Inspection on 19/07/06 for Howard Lodge

This inspection was carried out on 19th July 2006.

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

Howard Lodge 27/01/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Howard Lodge 5 Warren Road Purley Surrey CR8 1AF Lead Inspector Claire Taylor Key Unannounced Inspection 11:35 19th & 28th July 2006 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 Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Howard Lodge Address 5 Warren Road Purley Surrey CR8 1AF 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) 020 8668 1165 020 8763 9909 Mr Dineshbhai Patel Mr Divyakumar Patel, Ms Heena Patel Ms Heena Patel Care Home 21 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (21) of places Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow 5 specified service users in the Dementia (DE(E)) category to be accommodated. 27th January 2006 Date of last inspection Brief Description of the Service: Howard Lodge is a family run residential care home registered to provide personal care for up to twenty-one older people. A variation has been granted to allow the home to accommodate a maximum of five people over the age of 65 years who have additional dementia needs. The house is a large detached Edwardian property situated in a pleasant suburban area of Purley. The home is within easy walking distance of local shops, bus routes and a main line train station. The home consists of seventeen single occupancy bedrooms and two doubles, eleven of which have their own en-suite facilities. On the ground floor there are two spacious lounges, a conservatory and wood panelled dinning room. Sufficient numbers of suitably adapted bathroom and toilet facilities, including en-suites, are conveniently located near service users bedrooms and communal areas. The home has a separate kitchen, laundry facilities, two offices of which the manager uses one. The garden and patio area are well maintained and there is able space for parking vehicles in the front drive. Fees charged range from £435.00 to £500.00 per week and were accurate at the time of this inspection. Additional charges may be payable for some extras such as hairdressing, newspapers and chiropody but would be discussed prior to admission. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report is based on findings from two unannounced visits made to the home that lasted just over nine hours in total. In accordance with the Commission’s “Inspecting for Better Lives” programme, all of those standards considered to be key to the inspection process were assessed. There were 19 residents in the home and 2 vacancies. Time was spent meeting with residents to discuss what it is like to live at Howard Lodge. Discussions were held with some of the staff on duty and the manager who facilitated the inspection process. Various records were looked at in relation to care planning, staffing and the general operation of the home and a walk round the premises took place. Some information was taken from the questionnaire that the manager had filled in prior to the inspection. Eight relatives and seven residents kindly completed a questionnaire about the home. The Commission welcomes their comments as a valuable contribution to the inspection process. Some concerns regarding staff recruitment were identified during the first visit and as a consequence an official letter known as an “immediate requirement” was issued. This advised that the identified concerns must be put right within 7 days or enforcement action may be taken. A second unannounced visit was undertaken on the 28 July 2006 to check compliance and the registered manager had promptly taken the required action. What the service does well: Howard Lodge continues to provide good standards of quality care within welldecorated, pleasant and homely surroundings. The large conservatory is a popular feature which residents spoke favourably about. The home has a stable group of staff, most of who have worked at the home for some time and know the residents’ needs. They work well to ensure the well-being and comfort of the residents’ and treat them with great respect and kindness. All residents’ spoken with praised the care they received from the staff and said they were happy living at the home. Meals are well balanced and nicely presented and offer choice and variety for the residents. Residents complimented the food with one description of the meals as “Plentiful and well cooked.” The staff team manage the daily activities well and provide opportunities for residents to maintain their preferred interests and lifestyle. All the residents spoken with were pleased with the choice and variety of activities available. The home places a strong emphasis on monitoring the quality of care for its residents and the manager actively seeks the views of the people who live there as well as their representatives. Recent quality assurance surveys showed a high percentage of responses as “very satisfied”. Comment cards received by the Commission also contained complimentary remarks such as “ We were fortunate to find this ‘homely’ home for my mother that is one we can afford and that cares for her well. