Inspection on 01/06/05 for Ireland Lodge

This inspection was carried out on 1st June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ireland Lodge 18/06/09

Ireland Lodge 31/07/08

Ireland Lodge 18/09/07

Ireland Lodge 20/06/06

Ireland Lodge 30/01/06

Ireland Lodge 24/01/05

Ireland Lodge 08/06/04

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

CARE HOMES FOR OLDER PEOPLE Ireland Lodge Lockwood Crescent Woodingdean Brighton BN1 6UH Lead Inspector James Houston Unannounced 1 June 2005 9:00 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 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. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Ireland Lodge Address Lockwood Crescent Woodingdean Brighton East Sussex BN1 6UH 01273 296120 01273 296145 None Brighton & Hove City Council Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant Care Home 23 Category(ies) of Dementia - over 65 years of age (DE(E)), 23 registration, with number of places Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1 The number of service users must not exceed twenty-three (23). 2 Service users must have a dementia-type illness. 3 Service users must be over sixty-five (65) years of age on admission. 4 That one named day centre service user may be accommodated in communal areas between 15:30 and 19:00, taking the registered numbers to twenty-four (24) for part of each day. 5 That a named service user may be accommodated (who is under sixty-five (65) years) for rolling respite care. Date of last inspection 24 January 2005 Brief Description of the Service: Ireland Lodge is registered to provide accomodation and personal care for 23 older people with dementia. The registered provider is Brighton and Hove City Council. The responsible individual is Terry DSouza. The acting manager is Louisa Young. Ireland Lodge is located in Woodingdean with access to transport and local amenities. The home is single storey and has 23 single rooms with en-suite facilities. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the morning and afternoon of the first of June 2005. Before the inspection papers held by the Commission for Social Care Inspection were read, and those standards to be assessed prepared. The inspection in the home took 7.9 hours. A tour was made of the whole home, and the manager, ten residents, a visiting relative and seven staff were spoken to. What the service does well: What has improved since the last inspection? What they could do better: The provider has not ensured since the last inspection that all staff that deal with infection control situations have received appropriate training. The number of permanent staff on duty during the inspection was still low. Further improvements to the quality assurance system need to be made. The medication administration record sheets were not fully kept. Some staff need training in first aid. Some staff need training in adult protection. Paintwork in the inner courtyard around the middle garden needs attention. Gardening items in the shed there could be removed, as the shed is not secured. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 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 standard(s) 1,3,5, and 6. The home’s statement of purpose and service users’ guide offer full information to prospective residents and their representatives to assist them in deciding whether or not to enter the home. The home fully assesses prospective new residents. Prospective residents and/or their representatives visit the home before coming in, in order to assist with the decision with admission. Intermediate care is not provided. EVIDENCE: The home’s statement of purpose and service users’ guide have been amended since the last inspection and now contain the required information. Records inspected showed that the home obtains a copy of a care management assessment where this exists, and also conducts its own detailed needs assessment. The manager said that residents visit the home before coming to live there. A senior member of staff also visits prospective residents in their own home or where they then are (eg in hospital) before they come in. Admission initially is for a trial period. Emergency admissions are made from time to time especially into one of the five respite beds that the home has. Intermediate care is not offered. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 9 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 standard(s) 7,9,10,and 11. The plans of care are detailed and comprehensive. The medication administration records are not correctly completed. Residents are treated with respect and dignity. The home is working to ensure that its guidance on how to deal with death and dying residents is appropriate and accessible to staff so that they know how to act in these situations. EVIDENCE: The home has taken action to improve residents’ records. Plans of care checked were comprehensive and up to date. Plans of care and risk assessments inspected were found to be regularly reviewed. Update sheets were found to be up to date and appropriately completed. None of the home’s residents self-administer their drugs. No controlled medication is held at present for residents, although the facility to do so exists. The home has a pharmacist who visits and gives advice on the home’s systems. Staff spoken with said that they have had relevant training and the records inspected confirmed this. The record of drugs administered contained several errors. There were several gaps at different times and on different days where it was not clear whether drugs had been administered or not. Entries had been made on the record giving a code meaning that the reason for Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 10 non-administration had been entered elsewhere on the form, when this had in fact not been done. Staff said that they treat residents with dignity and respect their privacy. Those interactions between staff and residents observed during the inspection confirmed this. The home’s philosophy is for residents to remain in the home for as long as possible, with support from healthcare professionals. At the last inspection not all the relevant information re the home’s policies on death and dying could be easily located. The manager is working on revising the documentation, and has raised the topic at a staff meeting. Minutes inspected confirmed this. