Inspection on 18/09/07 for Ireland Lodge

This inspection was carried out on 18th September 2007.

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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Ireland Lodge Lockwood Crescent Woodingdean Brighton East Sussex BN1 6UH Lead Inspector Jane Jewell Key Unannounced Inspection 12:00 18 September 2007 th 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 Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ireland Lodge Address Lockwood Crescent Woodingdean Brighton East Sussex BN1 6UH 01273 296120 01273 296145 louisa.young@brighton-hove.gov.uk 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) Brighton & Hove City Council Louisa Young Care Home 23 Category(ies) of Dementia - over 65 years of age (23) registration, with number of places Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is twenty three (23). Service users must be older people aged sixty-five (65) years or over on admission. Service users with a dementia type illness only to be accommodated. Two places to be available for service users under sixty-five (65) years of age. 20th June 2006 Date of last inspection 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 twenty-three older people who have dementia. The home provides various placement arrangements which are long term, transitional and respite care. 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 occupancy en-suite bedrooms. Shared facilities include three combined lounge / diners and two enclosed garden areas. Part of the building is used as a day centre which residents also have access to. The homes literature states that is aims of the service is to provide the same range of opportunities for older people with mental health as exists for everyone else. The fees for residential care are currently £99.00 to £650.00 per week, depending on the services and facilities provided. Extras such as: newspapers, hairdressing, chiropody, transport , toiletries are additional costs. Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information contained in this report has been comprised from an unannounced inspection undertaken over six and half hours and information gathered about the home. This includes: discussions with relatives, stakeholders involved in resident’s care and health care professionals. The manager had completed an Annual Quality Assurance Assessment form prior to the inspection and the information contained in this document has been used to inform the inspection of the home. The inspection was facilitated, in the main, by Louisa Young (Registered manager). The inspection involved a tour of the premises, observation and examination of records and discussion with residents and staff. The focus of the inspection was to look at the experiences of life at the home for people living there, this involved observing residents and their interactions with staff and examination of the homes facilities and documentation. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection reports. The Inspector would like to thank the residents, staff and management for their assistance and hospitality during the visit. What the service does well: Residents continue to live in a clean and homely environment with parts of it decorated and furnished to a good standard. The home is currently undergoing a phased refurbishment with residents participating in choosing the décor. There are a large number of admissions and discharges each week. This requires much organisation and planning. A health care professional commented that staff were always very welcoming to new residents. A sample of comments made by residents regarding their experiences include: alright”: “best bit about living at the home is my room clean and tidy and no one is bossy”; “nice, looking after me” and the “Best bit is having my lunch”. A relative said: “Look after mum well”. The inspector observed many wellbeing indicators of residents who were not able to verbally share their experiences about the home. The health needs of residents are being met with evidence of regular input from health care professionals. The meals are good offering both choice and variety. Residents commented “I make a cup of tea myself” and “I like that there was a fruit bowel”. Links with families continued to be valued and supported by the home. Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 6 Staffing levels enable individual time to be spent with residents, comments made about staff include: “Nice”; “all nice people that work here”; “couldn’t care more”; “absolutely delighted 95 of the time”; “very caring people” and “Nice people have been very nice to me”. What has improved since the last inspection? What they could do better: It is of concern that the majority of requirements made at the previous inspection have not yet been fully address. Positive steps must be taken to address these shortfalls and meet all of the outstanding requirements. The manager had completed an improvement plan as part of the service development of the home. This showed the action, planned to address many of the outstanding areas of shortfall. Residents need to have a range of information about the home and the services it offers in order to make informed decisions. A comprehensive and robust pre-assessment process needs to be implemented to ensure that only residents who’s needs can be safely met at the home are admitted. Residents would benefit from a more comprehensive care planning and risk assessment system that guides staff in all aspects of their personal, health and social care needs and which residents are involved in their development and review. In order to ensure residents safety the homes medication policies need to be consistently carried out by all staff. Staff need further specialist training to ensure that the aims of the home can be met be in terms of residents receiving transitional care. Residents would benefit from the development of a comprehensive Quality Assurance system to enable the effective self-review and monitoring of the home’s own services and facilities. Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ireland Lodge DS0000031718.V343258.R02.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.V343258.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 3 4 and 5 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are still not being provided with a range of information on the services and facilities at the home in order to help them make informed decisions. The home is not able to evidence that it can meet the needs and aspirations of most residents as further work is still needed to the pre admission assessment and care planning process. EVIDENCE: There is some information about the home available to prospective residents, this includes a Statement of Purpose. A copy of this was available in the entrance of the home. None of the residents and their families consulted, said that they had received a copy, or were made aware of its location as part of their induction to the home. Although this document had been reviewed it did Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 10 not provide service specific information on the different types of placements offered by the home, their aims and the level of services that residents can expect. The homes service users guide could not be located. The manager reported that one is available. In order to ensure that prospective and existing residents have the necessary information to make informed choices it is required that the home provide a range of information on the terms conditions, services and facilities provided. This includes an up to date Statement of Purpose and Service Users Guide. Due to the nature of the various placement arrangements there is a large number of admissions and discharges each week. This requires much organisation and planning. A health care professional said that staff were always very welcoming to new residents. A staff member was observed showing a newly admitted resident around the home to assist in the resident’s orientation. In line with the previously made requirement, the manager said that they have developed a more comprehensive assessment tool in which to assess prospective residents needs. This had not yet been introduced. The assessments documentation seen for recently admitted residents showed that copies of social care needs assessments had been obtained along with the homes own assessment of need. Examples were noted however whereby significant needs had not been identified or had not been further explored by the home. Therefore it remains required that residents have a detailed preadmission assessment before admission to the home. Good practices were noted in resident’s needs being re-assessed following hospital admissions prior to any discharge back to the home. This helped to identify any changes in needs and to determine whether their needs can continue to be met by the home. The home provides a wide range of different style placements, which include emergency referrals, short-term and long term placements, rolling respite, interim and transitional care. In addition residents needs were assessed from low to height, creating a diverse range of placements types and needs. Residents spoke positively about their experiences. A sample of their comments include: “alright”: “best bit about living at the home is my room clean and tidy and no one is bossy”; “nice, looking after me” and the “Best bit is having my lunch”. A relative said: “Look after mum well”. For some residents not able to verbalise their experiences the inspector observed many wellbeing indicators in their behaviour throughout the course of the inspection. Improvements are however needed to the care planning process and preadmission assessments in order for resident’s needs to be identified This is further discussed under standard 7. Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 11 Staff spoke of the pressure they sometimes felt, from health care professionals, to admit residents who have needs beyond which the home have assessed as they are able to meet. A health care professional commented that sometimes residents were admitted who had complex needs and needed some nursing input, although they felt that staff were very caring they were not trained nurses. This is of particular concern and further highlights the need for a comprehensive assessment process and for the manager to monitor all admissions to the home. The home encourages residents or their representative to visit the home prior to admission. Where residents are admitted for rolling respite most residents had visited the home prior to their first stay. However for many residents admitted as an emergency or from hospital the practicalities of this often means that relatives visited on their behalf. It was identified that transitional care placements were in effect being provided with intermediate care services and as such the home should therefore be assessed against the national minimum standards for intermediate care. This matter is to be discussed with the home’s providers outside of the inspection process. Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 and 11 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents would benefit from a more comprehensive care planning and risk assessment system that guides staff in all aspects of their personal, health and social care needs. The health needs of residents are being met with evidence of regular input from health care professionals. In order to ensure residents safety the homes medication policies need to be consistently carried out by all staff. EVIDENCE: The manager reported that that they are currently developing a new care plan format specially designed for people who have dementia. This had not yet been Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 13 introduced. Care plans examined consisted of various pieces of information including risk assessments, restrictive practices agreements and plans of care. The standard of information recorded and reviewed was not consistent. An example was noted of clear guidance being provided for staff on how to ease the anxieties and challenging behaviour with a resident. For another resident whom the inspector was informed can display challenging behaviour this had not been identified or guidance provided for staff. Although care plans had been recorded as having been regularly reviewed, an example was noted of significant changes in needs not being recorded and the appropriate guidance provided. A staff member felt that they received a good level of information at handover regarding any changes in residents needs. There was no mechanism in place for residents whose first language is not English to be directly involved in identifying their own needs. Not all of the care plans had identified resident’s social needs and for one resident, the inspector was informed, this was central to their well being. For residents who are in receipt of transitional care there was no evidence to confirm the programme of support/rehabilitation or services they require or are in receipt of, as this documentation could not be located at inspection. In light of the above shortfalls it remains required that care plans accurately reflect the needs of residents and are updated on a regular basis. The home maintains a daily record for each resident on events and occurrences. Examples were noted whereby the tone and language used was not always respectful. This was discussed with the manager who acknowledged that some comments lacked relevance, objectiveness or factual content. The manager said that they were aware of the need for staff to undergo training in record keeping and would organise this for the near future. It was previously required that risk assessments pertaining to continence management/ communication and smoking are developed and accurately reflect the service users needs. This had not yet been completed and is therefore repeated in this report. The system for the administration of medication did not always provide for a clear audit trail of medication, therefore it was not always possible to ensure that medication was being accurately administered or accounted for. This was discussed with the manager who agreed to address the shortfalls in practices noted immediately. Good practices were noted in the conduct of a member of staff who was observed providing relaxed and discrete assistance during the administration of medication. Records of medical intervention showed that the home works closely with health care professionals including GP’s, Occupational therapists, District and specialist nurses, to ensure residents receive the necessary health care intervention. Where possible residents own GPs are contacted for medical advice and intervention, if this is not possible temporary arrangements are Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 14 made. A Registered Mental Nurse (RMN) works full time at the home. A staff member described their role as working alongside the care staff to help support residents mental health needs by assisting with care planning and offering advice on the practicalities of supporting residents. A health care professional said that “staff always seem prompt to seek assistance”. Health care professionals spoken to felt that the home responded appropriately to the health needs of residents consulting with them regularly. In the main the homes practices helped to preserve resident’s privacy and dignity. Observation of such practices included staff using residents preferred names, knocking on bedroom doors prior to entry and in the respectful tone of language used during interactions with residents. However, at least two toilet/bathroom doors did not close flush to the door leaving a gap large enough to see through. The manager agreed to address this. A relative said that they had raised a concern with a senior member of staff regarding the tone of the language used and lack of respect for a resident’s privacy by a staff member. They felt that this was dealt with effectively and felt confident that this would not occur again. Staff spoke of the support they had received in the past from health care professionals during the care of residents who were dying. Staff also spoke sensitively about the care and support provided to residents and their families when residents have become terminally ill. A staff member felt that the home was very good at supporting residents who have recently been bereaved, as this is often the reason for their admission to the home due to the death of their carer. A resident spoke of the support that staff had provided in helping them make funeral arrangements and the kindness and understanding of staff at this traumatic time in their life. Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 and 15 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Flexibility in the daily routines, helps to promote resident’s choices. Not all residents however are currently able to make choices and have their individual preferences respected, due to language and cultural differences. The meals are good offering both choice and variety. Links with families continued to be valued and supported by the home. EVIDENCE: Observation of the daily routines and discussion with residents continue to confirm that staff accommodate resident’s personal wishes with regard to meal times, going to bed, rising and bathing. During the inspection residents were observed to move around the home choosing which room to be in and what level of company they wanted to enjoy. There is an orientation board in each lounge, which identified the planned activity for the day, along with other information such as the day, date, weather and staff members. The planned activity for the day of the inspection Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 16 was board games. Staff said that other planned activities include walks, discussions, music, painting, bingo and videos. A staff member spoke of the outings they had organised over the summer that included local points of interests. A staff member said that they try and organise at least one outing per month. A resident spoke of their enjoyment of completing jigsaw puzzles and how the staff helped them to find different ones to complete. Another resident said: “it would be nice to have something to do”. At the time of the inspection an occupational therapist was undertaking a small group activity in the garden. Staff were observed trying to encourage residents to attend. For residents who are not able to communicate their interests it was previously required that care plans include information on how residents are to be enabled and encouraged to participate in the homes activities. This had not yet been fully completed but some progress had been made to address this concern. The manager said that they are currently reviewing the level and type of activities on offer and developing ways of improving them. Visitors commented upon how welcomed they are made to feel during their stay, this included being offered beverages or meals and staff being friendly and approachable. All visitors consulted with said that they can visit at any reasonable time. There were inconsistent standards in residents being able to exercise choice and control in their lives. For example a staff member was observed throughout the course of inspection offering choices to residents regarding food, drinks and occupation. For some residents for whom exercising their choice was more difficult, staff were seen to use their acquired knowledge of a person to help them make choices. Good practices were noted in the development of restrictive practices agreements that ensures that resident’s views have been formally assessed on issues affecting their personal freedoms. However, due to cultural and language differences, for some residents, their needs and preferences were not always identified and therefore residents did not have much control over their daily lives or the choices within it. Not all staff consulted with were knowledgeable about the cultural and religious needs of residents. The meal served at inspection was presented well with resident’s individual preferences respected and diabetic diets being catered for. The atmosphere was generally relaxed. However, in one lounge the television was kept on throughout lunch, which did not help to create a social environment. The manager agreed to address this. A sample of comments made regarding food included: “food very good I can make a drink or ask someone else”; “good”; “I make a cup of tea myself” and I like that there was a fruit bowel”. Residents were seen to be encouraged to make their own drinks for themselves and visitors with one residents was supported to make the inspector a drink. Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A complaints procedure and appropriate adult protection policies and training for staff in safeguarding adults helps to enable resident’s rights and interests are promoted and protected. EVIDENCE: Details of how to make a formal complaint are displayed within the home. All residents and relatives consulted with felt confident to approach staff with any concerns. A relative consulted said that when they had raised a concern it had been dealt with to their satisfaction. Records of formal complaints are maintained which includes the outcome of any investigation. The manager said that the main theme of recently received complaints was regarding lost laundry and they reported that they were taking steps to change the way that laundry is now completed. There are written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. The staff consulted with said that they had attended safeguarding adults training and showed an understanding of their roles and responsibilities under safeguarding adults guidelines. Ireland Lodge DS0000031718.V343258.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 24 25 and 26 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents continue to live in a clean and homely environment with parts of it decorated and furnished to a good standard with minor redecoration and refurbishment needed to some parts to ensure a consistently pleasant environment throughout. The home ensures that resident’s private accommodation is equipped to provide comfort and privacy. Residents have access to a range of specialist equipment to aid mobility and independence. EVIDENCE: The home is located in a residential area with some bus routes a short walk away. The home is laid out into three units with the day centre occupying part Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 19 of the premises. A resident, who was able to access all areas, as it is level access throughout the home, was able to give the inspector a guided tour of the building. The manager reported that the home is currently going through a phased refurbishment programme, with the external and some internal parts recently redecorated. Some of the corridors have recently been redecorated and the staff were in the process of individualising the corridors to aid orientation and interest. There had been a consultation process to involve residents in choosing the colours for redecoration. One lounge remains in need of redecoration with no