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Risk assessments covering key areas such as fall prevention for residents are well written and informative but they must be regularly updated to reflect any changed mobility needs. Although the home shows vigilance in its recruitment of staff, the manager must ensure that any future employees obtain a CRB and POVA check before they commence work. Three new staff had been working in the home without such checks which may place residents at risk if staff are not vetted correctly. The home’s recruitment procedures must therefore also be amended to ensure that all necessary checks are undertaken prior to the appointment of new staff. The hot water was running above the required temperature in the bathrooms and residents bedrooms. In addition, the records for weekly temperature checks were not up to date and residents’ hand basins are not fitted with taps that have thermostatic valves. This is required for the protection of residents from potential harm. Aside from these issues, Howard Lodge continues to be a well run home and the manager and staff team maintain high standards of care. Areas of good practice to consider are outlined as follows. Either the resident and/or their close relative should sign their care plan to evidence their involvement and verify that the details are a true record. It is suggested that healthcare records and correspondence relating to each resident’s needs are documented separately so that staff have a readily accessible summary of a person’s specific healthcare needs and issues. The induction pack for new staff could be slightly improved to include specific dates for staff to achieve key steps within the expected timescales. Some residents said that the new staff did not always understand what they said due to language differences. It may therefore benefit residents if the manager arranges for staff to access an appropriate education course when English is their second language. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 7 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. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 8 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 Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 9 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 and 5. Standard 6 is not applicable to this home as it does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. The home provides good clear written information about the facilities offered at the home and introduction opportunities for prospective service users and their families to make an informed choice about whether to live there. Residents’ needs are assessed prior to admission to ensure that the home can meet their needs and that staff are aware of how to support them. EVIDENCE: A detailed Statement of purpose and guide is in place, which sets out in detail the home’s aims and objectives, and the services and facilities provided. The documents had been recently updated to reflect the change in management at the home. Care records show that assessments take place before people move to the home and where appropriate, some also contained information, which had been provided by Social Services. Discussion with residents and care records indicated that the home was meeting their assessed needs. Prospective Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 10 residents are encouraged to visit the home prior to taking up residency. This was confirmed through the returned comment cards; one example read “ I received all the necessary information. The manager spent two hours with us when we first visited the home.” The manager or a senior staff undertakes the pre-admission assessment. This is usually completed with the resident, his/her relative or representative and if appropriate, any other relevant professional associated with the referral. Following the trial stay period, the manager evaluates a person’s care needs and writes a summary of outcomes. Correspondence letters are then sent to the resident’s relative or representative. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. Care planning remains well organised and regular informal reviews ensure that staff are aware of each residents’ current needs. Some mobility risk plans need further development to fully safeguard individual residents from potential harm. Residents are able to access care from additional services so that their healthcare needs continue to be met and can be confident that they will be treated respect and in a way that respects their privacy and dignity. The systems for the receipt, monitoring and administration of medicines, are robust and provide the necessary safeguards for residents. EVIDENCE: As well as those for the two newest people, the records for five residents who live at the home were looked at. They each contained a detailed care plan that was initially based on the pre-admission assessment and addresses the health, personal and social care needs of each resident. There were details about how staff should support them, and about where the person was independent in meeting their needs. All staff are trained to use the home’s computer which is used to store necessary information concerning the residents’ plans of care. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 12 The general care provided by staff to residents was seen to be sensitive and caring. Records were once again, well organised and held in accordance with the Data Protection Act. In response to the last inspection, updated care plan records are now printed off and kept on each resident’s file. Sampled plans showed that they are reviewed each month so that any changing needs are identified and appropriate amendments can be made. As good practice, either the resident or their close relative should sign the care plans to evidence their involvement and verify that the details are a true record. Residents are encouraged to maximise their mobility through walking and other gentle exercises. Falls are minimised through the use of risk assessments and individual guidelines although those for one resident were in need of updating. Records revealed that the person’s mobility had somewhat deteriorated and that they now used a wheelchair. The risk plan had not been reviewed to reflect these changed needs and there was no moving and