Inspection on 24/07/07 for Garden Lodge

This inspection was carried out on 24th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Garden Lodge 20/07/06

Garden Lodge 24/10/05

Garden Lodge 12/05/05

Garden Lodge 13/10/04

Garden Lodge 10/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Garden Lodge Philipson Street Walker Newcastle Upon Tyne Tyne & Wear NE6 4EN Lead Inspector Allan Helmrich Unannounced Inspection 09:30 24 and 25th July 2007 th 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 Garden Lodge DS0000000446.V343993.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. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garden Lodge Address Philipson Street Walker Newcastle Upon Tyne Tyne & Wear NE6 4EN 0191 263 6398 0191 2636946 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) Manor Care Home Group Mrs Jackie Mead Care Home 41 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (21) of places Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th July 2006 Brief Description of the Service: Garden Lodge is a modern purpose built care home providing accommodation with personal care for up to 41 residents. The accommodation consists of 2 units, both on the ground floor with the upper floor used for storage and staff facilities. One unit consists of 20 bedrooms with ensuite toilet facilities for frail older people; the other is of 20 bedrooms with ensuite toilet facilities for older people with a dementia. The home does not provide nursing care. Garden Lodge is situated in a residential area of Walker, a suburb to the east of Newcastle upon Tyne. The home is close to local shops and public transport links. Information about the home and current inspection reports are available in the home. The home’s fees range from £363 to £373. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s periodic unannounced key inspection visit. The inspection was conducted over two separate days and took 9 hours. Time was spent with the manager, some care staff and several residents. Some of the home’s care records were reviewed and the systems that maintain residents safety. Some residents’ case records were specifically assessed against the style of care provided. This is called ‘Case Tracking’. Questionnaires were provided for residents and visitors to the home. Responses were received from five visitors and four residents. Information provided by them is used in the report. What the service does well: The home is well managed and run in the best interests of residents. The home management have used questionnaires to obtain comments from residents and their visitors as to the quality of care provided. The manager is currently reviewing these questionnaires and any issues identified are to be addressed. There is a stable staff team of experienced, mature carers that provide a good standard of care for residents. There is a thorough assessment of residents’ needs to ensure that appropriate care is provided. Residents are encouraged to be involved in activities. Residents are treated with great warmth and respect. Positive comments from visitors questionnaires are; My mother is very well cared for and I am extremely pleased with the care she receives. Staff always keep me informed. Very happy and open atmosphere. Staff respond quickly and efficiently to residents needs. My mother is always well dressed and comfortable. The staff are always around to speak to if I need to discuss anything with them. The staff are friendly and provide good meals. Garden Lodge is always clean and tidy with very pleasant and helpful staff. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 6 A resident commented that she has no complaints and is perfectly happy and another that she is happy to be in the home What has improved since the last inspection? 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. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 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 Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. A range of useful information about the home is available to prospective service users. Before being accepted into the home each service users needs are assessed by a senior member of the care team to ensure their needs can be met. Intermediate care is not provided. EVIDENCE: Available in the home are; copies of the home’s brochure and service user guides. These contained location plans and details to enable prospective residents to make an informed choice about the home. A file of other Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 9 information and photographs is being put together to show visitors past events and activities that residents have been involved in. Six care plans were reviewed and each contained a full assessment of the residents needs obtained prior to offering a place in the home. The files contained care managers assessments and details obtained to limit the possibility of the home offering a place to someone whose needs they could not meet. Each file detailed the residents’ daily living and healthcare needs to ensure staff provide appropriate care. Several residents spoken to all said that they enjoy living in the home. A respite bed is available in the home but the home does not offer a specialist rehabilitation service to enable residents to return to independent living. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are addressed and their plans of care are regularly reviewed. The home’s system for the administration and dispensing of medicines does not ensure residents are safe. Residents’ privacy and dignity is maintained. EVIDENCE: Six care plans were reviewed. They all contained a social assessment and a plan for daily living. Two plans for recently admitted residents did not contain a photograph to identify them to staff reading the files. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 11 Care plans contained information to describe to staff how care is to be provided. Each resident’s health is assessed and support is obtained when necessary from relevant professionals. Residents are weighed regularly and recorded. Care plans are generally reviewed monthly to ensure the care provided meets the individual’s needs. Systems are in place to meet the needs of any resident with a pressure sore and residents at risk are provided with the equipment to support them. All of the care plans have been regularly assessed. The home’s system for administering and dispensing medicines was checked and the following issues that could affect the wellbeing of residents were found. The temperature in the medication room has been a concern at previous inspections as it often exceeds the maximum temperature at which medicines should be stored. The medication fridge was operating at a temperature below freezing. This can have an adverse effect on stored medicines. A medicine that should be kept refrigerated was stored with other medicines in the medication trolley. Medicines with a limited life were not dated when opened with the possibility they could be dispensed when out of date. Medicines prescribed with a variable dose were not enumerated in the medical administration records to show the actual amount given. Residents seen were dressed appropriately in their own clothes. Staff were seen to treat residents respectfully and deal with any personal issues with dignity. Locks on bathroom and toilet doors checked during a tour of the building worked smoothly to enable people with less mobility to use them. Residents spoken to during the inspection all said that staff provided good care and were respectful. None of the returned questionnaires criticised the healthcare provided by staff and one visitor commented ‘my mother is very well cared for and I’m extremely pleased with the care she receives’. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 12 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, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to access community facilities and make choices. But unsupported activities are discouraged. Visitors are made welcome in the home. Meals are well presented and a healthy diet is offered. EVIDENCE: Each of the six care plans reviewed contained good detail of residents preferred social activities and interests. A life history is obtained together with details of family and friends. This is particularly useful for staff when assisting residents with a dementia. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 13 Some residents complained they could not carry a lighter and that they could not leave the home without the support of staff. Although these actions take away freedom of choice, they were not addressed in care plans and the risks associated with these actions have not been quantified. Although no visitors were spoken to during the inspection, residents confirmed they have regular visitors and a welcome note to visitors is posted at the entrance. Staff provide activities throughout the day and a record is made of those residents involved and those who choose not to be. During the inspection staff were involved with residents in various activities and also there was a video being shown in one of the home’s lounges. Two residents spoken to said they regularly go out and staff stated they take residents to local shops and parks. Several residents attend a day centre nearby and community church groups visit the home. Some photographs of social occasions and activities residents are involved in are being placed in an album to show to visitors and to remind residents of past times. Following a meeting where some residents complained of insufficient activities for men, a dartboard has been provided. One resident stated he enjoys a game of darts with other residents in the home. Seating areas are located throughout the home to enable residents to form small social groups. The seating in one area has been removed to restore harmony but the manager is reviewing this situation. One resident stated that when she had visitors she could choose to see them privately. Residents were unhappy that the television had been removed from their smoking room. The manager reviewed this situation with the inspector and the television was restored. Some residents handle their own finances supported by their families but where the home are involved a record is kept of all transactions. Two signatures support each transaction and receipts are kept. Management have not audited these records on a regular basis to ensure their accuracy. Menus reviewed demonstrated that a range of healthy foods is provided. A choice is offered at each mealtime. A lunchtime meal was taken with a group of residents. The meal was well presented and unhurried with adequate staff numbers supporting residents in a quiet dignified way. Residents confirmed they enjoy the meals provided. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 14 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): 16, 18. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and a well-trained staff team protects residents. EVIDENCE: A complaints procedure is provided in the home’s Service User Guide given to each resident on admission. The manager takes complaints seriously and records all issues of dissatisfaction with the service provided. Each issue brought to the attention of the manager was recorded in a log with how they were resolved. All staff have received training related to abuse awareness and the manager and some senior care staff have attended an advanced course. Appropriate procedures and Department of Health guidance are available in the home for staff and the manager has undertaken an assessment of staff awareness in relation to protecting residents. Staff spoken to were aware of their responsibilities in this area of care. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 15 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, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is safe, clean and well maintained. EVIDENCE: The home is purpose built. It has two separate units providing care for older people and older people with a dementia. All living space is on the ground floor with level access to the outside. In addition to lounge and dining areas, seating is provided in corridors and at the entrance to encourage residents to collect in small groups. Improvements to the garden are planned to provide better access and seating. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 16 Residents’ bedrooms are individually styled and contain many personal possessions. Residents spoken to during the inspection are happy with the standard of appointment. A programme of cleaning is in place, the home is clean and no odours were detected. Maintenance of the building is ongoing. The glass in a fire door is broken and is to be replaced by the maintenance team. The laundry contains appropriate equipment to meet disinfection standards and laundry staff are provided with information and instruction regarding laundry. A member of senior staff attends meetings with the infection control nurse in the NHS to obtain best practice information. