Inspection on 18/06/09 for Ireland Lodge

This inspection was carried out on 18th June 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ireland Lodge 31/07/08

Ireland Lodge 18/09/07

Ireland Lodge 20/06/06

Ireland Lodge 30/01/06

Ireland Lodge 01/06/05

Ireland Lodge 24/01/05

Ireland Lodge 08/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Ireland Lodge Lockwood Crescent Woodingdean Brighton East Sussex BN2 6UH Lead Inspector Jennie Williams Key Unannounced Inspection 18th June 2009 10:30 DS0000031718.V376399.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ireland Lodge Address Lockwood Crescent Woodingdean Brighton East Sussex BN2 6UH 01273 296120 01273 296145 Louisa.Young@brighton-hove.gov.uk www.brighton-hove.gov.uk Brighton & Hove City Council 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) VACANT Care Home 23 Category(ies) of Dementia (0) registration, with number of places Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE). The maximum number of service users to be accommodated is 23. Date of last inspection 31st July 2008 Brief Description of the Service: Ireland Lodge is owned by Brighton and Hove City Council and is registered to provide accommodation and personal care for up to twenty-three older people who have a dementia type illness. The home provides various placement arrangements that are long term, transitional and respite care. No nursing care is provided at the home. District nurses will supply nursing input when needed. The home is located in the Woodingdean area of Brighton with access to transport and local amenities. The home is single storey purpose built facility with resident’s accommodation being provided in single rooms, of which all have en suite facilities. Shared facilities include three combined lounge/dining rooms and two enclosed garden areas. Part of the building is used as a day centre which residents also have access to. There are suitable numbers of communal bathrooms and toilets located throughout the home to meet the needs of residents. The fees for residential care are currently £140 to £740 per week. Additional costs are for: newspapers, hairdressing, chiropody, transport and toiletries (at cost). Further information regarding additional costs is available from the service. This information was provided to us on 18 June 2009. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. It should be noted that following consultation, it was identified that service users prefer to be called people who use services. For the purpose of this report, people who use the service will be referred to as residents. This site visit was facilitated by the Registered Manger. This unannounced site visit took place over six and a half hours on the 18 June 2009. Evidence obtained at this site visit, previous information regarding this service and information that we have received since the last inspection forms this key inspection report. An annual quality assurance assessment (AQAA) was sent to us by the service, completed by the home on the 08 April 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The AQAA was completed by the Registered Manager and returned when we asked for it. We spoke with seven residents throughout the day. One care plan was viewed and specific areas of care looked at in a further six care plans. Seven staff were spoken with and three new staff files viewed, along with some training records. Medication procedures were viewed and the procedures and records for handling residents finances were inspected. Some individual rooms were viewed, along with communal areas. The quality assurance system, complaint records and quality monitoring checks in place were viewed/discussed. There were 17 residents residing at the home at the time of this site visit. Four permanent placements, eight in receipt of transitional care and five residents admitted for respite. What the service does well: Care staff demonstrated an understanding of the individual needs of residents and was attentive to them on the day of the site visit. Residents make decisions about their lives and are consulted on aspects of life in the home to ensure choice and preferences are accounted for. Residents have access to health professional when the need arises. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 6 Residents are provided with opportunities to participate in activities if they choose to. Visitors are welcomed at the home and there are no restrictions imposed. The home employs a stable and committed team of staff who know and respect the needs of the people who live there. Resident felt that their privacy and dignity are respected. Residents free to air their views and know that action will be taken where needed. The physical environment of the home fulfils the homes stated purpose and aids are in place to maximise peoples independence. Some comments received from residents were: the food is quite good, I look forward to coming, staff are angels and always somebody to help if need. What has improved since the last inspection? What they could do better: The home needs to ensure that they send a letter to prospective residents confirming that having regard to their assessment, the care home is suitable Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 7 for the purpose of meeting the residents needs in respect of their health and welfare. Whilst work has been done on reviewing and updating medication policies and procedures, action must be taken to ensure that these are put into practice. This will ensure residents receive their prescribed medicines and are safeguarded. Robust recruitment procedures need to be followed to ensure residents are safeguarded. This includes obtaining written confirmation for staff sent to work at the home from outside organisations/agencies. Policies and procedures need to be updated and regularly reviewed to ensure that guidance for staff is up to date and in line with current good practice guidelines. The home must inform us of any significant events as required by legislation. Whist the home has taken action to address requirements made at the last inspection and residents identified they were overall satisfied with the care provided, the registered persons need to be more proactive in ensuring their own internal quality monitoring within the service is used effectively and residents are safeguarded. This is particularly relating to but not limited to medication practices, recruitment procedures and implementing risk assessments where needed as a priority in relation to care of individuals. Action must be taken to ensure that cigarette smoke does not permeate into the non smoking areas. Any other shortfalls noted of which no requirement or recommendation made has been reflected throughout the report. The AQAA identifies areas that the service has improved in the last 12 months and identifies areas that they could do better and their plans for improvements in the next 12 months. Further changes they are planning to make as a result of listening to people are: developing a leaflet regarding the home to ensure information is in an easily accessible format for people who use the service, each room with have a photograph and written information about the key worker so people know which member of staff will be responsible during their stay, photographic menu is being developed to assist resident to make their choice at meal times and a staff photo board is to be displayed in reception so that anyone new the home can identify staff and their roles. