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Inspection on 23/09/05 for Ladyville Lodge Nursing Home

Also see our care home review for Ladyville Lodge Nursing Home for more information

This inspection was carried out on 23rd September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Ladyville Lodge provides a comfortable and welcoming environment for its residents. It is well decorated, furnished and is clean bright and airy. The home operates a good pre-admission assessment process and is helpful in assisting residents to settle into the home. Activities are well organised and community contact is promoted by regular trips out. General health needs were well recognised and managed. Staff were friendly and concerned for residents` welfare. The home listens to its residents and relatives through regular quality assurance meetings and actions any issues through these meetings.

What has improved since the last inspection?

Maintenance work required by the last inspection has been completed by the home.

What the care home could do better:

The privacy and dignity of residents must be upheld at all times. A policy and procedure on dying and death must be available at all times in the home. Cultural dietary needs must be met by the home and alternative meal choices must be communicated to residents from different ethnic backgrounds appropriate to their communication needs. All emergency call buttons must be in working order in all bathrooms and toilets throughout the home to all ensure the health and safety of all residents. The manager must reduce health and safety risks posed to residents by ensuring there is appropriate storage facilities for all equipment and that all hazardous liquids are locked away in a secure cupboard.

CARE HOMES FOR OLDER PEOPLE Ladyville Lodge Nursing Home Fen Lane North Ockendon Upmister Essex RM4 3PR Lead Inspector Harbinder Ghir Unannounced Inspection 23 September 2005 10:00 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 Ladyville Lodge Nursing Home DS0000015597.V252292.R02.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. Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ladyville Lodge Nursing Home Address Fen Lane North Ockendon Upmister Essex RM4 3PR 01708 855 982 01708 854 899 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) Ashbourne Homes Ltd Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 26 BEDS FOR ELDERLY INFIRM 18 BEDS FOR RESIDENTIAL CARE MINIMUM STAFFING NOTICE Date of last inspection 21st March 2005 Brief Description of the Service: Ladyville Lodge is a 44- place care home for older people. Twenty-eight of the beds are registered for nursing care and 18 for residential. The home is owned and run by Ashbourne Homes Limited. The home consists of a large, two storey house, with a large purpose built annex, set in spacious grounds. All bedrooms are spacious, airy and bright. They all have hand basins, TV points and a call system. There is a passenger lift in place. There are two lounges and a dining room overlooking the garden with disabled access. There are car parking facilities to the front of the property for staff and visitors. The home is situated in a rural part of Upminister and is not convenient to access by public transport. It is close to the M25, A127 and the A12 and easily accessible by car. Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2005 to March 2006. The inspection was completed on the 23.09.05 with the inspector at the premises from 10.00am to 1.45pm. As part of the inspection members of staff, the deputy manager, residents and relatives were spoken with. Some records were examined and the premises were inspected. What the service does well: What has improved since the last inspection? Maintenance work required by the last inspection has been completed by the home. Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 6 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. Ladyville Lodge Nursing Home DS0000015597.V252292.R02.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 Ladyville Lodge Nursing Home DS0000015597.V252292.R02.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): 2, 3, 4, 5 The statement of terms and conditions are comprehensive, informing residents of the services that they are entitled to recieve when moving into the home. Trial visits are offered and pre -admission assessments are completed prior to admission to ensure identified needs can be met by the home. EVIDENCE: All residents receive a written contract of terms and conditions, which was very comprehensive. Contracts seen were signed by the home and the resident or their representative. The home has a good pre-admission assessment form. Pre-admission assessments are completed by the manager and deputy staff who assure potential residents their needs can be met by the home. Trial visits to the home are encouraged and are an opportunity for potential residents and their family to identify how appropriate the home is for them in meeting their needs. One resident spoken to informed that her family visited the home prior to her moving in. Another relative spoken to informed that they visited the home on the behalf of their mother and stayed at the home for the day and were shown Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 9 round the home. The relative stated that they were very happy with the information provided which helped them to decide that Ladyville Lodge would be most suitable for their mother. The home does not provide intermediate care. Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 10 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, 8, 10, 11 The care planning system is clear and consistent to provide staff with the information they need to meet residents’ needs. Residents’ privacy, dignity and independence is promoted, but ways to promote privacy whilst attending to personal care needs, needs to be revisited by the home. Residents’ wishes in the event of death were established in care plans. However, a policy and procedure for handling dying and death is not in place at the home. EVIDENCE: The home has a clear and easy to follow care plan format. All residents have a detailed plan of their daily routine, personal, physical, emotional and healthcare needs. Cultural needs of residents are also identified in care plans in regards to spiritual, dietary and language needs. Care records showed that residents’ health is monitored and prompt referrals are made to external healthcare professionals when required. Nutritional screening takes place monthly by weight charts and nutritional and fluid intake is logged for each nursing care resident in their care plan to monitor their nutritional intake. Four Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 11 care plans with risk