confirmed date for when this is to be completed. The manager reported that new lounge furniture to replace tired and worn furniture had been ordered. Comments received regarding the environment included: “very nice”, “Doesn’t smell” and “home very accommodating when it was felt that my mother needed to be nearer to the lounge”. Much effort is made to create a homely feel to the premises with residents encouraged to personalise their room, even if staying for a short period. The majority of bedrooms are decorated and furnished to a good standard. There are two secure gardens, with one having recently been laid to turf and raised flowerbeds created. Voluntary workers completed this. The central garden although providing a considerable number of seats was uninviting and unattractive. An occupational therapist and a small group of residents were in the process of planting up some containers with flowers. It was discussed that residents would benefit from a more formalised plan for the upgrade and maintenance of the garden to create a nice environment in which to use and view. Security measures are in place to ensure that access from the day centre into the residential side is restricted, thus helping to promote the privacy of residents. There are sufficient number of toilets and bathrooms located around the home this includes several assisted baths and showers and all bedrooms providing en-suite facilities. There continues to be a range of individual aids and adaptations to assist resident’s mobility and independence, including raised toilet seats, walking aids, grab rails, hoists, and moving and handling equipment. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. All areas inspected were cleaned to a good standard and free from offensive odours. Ireland Lodge DS0000031718.V343258.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 and 30 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing levels are suitable to ensure the needs of the residents living in the home can be met. Residents generally benefit from a trained staff team, however in order to meet the aims of the service, staff still need to undergo specialist training. Residents are largely protected by the home’s recruitment policy and practices. EVIDENCE: Staff, visitors and residents felt that there was sufficient numbers of staff on duty for staff to undertake their roles in a timely manner and for residents to receive the support they needed, when they wanted it. In addition to care staff there are senior care officers, management and ancillary staff on duty. Staff confirmed that there is some flexibility in staffing levels should residents needs increase. All staff were found to have a good rapport with residents and visitors and promoted a relaxed atmosphere in the home. A sample of comments made about staff include: “Nice”; “all nice people that work here”; “couldn’t care more”; “absolutely delighted 95 of the time”; “very caring people” and “Nice people have been very nice to me”. A member of staff said that the best bit about working at the home “is being able to Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 21 spend time with residents on a one to one and just spent time talking”. Another member of staff also felt that the home was very good at enabling staff to spend one to one time with residents. Several health care professionals were consulted, they commented that “Staff seem very caring and there always seems to be a lot of staff on duty” however they felt that information they pass onto staff regarding the care of residents is not always consistently communicated to others and implemented as there is often different staff on each day. Comments were also received regarding the lack of consistency across the staff team in following plans of care/rehabilitation. Staff said that the use of agency and care crew has reduced over the previous year and where care crew are used, then where possible this is the same staff, in order to promote continuity. The personal files of newly appointed staff were inspected and these showed that a recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. One written reference could not be located, the manager assured the inspector that this would have been obtained but a copy had not been forwarded to the home from human resources. The manager agreed to address this. There is a continuous programme of staff undertaking NVQ training, with the home committed to ensuring that more than 50 of carers attain this qualification. Staff have the opportunity to undertake a variety of training courses, which include core topics such as manual handling, fire safety, safeguarding adults and food safety as well as specialist training in restrictive practices and dementia. It was previously required that a training programme be developed to ensure that staff receive the training needed to fulfil their role and the aims of the home. This had not yet been actioned and remains a priority in order to ensure that the aims of the various placements offered can be achieved. New staff confirmed that they had completed an induction and had the opportunity of undertaking “skills for care” inductions, which are the industry recommended minimum induction standards. Ireland Lodge DS0000031718.V343258.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 35 36 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has a good understanding of the areas in which the home needs to improve. Planning was in place on how this improvement was going to be undertaken. The systems for resident consultation are good with a variety of evidence that indicates that resident’s views are sought. Residents would benefit further by a system for the effective self-review and monitoring of the homes own services and facilities. A range of regular health and safety checks helps to ensure the health and safety of residents and staff. Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 23 EVIDENCE: The manager has been the registered manager since 2005 and has completed the recommended management qualifications. None of the relatives consulted said that they had any contact with the manager as they have only ever met duty officers. The consensus of staff consulted was that they could approach the manager if they had any problems. Key management tasks are split amongst the management team, which is made up of the manager and senior care officers. Senior care officers are largely responsible for the day to day running of the home. It was discussed with the manager that positive steps must be taken to address the number of outstanding requirements. The manager reported that prior to the inspection, they had completed an improvement plan as part of the service development of the home. This showed the actioned planned to address many of the outstanding areas of shortfall . Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible person external to the home. Where small amounts of monies are held on behalf of residents these are kept secure at reception with the manager reporting that records are kept of any monies spend on behalf of a resident. Staff are supervised by senior care officers working along side them each shift and all staff consulted with felt well supported. Care staff spoke of receiving formal supervision in the main on a regular basis. Much work has been undertaken to obtain feedback on the quality of the services and facilities offered from residents, and other stakeholders involved in their care. This involves residents meetings, placement reviews, feedback questionnaires and annual consultation week, which was held over the summer. The manager said that they are still awaiting the outcome of the consultation so they can identify any action that may need to be taken. It was previously required that there is a comprehensive quality assurance and monitoring systems in place. It was discussed that feedback obtained on the quality of the services still needs to be integrated into a structured quality assurance system. This remains necessary for the home to use in the selfmonitoring and review of its own practices. There are extensive policies and procedures related to health and safety. Records submitted by the manager prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Systems were in place to support fire safety, which included: regular fire alarms and emergency lighting checks, staff training and maintenance of fire Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 24 equipment and fire drills were reported to have been undertaken. A fire risk assessment had been undertaken by a fire safety expert, which recorded significant findings and the actions taken to ensure adequate fire safety precautions in the home. A recent visit by the Fire authority highlighted some areas that needed to be addressed which the manager reported had been undertaken. Ireland Lodge DS0000031718.V343258.R02.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 2 x 1 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 2 3 3 x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 3 x 3 Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4(1-2) &Sch 1 Requirement That the Statement of Purpose provides clear information on the level and type of services and facilities offered at the home, is made available and is reviewed regularly. That a Service Users Guide is made available to service users in order that they are aware of the terms and conditions, services and facilities at the home. That all service users have a detailed pre-admission assessment before admission to the home. (Previous timescale of 20/06/06 not met). That the care plans accurately reflects the needs of the service users and are updated on a regular basis. That care plans include information on how service users are to enabled and encouraged to participate in the homes activities. That service users and/or their Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 27 Timescale for action 30/11/07 2 OP1 5(1)(a-f) 30/11/07 3 OP3 14(1acd) 12(1a&b 30/10/07 4 OP7 15(1)(2) 12(1)(a)( b) 30/11/07 5 OP8 13(4bc) 6 OP9 13(2) 7 OP12 16(1)(2) (n) 8 OP30 18 (1) (2) (a) (c) (i) 9 OP33 24 representatives are consulted regarding the formation of the care plans. (Previous timescale of 20/06/06 not met). That records and risk assessments pertaining to continence, communication and smoking are developed and accurately reflect the service users needs. (Previous timescale of 20/06/06 not met). That there are arrangements in place for the adequate recording, handling, safekeeping safe administration and disposal of medicines at the home to ensure that service users receive medication in accordance with their prescribed instructions. That all service users have a social care plan, that is designed to meet their interests and preferences and that activities are held on a regular more formal basis. (Previous timescale of 01/12/06 not met). That a training programme is developed to ensure that staff receive the training needed to fulfil their role and the aims of the home. Previous timescale of 01/12/06 not met). Ensure that the home has comprehensive quality assurance and monitoring systems in place. (Previous timescale of 30/4/05 & 31/10/05 & 01/12/06 not met). 30/10/07 30/10/07 30/10/07 30/11/07 30/11/07 Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 28 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.V343258.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Extracts may not be used or reproduced without the express permission of CSCI Ireland Lodge DS0000031718.V343258.R02.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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