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Ireland Lodge DS0000031718.V376399.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 Ireland Lodge DS0000031718.V376399.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 & 6. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst current residents living at the home have their needs met, the pre admission assessment process poses a risk that some residents may be admitted into the home without all of their needs being identified prior to admission. EVIDENCE: The home has a Statement of Purpose and Service Users Guide available for prospective residents. These are currently in the process of being updated. An easy to read leaflet is in the process of being printed that provides basic information about the service in an easy to read format. It is recommended that the home be transparent and provide information to prospective residents that one garden at the home is accessible by passing through the designated smoking area. There is another accessible outdoor area at the home. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 10 Due to the nature of the various placement arrangements there are a large number of admissions and discharges within the service every month. There are currently four permanent residents residing at the service. Other beds are allocated for respite, general stay of one to two weeks, or transitional care, average of a six week stay. All placements at Ireland Lodge are referred through the Care Matching Team. No referral is accepted without all relevant information being provided. Senior care officers will undertake and assessment of prospective residents and discuss these needs with the Registered Manager. A Level of Ability Assessment Tool is used for pre admission assessments. It was confirmed that if an individual is provided respite on a regular basis, the individuals key worker will ring relatives/representatives of the individual prior to readmission, to ascertain if their needs have changed. If the period between visits is over three months, the service ensures that another assessment is undertaken by them. Action must be taken to ensure all areas of the pre admission assessment tool are completed. The individuals overall dependency is calculated from this assessment, which in turn assists in determining staffing levels required. There was an identified need of an individual, however not reflected in the pre admission assessment which will affect the overall dependency level. The Registered Manager confirmed that she will address this with staff involved in the assessments of prospective residents. There was no evidence that a letter is provided to prospective residents, confirming that following an assessment the care home is suitable for the purpose of meeting their needs in respect of their health and welfare. Wherever possible, the person who undertook the pre admission assessment is on duty on the day of arrival to meet and greet the new resident into the home. A resident confirmed that they came to visit the home prior to being admitted for a short term visit, however confirmed that no information was provided to them for reading. One resident who has previously stayed at the home commented I look forward to coming. A staff member commented I would be happy for my parents to come here. The Registered Manager confirmed that there was no one residing at the home from any minor ethnic community, social/cultural or religious groups with any specific needs or preferences. There are allocated rooms within the home for the variety of care provided at the home; however residents are able to use any communal areas within the home. There is no dedicated accommodation for intermediate care. Ireland Lodge DS0000031718.V376399.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are generally met with the information contained in their care plans. Staff practice reflects a good understanding of residents personal and healthcare needs. Residents are not always safeguarded by the medication practices within the home. EVIDENCE: There was evidence that work has been done to improve the information recorded in individual care plans. Staff were positive about the changes that have been made and an agency worker confirmed that they found care plans to provide very clear information regarding the needs of individuals. On viewing care plans, there were some minor shortfalls noted that the Registered Manager will address with staff. An example is where information in an assessment and the care plan were not consistent. Specific areas of care Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 12 identified for four residents were noted to be reflected in the care plan, providing guidance for staff on how to meet these needs. The home has access to a full time Registered Mental Nurse (RMN) who develops care plans regarding the mental health needs of residents. There was evidence of a resident having been involved in their care plan. Residents spoken with expressed that they were happy residing at the home and felt that staff encouraged their independence and were always around if they needed assistance. It was observed at the site visit that staff had an understanding of peoples needs and there was a relaxed atmosphere within the home. Assistance was observed to be provided sensitively to residents. A staff member commented the care is excellent. It was noted that a resident who had been admitted two days prior to the site visit had a care plan in place for personal care and mobility. It was confirmed that this individual was at risk of choking; however no risk assessment or care plan was in place for staff on how to provide assistance for the individual or on how to reduce the risk. The Registered Manager