CARE HOMES FOR OLDER PEOPLE
Foxley Lodge 24-26 Foxley Hill Road Purley Surrey CR8 2HB Lead Inspector
Alison Ford Key Unannounced Inspection 7th November 2006 09:30 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.V319188.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.V319188.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.V319188.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. 11th May 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.V319188.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report is based upon information gained before and during an unannounced visit to the home. During the inspection, time was spent talking to the residents and staff and the manager /owner Mr Abhee. A brief walk round the premises took place, the care plans of five residents were assessed and various records relating to the health and safety of residents and staff were checked. Regulations that have not been met in relation to the concerns raised are included in this report. The Commission has not received any complaints or concerns regarding the service since the last inspection in May 2006. All those who contributed to the inspection process are thanked for their time and assistance. What the service does well:
The home continues to demonstrate that it is able to meet the needs of its residents. Pre-admission assessments are detailed 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, many of whom have some form of memory impairment. 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. Residents appeared comfortable and content and those who were able gave complimentary views about the staff team. Comments included, “ this is a nice place to live” and “ the staff here are nice.” Residents described the overall food quality as good and meal choices are offered. Activities are offered which appear to suit their remaining skills and abilities.
Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 6 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? What they could do better:
Medication records and storage were generally in order at this visit although some additional processes need to be put into place to ensure the complete safeguard of residents. Residents confirmed their satisfaction with the food in the home however, from the evidence available, it was not possible to confirm that they always had a choice of what to eat at mealtimes. Work must be undertaken with their families and representatives to ensure that they receive food according to their preferences and dislikes. Despite previous requirements issued at the last inspection, staff still had not received up to date training in issues around abuse and the protection of vulnerable adults. The importance of this training for those looking after these residents was emphasised and the training has now been arranged.
Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 7 The dining room is in urgent need of redecoration and the homes manager has agreed to do this as a matter of priority. The floor particularly needs deep cleaning while it is awaiting replacement and he has agreed to do this. It was noted that there was no alarm when fire doors leading from the home were opened. Recognising the possibility of residents opening these doors unnoticed and possibly wandering out or falling, they must be alarmed at all times. In order to promote reality orientation for these residents, many of whom have advanced stages of dementia, the manager must improve signage throughout the home. Pictures or photographs should be put on resident’s bedroom doors toilet and bath facilities to help them recognise where they are. At the time of this inspection one of the washing machines had broken and this must be repaired or replaced as soon as possible. In addition alginate bags must be purchased for soiled linen as the current method for cleaning them prior to washing could pose an infection control risk to staff or residents. As the homes manager is also the owner there must be some indication that an independent person visits on a regular basis to ensure that residents are happy with the standard of care that they are receiving. In addition further ways of monitoring the views of relatives and other visits must be explored. 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.V319188.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.V319188.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 3,6 Quality in this outcome area is good This judgement has been made using available evidence including a 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. This home does not offer intermediate care; standard 6 is not applicable. EVIDENCE: Five care plans were seen, including two from residents admitted since the last inspection. All of them provided evidence that a comprehensive pre-admission assessment had been undertaken to ensure that the home would be able to meet their healthcare needs. Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 10 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 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. Foxley Lodge DS0000025783.V319188.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. Individual care plans set out all of the support and interventions required by each resident and these are reviewed regularly to ensure that their changing healthcare needs remain met. Medication policies and procedures are generally in place to protect residents and they can be confident that they will always be treated with respect and dignity and in a way, which safeguards their privacy. EVIDENCE: The care plans of five 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 and regular review is undertaken of factors, which may contribute to the development of pressure sores. Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 12 Other members of the multidisciplinary healthcare team visit as necessary and theses 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. Comments were received from residents about how kind the staff were to them, and many have been there for some time, providing familiarity and stability. Medication storage and administration were all in order at the time of this visit apart from the means to identify staff members from their signatures. The manager must ensure that a list of all those trained to administer medication and their usual signatures must be with the medication record sheets. It was also noted that where medication is prescribed halfway through the cycle and instructions are not printed on the MAR sheet there was no date of the start of the course and no indication as to the duration. The responsible person must ensure that the date of starting a course of medication and how many days that it should be given for are clearly indicated on the MAR sheet. Since the last inspection more training has taken place so that all staff are able to administer medication. Foxley Lodge DS0000025783.V319188.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 adequate. This judgement has been made using available evidence including a visit to this service. Routines of daily living are made flexible and activities are provided to provide interest and stimulation for residents. Residents are assisted to maintain contact with family and friends and visitors are welcomed to the home. Meals offer a healthy and varied diet for the people who live there however the evidence available suggests that they do not choose 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. A previous recommendation was that the manager should explore ways that the home could facilitate more community-based activities. The manager explained that this had proved difficult due to a lack of response from relatives
Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 14 when asked for additional funding for trips out. He is still exploring the possibility of purchasing transport for the home. No residents at this inspection expressed any wish to go out more. The daily menu is displayed on a large notice board in the dining room and apparently staff ask residents each day for their choices. Alternatives to the main meals can always be provided. It was noted that, according to the list, all residents had chosen the same meal and this was not in fact what had been served for lunch. Due to the degree of dementia of the majority of residents the manager suggested that few of them would in fact be able to make a choice. He must ensure that work is done with relatives to establish resident’s particular preferences and dislikes and this list should be available in the kitchen to make sure that they are served the food that they like. 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’. Staff were observed to be treating residents with respect and dignity during the inspection and seemed to have time to spend with them and visitors would always be made welcome into the home. Foxley Lodge DS0000025783.V319188.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 adequate This judgement has been made using available evidence including a visit to this 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 training must be undertaken 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. Since the last inspection, policies regarding difficulties encountered due to aggression or agitation of residents have been updated and risk assessments are in their care plans. Despite previous requirements being made staff training on abuse awareness has not been updated for some time. Staff still need to receive further training on abuse awareness and adult protection as organised by the local Croydon authority. Places have been applied for however they are limited. Following the inspection in - house sessions have been arranged with the Adult Protection Co-ordinator and the homes own trainer.
Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 16 The registered person must ensure that all staff have attended one of these sessions. Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. Parts of the home still require decorating to ensure that residents live in a wellmaintained environment. Concerns were raised about infection control issues, which could pose a potential risk to the health of residents and staff. EVIDENCE: The interior of the home generally presents as clean and pleasantly decorated however the dining room is in urgent need of attention and the flooring appeared dirty and sticky despite having been cleaned. The manager has agreed to attend to this as a matter of priority. Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 18 Given the degree of dementia of many of the residents and the chance that they may wander out of the home, fire doors in the home must be alarmed to notify staff if they have been opened. Residents would also benefit from increased signage throughout the home and a means for them to identify their rooms, and bathrooms and toilets. Apparently problems have been experienced in the past with residents taking these down. Therefore a more permanent method must be found to put these up. The laundry area complies with current recommendations. At the time of this visit however one of the washing machines was out of order. A representative was due to discuss its replacement. The remaining machine does not appear to have a specific pre-was facility for soiled linen. Staff explained that they rinse soiled sheets in a hand basin prior to washing. This is apparently a rare occurrence, appropriate continence products are used, however must not happen. Soiled sheets must be put into appropriate alginate bags and the washing machine must be replaced as soon as possible. Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this 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. 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. An extra member of staff is employed 4 times a week to enable a hot snack supper to be provided. 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. 50 of care staff have now either completed or are undertaking an NVQ level 2 qualification. The intention is that all of the others will follow. An in - house trainer visits on a monthly basis and covers a wide variety of subjects.
Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 20 As detailed in Standard 18 staff must have more training around adult abuse issues and following this inspection this has been arranged. Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 21 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 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can feel confident that the manager has the valid experience and qualifications to run the home in the best interests of the residents and that their views will be taken into account. Health and safety practices ensure that residents live in a safe environment and the welfare of residents and staff is protected. EVIDENCE: In response to the last inspection, the owner has devised an annual quality assurance plan for the home. Surveys and questionnaires have now been
Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 22 offered to the residents, their relatives and other relevant stakeholders however responses have not been very good. Other ways of gaining their views such as relatives meetings will now 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 not been done and now becomes a requirement. Records of accidents in the home are now audited and have highlighted where there may be a need for the re-assessment of residents healthcare needs. Concerns regarding the lack of an alarm on fire doors have already been highlighted in standard 19. Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 2 Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 13(2) Requirement The responsible person must ensure that a list of all those trained to administer medication and their usual signatures must be with the medication record sheets. Timescale for action 30/11/06 2 OP9 13(2) 3 OP15 16(2)(i) The responsible person must 30/11/06 ensure that the date of starting a course of medication and how many days that it should be given for are clearly indicated on the MAR sheet The responsible person must 30/01/07 ensure that work is done with relatives to establish resident’s particular preferences and dislikes and this list should be available in the kitchen to make sure that they are served the food that they like. The responsible person must ensure that an arrangement has been made to ensure that all staff have received further training on abuse awareness and adult protection. I.e. as organised by the local Croydon
DS0000025783.V319188.R01.S.doc 4 OP18 13(6) 18(1 c (i) 30/11/06 Foxley Lodge Version 5.2 Page 25 authority. (Previous timescale 30/09/06 not met however sessions were arranged immediately following the inspection.) 5 6 7 8 OP19 OP19 OP19 OP19 23(2)(d) 23(2)(d) 13(40(c) 23(2 )(n) The responsible person must ensure that the dining room is redecorated The responsible person must ensure that the dining room floor is cleaned or replaced. The responsible person must ensure that all fire doors are alarmed. The responsible person must provide increased signage throughout the home to help orientate residents. The responsible person must ensure that the broken washing machine is repaired or replaced. The responsible person must provide alginate bags in which to place soiled linen. The responsible person must ensure that an independent agency visits the home annually to carry out an internal quality audit. The responsible person must explore ways of gaining the views of residents and their relatives so that they can be used to influence the running of the home. 30/01/07 30/11/06 30/11/06 30/01/07 9 10 11 OP26 OP26 OP33 13(3) 13(3) 24 (1) 30/11/06 30/11/06 30/01/07 12 OP33 24 (1) 30/01/07 Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Foxley Lodge DS0000025783.V319188.R01.S.doc Version 5.2 Page 27 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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