Inspection on 28/05/09 for Garlinge Lodge

This inspection was carried out on 28th May 2009.

CQC found this care home to be providing an Good service.

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

Garlinge Lodge 09/06/08

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Garlinge Lodge 6 Garlinge Road Southborough Tunbridge Wells Kent TN4 0NR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gary Bartlett     Date: 2 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Garlinge Lodge 6 Garlinge Road Southborough Tunbridge Wells Kent TN4 0NR 01892528465 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : raj22@onetel.com Sira Care Home Ltd care home 14 Number of places (if applicable): Under 65 Over 65 14 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 14. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home The premises at Garlinge Lodge were converted over 30 years ago as a care home for elderly people. It provides residential care for up to 14 people over the age of 65. It is owned and operated by Sira Care Home Ltd, with Mr Kritanand Ramtale as Managing Director and Mr Rajiv Jugdharree as co-director and home manager. The Homes staffing team comprises the Manager, senior care staff and care staff who work a roster that gives 24-hour cover. The Home also employs other staff for catering and domestic duties. Care Homes for Older People Page 4 of 26 Brief description of the care home Current fees range from £342 to £525 per week. Residents pay separately for hairdressing, chiropody, personal toiletries and newspapers at cost. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Garlinge Lodge from 8:15 a.m. until 1:30 pm. During that time the Inspector spoke with some residents, a visitor, the proprietor and Manager and some staff. Parts of the home and some records were inspected and care practices observed. The Manager had completed an Annual Quality Assurance Assessment, from which information was used to inform the inspection process. The Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older People refer to people who use the service as service users. People Care Homes for Older People Page 6 of 26 living at Garlinge Lodge prefer to be referred to as residents. Accordingly this shall be done in the text of this report. The Inspector would like to thank everyone involved for their contribution to the inspection. What the care home does well: What has improved since the last inspection? What they could do better: The Manager understands the need to review the current facilities for the storage of medicines to ensure they fully comply with the latest guidelines from the Royal Pharmaceutical Society. Some daily records could better convey how residents have responded during the day or how they feel emotionally. This would give a fuller picture of the persons lifestyle and help staff when it comes to reviewing care plans. More social outings should be made available to residents. Handrails should be fitted alongside the paths in the garden so residents can use the garden more independently and safely. The views of health care professionals and Care Managers should be more formally included in the homes quality assurance process. Care Homes for Older People Page 8 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that they are appropriately placed due to good preadmission assessments and benefit from being able to visit the home prior to admission. Evidence: The Manager described how a pre-admission assessment is made of each prospective resident. The assessment process includes recording the findings of the assessment, the detail of which then informs the initial care plan. He said prospective residents, their families, advocates, and relevant health care professionals are involved in the assessment process. The records seen show that specialist advice is sought from external sources where required. Residents said they or their families had been able to visit the home before moving in. They also said staff had been very helpful in assisting them to settle in. Care Homes for Older People Page 11 of 26 Evidence: Intermediate care is not offered at Garlinge Lodge. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents personal health needs are assessed and maintained through their individual care plans and with good liaison with relevant health care professionals. Staff treat residents with respect and maintain their privacy and dignity. Evidence: The judgment for this outcome group has taken into account the quality of life for the residents. The judgment also includes assessment of the level of knowledge and understanding displayed by staff when providing both personal and health care. Each resident has a care plan and four were inspected in detail. Since the last inspection, they have been made more comprehensive with information about residents needs and capabilities. The care plans seen are up to date and are reviewed regularly. The Manager is aware that daily records of care need to be more consistently written Care Homes for Older People Page 13 of 26 Evidence: to accurately reflect residents current welfare. Accordingly, the records are being monitored and guidance given where required. Some daily records are repetitive and just descriptive of the care given, not conveying how the resident has responded during the day or how they feel emotionally. This would give a fuller picture of the persons lifestyle and help staff when it comes to reviewing care plans. Residents consider their health needs are well met. They say they have ready access to healthcare professionals including local doctors, chiropodists, dentists and opticians. The records seen confirm this. Staff say they receive good support from healthcare professionals such as District Nurses and GPs. Staff spoken with generally have a good understanding of getting a balance between perceived risks and promoting independence. Risk assessments are now more comprehensive in scope to minimise risk as far as is practicable. One risk assessment for manual handling seen could be more detailed to better inform staff how help is to be given. All staff spoken with have a good understanding of residents individual needs, welfare and preferences. Garlinge Lodge has a small staff group and a lot of information is shared verbally. The Manager said he is reviewing the current facilities for the storage of medicines to ensure they fully comply with the latest guidelines from the Royal Pharmaceutical Society in the immediate future. The Medication Record Administration Record (MAR) sheets seen were completed appropriately with one exception. This omission was very recent and immediately addressed by the Manager. Medications are only administered by staff authorised to do so. There was some discussion about providing additional secure storage facilities for medicines in the communal areas as an extra safeguard if the person giving medicines is distracted during the process. Residents like the staff and say they are polite and gentle, this was confirmed by observation. It is clear that staff have developed friendly and positive relationships with residents and are considerate of their age and dignity. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to exercise choice and control over their daily lives as far as is practicable and to maintain links with friends and relatives. Residents enjoy the meals which are of good quality. Evidence: Staff spoken with are aware of the rights of residents to have the opportunity to have choice in daily routines and activities. Residents say that, within reason, they can get up and go to bed when they chose. It seems all except one like to get up early as night-staff had made the beds by the time the Inspector arrived at 8:15 am. Residents have opportunities to take part in activities at the home and the weekly program of activities is displayed in the dining room. Each Tuesday afternoon, a visiting activities person conducts an afternoon session that includes quizzes and general knowledge questions. Residents say they enjoy this as well as visits on Thursday afternoons by a Physiotherapist and Motivation Classes held on alternate Fridays. Care Homes for Older People Page 15 of 26 Evidence: The Manager said that outings can be organised but take up is variable. The home does not possess its own transport. The AQAA indicates the Manager intends to encourage more outings. Some residents expressed a wish to see this. Residents wishes in respect of any religious observances are ascertained at time of admission. If residents have strong spiritual beliefs the home supports them in meeting these. One resident attends church with assistance from one of the home owners. The AQAA states that volunteers from the local church visit the home to socialise with residents and a religious minister conducts a service at the home fortnightly. Family and friends feel welcome and know they can visit at any reasonable time. The visitors book records regular visits by families, friends and others. The design of Garlinge Lodge provides seating areas within the communal areas where residents can entertain their visitors, in addition to the privacy of their own room. Residents are encouraged to personalise their rooms with their own possessions if they wish. Some residents have brought items of furniture and personal effects with them. Residents are encouraged to take responsibility for their own financial affairs and to use their money as they wish. Where a resident can no longer manage their own money, family or an advocate gives support. An experienced cook, of whom residents and staff speak very highly, provides good quality meals that meet the dietary needs of the residents. A menu offers a choice of main meal. Mealtimes are relaxed; staff are patient and helpful and allow residents the time they need to finish their meal comfortably. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives know their complaints are listened to and acted on. There are systems to protect residents from abuse. Evidence: Residents state they feel safe and well supported and are satisfied with life at the home. The complaints procedure is readily available to residents and their relatives. They say they feel confident they are listened to and any necessary action is taken. The Manager said the home would keep a record of all complaints received by them, the result of the investigation and how the complaint has been resolved. The AQAA indicates there have not been any complaints in the last twelve months. The Commission has not directly received any information regarding complaints about the home since the last inspection. There are procedures for responding to suspicion or evidence of abuse or neglect and ongoing training for staff to ensure the safety and protection of residents. Staff members spoken with have a sound understanding of need to report suspected abuse without delay. There has been one safeguarding alert since the last inspection and this is closed. Care Homes for Older People Page 17 of 26 Evidence: The Manager described how all residents are on the electoral roll and postal votes have been obtained for them. The residents spoken with are aware of this. Care Homes for Older People Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Garlinge Lodge provides a homely environment and comfortable place in which to live. Evidence: Garlinge Lodge is a large building set at the end of a quiet road near the centre of Southborough. Shops and other facilities are near to hand. It has been used as a care home for many years and some corridors are narrow. The Manager said careful consideration is given to residents abilities when allocating bedrooms. All floors are served by a shaft lift. The standard of cleanliness is good and residents commented on how clean the home is kept. Residents spoken with like their rooms, those on the top floor are the more mobile and if a need is identified for a move downstairs this is facilitated whenever possible. All the bedrooms are for single occupancy. The home has a main lounge and a conservatory/dining area, both were being frequently used during the inspection and some residents were choosing to alternate between spending time in communal areas and their rooms. Care Homes for Older People Page 19 of 26 Evidence: The Manager said there is an ongoing program of redecoration and refurbishment. Worn furniture and carpets are gradually being replaced. Staff consider the bathing facilities are adequate for the needs of the residents, there being three bathrooms. One of these is small and rarely used. The Manager agreed to make good damaged paintwork on a bath-side lifting hoist, to better promote infection control. Residents say they consider there to be enough toilets and they are conveniently situated. There is a garden with a patio area to the rear and side of the home that residents can have access to with assistance. It is recommended handrails be fitted alongside the paths in the garden so residents can use the garden more independently and safely. Care Homes for Older People Page 20 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel there are adequate numbers of staff on duty and that the staff are caring people. Evidence: Residents speak very highly of the staff and of the care given. One of the comments made was I think they are very kind and good. People applying to work at the home have to complete an application form, attend an interview, provide references and satisfactory POVA and Criminal Record Bureau (CRB) checks. The files of the most recently recruited staff show that appropriate checks were made prior to them commencing duties. New staff are required to undertake an induction program and there is ongoing training for all staff. NVQ training is encouraged. Staff speak of regular training and there are certificates on their files. Residents say there are enough staff available when needed. The staff rosters seen indicate staffing levels are geared to peak times of activity. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of residents. There is an open and friendly atmosphere. Evidence: Mr Jugdharree qualified as a Registered Mental Nurse in 1993, since which time he has had experience of working in Elderly and EMI Units, Acute Admissions and in a rehabilitation unit for younger adults, which has included responsibility for community outreach work and working closely with families. He has completed a Managing Change workshop and a Safeguarding Adults Awareness course in July 2007; he also has a Higher Education Diploma in Health Care Studies and the NVQ at level 4 in Management, awarded in 2005 and is an NVQ Assessor. The atmosphere is relaxed and friendly and staff and residents find the Manager approachable. Care Homes for Older People Page 22 of 26 Evidence: The Manager agreed to indicate who is in charge of each shift to give clearer lines of accountability. The home has some quality assurance processes including residents relatives surveys. The Manager said it is intended to include health care professionals and Care Managers in future surveys. Residents are encouraged to manage their own monies with most having family or advocates who act on their behalf. The home prefers not to become involved in looking after residents monies. The standard of cleanliness in the kitchen and surrounding area is good. In December 2007 the home was awarded the Borough Councils Gold award for food hygiene for the third year running. There are records of fire systems checks and fire drills/training. Staff members spoken with have a good understanding of emergency procedures. The Manager stated that records of maintenance and safety checks are in order. These were not inspected on this occasion. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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