assured us that she would ensure this is addressed immediately. Residents receive input from health professionals whenever the need arises. The Registered Manager confirmed that there have been changes made in the policies and procedures in relation to medicines. Following the last inspection, she confirmed that there were gaps noted in relation to procedures. She undertook a medication round herself with the RMN and realised practices in place were not user friendly. Meetings with staff were held to discuss the best ways to improve this service. The improvement plan received and the Registered Manager confirmed that monitoring systems have been implemented to ensure better audit trails are maintained of all medicine received into the home and improve communication between staff. The AQAA identifies that medication policies and procedures have been extensively reviewed. On viewing medication administration records (MAR) charts there was evidence that changes in policies and procedures were not being put into practice. An individual was observed to follow good practice when administering medicines. Whilst information regarding the use of as needed (PRN) medicines and prescribed creams/lotions has improved, further action is required to ensure robust procedures are followed. MAR charts viewed and medicines remaining identified that robust systems are not in place. Where a medicine is prescribed to give one or two, staff were not consistently writing how many were given. There was not clear evidence to identify that all medicines were being administered as prescribed. Some Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 13 medicines were removed from the blister pack, however not signed for and no other information to identify if they had been administered or not. An example was also seen where a tablet had been signed for but remained in the blister pack and no other information to identify why this occurred. For those residents coming into the home with medicines in the original packaging (i.e. not in blister packs), the tablets signed for and numbers remaining did not always correspond. Half a tablet was also found to be sitting in the medication trolley with no identification what it was or who it was for. It was confirmed that senior staff check MAR charts on a daily basis and a full audit of medicines is undertaken weekly. Management must take action to ensure their monitoring system is effective and not just a tick box exercise for staff as the above shortfalls should have been noted through their own monitoring process. Medicines were viewed with the Registered Manager, who confirmed that she will address shortfalls noted with the staff. There were no controlled drugs being used at the home at the time of this site visit. A prescribed cream was noted to be an individuals room for who it was not prescribed. The Registered Manager removed this immediately. Staff were observed to have a good professional rapport with residents and were heard to be calling them by their preferred term. Of the residents that were asked, all confirmed that staff respect their privacy and dignity. Recent results from the homes own quality assurance and quality monitoring system identified that most thought that overall they were treated with dignity very well all/most of the time and that staff always/most of the time wait for an answer when knocking on their room doors. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lifestyle within the home is their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. EVIDENCE: All residents asked confirmed that their lifestyle within the home is to their own choice and preference. Residents were observed to move freely around the home on the day of the site visit. There is a daily activities plan in place that are provided in the different lounges. Activities are on the agenda for discussion at resident meetings held once a month. There home shares the mini bus with the day centre located at the same site. This can pose some restrictions when arranging outings. Residents within the home can choose to be involved in any activities arranged by the day centre if they choose. A resident confirmed that they have enough things to do to keep themselves busy. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 15 The AQAA identifies an area in what they could do better is to provide an activities co-ordinator. This was still in progress at the time of this site visit. The AQAA also identifies that plans for improvement in the next 12 months is to purchase a car to improve transport arrangements to assist in promoting activity and involvement within the local community. Recent results from the homes own quality assurance and quality monitoring system identified that six resident felt stimulated during the day, one did not and four commented most of the time. Visitors are welcomed at the home and there are no restrictions imposed. A resident confirmed that they were able to receive visitors in private. Information regarding local activities are provided at the home should residents wish to participate. There was information regarding a forthcoming local carnival on display in reception. A notice board within the home informs residents/visitors of upcoming events. Residents were complimentary about the food provided at the home. Comments ranged from not bad, jolly good to very good. Residents confirmed that they have a choice in meals. One resident confirmed that if they didnt like what was on offer the home would find something else for them. Staff spoken with also thought the food was lovely and confirmed that residents are given choice. The AQAA identifies that residents are actively encouraged to help themselves to snacks and drinks whenever they wish. There are three small kitchenette areas located throughout the home for residents use. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has systems in place to listen to residents views and safeguard them from harm. EVIDENCE: A resident spoken with confirmed that they would feel comfortable to raise any complaints they may have regarding the home. There have been three complaints made to the service since the last inspection of which none were upheld. Records are maintained and copies of correspondence kept. Records are maintained that identifies what action was taken to address concerns and identifies if the complainant was happy with the outcome. The AQAA identifies that they plan to have all staff to complete complaints training to ensure complaints are received positively and resident are encouraged to give feedback. We received copies of correspondence from a person who raised concerns with the service regarding smoking within the service. This was dealt with by the home. There is a designated conservatory for those residents who wish to smoke. At the site visit when visiting a lounge/dining area, we could smell cigarette smoke. The doors leading to the conservatory were open, allowing smoke to permeate into the non smoking area. