Inspection on 14/03/06 for Garden Lodge Care Centre

This inspection was carried out on 14th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Garden Lodge Care Centre 20/11/08

Garden Lodge Care Centre 20/07/06

Garden Lodge Care Centre 26/11/05

Garden Lodge Care Centre 18/01/05

Garden Lodge Care Centre 08/09/04

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

CARE HOMES FOR OLDER PEOPLE Garden Lodge Care Centre Middlemass Hey Liverpool Merseyside L27 7AR Lead Inspector Julia Toller Unannounced Inspection 14th March 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 Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 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 Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Garden Lodge Care Centre Address Middlemass Hey Liverpool Merseyside L27 7AR 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) 0151 498 4776 Ashbourne Homes Limited Mrs Jean Diane Thomas Care Home 48 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (24) of places Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named service user under 65 years old in the residential unit of the home. 26th November 2005 Date of last inspection Brief Description of the Service: Garden Lodge is a residential care home providing 24 hour personal care and accommodation for 24 older people and 24 older people with mental health problems (dementia) Garden Lodge is owned and managed by Ashbourne Limited, a subsidiary company of Ashbourne Consolidated Group, which provides healthcare services across the U.K. However, the manager informed the inspector that the company has recently been purchased by Southern Cross Health Care. The home is located on the edge of a housing estate in the Netherley area of Liverpool. Although the home is some distance away from local shops and amenities, they are easily accessible via a local bus service. The home is a purpose built single storey building that was opened in 1992. There are two separate units, catering for the two different categories of service users. The bedrooms do not have en-suite facilities, however there are sufficient bathrooms and toilets situated throughout the home to meet the needs of service users. Communal space within the home consists of two lounge areas on one unit and two lounges plus a separate dining room on the other unit. Central to both units is a garden area, which is well maintained. Garden furniture is provided and service users use it in the summer. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on a weekday, lasting five hours. As part of the inspection a full tour of the premises took place; a selection of records were inspected, discussions took place with service users, the manager, a senior care worker and a member of the staff team. What the service does well: What has improved since the last inspection? What they could do better: The manager has developed systems to assess quality assurance at the home. However, these systems are newly introduced, so the next inspection will provide greater evidence of this process and the subsequent improvements to standards of care. Staff vacancies over the past months, has resulted in some gaps in recording systems. Now that vacancies have been filled, this must now be addressed. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 Page 6 This is also true of staff supervision, and staff appraisals that are also not taking place in line with the standards. 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. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 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 Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 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): 1,3,6 The home assesses the needs of service user’s prior to their admission to the home. This information is used to develop risk assessments, which are used to promote the welfare of individuals. EVIDENCE: Inspection of a sample of service users files showed that staff at the care home assess the needs of the service user prior to admission. This is thorough and provides a detailed account of service user’s needs, upon which an initial risk assessment is developed. This information is also used to develop care plans to ensure that staff know how to meet the assessed needs of the service user’s, there was evidence that these plans are also reviewed on a regular basis. However, some files inspected showed that these records had not been updated adequately, the manager was aware of this issue and had allocated extra hours to staff to address the issue. Staff enter dates of reviews and comments as appropriate. The reviews highlight the short term and long-term needs of individuals. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 Page 9 The home does not provide intermediate care. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,and 10 The health care needs of individuals are monitored and appropriate action is taken to maximise individual’s well being. Staff promote the privacy and dignity of service user’s. EVIDENCE: There was evidence that the service user plan is reviewed monthly as required by the standard. Short-term care plans are drawn up if a service user is unwell admitted to hospital or if there is any other significant changes in the service user needs. Inspection of a sample of service users files showed that the service users receive regular assessment of their health needs from: GP, continence advisers, CPN, chiropodist, dentist etc. A high percentage of service user’s are registered with a local health centre; some have preferred through choice, to remain with their previous GP. The district nurse visits as necessary, to assist with nursing tasks, and provides appropriate aids to aid recovery. