CARE HOMES FOR OLDER PEOPLE
Jennifer`s Lodge 105 Wellmeadow Road Catford London SE61HN Lead Inspector
Sean Healy Unannounced Inspection 15th September 2005 09:30 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 Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 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. Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Jennifer`s Lodge Address 105 Wellmeadow Road Catford London SE61HN 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) 0208 4612516 Mr Eric Blackwood Mrs Jennifer Blackwood Mrs Jennifer Blackwood Care Home 4 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. up to 3 persons aged 65 years and above, one of whom may be suffering from dementia to include one person aged 55 years or above 29th March 2005 Date of last inspection Brief Description of the Service: Jennifer’s Lodge is a small, privately owned care home providing support and accommodation for four older people; on the day of inspection there were no vacancies. Mr and Mrs Blackwood are the proprietors and Mrs Jennifer Blackwood is the registered care manager. It is located on a residential road with direct access to public transport and a short distance from the main shopping area of Catford. There is on street parking available but no off road parking. The home is situated on the ground floor and first floor of a detached house. There are three service users bedrooms on the ground floor, all are ensuite with a toilet and sink. There is a separate toilet/bathroom. Also on the ground floor there is a kitchen open to service users at all times, a lounge and a small dining area in need of enlarging. There is access to a large wellmaintained garden to the rear of the building. The first floor is comprised of one service user bedroom, a small communal room for TV/reading and a living room used by the owners, where service users are welcomed. None of the bathing/toileting facilities are wheelchair accessible. Currently all of the service users are fully mobile. The family home of the proprietors and their family is located in separate quarters on the first floor. Currently one of the service users needs to go through this area to access his bedroom and small communal room. There is also a basement area, which the owners use as an office and for private use. Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on one day. It was facilitated by the manager, who provided her full co-operation. Four service users were present and gave their views on the quality and management of the home. The premises were viewed and all staff, service user and maintenance records were examined. The inspection was also supported by verbal and written information from the London Fire Brigade who had also recently inspected the home’s fire safety equipment and procedures making some recommendations included in this report. What the service does well: What has improved since the last inspection?
The information for prospective service users has now been improved to help them to decide whether they’d like to live there. There has been some improvement on information about service users’ preferred activities to help them to have more personal enjoyment. Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 6 Special dietary needs are now included on the menu and the GP and service users have been consulted on these. Service users are fully advised now about the home’s system for complaints and each person has a brief copy of the policy in their rooms. The home has now had the Fire Officer visit the home who has made various requirements, which the manager is in the process of dealing with. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Prospective service users have the information they need to make an informed choice. Service users do not have complete assessments of need prior to moving into the home, which means that social care needs and leisure activity needs are not fully catered for. EVIDENCE: The home has a good Statement of purpose and Service User Guide, which has recently been updated to include staff qualifications and training and comments received in surveys from service users and their families. There are also fairly comprehensive needs assessments in place for all service users prior to admission, which are being used to draw up, care plans in all cases. However the care assessments need to be improved to show service users wishes and consent regarding staff administering medication. There also needs to be assessments of each service users wishes and abilities to self medicate. All assessments have information on service users social and leisure needs (Refer to Requirements OP3) Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 and 10 Service users’ health and personal care needs are set out in a personal care plan and are being met; however, social care needs are not properly planned which can result in isolation and boredom. Service users’ plans regarding medication do not adequately reflect their consent, or their wishes about managing of their own medication, which is a denial of right to consultation and individual autonomy. Service users feel that they are treated with respect and privacy is maintained. EVIDENCE: Four care plans for service users were examined. Although there have clearly been efforts to improve the care plans there is still a need for more detail, more information on social and emotional needs, life histories and especially risk assessments. Risk assessments are not always supported by programme plans or guidance for staff, and five risk assessments showed the same means of reducing the risk, which was described simply as “staff support”. There is an existing requirement that all essential information, including risk assessments, must be included in care plans. Service users comments included; “I would like to go out more independently to places I like, without staff, maybe with a friend helping me”. (Refer to Repeated Requirement OP7)
Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 10 Care plans do not include service user signed consent regarding administration of medication and assessments and plans do not show that service users have been assessed regarding their ability and wishes to self medicate, though the manager said that this is asked at the admission stage. These issues need to be included in care plans. (Refer to Requirements OP7) Otherwise medication recording, storage and administration are being well managed. The home provides good systems and practices for ensuring service users rights to dignity and privacy are respected. They can speak privately on the phone in their own rooms, and all bedrooms are single rooms. Service users confirmed that they open their own mail, choose their own clothes and that staff are very respectful in helping with personal care support. Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Service users find that the lifestyle experienced in the home matches their expectations and preferences and satisfies their cultural, religious and recreational interests. Service users maintain contact with their families, are supported to exercise choice and control, and receive wholesome, appealing and balanced diets. EVIDENCE: The home has improved its weekly activity plans for service users and has done some work with one person to maximise outings in the community. This service users confirmed personal choice to go out fortnightly for church and other activities, but that other opportunities are there if they wish to avail of them. Service users and their family, if appropriate, are involved in activities planning. Service users confirmed the homes policy on encouraging and supporting service users to have visitors such as family and friends is being practiced. Comments include; ” I can see my family whenever I like and have regular visits” and “ I am very happy her and do go to church regularly which I like”. The homes policy on visitors was not on display. (Refer to Recommendations OP13)
Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 12 The home supports service users to manage their own money when they wish to, and currently two service users have decided that their families will look after their money. One other service user has her finances managed by the local authority and this is reflected in care plans. Menus are drawn up fortnightly and service users are offered the opportunity to have something different if they wish to and have full access to the domestic kitchen. All service users commented that the food is very good and they are happy with the system for choosing what they want to eat. Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Service users and relatives and friends are confident that their complaints will be taken seriously and acted on. Service users’ legal rights may not always be protected which may result in denial of rights in financial decision-making. EVIDENCE: The home now operates good policy and practices regarding complaints and all service users have been informed how to do this and have now got an abbreviated copy of the complaints policy in their rooms. A number of service users confirmed that they know how to do this and that the manager is always available and listens to their views and concerns. The manager told the inspector that she is working to find advocates for two of the service users. This was requested at a previous inspection, the requirement still stands. There is a need to offer more support for access to advocacy in management of finances. (Refer to Repeated Requirements OP17) The service users are on the electoral roll. Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Service users have access to safe indoor and outdoor communal facilities but all areas are not comfortable and spacious. EVIDENCE: There is a comfortable and homely lounge of good size for the four service users. The manager has also ensured that one of the service users who likes to watch video has access to another small lounge where he can do this. There is however no dining room, only a small area adjoining the kitchen, which is not really big enough for all service users to eat together. This is the subject of a previous requirement now repeated. (Refer to Repeated Requirements OP20) The homes owners and family live on the premises, occupying some rooms on the first floor and a basement area. The owner also needs to consider ways in which service users areas in the home are not infringed upon by the owner’s family living there. At the moment one service use has to pass by the owners kitchen and living room area to access his own bedroom and another shared room. (Refer to Recommendations OP20)
Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29 and 30 The home’s training plans and staff qualifications do not yet demonstrate that service users are always in safe hands or that staff are as yet competent to do their jobs. Service users may not always be protected by the home’s recruitment practices. EVIDENCE: The national requirement for 50 of staff to have achieved NVQ level 2 in care has not yet been achieved. All of the current staff are enrolled on the NVQ course and hope to achieve this qualification over the next three months. (Refer to Requirement OP 28) Staff recruitment practices are now generally good with good interview practices, a good checklist for pre-appointment information to be checked and good checking regarding criminal records and POVA. However it is still the case that two professional references are not being acquired for all new staff, and one recently appointed member of staff only had one reference on file. This issue has been the subject of previous requirements and is repeated. (Refer to Repeated Requirement OP29) The home operates a system for training staff, which includes access to the local authority training. However staff do not have individual training and development profiles without which it is difficult to ensure that all training is up to date, and relevant to service users care and support needs. This area of planning was previously required to be implemented and still needs to be addressed. (Refer to repeated Requirement OP30)
Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 16 Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 38 The home is run and managed by a person fit to be in charge, who is of good character and able to discharge her responsibilities fully. The home cannot currently demonstrate that it is run in the best interests of service users, which may result in important decisions being made without their involvement. Health, safety and welfare of service users are generally being promoted but fire safety systems are not adequate which may place service users at risk. EVIDENCE: The manager has many years experience working with older people and has completed her NVQ4 in management and will be taking the care component. She has also been undertaking other training to update her knowledge of the needs of service users. The home is operating some good systems for seeking service users views and acting on them to improve the service offered. Two sets of surveys are
Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 18 conducted annually, one for residents and one for families and relevant professionals. The most recent survey included comments from the GP, Community Psychiatric Nurse, Chiropodist, visiting Opticians, Librarian, Dental Hygienist, and Hairdresser. Questionnaires have lots of relevant questions, and results are made available to service users and families. However this information together with other information from areas such as complaints, staff development plans and development plans for the home, need to be pulled together into an Annual Quality Report and an Annual Development Plan for the home, to ensure the home’s progress and improvement. (Refer to repeated Requirements OP33) The home has been subject to two other inspection reports recently. One of these was carried out by the London Fire and Emergency Planning Authority, and the other by the Water Board. Both have produced requirements for action. The first resulted in requirements to; 1. Undertake a risk assessment and formulate an emergency plan 2. Develop an ongoing training programme for staff and record attendance 3. Get certificates of maintenance for the fire alarm system annually and keep inspection results on the premises 4. Ensure that all exit routes are free from obstruction and that all exit doors are easily open-able without using a key 5. Ensure that all fire doors have self-closing mechanisms 6. Emergency signage to conform to Health and Safety regulations. The deadline set by the Fire Officer for doing this work is 14th February 2006, and is also reflected in this report. (Refer to Requirements OP38) The Water board requirements are for the home to purchase a washing machine with a maintenance cycle to prevent infection in the water system, to install non-returnable valves throughout the water system, and to regularly clean the water tank with chlorine. These are referred to as requirements of this report. (Refer to Requirements OP38) All other aspects of the homes safe working practices were found to be in order. Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 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 2 18 X X 2 X X X X X X STAFFING Standard No Score 27 X 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 2 Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 20 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 OP3 Regulation 14 (c) 17.1 a Requirement The registered manager must ensure that all service users are assessed regarding their abilities and wishes regarding self medication and that their decision is reflected in their needs assessments The registered manager must ensure that a record of service users’ consent to administration of medication is recorded on their care plans The registered provider and the manager must ensure that all essential information pertaining to the health and social care of service users is included in care plans, including risk assessments. This has remained unmet for two inspections. The last inspection report stated that continued non-compliance could lead to consideration of enforcement action, although work is progressing in this area. Timescales 30/10/04 and 31/07/05 partly met. Timescale for action 30/11/05 2 OP7 12.2 17.1 a 30/11/05 3 OP7 15 30/11/05 Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 21 4 OP17 12.1 The registered person must ensure that access to advocacy services is facilitated This is the subject of a previous requirement. Timescale 31/07/05 partially met. 30/11/05 5 OP20 23.2 g The registered person must ensure that there is a dining area large enough for all service users to eat together This is the subject of a previous requirement, Timescale 31/12/05 not exceeded. 31/12/05 6 OP28 18.1 a&c The registered manager must ensure that 50 of support staff achieve NVQ level 2/3 within required timescales 31/12/05 7 OP29 19.1 a&b The registered person must 30/11/05 ensure that all documentation required by regulation is received before staff start working in the home. This is the subject of a previous requirement Timescale 31/07/05. 8 OP30 18 c The registered provider must 30/09/05 ensure that there is staff training and development programme, which meets the National Training Organisation workforce training targets. This is the subject of a previous requirement. Timescale 30/09/05 not exceeded. 9 OP33 24 The registered provider must ensure that there is an Annual Development Plan for the home. This was a requirement of last inspection Timescale 30/11/05 Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 22 31/07/05 unmet. 10 OP38 23 The registered provider and manager must ensure that the requirements of the LFEPA fire officers report as described in YA Standard 38 are addressed by the due date of 14/02/06 The registered provider and manager must ensure that the requirements of the Water Board described in YA Standard 38 of this report are fully addressed. 14/02/06 11 OP38 23 31/10/05 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 2 Refer to Standard OP13 OP20 Good Practice Recommendations The registered manager should revise the homes written visitors policy to reflect visiting times and any restrictions on visiting and display this in the home The registered provider and manager should consider ways in which service users areas in the home are not infringed upon by the owners family living there, and include plans for improvement in the homes Development Plan. Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Jennifer`s Lodge DS0000025597.V250118.R01.S.doc Version 5.0 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