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 17 This was discussed with a staff member who confirmed that the windows in the conservatory had been shut for the resident smoking due to the cold weather. Action must be taken to ensure that suitable measures are in place to ensure that smoke does not permeate into the non smoking areas. The Registered Manager confirmed that the complaints policies and procedures are currently being updated within the council. There are procedures in place to ensure any allegations of abuse are dealt with appropriately. The AQAA identifies that there have been no allegations of abuse made within the last 12 months. The Registered Manager confirmed that staff continue to receive training in Safeguarding Adults procedures. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely environment and are provided with comfortable indoor communal facilities. EVIDENCE: The home is located in a residential area of Woodingdean within walking distance of bus routes. The homes layout consists of three units, with a day centre occupying part of the premises. All areas of the home are on ground floor and there is level access throughout the service. All rooms are for single occupancy and all have en suite facilities. The service is split into three units; however residents have access to any areas within the home and can choose which communal areas they want to use. The separation of the units can be identified by the changing themes and Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 19 colour schemes. Pictures and photos have been used throughout these areas as points of interest for residents and to assist with orientation. The Registered Manager confirmed that refurbishment work within the service is ongoing and rooms are currently being redecorated. Some individual rooms viewed were seen to be personalised. There are two secure gardens that residents have access to. Security measures are in place to ensure that access from the day centre into the residential areas are restricted, thus helping to promote the privacy of residents. There are sufficient number of toilets and assisted bathing facilities located throughout the home to meet the needs of residents. There continues to be a range of individual aids and adaptations to assist residents mobility and independence, including raised toilet seats, walking aids, grab rails, hoists and moving and handling equipment. All individual bedrooms and communal areas are provided with call bell points so residents are able to call for help when needed. The home was clean on the day of the site visit. The AQAA identifies that there are 31 care staff (full and part time) and 17 other staff not care/nursing, of which 25 staff have received training in prevention and control of infection. Sluice facilities are provided at the home. The home has a contract with a company for the safe disposal of clinical wastes. As mentioned previously, action must be taken to ensure cigarette smoke does not permeate into non smoking areas. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are being met with the skill mix of staff on duty. Residents are not always safeguarded by the recruitment process. EVIDENCE: Residents spoken with confirmed that staff were always available when they needed assistance. They were complimentary about the staff working at the home and some comments received were all such a treat, quite good, very patient and staff are angels. Staff confirmed that there a sufficient numbers on duty to meet the needs of residents. One commented that they may be short staffed on occasions when short notice is given due to staff illness. The AQAA identifies that one care staff has left employment in the last 12 months. This low turnover of staff assists in promoting continuity of care. The Registered Manager was open and honest with us and confirmed that new staff are being recruited, as she feels there are not sufficient numbers of staff to meet the physical and social needs of residents. This is not reflected as a requirement as action is being taken to address this. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 21 Staff informed us that care staff continue to do the laundry in the afternoons when the laundry person has finished their shift. Care staff confirmed that sometimes they may be in the laundry area for up to 20 minutes a time and felt that this may impact on the outcome for residents. Others felt that this was not an issue. This is for management to discuss with staff and take action to resolve if identified as being an area for improvement. The AQAA identifies that 20 of the 32 permanent care workers have National Vocation Qualification level 2 or above. A permanent Registered Mental Nurse works at the home. On discussion, the nurse felt that care staff were kind and caring and appreciated the needs of residents. The AQAA identifies that all people who have started work in the home in the last 12 months have satisfactory pre-employment checks. This was not evidenced at the site visit. Three staff files were viewed. Ensuring application forms are fully completed will assist in addressing shortfalls such as employment history and gaps in employment. Criminal Record Bureau (CRB) checks were unable to be viewed as these are held at head office within the council. There was information at the home to identify CRB numbers and dates they were undertaken. The Registered Manager confirmed that they are all enhanced and includes a Protection of Vulnerable Adults (POVA) check. For one staff that moved roles within the organisation from a non care position to a care position, no further CRB was undertaken. This must be addressed. One reference was only available for one file viewed with no evidence that the home had tried to obtain a reference from previous employers located overseas. The Registered Manager confirmed that the RMN is on secondment to the home from another trust. The Registered Manager did not request any recruitment information for this individual. The Registered persons should have written confirmation that seconded/agency staff have had satisfactory up-todate CRB and POVA checks before employing them and ensure that robust recruitment procedures have been followed. This will assist in ensuring residents are safeguarded. There was evidence of induction and training being provided to staff. Staff spoken with confirmed that they are kept up to date with training and a comment received was training is brilliant. There was evidence of training being provided within staff files. The RMN confirmed that he will be arranging in house training for staff in relation to mental health needs. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the home is run in the best interest of residents, robust internal monitoring systems will assist in ensuring residents are safeguarded and evidence that the home is meeting its aims and objectives. EVIDENCE: The Registered Manager informed us that she was leaving employment and action was being taken to ensure that the home continues to be managed by a suitably skilled and experienced person. We have not received written confirmation of this to date. Following the draft report, we have received confirmation from the provider regarding management arrangements in place. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 23 Staff were complimentary about the Registered Manager and confirmed that she is supportive and has an open door policy. The AQAA identifies that two senior care officers have completed NVQ level 4/Registered Manager Award. The home is currently accessing courses for Deprivation of Liberty Safeguard (DOLS) to ensure staff are familiar with new legislation. Staff were not familiar with DOLS when talking with them. There was currently no application for authorisation being processed. The home has implemented a quality assurance system to obtain feedback from residents and other stakeholders to ensure the home is run in the best interest for residents. Results from the most resident feedback were available for viewing in reception. This demonstrated that out of 12 surveys, nine were very satisfied with the overall standard of care and one was quite satisfied. Two did not answer. The results identified negative and positive points about the service and there was information to identify what was being done to address any issues. The Registered Manager confirmed that they are in the process of developing questionnaires for health professionals and propose to obtain their feedback on an annual basis. General staff surveys are sent to all staff working for the council, however is not service specific. Consideration must be given to ensure feedback regarding Ireland Lodge can be provided to the Registered Manager regarding any improvements that can be made. There is a suggestion box within the home that provides an opportunity for anyone to raise any issues anonymously. The AQAA identified that the home had two outbreaks of diarrhoea and vomiting. We were not informed of these outbreaks. It was reiterated to the Registered Manager the importance of notifying us of all significant events as required by legislation. The last key inspection identified that some policies and procedures had not been reviewed for many years but was confirmed this was being addressed by the registered providers. The AQAA identifies there are still some policies and procedures that have not been reviewed for up to five years and some that are not in place. The registered providers must be pro active and ensure policies and procedures are reflective of up to date good practice guidance. The home has developed a service improvement plan that identifies their plans on improvement for 2009/2010. Monthly visits are undertaken by a representative of the registered providers. All sections of the AQAA were completed; however it was reiterated to the Registered Manager to ensure that all key standards are addressed. The evidence found at this site visit did not always complement the information provided. It identifies areas in what they could do better, how they have Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 24 improved in the last 12 months and their plans for improvements in the next 12 months. Whilst the home obtains feedback regarding the service they are providing, further work is needed to ensure internal monitoring systems are used effectively and residents are safeguarded. This is particularly relating to but not limited to medication practices, recruitment procedures and implementing risk assessments where needed as a priority in relation to care of individuals. Residents are encouraged to manage their own finances as long as they are able and willing to do so. The home holds money for safekeeping is people wish to use this service. Receipts are kept of financial transactions. To ensure that a lot of money is not pooled at the home, there is a residents safecustody account, with residents having their own mini account within this, with their own personal account code. This is not an interest bearing account. Internal audits are undertaken every month. It was confirmed that regular health and safety checks are undertaken and the AQAA identifies that equipment in use has been serviced or tested as recommended by the manufacturer or other regulatory body. Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 25 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 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14 Requirement That written confirmation be provided to service users confirming that their needs can be met at the home. To confirm that following an assessment the care home is suitable for the purpose of meeting their needs in respect of their health and welfare. That policies and procedures in relation to medicines are put into practice. This is to ensure that service users receive the medication they require, are safeguarded and a clear audit trail is maintained of all medicines received into and leaving the home. That robust recruitment procedures are followed. This will ensure residents are safeguarded. That robust internal quality monitoring systems are implemented and used DS0000031718.V376399.R01.S.doc Timescale for action 18/08/09 2. OP9 13(2) 31/07/09 3. OP29 19 18/08/09 4. OP33 24 18/08/09 Ireland Lodge Version 5.2 Page 27 effectively. This will ensure residents are safeguarded and assist in evidencing the home is well managed. That policies and procedures are updated and reviewed regularly. This will ensure that staff within the home are provided with up to date information and procedures are reflective of current good practice guidelines. 5. OP33 24 30/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ireland Lodge DS0000031718.V376399.R01.S.doc Version 5.2 Page 28 Care Quality Commission The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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