handling assessment. This must therefore be addressed. The home retains close links with the local G.P. practice and a doctor visits the home each week to discuss any concerns or meet with individuals as needed. Residents have access to other NHS services as their needs so determine including optician, chiropody, hospital clinics and consultant psychiatrist for those individuals with dementia. Entries related to healthcare appointments are recorded in each resident’s progress notes although it would be good practice if healthcare records were written separately. This would then provide staff with an overall summary of a person’s specific healthcare needs and issues Nutritional records were in place such as monthly weight charts for residents and dietary guidelines for three individuals who have diabetes. As well as the bedrooms, there are suitable areas in the home for residents to meet their visitors in private if they wish. Residents spoken to confirmed that staff were respectful and ensured their privacy and dignity. Procedures and practices regarding residents’ medication remain well managed by the home. The home uses a monitored dosage system, supplied by “Boots” chemist. Medication records were sampled as accurate and corresponded with the residents’ individual prescriptions. Records confirmed that the manager and staff are trained to administer medication, having completed a course run by Boots. The pharmacist visited in February 2006 to complete an audit of the procedures and medication practices. Some areas were identified for attention including a recommendation to attach residents’ photos to the administration charts. The manager acknowledged that this had yet to be addressed. As good practice, the manager carries out an in house medication audit each week to ensure safe practice is maximised. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. The home offers a range of opportunities for recreational and social activity that matches the residents’ social, cultural and religious needs. Residents are fully supported to maintain contact with family and friends and visitors are welcomed to the home. Wherever possible, residents are able to exercise choice and control in their day-to-day routines, and receive appropriate support from staff to achieve this. The meals provide a balanced diet, choice, interest and variation for the residents. EVIDENCE: Care plans included details of the residents’ social needs and preferred lifestyles. Activities for residents are mostly offered during the mornings and include bingo, quizzes, gentle exercise sessions and reminiscence therapy. Records are kept of the activities that residents take part in and monthly meetings are also held for residents to discuss issues. During the first inspection, representatives from a local church were visiting and residents were joining in with singing hymns with an accompanying pianist. Residents’ religious needs and beliefs are catered for and some individuals confirmed that they are supported to attend church or as their faith so determines. The manager and staff enable good communication links with relatives, friends and Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 14 visitors. This was reflected within the returned comment cards and relatives feel very involved with the home as well as being able to contribute to its operation. Relatives were seen popping in during the course of the visits and being welcomed by staff. One relative said, “I am very happy with the home and the manager is very good”. The daily menu is displayed clearly on a notice board and staff ask residents each day for their choices. Residents confirmed this and were complimentary about the good quality meals at the home. One written comment card stated, “Plentiful and well cooked.” Drinks are provided when required and snacks can be obtained upon request. Staff readily offered hot and cold drinks throughout the day. Food is served in the communal dining room, or in the resident’s own room. Records are kept of food provided for the residents and special diets are catered for according to identified needs. e.g. diabetic foods for three residents. Menus seen indicated that residents are provided with a variety of nutritious foods that offers a balanced diet and meets their chosen preferences. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. There is a clear and accessible complaints procedure and the style of management enables residents to express their concerns or queries. The home’s practices generally protect residents although the vetting of employees must be improved to ensure that people living in the home are more fully protected. EVIDENCE: The home has a detailed complaints procedure that is well displayed and all residents have access to a copy. A book is kept in the home to log both formal and informal complaints and concerns. Residents stated that if they were not happy about anything they would speak to the manager. Visiting relatives and residents spoken to express a confidence that any concerns would be dealt with promptly. Comment cards also confirmed that residents and relatives were aware of the complaints process and there were no concerns. There are numerous organisational policies to safeguard the residents welfare e.g. management of their finances, dealing with abuse and a whistle blowing policy to state what action to take should staff suspect anything untoward. The majority of staff have attended an adult protection training course or undergone abuse awareness through the home’s induction programme. Staff files examined indicated that the home had not undertaken all the necessary recruitment checks to ensure the protection of residents. Neither POVA First nor Criminal Records Bureau checks were available for three newly appointed staff members. This issue has been discussed in further detail under staffing standards. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. Once again, Howard Lodge appeared well maintained, decorated and furnished to high standards enabling residents to live in clean, safe and comfortable surroundings. Residents’ bedrooms appeared comfortable and pleasantly decorated, reflecting their personal identities, and being suited to their individual needs. Overall the homes health and safety arrangements are adequate to protect residents and staff from avoidable harm although the hot water supply must be adjusted to the required temperature as a further safeguard. EVIDENCE: The home remains well maintained and furnished to very comfortable standards. The living accommodation is well decorated and homely. The large conservatory is a popular feature of which residents spoke favourably about. Since the last inspection, improvements have been made to the front garden which, weather permitting, is regularly used by the residents. Various Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 17 flowerbeds and shrubs have been planted and some large conifer trees removed. For safety reasons, the rear garden is not currently accessible to residents due to its steep access / layout of the steps. The area had been tidied however as many of the bedrooms overlook the rear garden and residents now have a more attractive view. Ms Patel explained that there were future plans to carry out work in the rear garden so that residents would be able to access it. Some of the bedrooms were viewed with the permission of residents. They appeared comfortably furnished and decorated to a high standard. Residents have personalised their rooms as they so choose with family photographs and other personal possessions. Individuals can bring their own furniture into the home if they wish. Time was spent with one resident in her room who said that the staff were very helpful and that her room was always kept clean. One area of concern was identified in that the hot water was running at a temperature which exceeds the recommended safe limit of 43 degrees Celsius. The registered manager must therefore ensure that the hot water supply for hand basins, baths and showers is maintained at the correct temperature. Aside from this issue, the premises presented as very clean and free from malodour with good standards of hygiene practice well observed. Residents also confirmed that the home was kept clean and tidy. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. There is a stable staff team who understand and respect the needs of the elderly people living there. Training for staff is well managed and they are provided with good training opportunities to do their jobs effectively. The procedures for the recruitment of staff are not robust and need improving to offer full protection to people living in the home. EVIDENCE: Staff allocation was checked on the home’s rotas and showed that adequate numbers of staff are in place for meeting the current residents needs. There is three to four care staff in the mornings, including a senior, three care staff in the afternoon and two waking night staff. The staff team remain largely unchanged resulting in consistency and familiarity for the people who live there. The manager reported that the home had one vacancy for a cleaner. Staff were undertaking domestic duties until the post is filled. One resident commented that there had been some changes in staffing but ‘the care is generally still good’. Five staff files were sampled on this occasion. On the whole, the home’s recruitment practices are generally well managed, although one area of concern was identified during this inspection. No POVA First check or CRB disclosure was available for three staff who had already started working in the home within the last three months. If staff are not vetted correctly this could potentially place residents at risk. An immediate requirement was therefore Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 19 issued with a follow up visit undertaken on the 28 July to check compliance. Evidence was seen that the manager had promptly taken the required action and implemented measures to ensure the correct supervision of the three identified staff. This is because staff must not work unsupervised until the owner is in receipt of an approved CRB/ POVA check and all necessary checks and documentation have been put in place. Aside from this, staff files contained the necessary documentation and records required by regulation. The three new staff who are all from overseas were employed through a recruitment agency and the necessary paperwork was in place including evidence of work permits. All new staff members undergo an induction programme. This includes training on the principles of care, safe working practices, worker role and the experiences and needs of older people. As good practice, the induction pack should identify specific target dates for staff to achieve the steps. This will then show more clearly how new staff are orientated to the home within the expected timescales. The manager keeps records which show what training courses staff have done, and when they did them. The staff team have a wide range of experience and knowledge and the majority of residents spoke positively about them, particularly the longstanding staff members. Some residents did feel however that the new staff did not always understand what they said. They felt that this was due to a language problem and remarked, “The new staff do not speak very good English.” It is therefore recommended that the manager arranges for staff to access an appropriate education course when English is their second language. The staff team does generally reflect the resident group however, most of who are from a White British background. Certificates showed that training undertaken since the last inspection has included medication and fire safety. There is an ongoing training programme for staff to refresh their knowledge as needed and attend mandatory courses such as moving and handling, first aid and infection control. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. The manager has relevant qualifications and demonstrates good management practice to run this home. Systems have been improved upon to ensure that quality of care is regularly appraised so that the home is run in the best interests of the residents. The home’s financial procedures are thorough and protect the interests of the residents. Overall, health and safety practices ensure that residents live in a safe environment although full hot water temperature checks need to be carried out as a further safeguard. EVIDENCE: Ms Patel took over management of the home six months ago and continues to run the home in a professional and efficient manner. Certificates and training records were in place. She has successfully completed her NVQ level 4 in Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 21 management and gained relevant experience, skills and knowledge in caring for older people. Relatives and staff stated that the manager is good at her job, approachable and one resident wrote “I am very happy that I can speak to management at any time about anything” It was also evident that she offers clear leadership, guidance and direction to staff. Staff spoken to felt confident that they could express their views about the home’s operation. In response to the previous requirement, residents and their relatives were given satisfaction surveys in February of this year. An audit of the care was compiled into a report and made available for residents and relatives to read. The report contained a high percentage of “very satisfied” responses and there were no negative comments noted. The manager actively welcomes feedback from visitors and ensures that regular residents meetings take place to ensure that they feel part of the home they live in. The manager has therefore improved upon the systems in place for monitoring the care provided at the home for which she is commended. The home does not take any financial responsibility for any of the current residents. All of them have relatives to manage their affairs. The manager does not oversee the payment/administration of any benefits or other financial transactions for residents (with the obvious exception of fees). The home was found to be well maintained and, generally, to promote a safe environment. A sample of health and safety practices and procedures were checked including fire records, accidents and incident records, staff training, risk assessments and gas/ electrical safety which were all satisfactory. The regulatory records were also checked with no requirements outstanding from either the Fire or Environmental Health departments. Records showed that fire training for staff was held in August 2006. One shortfall was identified concerning health and safety. Hot water outlets throughout the home are not thermostatically controlled to reduce the risk of burns and scalds. In addition the records for weekly hot water temperature checks had not been completed since May 2006. This is required for the protection of residents from potential harm. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 22 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 3 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 17 X 18 3 3 X X X X 3 2 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 13(4)(5) Requirement Risk assessments regarding the prevention of falls for residents must be reviewed as and when mobility needs change. The registered provider must ensure that the hot water supply for hand basins, baths and showers for the use of residents is maintained at a temperature of 43 degrees Celsius. The registered provider must ensure that staff identified at this inspection have applied for a CRB disclosure and have a POVA first check in place by 25/07/06 Immediate requirement issued on 19/07/06 and complied with within given timescale. Timescale for action 30/09/06 2. OP25 13(4) 23(2)(j) 30/09/06 3. OP29 13 (4 c) 18(1) Sch. 2 & 4(6) 25/07/06 4. OP29 13(6) 17(2) 19(4 & 5) The home’s recruitment policy 30/09/06 and practices must be reviewed and rewritten to ensure that all necessary checks are undertaken prior to the appointment of new staff. Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 24 5. OP38 13(4) 23(2 c, j) Hot water temperature checks on all hand basins, baths and showers must be carried out on a regular basis with records maintained. 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The manager should ensure that the resident, wherever capable, and/or relative/ representative signs their care plan. Records and correspondence relating to each resident’s healthcare needs should be documented separately. The manager arranges for staff to access an appropriate education course when English is their second language so that communication with residents is more fully enhanced. The induction pack should identify specific target dates for staff to achieve the steps. This will then show more clearly how new staff are orientated to the home within the expected timescales. The fitting of thermostatic valves to all hot water outlets to which residents have access. 2. 3. OP8 OP27 4. OP30 5. OP38 Howard Lodge DS0000066326.V302860.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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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