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 11 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 standard(s) 13 and 15. Visitors to the home are made welcome. Meals provide daily interest and activity for people living in the home. EVIDENCE: The home’s information to relatives and friends sets out clearly that visitors are welcome. Staff said that welcoming friends and family is an important part of their role and that they greet visitors and offer a cup of tea. Residents said that they like the food served in the home. Staff said that residents are given choices. The mealtime observed showed that food was attractively presented and in ample portions. Staff said that they have more time to give discreet assistance at mealtimes to residents who need it since an additional staff member has been put on duty recently to meet the high care needs of a group of residents. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 12 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 standard(s) 16 and 18. The home has a suitable complaints procedure. Attention to some paperwork re investigations is indicated. The home’s processes and procedures should protect residents in the event of any abuse or allegation of abuse. Some staff need an update in relevant training. EVIDENCE: The home has an appropriate complaints procedure made available to residents and their families. Records inspected showed the home has dealt thoroughly with complaints made to it, but in one case the home’s internal monitoring form as to whether or not a complaint had been upheld or not had not been completed. The Commission for Social Care Inspection has received no complaints about the home since the last inspection. The home has suitable adult protection and whistle-blowing procedures. A possible adult protection issue was handled appropriately by the home. The procedures were invoked, and after due consideration the matters were dealt with by another route. Not all staff have had recent relevant training and this should be addressed. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 13 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 standard(s) 19,20, 24 and 26 The home provides a good quality of accommodation. Paintwork in the middle garden courtyard requires attention. Communal areas and bedrooms are to a good standard. The premises are kept clean and hygienic. Some staff need training in infection control. EVIDENCE: The location and layout of the home are suitable for its stated purpose. The home is all at ground floor level, and shares the site with a day centre. The home is in general well maintained. Attention is required to paintwork in the inner courtyard around the middle garden. There is a system for addressing items needing attention. The home has three lounge/diners with a kitchenette in different parts of the home. One has a conservatory. These are well furnished and decorated. Lighting is domestic in style. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 14 All of the bedrooms are for single occupancy and with en-suite facilities. They are furnished and decorated to a good standard and residents said that they like their rooms. Where residents do not want to hold a key to their room this is recorded in their care plan. All areas of the home were observed to be clean and hygienic, with a good standard of odour management in place. The laundry is sited away from food preparation areas and is well equipped. Clinical waste is now stored appropriately and easily identified so that it may be disposed of safely. The manager confirmed that not all staff have undergone training in infection control. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The home has sufficient staff numbers at present, but the reliance on relief and agency staff remains high, affecting adversely the continuity of care offered to residents. Training for staff remains difficult to organise, with so many staff that work for agencies or the provider’s relief staff team. EVIDENCE: A requirement had been made at the last inspection that the provider must take action to increase the level of permanent staff employed at the home. The provider has recruited to the home’s vacant posts and three staff will start shortly, leaving one post to be recruited to. However staff absences have meant that the use of agency and relief staff has had to continue at a high level. The manager and these staff said that the home tries to get familiar staff. The manager said that she has not had to use agency staff at night since the last inspection. However there is an effect on the morale of permanent staff. An extra staff member has been deployed during the working day in the last few weeks to meet the needs of a small highly dependent group of residents. The requirement regarding staffing has been repeated. The inspector at the last inspection had recommended that the manager review the way that training records are maintained to clarify what training each staff member has had. This process has been started, but further work is required. The use of relief staff that also often work elsewhere for the same provider that means provision of some core training such as adult protection training for some relief staff may be needed. The home offers induction training for new staff and records inspected confirmed this. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31.32.33, 35, 36 37 and 38. The manager is experienced and competent. The management approach of the home creates an open atmosphere for residents but the high use of agency and relief staff affects staff morale. The home needs to further develop its quality assurance processes. The monies handled on behalf of residents are fully accounted for. Permanent and relief staff receive regular supervision. Records are generally well kept. The home ensures as far as is reasonably practicable the welfare of staff and residents. First aid training needs to be provided for some staff. EVIDENCE: The acting manager has been confirmed in post and is seeking registration with the Commission for Social Care Inspection as registered manager. The manager has considerable relevant experience and is undertaking relevant training to update her skills and knowledge. She hopes to complete the registered managers award by later in 2005. She has a suitable job description. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 17 Residents and a relative said that staff are approachable. Staff said that they consider the management approach in the home to be open and supportive. There is a structured programme of staff meetings, including meetings of the whole team and separate meetings for specific groups. These were made available to the inspector. Staff said that the high levels of use of agency and relief staff have affected morale. The manager reviewed the strategies she has adopted to address these issues, including spending more time on the floor with residents and staff. The home has some quality assurance systems in place. The manager said that residents or relatives have not used a form in the service users guide inviting feedback about the service. The home recently had a residents meeting, and the minutes were made available to the inspector. The home has not sought feedback formally from stakeholders as recommended by the standard. The home holds small sums of money for residents. Those systems checked were well maintained and two balances of monies held for residents on respite care stays tallied exactly with the written records. Staff receive regular support and supervision from their line manager. Agency staff said that they had been given induction into the routines of the house. Records are generally well maintained, except where indicated elsewhere in this report. Records were seen to be securely kept. The manager said residents and their families are aware that they can look at their records and that in one case this has been done. The home has dealt with the risk of accidental burning injuries from kettles in the kitchenettes since the last inspection, and no kettles with long leads were observed. Fire alarm checks, fire drills and emergency lighting checks are taking place regularly. The home has updated its written instructions and fire notices to reflect the change to a “stay put” policy. These changes were brought to the attention of staff in a staff meeting, the minutes of which were made available to the inspector. Not all staff have received first aid training recently and this should be addressed as a matter of priority. Consideration should be given to removing items of gardening equipment from the shed in the middle garden courtyard, as this was accessible to residents. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 x x 3 x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 2 2 x 3 3 3 2 Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 19 YES Are there any outstanding requirements from the last inspection? 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. 2. 3. 4. Standard 7 18 19 26 Regulation 17(1)(a)& Sch 3.3.i 18(c)i 23(2)(d) 13(3) Requirement Ensure the medcation administration record is fully kept. Provide training to all staff in adult protection. Redecorate the inner courtyard around the middle garden as needed. Ensure that all staff who deal with infection control situations have received appropriate training.(Previous timescale of 30/4/05 not met). Take action to increase the level of permanent staff in the home.(Previous timescale of 30/4/05 not met). Ensure that the home has comprehensive quality assurance and monitiring systems(Previous timescale of 30/4/05 not met). Ensure staff have training in first aid. Timescale for action Immediate 31 October 2005 31 October 2005 31 October 2005 5. 27 18(10(b) 31 July 2005 31 October 2005 31 October 2005 6. 33 24 7. 38 13(4) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 20 No. 1. 2. Refer to Standard 16 38 Good Practice Recommendations Review the complaints investigation records. Review if gardening equipment should be kept in a shed accessible to residents. Ireland Lodge H59 H10 S31718 Ireland Lodge V222052 010605 Stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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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