Inspection on 31/07/08 for Ireland Lodge

This inspection was carried out on 31st July 2008.

CSCI 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 18/06/09

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Ireland Lodge Lockwood Crescent Woodingdean Brighton East Sussex BN2 6UH Lead Inspector Jennie Williams Unannounced Inspection 31st July 2008 10:30 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.V367528.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ireland Lodge DS0000031718.V367528.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) Louisa Young Care Home 23 Category(ies) of Dementia - over 65 years of age (23) registration, with number of places Ireland Lodge DS0000031718.V367528.R01.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. 18th September 2007 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 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 £102.90 to £718.76 per week, depending on the services and facilities provided. Additional costs are for: newspapers, hairdressing, chiropody, transport and toiletries (at cost). This information was provided to the CSCI on 04 June 2008. Ireland Lodge DS0000031718.V367528.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 recent CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed that the home uses the term residents. For the purpose of this report, people who use the service will be referred to as residents. This unannounced site visit took place over eight and a half hours on the 31st July 2008. Evidence obtained at this site visit, previous information regarding this service and information that the CSCI have received since the last inspection forms this key inspection report. Ten residents were spoken with throughout the site visit. The Inspector had limited communication with some residents. One visitor was spoken with throughout the site visit. Three care plans were viewed and specific areas of care were viewed in a further three care plans. Six staff were spoken with throughout the site visit, along with the Registered Manager. Two new staff files were inspected, along with training records. A tour of the environment was undertaken and some individual rooms were viewed. Medication procedures were inspected. The quality assurance system was discussed, recent results from a Dignity Audit viewed and complaint records were viewed/discussed. There were twenty-two residents residing at the home on the day of the site visit. Six long-term residents, five residents on respite and eleven residents receiving transitional care. An Annual Quality Assurance Assessment (AQAA) was received from the home prior to the site visit. This was to obtain information about the establishment to assist CSCI in the inspection process. The AQAA also provided the Commission with numerical information. What the service does well: Staff practice reflects a good understanding of residents’ personal and healthcare needs, which ensure that needs are met. Residents spoken with stated that they were happy with the care provided at the home. Prospective residents are provided with an opportunity to ‘test drive’ the home prior to moving in, wherever possible. Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 6 Residents’ lifestyle within the home is generally their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. Residents are provided with varied nutritional meals and are provided with choice to ensure their preferences are catered for. Visitors are welcomed at the home. Residents feel comfortable to complain, reassuring them that they are being listened to and that action will be taken, if necessary. Residents live in a homely environment and are provided with comfortable indoor communal facilities. Residents found their rooms to be comfortable and the home clean. Residents’ needs are being met with the skill mix of staff on duty. Residents were complimentary about the staff working at the home and staff confirmed there was good teamwork and enjoyed working at the home. Comments received from current residents living in the home include: ‘ everybody I come into contact with I find very helpful’, ‘haven’t found anything that I disagree with’, ‘there are enough activities if I choose to be involved’ and ‘staff are very, very good and I like them very much’. What has improved since the last inspection? What they could do better: The documentation in place for some people does not fully reflect the level of care provided and there is a risk that care may not be consistently provided. Clear and complete risk assessments must be in place for all residents and Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 7 provide guidance for staff on how to reduce the risk, ensuring the safety of residents. These must be dated, signed and regularly reviewed. Clear records need to be maintained of all medicines received, administered and disposed of within the home to ensure that service users and staff are safeguarded and a clear audit trail is maintained. Advice needs to be sought and confirmation obtained that the controlled drugs cabinet is suitable and installed correctly to ensure compliance with current guidelines. Any minor shortfalls noted at the site visit, of which no requirement or recommendation has been made, have been highlighted throughout the report. 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.V367528.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.V367528.