CARE HOMES FOR OLDER PEOPLE
Glenkindie Lodge 27 Harborough Road Desborough Northants NN14 2QX Lead Inspector
Mrs Pat Harte Unannounced Inspection 10th April 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 Glenkindie Lodge DS0000012786.V288910.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. Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Glenkindie Lodge Address 27 Harborough Road Desborough Northants NN14 2QX 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) 01536 762919 01536 762919 Premedic Limited Mr Graham Edward Weekes Care Home 33 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (11), of places Physical disability over 65 years of age (4) Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. The Home will limit its services to the following service user categories: No person falling within the category Older Persons (OP) can be admitted where there are 33 persons of category OP already in the Home. No person falling within the category DE (E) can be admitted where there are 18 persons of category DE (E) already in the Home. No person falling within the category PD (E) can be admitted where there are 4 persons of category PD (E) already in the Home. The Home restricts its services in the Cottage to no more than 6 individuals within the category OP only. The total number of service users in the Home must not exceed 33. Date of last inspection 05/01/06 Brief Description of the Service: Glenkindie Lodge is a privately owned care home providing personal care and accommodation for up to 33 Older People. Within this total number the home is registered to provide care for up to 18 People with Dementia and up to 4 Persons with a Physical Disability. The Home is owned by Premedic Limited and the Manager is Mr. Graham Weekes. The Home is situated in the outskirts of Desborough close to local shops and the town’s amenities. The premises consist of a two storey main house with a bungalow annex for up to 6 Residents separated from the main building across a driveway. Residents are provided with single bedrooms with en suite facilities throughout the accommodation. Currently extensive building work is on going in the main house to provide an extension and major alterations to the existing main building. The Work has been considerably delayed and remains uncompleted despite the Commission’s expectation that it would be finished by April 2006. The Homes charges range from £400 per week for privately funded Residents. For Residents funded by Local Authorities the charges are £288. 45p per week
Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 5 for low dependency Residents, 331.60 for high dependency Residents and £348.55 for Residents with Physical Disability and Dementia care needs. In addition extra charges are made for Hairdressing and Chiropody services and newspapers. Any charges incurred for private Dentistry or Ophthalmic services are the responsibility of the Residents. Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for Residents and their views of the service provided. Inspection planning took one day and consisted of a full review of the Inspection record, requirements made, the Homes service history record including notifications of accidents, events and incidents, previous Residents and relatives comments received, the action plans submitted by the Provider and Manager and correspondence and contacts between the Commission and the Home. The information was collated and analysed to form the plan of inspection focusing on the outcomes for Residents. The primary method of inspection used was ‘case tracking’ which involved selecting three Residents and tracking the care they receive through review of their records, talking with them and the care staff. In addition five staff, one visiting Community Psychiatric Nurse and five Resident were spoken with to obtain their views. A full tour of the premises took place, a selection of records was inspected and observations made on care practices. Discussions were held with the Manager. The Inspection was unannounced and took place during the morning and afternoon over a period of seven and a half hours. What the service does well:
The Home has a stable staff group who demonstrated their commitment to the well being of their Residents. Staff turnover is low and this means that familiar staff are on hand to provide care for the Residents. Residents confirmed that they are aware of the home’s complaints procedure and are confident to raise any issues or concerns with staff or the Manager. Residents spoke very highly of the staff commenting that they were very caring, helpful and on hand and quickly responded to their needs. Residents commented and observations confirmed that relationships between themselves and the staff group were good. Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 7 Routines were relaxed and flexible and Residents had choice in how and where they wished to spend their time. Residents’ comments included “I can get up and go to bed when I wish.” “ I can spend my time in my room if I wish.” “If I don’t feel like going to the dining room I can have my meals in my room.” Observations confirmed that staff took care to protect Residents’ dignity and privacy by ensuring personal care tasks were carried out in private. Residents commented that staff took care to ease any embarrassment and make them comfortable when intimate tasks such as bathing were carried out. Residents’ records showed that they were encouraged to remain as independent as possible and do things for themselves. Care plan instructions reminded staff that Resident’s with Dementia must be consulted, involved in and assisted to make decisions such as choosing the clothes they wished to wear. Records and Residents comments showed that staff respond quickly to any changes in their health care needs and ensure that the relevant medical professionals visit them. They are enabled to receive their Doctors in private. Residents’ comments on the food provision were favourable. They felt that they were provided with a good range of meals, choices were available and the Catering staff were fully aware of their dietary needs and likes and dislikes. The serving of the midday meal was efficient and Residents were given help by staff where necessary to eat their meals. Records showed that weight is monitored and staff note daily nutritional intake to ensure any problems are quickly identified. Residents’ religious persuasions are respected and arrangements are made for them to receive visits from their relevant clergy in order that they may fulfil their religious observances. Despite the ongoing building and redecoration the standards of domestic and hygiene maintenance within the home were good. The systems for safekeeping Residents’ moneys, where necessary, were well maintained and receipts for items or services purchased by staff on behalf of Residents were carefully maintained. What has improved since the last inspection?