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 Page 11 At the time of the inspection the recording, storing and administration of service users medication was found to be satisfactory. No service user’s required controlled drugs at the time of the inspection. Where service user’s wish to self administer their medications, risk assessments are developed to assess the safe arrangements for this procedure. Observation during the inspection showed that service users right and privacy are upheld. This was evidence through observing staff assisting service users with various daily living tasks such as: assistance at mealtimes. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Service users are able to make choices about their life at the home, and access a range of activities within the home, and the local community. EVIDENCE: The home employs an activities co-ordinator for sixteen hours a week to arrange various activities for service users. These include visits to the local shops, visit to places of interests, video afternoons and engaging service users in art and craft activities, steps are also being taken to encourage service user’s to visit local pubs with staff and families. There was a programme of activities advertised in the entrance hall, which offered an activity every day for the next four weeks. It is recommended that these are also advertised in more regularly used areas of the home for service users. Observation during the inspection show that services provided at Garden Lodge are flexible and service users are able to choose when and where to have their meals, times of going to bed and getting etc. The home has an unrestricted visiting policy. Observation during the inspection showed that service users are able to choose where to see their visitors. Visitors were seen during the inspection using both lounges and resident’s own bedrooms as they wished. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 Page 13 The inspector was informed that residents are allowed to handle their own financial affairs for as long as they wish, and have the capacity to do so. However, some service users manage their own finances with the help of family members and solicitors. Inspection of financial records for those who do not handle their own finances, were clear and well maintained holding receipts were purchases were made. Each service user has a lockable facility in their bedroom. Service users are actively encouraged to bring their personal possessions and furniture as long as they can be safely accommodated in their room. Some service users have informal advocates. Service users can have a look at their own files and family members can look at service user files, with the service user’s permission. There are three dining rooms in the home. One caters to the general residential care unit. The other two dining rooms cater to the EMI unit. There is one kitchen catering to both units. The home operates a four weekly menu plan and the chef and the registered manager draw this up. The menu is reviewed with service users at the residents meeting and appropriate changes are made. The daily menu is displayed at the main entrance and on boards in the dining room. Appropriate choices are offered to all meals and sweet dishes. A carer goes around with a sheet to ask each service user about their preference. Observation during the lunchtime meal show that staff supports service users to maintain their independence. The staffing level at the care home enable staff to provide the appropriate level of assistance as required by the service user at the time of the inspection. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 The home has taken appropriate action to safeguard service user’s. Further work could be done around the investigation and recording of complaints. EVIDENCE: One complaint has been made at the home since the last inspection, whilst the manager could describe the steps that had been taken to investigate the issue, there were no records to support this. As the complaint involved a member of staff, there must also be clear trails of evidence regarding the monitoring of the individual’s future conduct. The central record of complaints did not hold details of the complaint, action taken in response to the complaint, or the outcome. This must be addressed. The home is reminded of the need to ensure that all complaints are recorded alongside the action taken in response in the homes central complaint record. Service users are able to vote if they wish, records showed that staff had been given this opportunity signing to reflect their choice. The home had information on independent advocacy services. The home has various policies in place for the protection of service users. This includes a Whistle Blowing policy and the document No Secrets. Staff meeting minutes showed that staff had reported incidents of inappropriate conduct had been reported, in line with whistle blowing procedures; appropriate investigations had taken place. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Overall the home is well maintained, with evidence of an ongoing refurbishment programme. EVIDENCE: Communal space within the home consists of two lounge/dining areas on one unit and two lounges plus a separate dining room on the other unit. Furniture and lighting are domestic in character and the outdoor space is accessible for all service users including those in wheelchairs. Refurbishment of the home continues, with refurbishment of lounges and hallways. New chairs have also been purchased. On the day of the inspection the home was clean and tidy throughout. All parts of the home are easily accessible by service users. At the last inspection, there had been issues regarding the temperature in some areas of the home. The manager stated that additional heaters had been purchased to address the issue, with risk assessments developed. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 Page 16 Although the bedrooms do not have en-suite facilities, there are sufficient bathrooms and toilets situated throughout the home to meet the needs of service users. Service users have the specialist equipment they require to maximise their independence. The home provides ramps to access the garden area, handrails throughout the home, hoists and assisted bathing facilities. The home has a call system in all areas of the home allowing service user to access assistance from staff when required. Observation during the tour of the building showed that service users bedrooms are personalised with their personal possessions and treasured items. Steps had been taken on the EMI unit to utilise picture recognition on bedroom doors to assist service users in finding their bedrooms. Bedrooms are fitted with locks, which could be easily open by staff in an emergency. Service users are given the opportunity to have a key to their bedrooms if they wish. Individual’s files hold evidence of their decision. All rooms have telephone connection, TV aerial point, call system and a lockable storage space for service user’s valuables. The handy-person carries out regular checks on the emergency lighting, fire alarm system, hot water, small electrical appliance tests etc. At the time of the inspection the home was clean and free of malodour. The laundry facility is sited away from the food preparation area and policies and procedures are in place for infection control. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Records and observations, reflect that service user’s needs are met. The arrangements for ensuring all staff including overseas staff have criminal record bureau checks need to be improved. EVIDENCE: Observation during the inspection and the staffing rota indicate that the staffing levels meet the needs of service users. However, one visitor who spoke to the inspector stated that in acknowledging the amount of work that staff have to do, said they felt that more staff would be beneficial in meeting service user’s needs. The home employs sufficient domestics to maintain the cleanliness of the building and the catering services is contracted out. Inspection of a sample of staff files show that two written references and Criminal Records Bureau check were obtained. Staff files showed that staff had a written terms and conditions of employment. The organisation of the staff files could also be improved upon, perhaps maintaining files in sections of recruitment, ongoing supervision, training and development and disciplinary issues. Inspection of staff files showed that staff supervision and appraisal of staff is not up to date, the new manager is aware of the standards expected and described the steps they will take to address the issue. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 Page 18 The home maintains a record of all training provided to staff. Observation of the training matrix show that staff receives at least three paid training days a year. One member of staff described the training opportunities that were available to her, both “in house” and external training that could be requested. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Overall the home is well managed, with evidence that systems, and procedures are in place to monitor standards at the home. Staff supervision and appraisal could be improved upon. EVIDENCE: A new manager has been recruited since the last inspection, an application must be submitted as soon as possible so that appropriate checks can be started for the fit person procedure. The organisation is reminded of their responsibility to demonstrate how the management standards will be met with this application. A new unit manager for the EMI unit, and a night care manager have been recruited since the last inspection. A record of supervision is maintained, however, this reflects, that supervision is not taking place in line with standards. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 Page 20 Staff meetings are taking place monthly. The new manager has developed a variety of “group” staff meetings, for example night staff, to address any issues that are ongoing. The administrator maintains a record of all service users incoming and outgoings for monies deposited in the home’s safe for safekeeping. Receipts are obtained for all purchases on behalf of service users. The home has a secure place for the storage of service users valuables. The registered person promotes a safe environment for service users and staff through, regular review of the service user plans, staff training and supervision, regular fire checks and maintenance of the building. A record is maintained of all accidents to service users and staff at the care home and where necessary the appropriate regulatory body is informed. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 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 3 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 3 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 2 X 3 X 3 2 X 3 Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP16 Regulation 22 Requirement The manager must ensure that all complaints are investigated, with records of outcomes available for inspection. The manager must ensure that records regarding investigations into allegations made against staff must be available for inspection, and that CSCI are notified appropriately. An application for the new manager must be submitted to CSCI. The manager must ensure that all staff are supervised appropriately and receive an annual appraisal. Timescale for action 14/03/06 2 OP18 13(6) 14/03/06 3 4 OP31 OP36 8,9 16(2) (m) 30/04/06 30/04/06 Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP29 OP13 Good Practice Recommendations It is recommended that the staff files are re-organised to ease accessibility. It is recommended that daily activities are advertised in areas of the home that are accessible to service user’s. Garden Lodge Care Centre DS0000025345.V289147.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 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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