CARE HOMES FOR OLDER PEOPLE
Howard Lodge 5 Warren Road Purley Surrey CR8 1AF Lead Inspector
Claire Taylor Unannounced Inspection 27th January 2006 09:40 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.V281288.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. Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 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.V281288.R01.S.doc Version 5.1 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. 7 September 2005 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 one is used by the manager. The garden and patio area are well maintained and there is able space for parking vehicles in the front drive. Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection, the home’s second for the year and lasted five and a half hours. Inspection time was spent talking to several residents and staff, one visiting relative and therapist and the new manager, Heena Patel, who facilitated most of the inspection. Time was spent with residents in the lounge, conservatory and in their own rooms. They are all thanked for their time and assistance. A brief walk round the premises took place and various records were checked in relation to residents’ plans of care the home’s operation and previous requirements/ recommendations. All key standards were assessed at the home’s last inspection in September 2005 and the reader is therefore referred to that report should they require any further information. What the service does well:
As at previous inspections, Howard Lodge continues to maintain good standards of care for its residents. The home remains furnished to an excellent standard and offers attractive and homely surroundings for the people who live there. Spacious communal areas are available that are in meeting with the residents needs. Facilities are clean, safe and well maintained. Pre-admission assessments are undertaken to ensure that the home only admits residents whose care needs can be met appropriately. Care planning is well organised to ensure that residents’ needs are addressed and met. Residents are consulted about the care they receive and spoke confidently and positively about the services provided. Comments included “ I am very well looked after” “the staff are very good and go out of their way to help”. Residents were particularly complimentary about the good food provided. Systems are in place for supporting residents to exercise choice and control over their lives. A wide range of social and recreational activities is available including discussion groups, gentle exercise sessions, massage, bingo, quizzes, reminiscence and singing. Staff are well trained in the work they perform, have valuable skills and experience meaning that residents’ needs are therefore well understood. In addition, the majority of staff have worked for many years in the home enabling good continuity of care and familiarity for the people who live there. Staff went about their duties in a calm and efficient way and spoke to residents in a caring and respectful manner. Good systems are in place to promote and protect the health, safety and welfare of people living and working in the home. Recruitment practices are well managed to ensure that residents are protected from staff who should not be working with vulnerable people. Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. Standard 6 is not applicable to this home as it does not provide intermediate care. Residents and their representatives are given the necessary information in advance of admission to ensure they are able to make an informed choice. The home carries out pre-admission assessments, ensuring that residents are appropriately placed and therefore receive the care that meets their needs. EVIDENCE: The new manager has rewritten the statement of purpose and residents guide to reflect the changes in the staffing structure and ownership at the home. Prospective residents are invited to visit the home and to meet other people living in the home and the staff team. The resident and his/her relatives are fully involved in the process leading up to an admission, and given the opportunity to fully assess the suitability of the home. During this inspection, the manager showed two visitors around who were viewing the home on behalf of their relative. Pre-admission assessments are comprehensive and form the basis for care planning, which is reviewed regularly and documentation remains well kept. Four residents had been admitted to the home since the last inspection. Their records were checked and needs assessments had been
Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 9 completed. These assessments help to ensure that the home only admits residents whose care needs can be met appropriately. Discussion with residents, staff, the manager and inspection of care records indicated that the care and accommodation provided at the home was meeting the residents’ assessed needs. Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 Residents’ care and health needs are identified and reviewed regularly so that they continue to be met and they are able to access care from additional healthcare services. Up to date written records also need to be available to residents and staff however as the home uses a computer for record keeping. Standards 9 and 10 were assessed as met at the September 2005 inspection. EVIDENCE: All staff are trained to use the home’s computer which is used to store necessary information concerning the residents’ plans of care. Records were sampled and well organised and held in accordance with the Data Protection Act. Residents care plans are reviewed each month so that any changing needs are identified and appropriate amendments can be made. These records must be made available to staff and residents in written format however. I.e. Each resident has a file which contains written copies of their care plans as well as other important information about individual preferences and personal history. Some were not fully up to date however and are in need of review. The manager is therefore required to ensure that residents’ files contain all documentation as listed in schedule 3 of the Care Homes Regulations 2001. Records confirmed that the staff team monitor health needs to a very good standard and ensure that residents’ psychological needs are reviewed
Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 11 regularly. The home maintains 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 are weighed on a monthly basis and appropriate records maintained. In addition, each person’s nutritional needs are clearly outlined within the care plan to ensure that staff know what support they require with eating or if a resident has particular dietary guidelines. Service users are encouraged to maximise their mobility through walking and other gentle exercises. Falls are minimised through the use of risk assessments and individual guidelines. As previously recommended, records were not available for one resident’s treatment of leg ulcers. Although the home has made efforts to obtain a copy of the treatment plan, this information should be available in the home as it forms part of the individual’s plan of care. The manager should therefore address this again with the relevant district nurse team. Residents spoke highly of the staff team and standards of care provided at Howard Lodge. Care records indicated that residents are consulted about the care that they receive. Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 The home arranges a wide range of activities which enhance the lives of its residents. Meals are nutritiously balanced and offer a healthy and varied diet for the people who live there. Standards 13 and 14 were assessed as met at the September 2005 inspection. EVIDENCE: Residents preferred social and leisure interests are recorded in their care plans and records kept to show what activities are undertaken. The home has a part time activities coordinator employed although the manager advised that the staff was due to leave soon. A notice board in the hall displays up to date information about activities and social events/ functions. The home arranges for residents to have their newspapers delivered daily as they so choose. Activities provided include discussion groups, gentle exercise sessions, massage, bingo, quizzes, reminiscence and singing. Residents and relevant family members are encouraged to fill in life history sheets so that they can be used for reminiscence therapy. A hairdresser visits weekly and several residents said they look forward to her coming. Entertainers visit the home including a musician who plays the home’s piano. Individuals have the opportunity to participate in Holy Communion as their faith so determines. Menus are varied, balanced and provided extensive choice. Staff served and assisted residents appropriately and sensitively with their lunch on the day of inspection. Residents spoke very positively in respect of the food provided at
Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 13 the home, flexibility of meal times and choice of meals provided. Comments included ‘ the food is very good here’, ‘I can choose something else to eat if I don’t like what is on the menu’. Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 An appropriate complaints procedure is in place to ensure that the views of residents, their families and friends are listened to and acted upon. Standard 18 was assessed as met at the September 2005 inspection. EVIDENCE: There are policies and procedures in place for dealing with complaints and copies are accessible to residents, relatives and other parties. Information is made available in the Service User Guide about how a compliant, concern or suggestion should be made, and how this will be handled. Having spoken with residents, it was clear that people who live in the home have great confidence that their concerns would be dealt with. A record book is kept and no complaints have been made either to the home or to the Commission for Social Care Inspection since the last inspection or within the last twelve months. It is recommended that the complaint log form be revised for better clarity i.e. the date; nature of complaint; outcome and action taken should be specified. Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Howard Lodge is maintained, decorated and furnished to high standards enabling residents to live in clean, safe and comfortable surroundings. Bedrooms are comfortable and pleasantly decorated, reflecting residents’ personal identities, and being suited to their individual needs. EVIDENCE: The home is kept clean, very well maintained and provides residents with a comfortable and homely environment in which to live. The standard of décor and furnishings appears attractive and homely and in meeting with the residents needs. Residents have the choice of two lounges that are homely and well furnished with an assortment of armchairs. The conservatory area is a particularly nice feature and very popular with the residents. Since the last inspection, the premises has been inspected by the local fire authority (October 2005) and found to be satisfactory. 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
Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 16 spent with one resident in her room who said that the staff were very helpful and that her room was always kept clean. Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 There is a well-established staff team who understand the needs of the elderly people living there. Staff receive good training opportunities so that they have the skills and knowledge to meet residents’ needs. Robust recruitment procedures are in place to ensure that residents are cared for and protected. EVIDENCE: Staff provision allows for three carers to be on morning duty, three in the afternoon with two waking staff at night. The manager or deputy manager is also available during the day. These levels are in meeting with current guidance for the current resident group. Valuably, staff turnover remains low and most of the staff have worked in the home for many years. This means that residents benefit from a stability and consistency of care. Nine staff have trained and achieved the qualification of NVQ level 2 in care. This easily meets the required target set by the National Minimum Standards for 50 of the staff team to be trained to this level. The manager advised that two staff are currently studying for their NVQ level 3 qualification. The manager reported that the home had one vacancy for a cleaner. Staff were undertaking domestic duties until the post is filled. Four staff files were sampled on this occasion. Records confirmed that the home’s recruitment practices are robust to ensure that residents are protected from people who should not be working there. Staff have provided the necessary documentation and undergone the appropriate checks before commencing work. This included the completion of a police CRB and POVA check. A training programme is available that provides a variety of courses for staff to update their skills and knowledge along with
Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 18 recognition of mandatory training that they must attend. Records showed that staff have received appropriate specialist training that is in meeting with the residents’ needs. I.e. on Dementia and diabetes. There has been recent training in fire safety and moving and handling since the last inspection. Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 There is a new manager who has relevant qualifications and a good leadership approach to continue to run the home in the best interests of the residents. The home’s financial procedures are thorough and protect the interests of the residents. Based on residents’ views, the home still needs to develop its quality monitoring systems further to show how they intend to make positive changes and monitor quality of care. Good systems are in place to promote and protect the health, safety and welfare of people living and working in the home. EVIDENCE: Howard Lodge had recently undergone changes to the ownership and management structure at the time of this inspection. The newly registered manager, Miss Heena Patel, has completed the required NVQ level 4 management qualification and has acquired valuable experience in the care of older people. She had previously worked at the home as a care assistant in 1999 and therefore has a good knowledge of the home’s operation. Despite a natural apprehension of new ownership, staff members spoke positively about
Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 20 the transition and felt well supported. This was also reflected by the low turnover of staff in the home and continued stability of the running of the home. The new manager has also remained in close liaison with the previous one to ensure that good standards of care are maintained for the people who live there. 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). Some quality assurance systems are in place to ensure that the home regularly appraises its care practices. As well as regular care plan reviews, regular meetings (coffee mornings) are held where the residents have an opportunity to discuss issues and contribute to the home’s operation. Environment checks are carried out to ensure that the home and facilities are kept in a good state of repair. The home is required however to offer satisfaction questionnaires to residents, relatives and other parties to gain feedback with regards to the home and its services. Such surveys form an important part of quality monitoring and findings should be used to structure the home’s overall annual plan that includes their input. The home was once again found to be well maintained and, generally, to promote a safe environment. Previous inspection requirements (September 2005) had been addressed. Staff have undergone fire safety training and a policy and risk assessment has been put in place regarding the security of the front door. Other servicing and maintenance records for the home were checked at the last inspection and up to date. Therefore only a sample of health and safety records was checked at this inspection. Fire drills are appropriately organised and fire alarms and equipment checked at regular intervals. Accidents and incidents are documented appropriately. Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 17(1)(a) Requirement The registered manager must ensure that all the necessary written records pertaining to the residents are kept on their files i.e. in accordance with Schedule 3 of the Care Homes Regulations 2001. The manager must seek the views of residents, their family members / representatives and other interested parties to ensure that the home is meeting its aims, objectives and stated purpose. Results of these surveys must be made available in the home. Timescale for action 30/04/06 2. OP33 24 30/04/06 Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations A copy of the care plan for one residents treatment of leg ulcers should be available in the home. The manager should obtain a copy from the district nurse team. (Repeated from September 2005 inspection) That the complaint log form be revised for better clarity i.e. the date; nature of complaint; outcome and action taken should be specified. 2. OP16 Howard Lodge DS0000066326.V281288.R01.S.doc Version 5.1 Page 24 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
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