CARE HOMES FOR OLDER PEOPLE
Hesketh Lodge Hesketh Lodge 252 Abbey Road Barrow in Furness Cumbria LA13 9JJ Lead Inspector
Marian Whittam Unannounced Inspection 25th April 2007 09:00 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 Hesketh Lodge DS0000068447.V333437.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. Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hesketh Lodge Address Hesketh Lodge 252 Abbey Road Barrow in Furness Cumbria LA13 9JJ 01229 836000 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) Apple Healthcare Limited Miss Lorraine Gay Farraday Care Home 27 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number disorder, excluding learning disability or of places dementia (2), Old age, not falling within any other category (27), Physical disability (1), Physical disability over 65 years of age (5) Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of of 27 service users to include: *Up to 5 service users in the category of DE (E) (dementia over 65 years of age). * Up to 2 service users in the category of MD (Mental disorder excluding learning disability or dementia under 65 years of age).*Up to 1 service user in the category of PD (physical disability under 65 years of age). *Up to 5 service users in the category of PD(E) (physical disability over 65 years of age). * Up to 27 service users in the category of OP (old age not falling within any other category). Date of last inspection Brief Description of the Service: Hesketh Lodge is a Care Home registered to provide care for up to 27 people with a variety of needs. The home is an extended semi-detached Edwardian style house with residents bedrooms on three floors. The two upper floors of the home are reached by a chairlift and the access to one area is by two steps. The home is in a residential area on the outskirts of Barrow in Furness, and is set back from the main road into the town. The home is on a bus route into Barrow and out of town and the bus stops are close by. The home is close to local public houses, churches and a shop. Outside the home has a car park at the front and side of the house and at the back and side of the home there are two enclosed patio areas with flower borders and seating areas for service users and those who want to smoke. The rear patios have ramps for wheelchair users. Information is available to prospective residents from the recently updated and improved Statement of purpose and service users guide; this is provided for prospective residents and supplied to all residents when they come to live there. These are also available in large print on request. A copy of the last inspection report is also available on request. The fees charged by the home range from £360.00 to £455.00 per week as at the date of the inspection and an additional charge is made for personal toiletries, newspapers, magazines, books and tapes also hairdressing and chiropody, personal transport and outside activities and some electrical testing of items belonging to residents. Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced visit, which forms part of the key inspection, took place on 25th April 2007 with the regulation inspector spending eight hours in the home. The time was spent looking around the home talking with residents in the lounges and in their own bedrooms, speaking to the care staff, observing daily activities, routines and work practices and looking at care plans. Seven residents were happy to speak to the inspectors about their experiences of living in the home and also a visiting health care professional. Policies and procedures applied in the home, systems for recording complaints, medication records and procedures, personnel and training records were also looked at as well as other records and risk assessments required by regulation. The Providers returned pre inspection information on the service, requested by CSCI in advance of the visit. Before this site visit information was also gathered on the service from records of previous visits and complaints and concerns received. What the service does well:
People living in the home who talked with the inspector spoke well of the staff and the help and support they get from them. The home provides a homely and informal atmosphere for residents and care staff have a good rapport with them and know them well. The home is kept clean and tidy and many residents have chosen to personalise their bedrooms, to make them more homely. Staff work well with relevant health care professionals and take advice and direction to meet resident’s health care needs. The home works with other healthcare agencies and gets specialist help for residents when this is needed. This includes the local GPs and District nursing teams as well as specialist services such as the intermediate support team. Staff members spoken with were aware of the resident’s individual needs, clear about what they needed to do for them and were familiar with particular behaviours and interests. Staff do try to support people in social activities outside the home and also to have activities in the home as their work allows. The new providers, the deputy/acting manager and care teams have clearly been looking at ways to develop better systems of working to develop the service and respond well to the inspection process. Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
To further improve the service user guide the acting manager should make sure that a copy of the latest inspection report is included and the views of people living in the home are included to help inform people about the home and what it is like to live there. The revised statement of purpose also needs to include information for people on the size of bedrooms in the home and where they do not meet current minimum space requirements to inform their choice.
Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 7 Speaking with people living in the home and examining their individual care plans it was evident that they are not being fully involved in planning their care as it affects their lifestyles. There are also some limitations being placed on some residents with particular social needs and upon their choices. To improve this alternative ways to keep people safe, whilst letting them make choices in their lives, needs to be explored. The acting manager should consider developing person centred care planning in partnership with residents to reflect aspirations and needs and to help them in making decisions about their own lives. The activities programme also does not always give consideration to individual needs and abilities and those with dementia when planning group and individual opportunities for recreation. People living in the home should be consulted about the activities programme so that it reflects their needs and profiles or ‘pen pictures’ of people living in the home should be developed with them to help in providing meaningful recreation. Although medication handling and records are satisfactory overall more care must be taken with controlled medication recording. When it is administered to people using the service it must be checked and recorded properly to make sure that people get the right levels of medication. To aid this the deputy/acting manager should consider formalising medication audits for quality assurance purposes and to monitor practices. Although daily progress sheets have some information on psychological changes and behaviour this aspect of care is not being regularly monitored and recorded. Given that some people living in the home have particular psychological needs the monitoring of such needs should be more detailed and structured. This helps make review and evaluation easier so action can be taken quickly if needed for individuals There are policies and procedures in place for the care of the dying, although information is not being gathered expressing people’s wishes and preferences on this. The policies and procedures should be reviewed to ensure they reflect current good practice in palliative care. There is a complaints procedure in the home but to improve quality monitoring in this area the manager should consider including in the complaints investigation how they will prevent a reoccurrence. The procedures for safeguarding adults should also be reviewed and reflect current multi agency guidance. All care staff should receive formal supervision at least 6 times a year in addition to being supervised in the workplace. There is information on whistle blowing for staff but this too should be reviewed to make sure it is clear and with reference to the Department of Health guidance ‘No Secrets’. Health and safety procedures and policies and fire risk assessments in use in the home must be thoroughly reviewed also to make sure they are up to date and in line with current legislation and good practice. Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 8 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. Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 9 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 Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 10 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): NMS 1, 2, 3 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is information provided for people to help them make a choice about living in the home. Assessments of needs are done before coming to live there to make sure residents needs will be met. EVIDENCE: Information is available in the Statement of Purpose and Service User guide about the home for prospective residents and for people already living there. Both these documents have recently been updated and improved to provide clear information reflecting the improvements being made to the service and those planned for implementation shortly. The new documents are aimed at giving information to help people settle in and make the most of services offered and are in a final draft form at present and so not yet available generally in the home. The deputy/acting manager should make sure that the
Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 11 latest inspection report and the views of people living in the home are included in the new service user guide to further help inform people about the home. The statement of purpose also needs to include information on the size of bedrooms in the home and where they do not meet current minimum space requirements. People living in the home have been given contracts/terms and conditions of residency giving them basic information on what they can expect to receive living in the home. These are presently under review by the new owners with a view to improving them in the near future. Individual care plans show that new residents individual basic needs had been assessed before and at admission to make sure the home can meet their needs. The assessments examined by the inspector contained sufficient information to develop effective individual care plans. The home manager or the deputy do the individual assessments of needs before admission. In addition copies of the social services care management plans and discharge information from other care settings are also obtained. Where appropriate other care agencies and professionals have been involved in providing information before admission and advice after admission. Hesketh Lodge DS0000068447.V333437.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): NMS 7, 8, 9, 10 and 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are being assessed and planned for within individual care plans. Medication practices are satisfactory overall to keep people living in the home safe. EVIDENCE: All the people living in the home have their own plans of care and some clinical and personal risk assessments are in place. Care plans contain sufficient information for staff to follow to meet people’s personal needs and are reviewed but the information is at basic level and does not reflect a person centred approach to care and social and personal aspirations. However in speaking to staff it was clear they had a high level of knowledge about the people living there and what they liked and saw them very much as individuals, although not all of this was written in their plans. In order to improve the current care planning systems consultation is already going on between the owners and staff to introduce a new more comprehensive care planning system using a recognised care planning software package. This could
Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 13 provide the opportunity for a significant improvement on the method of planning and training would be given to all staff to use it. Care plan records and conversations with people in the home indicate that access to healthcare and support services and counselling, where appropriate, is being made available as needed. From speaking with people living in the home and examining their current care plans it is evident that they are not, at present, being routinely involved in planning their care as it affects their lifestyles and quality of life. This was also evident from some limitations having been placed on some residents with particular needs and upon their choices. Some of these restrictions and interventions have involved search people and their possessions, are not based on good practice and do not uphold people’s rights to privacy and personal dignity or reflect a person centred approach to helping people make decisions about aspects of their lives. The deputy/acting manager is now aware of this having occurred with some residents and is now seeking alternative ways to keep people safe whilst letting them make choices in their lives. Nutritional screening is being done using a recognised clinical tool and this has been successful in quickly identifying those at risk and in monitoring nutrition. This was evident for more than one resident where nutrition had been poor on admission. The daily progress sheet contains some information on psychological changes and behaviour but this is not routine or systematic. Given that some people living in the home have particular psychological needs the monitoring of such needs should be more detailed and structured. This would make reviewing and evaluation easier so action can be taken quickly if needed for people. The administration, storage and recording of medicines is generally satisfactory with staff having been given recognised training on this. However an example of poor practice was found within the controlled drugs register. Staff having given medication had not properly checked and recorded this in the register. This was followed up quickly during the inspection using the homes own procedures and steps taken to prevent its reoccurrence. All other medication records and information seen are in good order. The deputy/acting manager should consider formalising medication audits for quality assurance purposes and to monitor practice. There are policies and procedures in place for the care of the dying, although these should be reviewed to ensure they reflect current good practice in palliative care. Information was not being gathered expressing people’s wishes and preferences on this. Training on death and dying is booked and some staff said they were due to attend this and displayed an interest in gaining more knowledge. . Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are limited opportunities for social and recreational interests and flexible choice in lifestyles, although people living in the home do exercise choice in the varied menu on offer. EVIDENCE: There is a programme of organised activities displayed in the home and arrangements are in place to meet preferred religious needs. Residents spoken with said activities did not always take place and did not suit everyone. Some spoken to do not wish to take part and others who went out of the home preferred to follow their own interests. The home does support some residents to have a social life outside the home with some people going out of the home to mix socially and to use day services. Some interests and activities are recorded in individual care plans, some in more detail than others. Care plans do not give good pictures of people as individuals with information about them and their interests and aspirations. The activities programme in use does not give consideration to those with dementia in planning for group and individual opportunities for recreation. In conversation with the deputy/acting manager and the new providers it was clear that they had already identified this as an
Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 15 area needing improvement and started to implement changes and they should continue with this improvement. This includes using an activities coordinator from Age Concern and developing a ‘buddy system’ for people living there to improve community contact, access individual support and recreation opportunities generally. The home does also provide information on contacting advocacy services for those who want them Residents said that they could see whom they wanted to and go out, as they liked as long as the staff knew. Bedrooms seen with residents were personalised as people preferred. However two residents spoken with were unhappy with restrictions on their lifestyle imposed without their involvement and consultation. The deputy/acting manager is trying to find better strategies to help these people exercise more personal autonomy and choice whilst remaining safe. One resident did feel that the new owners were making changes that made “living here better”. Some residents handle their own finances and for others the home keeps small amounts of spending money only for daily needs. The recording and monitoring system for personal monies has improved with residents signing for receipt of their monies. Previously the system did not involve the resident or record the transaction in a way that could be audited. Residents spoken with said there is a choice of food at meals and that they are asked what they would like to eat. Minutes of residents meetings, held monthly, show that resident’s ideas have been asked for and their suggestions included in the menu. One resident said they had asked for lamb on the menu and this was now included, where previously their request had not been acted upon. Another resident said that the food was “much better” with the new owners and they particularly enjoyed the cooked breakfast they could now have on Sundays. Others commented on less restrictions on the food provided such as being offered more biscuits with their drinks. Residents confirmed they could take their meals where they wanted, some in their rooms or lounge as well as in the dining room. The menus show a choice and variety of food that can meet individual dietary needs and meals are attractively presented. Hot and cold drinks were made available and offered throughout the day. Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16, 17 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adult protection procedures are in place and training being provided on this to staff to promote resident’s safety and wellbeing. EVIDENCE: The home has a written complaints procedure that is displayed in the home and found in the new Statement of purpose and service users guide. Resident’s spoken with said they knew about the procedure and one said that they knew they could contact the Commission for social care inspection with concerns and had done so in the past. Records of complaints investigations are kept on file. Records of complaints investigations show the home has investigated complaints made and have informed CSCI where needed of outcomes. To improve quality monitoring and audit in this area the manager should consider including in the complaints investigation how a reoccurrence is to be prevented and this will be monitored. Information is available on advocacy services and using them and also financial support services. There was information in the home for people living there from different political parties for the forthcoming local council elections and people who chose to are able to use their vote. There are policies and procedures on protecting vulnerable adults including multi agency guidance. Although there is more than one procedure on the file and this could lead to confusion amongst staff. Also the home’s own
Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 17 procedures should be reviewed, as they do not reflect current multi agency guidance and best practice. There is information on whistle blowing for staff but this too should be reviewed to make sure it is clear about its purpose and the structure for protecting people and with reference to the Department of Health guidance ‘No Secrets’. This is pertinent as some staff spoken with expressed little confidence for protection of whistleblowers from their past experience. However, staff and residents both expressed greater confidence in the current management team to offer support and protection if they raised a matter. Training programme records show that training places are booked within the month for carers to attend a course on Adult Protection and identifying abuse from an outside trainer. Care staff have also looked at these issues as part of their NVQ level 2 training courses. Care staff spoken with knew what should be done if they suspected abuse was going on. Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20 21, 22, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is being maintained and is safe and clean for the people living there. EVIDENCE: Routine maintenance of the home is being done and there are 2 part time maintenance persons on site. Proposed improvements to the home are planned and the providers have obtained funds to significantly improve bathroom and shower areas for the benefit of the people living there. There are also plans to improve the grounds so that people living in the home can make better use of them. When these improvements are done the environment will be greatly enhanced for people living there. A new sluice facility has recently been completed to further improve infection control and good hygiene in the home.
Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 19 The dining and lounge areas in the home are spacious clean and homely with adequate lighting and ventilation. There has been redecoration of some toilets, the hall and a lounge and new appropriate floor coverings for a second floor toilet where odours have been a problem in the past. The home smelt fresh and clean at this visit with only a slight stale smell in the second floor bathroom that now has new floor covering and is also due for refurbishment. Resident’s bedrooms that were seen had an adequate standard of decoration, furnishings and soft furnishings and had locks on the doors, which some residents used when they went out. Many residents have brought into the home their own possessions, personal items and electrical equipment and this helps to make their bedrooms more personal and homely. There is screening available in the double bedrooms for privacy. The home is warm and tidy and there is a range of moving and handling equipment and some adaptations in the home to help residents get about, including a stair lift. Maintenance records show the regular testing of water temperatures to prevent risks from Legionella, water temperature testing at outlets and a showerhead cleaning schedule. The laundry is small but tidy and organised and the home has policies and procedures in place for infection control. From observation staff are following the procedures and using appropriate protective clothing. Staff have been given training on infection control good practice and this is recorded. Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of care staff on duty is adequate to be able to meet resident’s personal care needs along with relevant staff training. Recruitment procedures are being followed to promote resident’s safety. EVIDENCE: Staff rotas and observation during the visit suggested that the home had a motivated and competent care staff group and enough staff on duty to provide adequate personal care during the day and at night. Care staff currently lead activities provision for people living in the home as well as their other duties allow. Residents spoken with felt the staff are “kind” and “very agreeable”. One resident said the new owners were “a breath of fresh air” and thought things were, “changing for the better”. Recruitment procedures are in place Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) checks have been done for new staff in the home. There had been some recent instances where safe practice with CRB and POVA checks had not been followed and the new owners and deputy/acting manager have acted quickly to put this right upon discovery. Care staff spoken with enjoyed their work and some felt the change in provider has given fresh impetus to changing and improving the service for the people
Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 21 living in the home. Staff confirmed that there are regular staff meetings and records showed what was discussed and acted upon. Care staff spoken with demonstrated an understanding of their roles and were familiar with the needs and preferences of the people living in the home. The home has almost 50 of its care staff qualified at NVQ level 2 in care with some staff continuing this training to level 3. The home has a training programme, covering mandatory and some additional training and keeps staff training records. There was evidence of relevant and mandatory training being provided and encouraged, with a range of sessions planned and booked over the next few months. This includes updates on adult protection and on challenging behaviour, dementia awareness as well as on aging, death and bereavement. Staff appraisals have been done helping to identify training and development needs. The new providers have provided staff with a useful and informative staff handbook including the home’s equal opportunities policy, grievance procedure and disciplinary rules and procedures to promote greater clarity and openness with staff. Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures are in place to safeguard resident’s financial interests and promote their health and safety. EVIDENCE: The home now has new registered providers who are in the process of assessing the service and its future development for the benefit of people living there. The deputy manager is currently working as the manager of the home as the registered manager is currently suspended from duty pending a management investigation. The deputy has suitable NVQ Level 4 qualifications and care experience to fulfil this role competently on a temporary basis and is presently looking at how to develop existing systems with the providers.
Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 23 Regular staff and residents meetings are being held and minutes taken allowing feedback and information sharing. Surveys are in use to ask residents and visitors to the home their opinion of aspects of the service. However the management team should develop a clear plan for the home and use objective tools to measure its performance against it stated aims and get a range of opinions on how well they are achieving goals for the people living there. It was clear from changes that have already been made in the management approaches and resident involvement and the planned improvements in the care planning systems and environment that the providers and acting manager are planning ahead. As part of quality monitoring policies and procedures should be systematically reviewed. Those on file have been signed as reviewed but several examined did not reflect current good practice and should be reviewed and updated where necessary especially in health and safety and in light of changes in fire safety legislation. For some procedures there were different copies on file and various pieces of related information that only serve to cause uncertainty on the procedure to be followed. The deputy/acting manager was aware of the need to review current policies and procedures and this was under discussion with the providers. Systems and storage are in place to safeguard resident’s finances and adequate insurance is in place for the home. The system for recording resident’s personal money has been improved to give a clearer audit trail and included them in signing for their money. Staff are being supervised as part of the normal daily activity as they work but formal supervision is not being given to staff as a systematic one to one process and recorded. Records of equipment checks and servicing contracts indicate that the home has systems and practices to promote resident health and safety. Fire training for staff is being given and recorded and moving and handling training and updates being done. Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13 (2) Requirement When controlled medication is administered to people using the service it must be checked and recorded to make sure that people get the right levels of medication. All residents must have their privacy and dignity respected with strategies developed with them to achieve this and exercise control in their lives. Timescale for action 30/05/07 2. OP14 12 (2) (4) 30/07/07 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 OP1 Good Practice Recommendations A copy of the latest inspection report and the views of people living in the home should be included in the new service user guide to further help inform people about the home. The revised statement of purpose should include information on the size of bedrooms in the home where they do not meet current minimum space requirements.
DS0000068447.V333437.R01.S.doc Version 5.2 Page 26 2. OP1 Hesketh Lodge 3. 4. 5. 6. OP8 OP9 OP12 OP16 Where needed people’s psychological health should be systematically monitored. The deputy/acting manager should consider formalising medication audits for quality assurance purposes. Profiles or ‘pen pictures’ of people living in the home should be developed with them to help in providing meaningful recreation To improve quality monitoring and audit of complaints the acting manager should consider recording how they intend to make sure situations do not happen again and how this will be monitored. The procedures for safeguarding adults should be reviewed and made clear and reflect current multi agency guidance. Whistle blowing policies should be reviewed with reference to the Department of Health guidance ‘No Secrets’. The management team should develop a clear plan for the home and use objective tools to measure its performance against it stated aims as part of their quality assurance system.. All care staff should receive formal supervision at least 6 times a year. Health and safety procedures and policies and fire risk assessments in use in the home should be thoroughly reviewed to make sure they are up to date and in line with current legislation and good practice. 7. 8. 9. OP18 OP18 OP33 10. 11. OP36 OP38 Hesketh Lodge DS0000068447.V333437.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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
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