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, & 5 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. The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted. EVIDENCE: The home has a Statement of Purpose and Service Users Guide that is available at the home and provides prospective residents/representatives with information about the services and facilities provided at the home. The AQAA identifies that all prospective residents are provided with a copy of the Statement of Purpose. The AQAA identifies in what they could do better is to ensure the Statement of Purpose and Service Users Guide are available in relevant languages and formats so it is accessible to all. The Registered Manager confirmed that they are currently working with the design company Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 10 and designing a brochure to ensure information is available in different formats when needed. Service Users Guide is located in each individual room and a copy of both documents is available at reception. Due to the nature of the various placement arrangements there is a large number of admissions and discharges every month. The Registered Manager confirmed that a new assessment tool has been developed and this is used for all admissions. The AQAA identifies that all placements for Ireland Lodge are referred through the Care Matching Team and no referral is accepted without all relevant information being included. The Statement of Purpose identifies that five rooms are for long term care, five used for respite, ten transitional care beds and two rooms used flexibly for transitional care and respite. Staff working with the transitional team informed the Inspector of the work they have undertaken to improve the admissions process. Files viewed identified that suitable pre admission assessments are undertaken prior to admission. These staff confirmed that they always ensure that whoever undertakes the assessment is on duty on the day of admission to meet and greet the individual. The transitional team has worked hard to improve this process and confirmed that this process will be shared and introduced to all other areas within the home. Priority must be given to ensure that all staff implement these good practices. Action is being undertaken to ensure that when residents are discharged from hospital to the home they are appropriately dressed. A resident confirmed that they had visited the home prior to moving in. Another resident stated ‘when I come here I like it’. For some residents not able to verbalise their experiences, the Inspector observed signs of wellbeing in their behaviour throughout the course of the site visit. It was confirmed that senior care officers undertake assessments for residents and these are then discussed with the Registered Manager. The home continues to re assess those residents who may spend a period of time in hospital before returning to the home. Of the staff asked, all confirmed that they felt all residents were appropriately placed at the home with all needs being met. They stated that appropriate action is taken if someone’s needs can no longer be met at the home. The Registered Manager confirmed that when required, a district nurse will undertake an assessment and where it is identified that the needs will be met better elsewhere, individuals are moved to other service via the Care Matching Team. 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 Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 11 specific needs or preferences. The Registered Manager gave an example where a previous resident had specialist needs and the action they took to address these. The Registered Manager identified that the home is aware of equality and diversity issues. There are allocated rooms within the home for the variety of residents needs accommodated, however residents are able to use any communal areas within the home. There are no specialist facilities for intermediate care. The Registered Manager confirmed that they do not actually provide rehabilitation at the service and an occupational therapist (OT) takes residents to their own homes for assessments. There is space in the craft room for the OT to work with residents such as cooking. Ireland Lodge DS0000031718.V367528.R01.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 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. Staff practice reflects a good understanding of residents’ personal and healthcare needs, which ensure that needs are met. The documentation in place for some people does not fully reflect the level of care provided and there is a risk that care may not be consistently provided. EVIDENCE: Care plans viewed with the transitional staff identified that a lot of work has been undertaken to ensure all aspects of the individual’s health, personal and social needs are identified, providing guidance for staff on how to meet the needs. Goals are set for short-term residents and these are monitored. Tools have been developed and continue to be expanded to assist staff in communicating with residents with a dementia type illness. Pictures are being used for ease of communication. Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 13 For residents who are not receiving transitional care, further work is needed to ensure care plans and risk assessments are fully completed. The improvement plan received following the last inspection identifies that a new care plan and risk assessment format has been implemented. Some risk assessments were noted not to be fully completed, dated or signed to identify when and by whom it is implemented. Where an area of risk was identified, there was no written guidance for staff on action to take to reduce the risk. A staff member confirmed that there should be a more detailed risk assessment in place. This was not located. It was confirmed that falls risk assessments are only done if there is a history of an individual falling or if it is relevant at the time. Falls risk assessments should be implemented for all residents at the time of admission. The Registered Manager confirmed that social care plans have been implemented, however on viewing one file there was no information found regarding social care needs. There is a key worker system in place. It was confirmed that the majority of staff have undertaken person centred care and risk assessment training. It was confirmed that care plans are reviewed with the individual resident/representative, wherever possible. It is recommended that staff record if the individual has been involved or not. One file viewed identified that the care plan had not been reviewed for a period of up to six months. One resident commented to the Inspector ‘staff are very good at discussing care’. Residents receive input from health professionals whenever the need arises. One resident commented that they noticed another resident with ‘a small amount of pain that was addressed immediately.’ There is a Registered Mental Health Nurse (RMN) employed at the home who provides guidance for staff and monitors the mental health needs of residents. Of the staff that were asked, they confirmed that they find the care plans are laid out well and are easy to understand. They felt they contain enough information for them to be able to effectively meet the needs of residents. Daily notes recorded about residents could be better improved. As residents have a dementia type illness, it is important that records are maintained of peoples well being/moods, so the treatment provided can be better monitored. Some daily notes observed identified good documentation, however this was not consistent for all residents. It is proposed that the format being used for transitional care will be shared for all areas within the home. Priority should be given to ensuring this is done so that all individuals’ needs are identified. Care planning has not been reflected as an outstanding requirement as work is being done to improve this area. A new timescale has been given in which compliance must be met. It was confirmed that there are policies and procedures in place for all aspects of dealing with medications. These were not read. Staff administering Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 14 medication have all received training for this procedure. It was confirmed that records are kept of all incoming and outgoing medicines in the home. On viewing Medication Administration Records (MAR) charts and blister packs there were discrepancies noted between them. An example is: one MAR chart identified that there should be 12 tablets left, however on viewing blister packs there were only eight left. There was no audit trail to account for the missing tablets. It was confirmed that weekly medication audits are undertaken. Staff need to review this procedure, as the above shortfalls should be noted during the audits. There is guidance in place for the use of as needed (PRN) medicines and directions in place for the use of prescribed creams/lotions. It is recommended that where a prescription is hand written, two staff that have undertaken medication training sign these. This will further safeguard staff and residents from the risk of errors. The Registered Manager needs to obtain confirmation that the controlled drugs storage cabinet is compliant and attached to the walls in line with current guidelines. The screws used to attach this cabinet to the wall were standard and could easily be removed. Residents are provided with an opportunity to self medicate if a risk assessment identifies that it is safe for them to do so. There was no one selfmedicating on the day of the site visit. Of the residents that were asked, all confirmed that they felt staff respect their privacy and dignity. Staff were observed to have a good professional rapport with residents and were observed to interact well with residents and heard to be calling them by their preferred term. Ireland Lodge DS0000031718.V367528.R01.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 & 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. Residents’ lifestyle within the home is their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. Residents are provided with varied nutritional meals and are provided with choice to ensure their preferences are catered for. EVIDENCE: It was observed throughout the site visit that residents were able to move freely within the home. Residents spoken with confirmed that their lifestyle and daily routines within the home is to their own choice and preference. Residents choose their own bed time, clothes to wear, bathing times and preferences and whether they wish to be involved in activities or not. One staff member commented that the routines of the home are service user led, identifying that they are responsive to individual needs and choices. There are notices within the lounge rooms identifying what and where the planned activities are going to be, the date/day, weather forecast and what meals are on offer for the day. Activities are rotated throughout the three Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 16 lounge rooms. Four residents were observed to be joining in a quiz on the day of the site visit. Of the residents that were asked, all confirmed that there are enough activities provided at the home if they choose to be involved. One individual identified that they prefer to remain in their room and this is respected. A resident confirmed that they have outings to the shops. There is a mini bus that is shared between the home and the day centre. Outings to local points of interest are arranged, weather permitting. Residents within the home can choose to be involved in any activities arranged by the day centre. Work has been done and is continuing to be done to ensure the provision of activities continues to be improved. The Registered Manager confirmed that