CARE HOMES FOR OLDER PEOPLE
Friars Lodge 18 Priory Road Dunstable Bedfordshire LU5 4HR Lead Inspector
Leonorah Milton Unannounced Inspection 13:45 1 December 2005
st 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 Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 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. Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Friars Lodge Address 18 Priory Road Dunstable Bedfordshire LU5 4HR 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) 01582 668494 01582 670966 Friars Lodge Ltd Mrs Sara Kennett Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20), of places Physical disability over 65 years of age (20) Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The registration of Friars Lodge Ltd as the proprietors of Friars Lodge Care Home. The home is registered to provide accommodation for twenty people over the age of 65, four of whom may be accommodated in two rooms for double occupancy where it can be shown that the decision to share was a positive choice. The registration to be agreed as of 1st December 2004. 3. Date of last inspection 9th August 2005 Brief Description of the Service: Friars Lodge was a private residential home, registered to provide for twenty older people, some of whom may have physical disabilities and/or dementia. The registration for physical disabilities was not applicable because the home was not adapted to provide for service users under this category. Existing service users who had mobility and similar needs associated with old age could be accommodated under the category for old age (OP). Ownership of the home transferred to Friars Lodge Ltd towards the end of 2004. The manager was appointed at that time. The directors of the new ownership were established care home providers in the vicinity. The home was located in a pleasant residential area of Dunstable within close proximity to the Priory and the towns amenities. The building provided a comfortable environment. The bedrooms were distributed on three floors that were accessible by staircases and a series of chairlifts. Building works to install a shaft lift were underway. Toilets and adapted bathing facilities were located for convenient access throughout the building. A large lounge/diner and a small visitors/television lounge were situated on the ground floor. The lounge overlooked an established and well maintained garden to the rear of the property. Parking was provided for a few vehicles to the front of the building. Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second of the statutory two inspections that the Commission for Social Care Inspection (CSCI) is required to carry out each year. This inspection was carried out in accordance with the CSCI’s procedures to assess core care standards within the two inspections as detailed on this report. This inspection therefore focused on the progress to meet requirements from the previous inspection and the core standards not assessed at that visit. During this inspection the planned arrangements for the care of one service user and her case file were assessed. Conversations took place with the service user and a member of her family. One other visitor also provided his opinion of the service. A partial tour of the building took place. The manager was absent as the inspection commenced but attended shortly after and was present for a written feedback. It is recommended that this report be read in conjunction with the report of the inspection carried out in August 2005 for a complete overview of the standard of the operation between these dates. What the service does well: What has improved since the last inspection?
There had been significant progress to complete the installation of a shaft lift. The commissioning of this lift will greatly improve the access to the upper floors for those service users with mobility problems. It will also allow those who may such problems to remain in the home.
Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 6 Action had been taken to improve safety standards that had been outstanding under the previous ownership in relation to uncovered radiators that posed a risk of accidental burn and the fitting of restrictors to windows that posed a risk of accidental fall. The integral heating system had been repaired so that there was no longer a reliance of back up heating from free standing appliances that posed a risk of accidental burn. Staff training had also continued to improve. 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. Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Standards 1 to 6 were not reviewed having been assessed as met at the previous inspection. EVIDENCE: The home did not provide a rehabilitation service. Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 The written guidance to care needs had not been sufficiently updated when needs had changed significantly. This could result in needs remaining unmet. EVIDENCE: The daily notes of a service user who had died recently in the home showed a significant and rapid decline in her physical condition. There was also evidence to show that the service user’s General Practitioner had been consulted, as had the District Nursing Services. Whilst the daily notes indicated some change in the pattern of care for the service user, the central plan of care had not been amended to show that the service user had become terminally ill and was confined to bed with the necessary change in care that this would have required. Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 The day-to day lifestyle in the home met the service users’ expectations and preferences. EVIDENCE: An advertised programme of daily events for stimulation and entertainment had been introduced since the previous inspection. Although some of the service users choose not to participate there was evidence to show that opportunities for individual and group activities were available. Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Satisfactory arrangements were in place to enable service users and others to raise concerns EVIDENCE: Records indicated that there had been one formal complaint since the previous inspection in relation to heating. This had been properly responded to and appropriate action taken following investigation. Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24. The environment was mostly suitable for the needs of frail older people. EVIDENCE: The environment had improved significantly after the change of ownership. During the last year in addition to the installation of the shaft lift, the privacy arrangements in a toilet had been improved and a hairdressing room had been created. The current building works were also increasing the size of an ensuite facility to one bedroom. It was noted that the CSCI had not been provided with a revised floor plan to show the change in the layout of the building. The building works had been carried out with as little disturbance to service users as possible. Areas of the building seen at this inspection were all clean and orderly. Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 13 One bedroom for double occupancy still had only one wardrobe to be shared by the occupants. Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29,30 Strategies were in place to improve the knowledge base of the team as a whole to ensure that service users received care appropriate to their needs. EVIDENCE: Previous reports had commented on the team at the home as being kind and caring but the overall approach to care under the previous manager as parenting rather than empowering. As was inevitable members of staff had difficulties in accepting the approach of the new organisation at the change over a year ago, which was more in line with current best practice for the care of frail older people. The introduction of staff meetings, individual supervision and training had assisted the team to understand this philosophy of care. Further training in dementia awareness and adult protection procedures should contribute to this development. The team had made progress towards achieving accredited training in the overall provision of care. It was reported that the deputy was working towards an NVQ in care management at level 4; two members of staff were working towards NVQ level 3 and five towards level 2. Three members of staff had already achieved NVQ awards at level 2. Assessment of two personnel files showed that satisfactory procedures/checks had been made for the protection of vulnerable people but that there was a need to check on applicant’s from overseas permits to work in the UK. Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 15 Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,37 There was evidence of the improving strategies to consult with and inform service users about the operation of the home. EVIDENCE: There was evidence to show that an audit of the quality of the service was underway through written consultation with service users or where appropriate their representatives. A newsletter had been introduced. It was reported that it is planned for this to be a quarterly event. Advice was given to the manager at this inspection in relation to the sorts of detail that should be recorded for notification to the CSCI under Regulation 37
Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 17 and that records of fire drills should include the names of staff attending so that gaps in attendance can be readily identified. Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 18 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 2 x x x x 2 x x STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 3 x x 2 2 Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP7 OP9 Regulation Requirement Timescale for action 31/12/05 31/12/05 3 OP20 4 OP24 12(1)(a)1 Care plans must be amended 5(1)(2)(b) when there have been significant changes in need. 13(2) Medications must be stored securely. This must include those for storage under refrigerated conditions. (Previous timescale of 30/09/05 had not been met) 12(1)(a) The registered provider must 39(h) provide the CSCI with an amended floor plan of the building to show recent changes to its layout. 23(2)(m) The registered person must provide: 1.Each bedroom door with a suitable lock with individual key that will also permit staff access in the event of an emergency. 2.A lockable facility to each bedroom (two in the event of shared rooms.) Service users must be given the keys to their rooms and the lockable facility unless their risk assessment indicates otherwise. (Previous timescales of 31/12/04,31/06/05 and
DS0000062259.V269288.R01.S.doc 31/01/06 31/03/06 Friars Lodge Version 5.0 Page 20 5 OP24 12(1)(a) 16(2)(c) 12(1)(a) 19(1)(a) 18(1)(c) (i) 18(1) (c)(i) 6 OP29 7 OP30 8. OP30 10 OP38 13(4)(a) 30/11/05 had not been met) Each service user must be provided with a wardrobe for storage of their personal clothing and similar. Recruitment procedures must include where necessary checks on applicant’s permits to work in the UK. All staff working in the home who have access to service user must receive training in adult protection procedures. Staff must receive training about the needs of service users with dementia and how these can be best met. (Previous timescale of 30/11/05 had not been met) Exposed radiator surface or hot water pipes must be covered to prevent the risk of accidental burn. (Previous timescale of 30/09/05 had not been met in full) 31/01/06 31/12/05 31/03/06 31/03/06 31/12/05 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 OP22 Good Practice Recommendations The registered person should arrange for the premises to be assessed by a qualified occupational therapist. (Planned.) Friars Lodge DS0000062259.V269288.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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