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 17 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 from evidence gathered both during and before the visit to this service. Trained staff employed in appropriate numbers support residents and ensures they are safe and their needs are addressed. The home operates a thorough recruitment process to ensure residents are safe. EVIDENCE: Staff levels on the day of the inspection met the agreed levels. Staff rotas reviewed at the inspection showed that the manager is available on weekdays and that seven care staff are on duty each day and four care staff each night. Domestic and catering staff are employed in sufficient numbers to maintain the home and meet residents needs. No care staff under 18 years old are employed and no-one under 21 years old is left in charge. Staff training needs are identified in supervision and appraisal sessions. Statutory training is reasonably up to date and video training sets have been Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 18 provided for in-house refresher training. These are in addition to specific accredited training. Nineteen of the twenty two care staff have achieved a National Vocational Qualification (NVQ) in care. Trainees are provided with induction training that meets nationally recognised standards. A senior member of the staff team ‘signs off’ this training. Many of the staff team have worked in the home for several years and throughout the inspection residents praised the quality of care provided. A member of the care staff has recently received a lifetime achievement award, presented by the Lord Mayor. Staff spoken to stated that a good range of appropriate training is provided, that clear direction is provided by management and that good support is available from other staff. This helps them provide a good service to the residents. Two staff files were reviewed that contained appropriate references and Criminal Records Bureau information. Inductions conducted by the home were detailed together with all training undertaken. Staff sign to confirm they have read important policies. The manager uses an employment checklist to demonstrate the homes recruitment process is followed. This checklist does not remind the manager to identify and record any issues that are highlighted in the criminal records checks. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 19 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, 33, 35, 38. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. An experienced person who understands the needs of residents manages the home. Systems for self-monitoring are in place and safe working practices are promoted. EVIDENCE: Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 20 The manager has been in charge of care homes for older people for several years. She has the Registered Managers Award which demonstrates her knowledge and experience in managing a care home for vulnerable people. Residents spoken to during the inspection stated that the manager is always available to discuss matters relating to the running of the home. A quality monitoring system is in place that involves the use of questionnaires. The manager is currently reviewing 35 resident and 10 visitor questionnaires returned to her and intends to address any issues identified. There are regular meetings involving staff and residents where a good range of issues is discussed. The last meeting involving residents with a dementia was abandoned and the manager is reviewing how their opinions can be obtained. Monies held for residents are recorded in a log and all spending is recorded and signed by two staff members. A receipt is retained for all purchases made for residents by staff. Management does not regularly audit this system. Systems are in place to ensure the home is safe for residents. Certificates were seen to demonstrate maintenance tasks carried out by external contractors were done. Water temperatures are checked and a risk assessment is in place to show the water system is free from Legionella. Accidents in the home are recorded and reviewed by management to keep residents safe. A fire risk assessment has been produced and regular fire checks are recorded and staff training provided to ensure residents are safe. Each member of staff has a handbook that includes details of health and safety in the home. Kitchen staff are working through a system to promote better food standards in the home. Infection control systems and systems to ensure a good standard of hygiene is maintained is in place and a member of senior staff meets periodically with the infection control nurse to obtain current best practice information. Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 21 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 22 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 Timescale for action 31/08/07 2. OP12 12(2) Ensure medicines are stored below 25 deg C in accordance with instructions provided. This element of the requirement has not been satisfactorily addressed from the last inspection. The manager must ensure that in addition to ensuring medicines are stored at the correct temperature in the medication store, the following issues are also addressed; The fridge used to store medicines must have its temperature controlled at about 5°c. All medicines identified as requiring refrigeration must be stored in the fridge. All medicines with a limited life must be dated when opened to limit the possibility of using them when outdated. When variable dose medicines are prescribed the actual dose given must be recorded. When a residents choice is 31/08/07 restricted, e.g. not able to carry a lighter or leave the home DS0000000446.V343993.R01.S.doc Version 5.2 Garden Lodge Page 23 3. OP29 18(2) unsupervised, a risk assessment should be produced to show that management have considered all ways of maintaining choice and independence. The manager must record any issues identified in criminal record bureau checks conducted for new staff and record any additional supervision required to ensure residents are safe. 31/08/07 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 OP7 Good Practice Recommendations The manager should ensure that a recent photograph of the resident is placed in their files to identify new residents to the staff team when reviewing their care plans. Management should audit personal allowance records more frequently. 2. OP14 Garden Lodge DS0000000446.V343993.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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. 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