a lot of work has been undertaken to obtain information around resident’s personal life history. This information is added onto as staff get to know residents and as information is shared with them from the individual or friends/family. As previously mentioned, management needs to ensure that social care plans are implemented for all residents. This had been a previous outstanding requirement. This has not been reflected as an outstanding requirement as action is being taken to ensure that this is addressed. There are photos displayed within the home of some activities that residents have recently participated in. One recent activity that residents appeared to enjoy was a recent fruit tasting morning. This involved having some exotic fruits from around the world available for tasting, with information being provided on which country they were from etc. Visitors are encouraged and welcomed to visit the home. A visitor spoken with confirmed that they are able to visit at any time and had no concerns regarding the care and services provided at the home. They also commented that they always find their relative clean and well dressed. The Registered Manager confirmed that there is a three-week rolling menu and the cook has just met with residents regarding food preferences and discussed the menus. Residents are offered a choice and staff ask residents every day what meal they would like. The cook has a list of residents’ likes/dislikes/allergies in relation to food. Residents spoken with were complimentary about the meals provided at the home and comments ranged from ‘they know what I don’t like’, ‘very nice’, ‘plenty of it’ and ‘there is choice’. A visitor spoken with confirmed that although they have not eaten at the home, the food always looks presentable. There was no one currently residing at the home that required any specialist diet in relation to cultural/religious needs. Diabetics are catered for. Residents are able to choose where they wish to eat their meals, in any of the lounge/dining areas or in their rooms if they prefer. Not all residents would be able to be accommodated in one dining room at one given time. Staff were observed to offer discreet assistance to those who required assistance at meal times. Ireland Lodge DS0000031718.V367528.R01.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 & 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. Residents feel comfortable to complain, reassuring them that they are being listened to and that action will be taken, if necessary. Residents are safeguarded by the procedures in place and the training of staff in Safeguarding Adults. EVIDENCE: There is a complaints procedure available at the home that all people have access to. Records of all complaints received are maintained and copies of any correspondence are kept. The AQAA identified that there have been six complaints made in the last 12 months. Five of these were substantiated and action was taken to resolve these. One is still currently unresolved. Residents spoken with confirmed that they would feel comfortable to raise any concerns/complaints. One resident commented ‘I haven’t found anything that I disagree with’. A visitor also confirmed that they would feel comfortable to raise any concerns. All but one resident asked confirmed that they knew who to speak to if they needed to raise a complaint. Of the staff that were asked, all demonstrated knowledge on procedures to follow in the event of residents making a complaint. Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 18 The Registered Manager confirmed that she undertook Safeguarding Adults training for managers within the last year. All staff are kept up to date with Safeguarding Adults training. Staff spoken with confirmed that they have undertaken this training, which included whistle blowing. Staff confirmed that they are familiar with the procedures to follow in the event of an allegation being made and would feel comfortable to raise any concerns they notice within the service. There have been no Safeguarding Adults alerts raised regarding the practices within the service, however the home raised one alert that is not related to any practices within the service. Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 19 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 & 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 live in a homely environment and are provided with comfortable indoor communal facilities. EVIDENCE: The home is located in a residential area with bus routes a short walk away. The home is laid out into three units with the 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 are all provided with en suite facilities. Although the service is split into three units, all residents have access to any areas within the home and can choose which communal areas they want to Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 20 use. The separation of the units can be identified by the changing themes and colour schemes. Themes are: sea and land, New Brighton and Old Brighton. Pictures and photos have been used throughout these areas as points of interest for residents. These themes and decorations have been devised with the consultation of residents. Signage was seen throughout the home to assist in residents’ orientation. Residents spoken with were happy with their individual rooms and confirmed that they are able to personalise them. This was observed on viewing some individual rooms. One resident was happy to show the Inspector their room. Comments received from residents were ‘nice home’, ‘my room is comfortable’ and ‘am happy living here’. The visitor spoken with confirmed that they always found the home clean. On tour of the environment, it was noted that an offensive odour from one room was permeating into a communal area. This was discussed with the Registered Manager who confirmed that action was being taken to address this problem. There are two secure gardens that residents have access to. Work has been done and is continuing to be done to make these areas more inviting and attractive. 