ personal preferences and needs. Monthly care plan reviews take place and any changed needs are clearly documented. The majority of staff have worked in the home for a number of years enabling important stability and familiarity for residents. Staff training remains well 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 valuable 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. The home liaises with a range of health care professionals to ensure that residents’ care needs are met. This includes maintaining close links with specialist services for people with dementia. What has improved since the last inspection?
Since the last inspection one concern was investigated using the local authority adult protection procedures. Allegations regarding the home were found to be unsubstantiated and concerns regarding communication and recording have now been addressed. Staff have all received extra training sessions in these areas and training has also been provided by the Adult Protection Coordinator. So that residents continue to have a pleasant homely place to live in, some areas have been redecorated and re carpeted and a shower has been installed. A new washing machine has been put in and infection control measures have been improved in the laundry with the introduction of special bags for soiled linen.
Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 7 A handyman is now available at the weekends to attend to any repairs that are needed in the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 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.V347269.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3,6 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The people who use this service have their healthcare needs assessed prior to admission to ensure that the home can meet them and there is information available to them to help them decide if the home will suit them. This home does not offer intermediate care; standard 6 is not applicable. EVIDENCE: There is a Statement of Purpose available for the home and a Service User Guide is given to potential residents relatives at the time of admission. Some amendments need to be made to this in line with current regulations to ensure that they have all of the information that they might need and it is recommended that copies should be put into resident’s bedrooms for future reference.
Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 10 Pre-admission information is particularly detailed and informative. 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. Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 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 consider that their healthcare needs are met. They have an individual care plan, which sets out all of the support and interventions that they need and these are reviewed regularly so that any changes are identified. Medication policies and procedures are in place to protect them and they know that they will always be treated with respect and dignity and in a way, which safeguards their privacy. EVIDENCE: The care plans of four residents were assessed at this visit. All of these showed that consideration had been given to both their medical and psychosocial needs. Manual handling assessments and falls risk assessments were in place
Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 12 and regular review is undertaken of factors, which may contribute to the development of pressure sores. Other members of the multidisciplinary healthcare team visit as necessary and these visits are all documented along with any professional advice that they may give. At the time of the inspection residents all looked clean and well cared for and staff were observed interacting well with them and treating them with respect and dignity. Bedroom doors have locks on to preserve privacy and stop residents wandering into the rooms of others although; they are able to go into their own rooms at any time. Some residents said how kind the staff were to them, many of whom have been there for some time, providing familiarity and stability. Medication storage and administration were all in order at the time of this visit and a local pharmacist provides training for the staff. It was noted that no residents have any sedative drugs prescribed for them. Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 13 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): Standards 12,13,14,15 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 enjoy flexible routines of daily living and activities are arranged for them to provide interest and stimulation. Their friends and visitors are always welcome to visit the home. Meals offer a healthy and varied diet for the people who live there however the evidence available suggests that they still have a limited choice over what they would like to eat. 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 and the manager has now allocated one or two staff to take responsibility for organising them. Several of them were enjoying a musical session at the time of the inspection.
Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 14 A previous recommendation was that the manager should explore ways that the home could facilitate more community-based activities. A seven-seat people carrier is now available and some residents have enjoyed trips out with carers. Residents said that the meals served to them are very good. The homes manager is always in the dining room at meal times so that he can monitor what is being eaten however, a record now needs to be kept so that there is evidence that people are getting an adequate diet. All residents are weighed monthly. The daily menu is displayed on a large notice board in the dining room a choice is shown and work has been done with relatives to establish resident’s particular preferences. Curries are provided for two residents who particularly enjoy them. However, despite this it would appear that choices are not routinely offered to residents unless it is known that they particularly dislike an item. There must be evidence to show that residents are actually offered a choice of meal. Staff were observed to be treating residents kindly and respectfully during the inspection and they had time to spend chatting with them. Visitors are always welcome into the home. Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 15 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): Standards 16,18 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 a complaints procedure that ensures that their views listened to and acted upon. Policies and procedures are in place to safeguard residents EVIDENCE: A copy of the home’s complaints procedure is displayed in the hall. Most of the residents would probably not have the ability to understand or access the procedure although some of them said that they would tell the staff if they were not happy. The complaints book was seen and only one issue had been raised since the last inspection. This was investigated using local authority safeguarding procedures and had highlighted problems with recording and communication, which have now been addressed. Since the last inspection all staff have received training on abuse awareness from the Adult Protection Co-ordinator and the homes own trainer. One new member of staff has been recruited since the last inspection and records showed that the appropriate checks and clearance had been obtained. Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 16 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): Standards 19,26 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 live in an environment, which is clean and generally safe and comfortable for them. EVIDENCE: The interior of the home is clean and pleasantly decorated. Some decorating has been completed since the last inspection and new carpets have also been laid. Some concerns were raised again about a lack of alarm on the patio doors. During the visit it was noted that one resident was trying to open the doors and measures must be put in place to make sure that no-one could get out unnoticed. As previously highlighted, residents would benefit from increased signage throughout the home and a means for them to identify their rooms, and bathrooms and toilets. Their names have been put on their bedroom doors however; it is recommended that pictorial prompts would also be beneficial.
Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 17 Relatives should also be encouraged to bring in items from home, which would personalise their rooms and make them more homely. The home was very clean and tidy on the day of the inspection and infection control procedures have improved in the laundry with the provision of a new washing machine and alginate bags for soiled linen. Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 18 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): Standards 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 a well-established staff team who have had suitable training to help them understand their needs. Robust recruitment procedures are in place to help ensure that residents are protected from people who should not be working with them. EVIDENCE: Duty rotas seen indicated that sufficient staffing levels are maintained; the Registered Manager is in the home for the majority of the week and always on call if needed. Staff turnover is very low giving continuity of care for the residents living in the home. One new member of staff has been employed since the last inspection and there was evidence that appropriate checks had been carried out prior to them starting work. All of the care staff have now either completed or are undertaking an NVQ level 2 qualification. An in house trainer visits on a monthly basis and covers a wide variety of subjects. Recent sessions have included communication and the Mental Capacity Act. Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 19 Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 20 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): Standards 31,33,35,36,38 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 can feel confident that the manager has the valid experience and qualifications to run the home in their best interests and that their views will be taken into account. Health and safety practices ensure that they live in a safe environment and their welfare is protected. EVIDENCE: The Registered Manager has many years experience in caring for this client group. In order to allow those using the service to influence how it is delivered he has devised an annual quality assurance plan for the home. Surveys and questionnaires were offered to the residents, their relatives and other relevant
Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 21 stakeholders however responses have not been very good. Other ways of gaining their views such as relatives meetings or social events still need to be explored. It was also suggested at the last inspection that an independent audit should be carried out on the home on an annual basis. This has still not been done. Resident’s financial affairs are dealt with by family members or their representatives. Small amounts of money are banked on their behalf for items such as newspapers or hairdressing. All staff are now receiving regular supervision sessions, which enables their performance to be monitored, and any future training needs to be identified. A selection of records, required to be kept as evidence of the home’s commitment to the health and safety of residents, were seen. Those maintenance certificates that were seen were all up to date and a fire risk assessment is in place. Hot water temperatures are monitored regularly and records of any accidents are appropriately documented. Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 22 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 23 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 OP1 Regulation 4 5 2 OP15 16(2)(i) Requirement The Statement of Purpose and Service User Guide must be updated in line with current regulations to contain all of the required information. There must be evidence that residents are being offered a choice of meals and a record must be kept of what they have actually eaten as evidence that they are having an adequate, balanced diet. Signage throughout the home must be improved to help orientate residents. Previous timescale 30/01/07 not achieved The patio doors must be alarmed so that residents cannot leave the home unnoticed. Additional ways of gaining the views of people who use this service must be explored so that they are able to influence the way that the home is run. Previous timescale 30/01/07 not achieved
Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 24 Timescale for action 30/11/07 30/11/07 3 OP19 23(2)(n) 30/11/07 4 5 OP19 OP33 13(4)(c) 24 (1) 30/11/07 30/11/07 6 OP33 24 (1) The responsible person must ensure that an independent agency visits the home annually to carry out an internal quality audit. Previous timescale 30/01/07 not achieved 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations It is recommended that copies of the Service User Guide are put into individual residents bedrooms for them and their relatives to refer to. Foxley Lodge DS0000025783.V347269.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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
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