CARE HOMES FOR OLDER PEOPLE
Kings Lodge 50 North End Higham Ferrers Northants NN10 8JB Lead Inspector
Sheila Smith Unannounced 26 May 2005 at 10.00am
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Kings Lodge Address 50 North End Higham Ferrers Northants NN10 8JB 01993 315 321 01992 710 401 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Claude Fonseka Vacant Care Home 27 Category(ies) of DE (E) Dementia - over 65 registration, with number of places Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: No person within the category DE(E) can be admitted where there are already 27 persons of category DE(E) already in the home. Date of last inspection 9th June 2004 Brief Description of the Service: Kings Lodge is situated on the outskirts of Higham Ferrers with public transport links to the neighbouring towns of Rushden and Wellingborough.The home provides personal care and support for up to 27 Older People over the age of 65 years, who have a dementia related condition The Home is a conversion of a large detached residential property with ground and first floor accommodation. There is a garden to the rear of the property, accessible to the residents. Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for residents, and upon their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting 2 residents, and tracking the care that they receive, through a review of their records, discussions with them, and with the care staff, and observations of care practices. The inspection took place during the day over a period of 4 hours and was carried out on an unannounced basis. Communal areas, and some bedrooms were visited. A selection of care records, and essential records of the home were reviewed. Several of the residents were spoken to as part of the inspection process. The position of Registered Manager is currently vacant and a recruitment process is underway. The Acting Manager was on duty throughout the inspection. What the service does well:
The home has a good quality detailed information pack, which makes it clear who the home is suitable for. Prospective residents are invited to spend time in the home to see if they like it before moving in. The home offers a friendly warm environment in which residents and staff are very friendly and welcoming. One resident said ‘ I love being here, and I have a nice room with my own bathroom, I particularly like the white tablecloths on the tables’. Residents are encouraged to be as independent as possible and to maintain links with relatives and friends in the community. District nurses visiting during the inspection reported that they were satisfied with the standard of healthcare, and had always found the staff to be kind and helpful, and that residents health needs were well monitored. A cook was on duty on the day of the inspection and the food served appeared appetising and healthy. One resident said that ‘ the food is very good, and we have plenty to eat, sometimes too much!’
Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 6 The garden is well maintained and has an aviary containing a large number of birds that can be enjoyed by the residents. The Acting Manager Patricia Jeffs is keen to raise the standards, and has an approachable and open style of management, which provides good leadership, support and guidance for the staff team. What has improved since the last inspection? What they could do better:
The pre admission assessment documentation would benefit by containing more information so that an accurate care plan can be produced. The care plans could be improved by regular accurate reviews to reflect the current needs of the residents. Pipe work and radiators should be guarded or have guaranteed low temperature surfaces to prevent vulnerable older people from burning themselves. The kitchen would benefit by a regular programme of deep cleaning. There was no evidence that activities are arranged to suit the individual wishes of the residents. The home does not employ an activities coordinator. Staff provide some activities, time permitting, however the whole area of activities does require developing. Some areas of the home appeared bare and would benefit by pictures or ornaments to give a more homely appearance. A Staff file that was examined did not have references obtained, and did not contain a photo, a copy of birth certificate or a copy of passport. 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.
Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 5 Prospective residents have the required information to enable them to make an informed choice about the home. EVIDENCE: A Statement of Purpose and a Service User Guide, is issued to prospective residents to enable them to make an informed choice of home No admission is made to the home until full assessments from other professionals involved with their care has been received, and the Acting Manager has met the potential resident and carried out the homes assessment. Advice was given to expand the documentation used to enable an accurate care plan to be developed. Opportunities are provided for residents and relatives to visit the home prior to admission and residents are given a trial period. Of the two files examined one had a signed contract, and one did not, however the Acting Manager said that she was awaiting its return by relatives. Minor adjustments need to be made to the document to fully comply with the standard
Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10. The health care needs of the people in the home are met although the care plans were not up to date. EVIDENCE: One resident had had an operation recently that had been reported on in the daily reports but the current care required had not been recorded in the care plan. District nurses visiting reported that they were satisfied with the standard of care provided in the home. Staff said that the senior staff responded quickly to reports that residents were unwell and referred to other professionals as required. The Acting Manager said that the home received good support from the local health surgeries. From discussion with a member staff, about how the service users needs are met, it was evident that the staff have a sensitive approach to the provision of personal care, and are aware of privacy, dignity and independence issues.
Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 10 The Acting Manager said that the chiropodist visits regularly although there were no records in the files. The Acting Manager said that the chiropodist keeps his own records; it is advisable to keep a record within the resident’s own file. There was evidence that the optician visited on a regular basis. None of the residents within the home have been assessed as able to self medicate. Apart from the medication trolley not being secured to the wall, the medication records identified a robust system that ensures safe practices. Due to the high dependency of some of the residents staff have to make some decisions on behalf of them, but it was clear that their preferences on how they were guided, supported, and assisted was clearly respected. Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 Residents are not consulted about their daily routines including activities, which have an impact on their individual aspirations EVIDENCE: There was no activity organiser employed in the home although the Statement of Purpose indicated that there was. Consequently the activities are the responsibility of the staff who often do not have the time to organise them There was a list of activities on the notice board but no records that indicated when these activities had taken place or who had participated. There was no evidence that individuals had been asked on the type of activities they would like to be involved with. One resident said that she would like to help in the garden, as she used to help her Dad with the allotment. Another resident said that she was bored. From the discussions with staff and residents visitors are welcome in the home and can be seen in private. Residents were given sufficient time to eat their mid day meal in an unhurried manner, and staff offered assistance in eating where required which was carried out discreetly, sensitively and individually The dining tables were laid with nice tablecloths, appropriate cutlery and condiments. The Assistant
Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 12 Manager said the menus were not available because they were in the process of being retyped. Residents were not aware of the food that they were about to be served (A recommendation has been made) Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 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 standard(s) 16, 18 The complaint and protection processes within this home are adequate and sufficient to protect residents. EVIDENCE: Residents were quite clear about whom they could complain to in the home if they should need to. However all of the residents spoken to said they had no complaints about the home and that they were very happy with the level of service they received. There are written complaints procedures for staff and residents, and records are kept in the Home of complaints made, investigations and outcomes. The staff that were interviewed had a good understanding of what to do in the event that they suspected abuse was occurring, and a chart on the wall indicated the correct procedure should abuse be suspected. The Manager is encouraged to arrange formal training in the protection of vulnerable adults for all staff. Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 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 standard(s) 19, 22, 26 Issues outstanding mean that people living in the home are not provided with comfortable safe, homely surroundings . EVIDENCE: Some of the rooms were personalised and some of the rooms were very sparse and contained very little personal possessions. The Acting Manager said that this was to prevent residents picking up items and harming themselves, however the Manager may like to consider other ways of personalising the rooms such as pictures, and high shelving. It was noted that some radiators were not guarded or have guaranteed low temperature surfaces, which could result in residents receiving burns. (A requirement has been made) Paintwork is chipped, particularly on the ground floor of the home, which creates a poor first impression of the home (A recommendation has been made).
Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 15 Specialist equipment e.g. ‘pressure relieving ‘mattress and cushion have been accessed for one of the residents. Residents were able to use and access other items of walking aids, and staff had access to items of equipment to enable them to safely aid less mobile residents. Areas of the kitchen were in need of cleaning, particularly the cooker and there was no evidence of cleaning plans. (A requirement has been made) Fridge and freezer temperatures had not been checked since 21st May 2005. (A recommendation has been made) Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 Recruitment procedures were not robust, thus potentially leaving residents at risk. EVIDENCE: The Acting Manager holds meetings on a regular basis with her staff team. Residents commented on the willingness of the staff to help them. The home has had recruitment problems and the Acting Manager has worked hard to meet the standard of having 50 of her team qualified in National Vocational training level 2/3 by this year, however because of staff changes she will not achieve this. Two staff files were examined, and it was noted that one file had no references, photograph or proof of identity. (This is the subject of a requirement) The Acting Manager was not aware of the General Social Care Council codes of practice, and had therefore not distributed copies to her staff (This is the subject of a recommendation). A member of staff said that the Registered Provider had a strong commitment to training and that she had attended fire, food hygiene, manual handling and first aid training, in addition training in dementia care had been arranged for May and June 2005. The staff felt that there was enough staff on duty to meet the needs of the current residents.
Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The well being, health and safety of the residents is promoted, and protected through staff observations and actions, policies and procedures EVIDENCE: Records observed included the accident book where records of accidents to residents and staff are recorded The fire log- book which was found to be satisfactory with weekly fire tests and emergency lighting tests regularly carried out and recorded. Policies and procedures relating to safe practices were available for all staff. A member of staff confirmed that there was an adequate supply of disposable gloves and aprons available for staff to assist with personal care.
Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 18 Control of Substances Hazardous to health policies and procedures, and general risk assessments were in place. It was noted that chemicals and liquids, stored in the laundry were not locked away. (A requirement has been made) Staff established that they were aware of their responsibility for health and safety and confirmed that faulty equipment was quickly replaced or repaired. A member of staff confirmed that she had received first aid training. Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2
COMPLAINTS AND PROTECTION 3 x x 3 x x x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 2 Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 20 NA Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 6 13(3) The kitchen , and the equipment must be cleaned regularly. The Registered provider must submit a cleaning plan to the Commission of Social Care inspection, Staff recruitment policies and practices must be put in place and consistently implemented in line with Regulations and having regard for Standard 29.1 to 29.6 An assessment of Radiators not guarded must be undertaken Cleaning chemicals must be safely locked away when not in use. 31-07-05 Standard Regulation Requirement Timescale for action 3. 29 19 (1) 08-06-05 4. 5. 25 38 23 (2) 12 (4) 30-09-05 08-06-05 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. Refer to Standard 2 Good Practice Recommendations A statement of the terms and conditions containing all of the items listed in 2.2 of the National minimum standards, and signed by the resident or their representative, should be kept within the residents file
C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 21 Lodge 2. 3. 4. 5. 6. 7. 7 19 38 15 29 12 The residents care plan should be reviewed each month and updated to reflect the current needs of the resident A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced. Records of refridgerator temperatures should be maintained Copies of menus should be available. The Registered Provider should issue copies of the General Social Care Council code of practice to all staff The Residents should be consulted about social interests, and activities provided which suits their needs. Lodge C51 C08 S61540 Kings Lodge V228993 Stage 4 260505.doc Version 1.30 Page 22 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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