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 resident’s 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, however it was discussed with the Registered Manager that she ensures the cleaners pay attention to under bath hoist seats. Ensuring these are kept clean will assist in infection control. Offensive odours were limited to the one area as previously stated. One resident commented ‘the home couldn’t be cleaner’. Sluice facilities are provided at the home and staff, including the cleaners, is provided with infection control training. All laundry is washed on site and following complaints received, the whole laundry system/procedures has been changed which has improved this service. The home has a contract with a company for the safe disposal of clinical wastes. Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 21 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 & 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. Residents’ needs are being met with the skill mix of staff on duty. Recruitment procedures in place ensure that residents are safeguarded. EVIDENCE: Residents spoken with confirmed that there are enough staff on duty and were very complimentary about the staff working at the home. Comments ranged from ‘very good’, ‘think there is enough’, ‘everybody I come into contact with I find very helpful’ and ‘sometimes I feel we ask too much, however staff don’t give us that feeling and just get on with it’. The majority of staff felt there were sufficient numbers of staff on duty to meet the needs of residents. For those who identified that they have been short staffed confirmed that they were aware that action was being taken to address this. They confirmed that all residents’ needs continued to be met. Staff identified that they enjoyed working at this service and there was good teamwork. Care staff were complimentary about the input they receive from the RMN that works at the home. A regular agency worker is currently covering this post three days a week. When this position is filled, the RMN will be working full time hours. Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 22 The AQAA identifies that 23 of the 30 permanent care staff have obtained National Vocation Qualification (NVQ) level 2 or above and two staff are currently working towards this qualification. The two staff files viewed identified that references, Protection of Vulnerable Adults (POVA) first and Criminal Record Bureau (CRB) checks are undertaken prior to commencing employment. Ensuring the application form is fully completed will assist management in ensuring all information is obtained. ie dates of employment. Some information was not available at the home. The Registered Manager confirmed that full copies had not been received from head office. Since the inspection written confirmation has been received that this has been addressed. The AQAA identifies that agency staff has covered 483 shifts in the last three months. Care crew employed by the Brighton and Hove Council and an agency covers these shifts. Wherever possible, the same people are used to ensure continuity is promoted. The Registered Manager confirmed that it is in the contract with the agency that they will only supply carers who have had all recruitment checks undertaken. Staff confirmed that they are up to date with mandatory training and are provided with enough training opportunities that are relevant to their roles. The Registered Manager confirmed that staff have undertaken dementia awareness training. Staff confirmed this. Records viewed identifies that recent training undertaken has been: risk assessment, infection control, Safeguarding Adults, record keeping and managing aggressive behaviour etc. The Registered Manager confirmed that there is a training department within the council and individual development plans are implemented for staff that fits into a team development plan. The Registered Manager confirmed that new staff undertake an in house induction and common induction standards as set by Skills for Care, unless an individual has completed NVQ level 2 or above training. The staff files viewed evidenced that an induction programme is undertaken. Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 23 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, 33, 35 &38 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. Staff and residents benefit from a well managed home. A recent Dignity Audit undertaken identifies that the home is being run in the best interest of the residents, however further work is needed to ensure that a quality assurance system is regularly undertaken. The health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable. EVIDENCE: The Registered Manager has completed the recommended management qualifications. It was confirmed that she has overall responsibility of the service but a lot of the day to day running of the service is lead by senior care Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 24 officers. Responsibilities are delegated throughout the team. All staff spoken with confirmed that there are clear roles and responsibilities within the home. Staff were complimentary about the management support provided by the senior care officers. Staff commented that they find the Registered Manager supportive and approachable, however some stated that they don’t really have any dealings with her and would feel better supported with the Registered Manager being seen on the