The reviewing of care plans has been increased to monthly but care needs to be taken to ensure that the individual plans are updated when changes occur and new instructions are provided for staff. The Manager has reviewed the staff recruitment processes and the two staff members’ files inspected showed that the necessary clearances and references had been obtained prior to staff commencing work and ensuring the protection of Residents.
Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 8 Protection of Vulnerable Adults training has been provided for all care staff since the last inspection. With one exception staff spoken with demonstrated their knowledge and understanding of the procedures to protect Residents from abuse. What they could do better:
Information given to Residents on the Home’s facilities and services in the form of the Statement and Purpose/Service User Guide should be reviewed to ensure prospective Residents are provided with all the information they need to make an informed decision on their possible placement and to meet the required Regulations. The revision of the assessment process is on going and attention needs to be paid to the risk assessments for areas such as skin care and nutrition, alongside a more in-depth approach to the assessment of Residents with Dementia care needs in order to ensure the home can meet the needs in full. The development of Residents care plans is ongoing; this was the subject of a previous requirement made in the last inspection report. Whilst some improvements were noted to the level of instruction on physical care needs areas such as emotional care and support and care for Residents with Dementia have not been developed The Manager must now ensure that all plans are revised to show a good level of instruction and guidance for staff on the areas of need and how the care and support is to be provided. Whilst overall the home’s medication system was in good order with records well maintained there was an instance of unsafe storage where a Resident selfmedicates. Lockable facilities had not been provided and medication had been left out in a Residents bedroom. Currently Residents are not provided with an activity programme and there is no provision for meaningful activities for Residents with Dementia who were observed to just sit or walk aimlessly about. It was clear that staff find time in the afternoons to converse with them but otherwise there was a lack of stimulation and occupation. This area was the subject of a previous requirement and must now be addressed to ensure that all Residents are provided with suitable opportunities for the promotion of their social needs and well being on both a group and individual basis. Training for staff should be undertaken in order that meaningful activities can be provide for Residents with Dementia. Serious concern is expressed on the failure to progress and complete the building works, which continues to detract from the appearance of the home and results in the potential for risk to the health and safety of Residents and staff. Potential risk issues were identified during the inspection for example a trip hazard resulting from the removal of floorboards by the Office, potential access to the first floor extension area by Residents, pipe work to the new
Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 9 boiler had not boxed in the kitchen of the Cottage annex and radiator covers removed for plumbing work had not been replaced. The Manager made arrangements for the issues to be resolved during the course of the inspection but must adopt a more proactive approach to check work completed to ensure the Health and Safety of Residents and staff. Not all previously identified maintenance and redecoration work had been addressed. 16 Residents bedrooms and/or en suite facilities and the home’s bathrooms and hallway still require redecoration and/or repair. The new alarm call system has not been installed despite an action plan stating this would be completed by the end of February 2006. The staff-training plan together with records of staff training were not available to demonstrate that training is appropriately undertaken and updated. Induction and Foundation training for staff is still limited and has not be revised in line with the Sector Skills Council’s guidelines and timescales. No progress has been made in enabling staff to undertake National Vocational Training to reach the minimum expected standard of 50 qualified staff. There are concerns regarding the failure of the Manager to address requirements made in the previous inspection report with regard to the development of Residents care plans, the Residents activity programme, staff supervision and training within the set timescales. He must now show commitment to developing the identified areas to demonstrate his on-going fitness for Registration. 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. Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 10 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 Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 11 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, 2, 3, 4 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The information provided to prospective Residents should now be reviewed and updated to ensure they are enabled to make an informed choice regarding their placement. The pre-admission assessment is not fully effective in ensuring that the needs of Residents admitted to the Home can be met. EVIDENCE: Prospective Residents and their relatives are given the home’s Statement of Purpose/Service Users guide including information on the home’s services and facilities. The Statement does not contain all the elements required by the Regulations and is in need of review. For example there was no reference to the organisational structure of the care home and the numbers, relevant qualifications and experience of staff working in the home. The admission criteria requires further development to clarify the range of physical disabilities, dementia conditions and behaviours that the home can provide for. There were no references to the arrangements made for contact between Residents and their relatives and friends other than a statement on visiting
Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 12 hours. There was no reference to the arrangements made for consultation with Residents about the operation of the home. Information on the room sizes and facilities was not fully detailed. The process for the reviewing of Residents’ care plans was incorrectly stated. Reference was made in the Statement to the home’s limitations on providing for some dietary and cultural needs, currently all Residents are of British origin. Prospective Residents are informed of the arrangements that can be made to enable them to pursue their religious needs. The Manager gave a commitment to the updating of the Statement/Service Users Guide to be forwarded to the Commission by the middle of May 2006. The admission process ensures that all prospective Residents are visited and assessed by the Manager and/or Deputy Manager from the home. Residents and their relatives have opportunities to visit the home to in order that they can discuss their needs further and are enabled to make an informed decision on the placement The Manager demonstrated that he is reviewing the assessment process in order to expand the information gathered on prospective Resident’s needs. The assessment record of one new Resident was reviewed and showed an overall good approach to identifying physical care needs though the use of recognised and specific assessment tools, such as Pressure and Nutritional assessments, has not yet been incorporated into the process to ensure that the level of risk is fully identified to enable strategies for the management of any risk to be developed. The assessment process for Residents with Dementia care needs remains limited. This is an on going area for development to identify the individual conditions and stages experienced by Residents and any resulting behaviours. It is important that this development is thorough in order that judgements can be made on whether the home is able to meet the needs of individuals in full. Information gathering on individual Life Histories is currently limited and specific and recognised assessment tools are not currently utilised to establish mental functioning abilities. The information is vital to ensure that new Residents are supported to settle and are assisted to manage their frustrations and anxieties and to develop where necessary strategies for the management of behaviours. The review of three Residents’ records demonstrated that that contracts are provided with copies maintained on individual Residents files. Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 13 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, &10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Care Plans do not detail all areas of need particularly those Residents with Dementia care needs. Detailed instruction and guidance on how the care is to be carried through is not thorough resulting in a risk that needs may not be met. EVIDENCE: Since the last inspection the Manager confirmed that there has been only limited progress in the development of Residents’ care plans and that the requirement timescale, set by the Commission, has not been met. Of the three care plans inspected only one showed further development. Physical needs were generally detailed although some elements of personal care were not documented for example hair, foot care and detailed continence management plans. Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 14 The timings for routines were not always detailed to guide staff on Residents preferred lifestyle preferences although Residents spoken with did confirmed that routines were relaxed and in keeping with their wishes. The plans showed that Residents are encouraged to do things for themselves and retain as much independence as possible. There were no references to the emotional support to be given to assist new Residents to settle into their placements. Whilst references were made in daily notes to Residents feeling “down” care plan instructions on how they were to be supported were not detailed. Individual Dementia care plans still have not been developed to guide staff on how to support Residents who suffer memory loss, anxiety and frustration. Strategies for the management of behaviours were not in place. There was no reference to Residents’ Mental capacity in relation to the management of their finances and no guidance for staff. This is particularly important for Residents with Dementia to ensure appropriate arrangements have been made to determine their abilities to have access and management of all or part of their finances or to the support required to assist them. It was clear from observations made and Residents’ comments that staff provide good basic care. However the continued lack of instructions on care plans, particularly for dementia care gives rise to the potential for areas of care to be missed and affect positive outcomes for the Residents. Further development work is needed to ensure a holistic approach and to develop Dementia care plans. Records showed that reviews of the care plans were carried out on a monthly basis. Discussions were held with the Manager on ensuring that any changes in need are fully recorded on the care plans with new instructions given to staff. Records and Residents comments showed that Staff responded quickly to any health care needs and referred concerns to relevant Medical and ancillary Medical Professionals such as Opticians and Chiropodists. Records of visits are maintained. Residents confirmed that they are enabled to receive visits from their medical professionals in private. A visiting Community Psychiatric Nurse commented that staff were quick to refer any concerns to him and seek advice and guidance. Observations confirmed that staff ensured the protection of Residents’ dignity and privacy by carrying through personal care tasks in private. Residents spoke very positively about staff taking care to put them at their ease when personal care tasks were carried through. The Home’s Medication system and records were in generally in good order. Storage in the main house was safe and appropriate. However in the bungalow annex a lockable facility had not been provided for a Resident who was selfmedicating and the medication was left out on a chest of drawers in the
Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 15 bedroom. The Manager immediately addressed the issue and agreed with the Resident that the medication would be stored in the Medication cupboard. Assurances were given that lockable facilities would be provided in future for Residents who are able to self medicate. The required incoming, administration and disposal records were well maintained and in good order. Protocols were in place and known to staff for the use of PRN Medications. Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 16 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service Residents are not provided with an activity programme and face long days without stimulation resulting in boredom and with the potential for developing depression. No progress has been made in developing meaningful activities for Residents with Dementia, which has the potential for an adverse effect on their behaviours as well as their well-being. . EVIDENCE: Residents confirmed that they had choice in where and how they wished to spend their time and that daily routines were relaxed and flexible and took account of their personal preferences including rising and going to bed times. Two Residents had chosen to lie in on the morning of inspection and were provided with a late breakfast when they got up. Residents commented that currently no activity programme was provided and whilst staff made time in the afternoons to sit and talk with them on an individual basis they had nothing to do. The Manager stated that a care staff member who used to provide activities on two days per week was no longer
Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 17 available to do so. He confirmed that he had failed to address a previous requirement to develop the programme. This is an area in need of urgent attention and development, in consultation with Residents, to ensure they are enabled and supported to pursue their hobbies and interests and enjoy both general and individual activities. Consideration should be given to developing 1 – 1 programmes and group activities taking account of appropriate sizes of groups. Attention must also be paid to developing meaningful activity programmes for Residents with Dementia taking account of their interests, preferences and abilities. Currently no programmes are in place to provide stimulation. One Resident was observed to walk aimlessly and constantly about and others were observed to just sit in lounges with no recourse to anything other than sleep. The Home has an open visiting policy and Residents confirmed that they are able to receive their visitors in private if they wish. Residents spoke very positively about the food provided. They felt that their likes and dislikes were respected, that they were given more than enough to eat and were provided with choice including additional alternatives to tempt their appetites. The midday meal was observed to be efficiently served and staff were on hand to assist residents with their meals where necessary. Food records were found to be in good order and systems are in place to ensure Residents’ nutritional intake is monitored at each meal. This together with Residents weight monitoring ensures that any problems will be promptly noted and acted upon. The current Kitchen was hygienically maintained. However little progress has been made to complete the building work and enable the transfer of the kitchen to new and more appropriately site kitchen facilities. Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 18 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The Home’s Complaints Procedure ensures that any complaints are listened to, investigated and acted upon. Training in the Protection of Vulnerable Adult procedures has been updated though some staff still do not have a clear understanding and this leads to the potential risk of abuse situations not being recognised and reported. EVIDENCE: The Home has a complaints procedure, which is made available to all Residents, their Relatives and Representatives. Residents spoken with felt they had confidence to raise any issues of concern with staff. A record of complaints is maintained. No complaints have been made to the Home or the Commission since the last inspection. Training for all staff in the Protection of Vulnerable Adults procedures has taken place since the last inspection. The responsibility for reporting any suspicions or allegations to the relevant Authorities lies with managerial staff. In discussions with three staff members it became apparent that one member of the care staff did not have an awareness and understanding of the procedures and could not give examples of the types of abuse. The Manager agreed to address this area with the staff member concerned but it is clear
Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 19 that regular updates on the procedures should be incorporated into to ensure the protection of residents and refresh staffs’ understanding. Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 20 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, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service The Providers action plans for the completion of the building and re-decoration work have not been carried through. The lack of progress continues to have an adverse effect on the running of and the appearance of the Home. The failure to install the new alarm call system poses potential health and safety risks to Residents, some of whom are not able to operate the existing fixed system to summon assistance. EVIDENCE: The Commission, in a meeting with the Company’s Responsible Individual on 24th January 2006, expressed serious concerns at the lack of progress in completing the building work to the extension of the Home, which has been ongoing for over three years, and to the overall redecoration and maintenance of the existing home. The Provider submitted an action plan in February with updated reports on progress in March 2006. There has been a slippage of the work carried through to the extension and the plan for the redecoration of the
Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 21 existing rooms has not been fulfilled despite assurances that this area would receive urgent attention. A full inspection of the premises was carried through. Safety fencing to the Residents garden area has been completed. A new entrance porch has been constructed enhancing the entrance area to the home. An alarm has been fitted to the door leading to the ground floor extension, to alert staff of any unauthorised access to that area. Access to the Home remains severely restricted through the front door entrance only. There is no safe access from the side of the home this area remains temporarily ramped. Building rubbish has not been cleared from the site and the extension remains far from completion on both the lower and upper floors. The new Kitchen and Laundry has still not been completed. Four areas of immediate concern were noted. Radiator covers have been installed in the cottage annex although it was noted that two covers had been removed due to recent plumbing work. The failure to re-fix the covers led to a potential risk to Residents from the hot surface temperatures. A new boiler had been installed in the cottage annex but there had been a failure to box in the pipe work next to the kitchen work surface leading to a potential risk to staff and Residents from contact with hot pipes. On the first floor area of the main building by the Office a section of floor boarding by the wall had been removed leaving a trip hazard to Residents or staff should they access this area. The door leading to the first floor extension in this area was not alarmed and there was potential for Residents to access the building works. The Manager had not noted these Health and Safety issues but took immediate action on the day of inspection to ensure the radiator covers were replaced and the boiler pipe work was boxed in. A gate to prevent access to the landing area by the office was constructed to eliminate the trip hazard. Redecoration work to the Lounges and corridors has been carried out but the entrance hall remains in need of full redecoration and re-carpeting. Limited attention has been paid to the redecoration of Residents’ bedrooms and en suites. However many en suites remained unfinished with plaster board in need of replacement, pipe work remaining exposed, holes in walls or ceilings have not been attended to. In total 16 bedrooms and/or en suite facilities still require attention. The existing bathrooms remain in need of redecoration. The requirement for the completion of the installation of the new alarm call system by the 28th February 2006 has not been met. Existing Residents’ en
Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 22 suite facilities do not have alarm pull cords. Alarms switches in Residents bedrooms are fixed and some Residents have difficulty in reaching them posing a potential risk to their health and safety. The new en-suite doors fitted in bedroom 8 require a magnetic catch to keep them closed. The guttering over the conservatory lounge area is broken. It was noted that melting snow escaping from the guttering created loud and irritating noises from falling water on the conservatory styled roof causing annoyance to Residents. This area was discussed by telephone call with the Responsible Individual as being in need of urgent repair. The staff are to be commended for the good levels of domestic and hygiene maintenance considering the difficult circumstances they are working in. Appropriate aids and specialist equipment are obtained where necessary for Residents with mobility needs. Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 23 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The revision of the home’s recruitment procedures now ensures that the required checks are undertaken for all potential staff and Residents are afforded protection. The Home was unable to demonstrate that staff are appropriately trained to meet their Residents needs. EVIDENCE: The Home has a stable staff group with sufficient numbers employed to maintain the rotas, there has been no need to employ any Agency staff and staff turnover is very low. Staff rotas indicated that four care staff are on duty on daytime shifts from 8am to 10pm, with a further carer deployed to the Cottage annex during those hours. Two waking Night staff provide night care in the main building with a sleeping in carer providing cover at the cottage annex. The Manager and Deputy Manager are on duty during the day from Monday to Friday. In addition the Home employs catering and domestic staff and a handyman. When the Manager, Deputy or Senior Carer is not on duty one care staff member is designated as Shift Leader. The Staff spoken with were viewed as dedicated, caring and committed to the well being of their Residents. Relationships and interaction between Residents
Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 24 and staff were observed to be very good. Residents stated staff were very supportive and responded quickly to their needs. Two staff records were inspected and found to be in good order. The records showed that the required Criminal Records Bureau Clearance had been obtained; in the case of a new staff member prior to employment and that two references had been obtained. There is no overall staff-training plan and records of training undertaken were in complete. This is an on-going area for development discussed with the Manager at the time of inspection. An induction programme is in place but the Manager acknowledged that the programme had still not been revised in accordance with the Sector Skills Council guidelines. This is an on-going area for development for both induction and foundation training to be reflect the Sector Skills Councils guidelines and timescales. A two-day training course in Dementia Care has been provided for approximately 22 managerial and care staff and a further course is arranged for May 2006 for the remaining staff. Care staff spoken with were positive in their comments on the training programme and demonstrated a fuller understanding of dementia conditions and needs. No progress has been made in securing National Vocational Training for staff. Currently only 5 care staff out of the 35 hold a qualification, this is well below the expected ratio of 50 . Staff training and particularly National Vocational Training is an ongoing area for development. Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 25 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, 32, 33, 35, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service The home’s own quality assurance processes are not effective in ensuring that the Regulations and standards are met and maintained and the Manager has failed to address his managerial responsibilities in relation to the care of his Residents. EVIDENCE: The Manager has a number of years experience in running a care home. He has commenced a National Vocational Training Course at level 4 which will update his skills and meet the minimum requirement for registered managers although he anticipates that the completion of the course will take a further 18 months. He has also undertaken a two-day training course to update his knowledge in modern Dementia care practice.
Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 26 Whilst it is clear that the Manager strives to run the Home in the best interests of the Residents the ongoing building work has distracted him from his managerial oversight and responsibilities. The inspection of the premises raised health and safety issues that had not been noted and addressed by the Manager as stated in the environment section of this report. Discussions were held with the Manager that on his responsibility for ensuring that areas currently used by the Residents are safely maintained. Discussions were also held with him on the failure to meet requirements made in the January report in relation to the development of Residents care plans, the Residents activity programme, staff supervision and training within the set timescales. It is acknowledged that the Manager has carried through other requirements regarding Dementia care training but he must now show commitment to developing the identified areas to demonstrate his on-going fitness for Registration. No requirement has been made in this report concerning the lack of progress however it is the intention of the Commission to discuss this area further with the Manager. Residents stated that the Manager was readily available to them on a daily basis and they felt that they could discuss any worries or concerns and would be assured of his attention. Staff confirmed that the Manager provided them with informal supervision and good support on an on going basis. However they stated, and the Manager acknowledged, that formal supervision was still not being carried through regularly. The systems for the management of Residents finances were inspected and found to be in good order. There is an audit system for moneys deposited for safekeeping and receipts were maintained for items or services purchased on behalf of Residents by staff. Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 27 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 2 3 3 2 3 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 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 2 3 3 2 2 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 3 2 X 2 Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 28 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 OP7 Regulation 15 (1) & (2) Requirement Residents care plans must be developed further to ensure all needs including Dementia care needs are fully recorded with detailed instructions for staff on how the care is to be carried through. Lockable facilities must be provider to ensure the safe storage of medication for Residents who self-medicate. The Activities programme must be developed to include meaningful activities for Residents with Dementia. The redecoration and maintenance programme for the 16 bedrooms, bathrooms and hallway must be completed. A staff training plan for the year 2006 must be submitted to the Commission detailing all training currently undertaking by staff and showing planned training and updates. Staff training records must be maintained
DS0000012786.V288910.R01.S.doc Timescale for action 31/05/06 2 OP9 13 (2) 20/04/06 3. OP12 16 (m) 31/05/06 4 OP19 23 (2) (b) & (d) 18(1) © 31/05/06 5 OP30 31/05/06 6 OP30 Schedule 2.4 31/05/06 Glenkindie Lodge Version 5.1 Page 29 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 OP3 Good Practice Recommendations The assessment process should reviewed to ensure a holistic approach to identifying needs with specific attention given to the assessment of Dementia care needs. The use of recognised risk assessment tools should be introduced as part of the Assessment and ongoing care plan reviews to identify and monitor areas such as Nutritional, Skin and Dementia care Risks. Consideration should be given to staff training in order that a suitable activity programme can be developed in general and specifically for Residents with Dementia. Consideration should be given to the development of the staff Induction and Foundation Training in line with the Sector Skills Council guidance and timescales. 2. OP3 3 4 OP12 OP30 Glenkindie Lodge DS0000012786.V288910.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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