floor more. When discussing the needs of residents with the Registered Manager, she was not clear on all the residents needs currently residing within the home due to the high turnover of residents and the day to day running of the service being left to the senior care officers. There are internal quality assurance and quality monitoring checks that are carried out on a regular basis to ensure the health, safety and welfare of residents are promoted, such as: monitoring records, environment checks, testing fire alarms and call bells etc. The Registered Manager confirmed that she undertakes random checks to ensure everything is being completed. ie care plans. Representatives within the council undertook a dignity audit within the service. This procedure obtained feedback from staff, residents, health professionals and other stakeholders with an interest within the home. Results of this survey was used as evidence throughout the AQAA. A copy of the results are also displayed at the home. The Registered Manager confirmed that this will not be completed annually and discussions were had to ensure that a structured quality assurance and quality monitoring system is implemented within the home to ensure it is run in the best interest of residents. Information obtained should be used to assist in developing their annual development plan. Regular staff and resident meetings are held, providing people with an opportunity to voice any issues. There is a suggestion box within the home that provides an opportunity for anyone to raise any issues anonymously. A survey has just been devised to obtain feedback from temporary residents to complete after their short stay at the service. There is also a page at the back of the Service Users Guide that people can use to write any comments on. Regulation 26 visits are undertaken that provide the home with guidance on areas they do well and areas for improvements. The AQAA received provides generally and overall a good picture of the services provided. Discussions were had with the Registered Manager on how the information in the AQAA needs to be improved when next requested. All key standards must be addressed and evidence provided in all areas could be expanded. The AQAA provided also evidences that management is aware of they could do better and there plans for improvement in the next 12 months. Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 25 Residents are encouraged to manage their own finances as long as they are able and willing to do so. The administrative workers maintain the records for resident’s money that is given to the home for safekeeping. To ensure that a lot of money is not pooled at the home, there is a resident’s safe-custody account, with residents having their own ‘mini account’ within this, with their own personal account code. This is not an interest bearing account. Records viewed identified that receipts are kept of any financial transactions or purchases. Records and money checked identified that generally clear records are being maintained. When viewing the records there was a discrepancy noted between the records and actual money. The administrator audited the money held on site and was able to advise the Inspector later in the day where and why the discrepancy occurred. The AQAA identifies that some policies and procedures have not been reviewed for up to 16 years. Priority must be given to ensure that these are reviewed and reflect current guidelines and good practices. The Registered Manager confirmed that this is currently being addressed within the local council. This has not been reflected as a requirement, however will continue to be monitored throughout the inspection process. Some outdated policies and procedures are in relation to equality and diversity issues. 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. The AQAA identifies that the Registered Manager has been part of a Fire Focus group, developing new fire policies and procedures and to ensure these are implemented. A new evacuation procedure has been implemented and staff have received training on the new procedures. Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X 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 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1)(2) 17 Requirement Timescale for action 30/10/08 2. OP7 13(4) (b&c) 3. OP9 13(2) 4. OP9 13(2) That clear and up to date information pertaining to individual needs are maintained in care plans and all care provided be accurately recorded to evidence that the home is meeting the needs of residents. That clear risk assessments are 30/10/08 in place for all service users and provide guidance for staff on how to reduce the risk, ensuring the safety of the service user. These must be dated, signed and regularly reviewed. That clear records be maintained 30/10/08 of all medicines received, administered and disposed of within the home to ensure that service users and staff are safeguarded and a clear audit trail is maintained. That advice be sought and 01/12/08 confirmation obtained that the controlled drugs cabinet is suitable and installed correctly to ensure compliance with current guidelines. Ireland Lodge DS0000031718.V367528.R01.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. 1. Refer to Standard OP9 Good Practice Recommendations That all handwritten prescriptions are double signed by staff that have received medication training to ensure residents and their colleagues are better safeguarded from errors occurring. Ireland Lodge DS0000031718.V367528.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone 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.V367528.R01.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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