assessments were viewed, which were reviewed on a monthly basis and all risk assessments were up to date. Residents spoken to stated that staff were very kind and caring and were approachable at all times. Privacy was maintained through lockable toilets and bathroom doors. Residents were able to keep their room doors locked and keep the key on them. However, ways of respecting and promoting privacy and dignity whilst bathing residents needs to be revisited by the home. It was observed during the inspection a resident was inappropriately covered whilst being taken to the bathroom by a member of staff. Residents must be treated with respect and their privacy must be upheld at all times. Relatives and visitors are able to visit the home at any time. The home does not have a procedure or policy in place in the event of a resident’s death. However, residents’ wishes in the event of death had been identified and were recorded clearly in care plans. Where residents did not wish to disclose this information was respected by the home. Four care plans seen contained information regarding individual resident wishes in the event of death. These had been recorded sensitively Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 12 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, 15 Social activities are organised daily within the home and community contact is promoted. The meals in the home are nutritious offering variety and catering for special diets, which is reflected through the homes daily menu. However, residents’ cultural dietary needs, need to be met by the home. Residents’ needs are promoted and they are encouraged to exercise rights and choices. EVIDENCE: The home has an activities co-coordinator who visits the home five days a week from 11.00am to 4.00pm. Activities timetables were displayed around the home and included a wide range of activities and entertainment for residents to participate in. The home also arranges external entertainers to visit the home each month. A relative spoken to informed that the activities provided were very good which her mother enjoyed. The home meets residents’ cultural and religious needs by a monthly church service. Families and relatives can visit any time and are also encouraged to take their loved ones out. Relatives were observed visiting throughout the day and one relative was visiting very early morning. A relative spoken to informed that she visits any time during the day. A resident informed that her daughter visits late evenings and that the home are very open on visiting times. The home has a private visitors room. Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 13 Residents spoken to said the routines of daily living were tailored to their individual preference as far as was practicable. One resident stated that she could go to bed late at night and have a lie in if she wanted to. She also informed that she usually has her breakfast in bed. During the inspection it was observed residents’ coming down to the dining room at different times for breakfast and were served individually. Residents from the nursing care and residential unit were encouraged to mix in the dining rooms and lounges, ensuring that they were not segregated according to their level of need. The menu was seen and showed that a choice of foods, alternative meals, fresh fruit and vegetables were available. Special diets were catered for and alternative meals were cooked for residents where requested. However, the manager needs to promote the selection of meals for those residents from ethnic backgrounds. One resident spoken to informed that she has not had any culturally appropriate food cooked for her and that her daughter brings in most of her meals. It was identified that the resident’s family had been spoken to about dietary likes. The manager must ensure that all residents’ dietary needs are met in regards to their cultural needs and choices available and alternatives prepared are communicated to residents in their language where English is not first language. The menu was displayed in the main reception area in large print and the daily menu and choices were communicated to residents by staff each afternoon. The chef kept a record of choices made by each resident. Residents said that the food was good with a wide choice of meals to choose from. The kitchen was seen during the tour of the building. It was clean and hygienic and records of all fridge, freezer and food temperatures were recorded daily. However, some items foods were found to be left open. All foods must be stored in airtight containers to reduce the risk of infection and pests. Residents had access to their daily records if they wished. Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 14 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, 18 The home has a clear complaints procedure and residents and relatives are aware of how to complain and feel that their views are listened to and acted upon. Policies, procedures and staff training were provided that protected residents from abuse. EVIDENCE: The home has a clear step-by-step complaints procedure that meets the requirement of the regulations. A log is kept of all complaints made and how these have been actioned by the management team. The complaints procedure was displayed within the home but needs to be updated to include the new address for The Commission for Social Care Inspection. Policies and procedures regarding the abuse of vulnerable adults were provided. Records seen identified all staff received training on adult abuse and the manager had also obtained policies and procedures from placing Local Authorities. Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 15 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): 19,20,21,22,23,24,25,26 The standard of the environment within the home was very good, providing residents with an attractive, homely and safe place to live. Residents were put at risk due to health and safety not being adhered to. EVIDENCE: The home was well presented, homely and clean. No odours were detected at the home. The home has one main and a smaller lounge and a dining room, which has wheelchair access to the garden. Communal areas in the home benefited from good natural light. Grounds around the home were well maintained. Equipment was provided where there was an assessed need and assisted bathing and toilet facilities were available to residents. However, the emergency call button was not working in one toilet and one bathroom and both rooms used for residents were also used to store equipment, which presented a health and safety risk to residents. Cleaning liquids were also found in bathrooms throughout the home. The manager must find suitable Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 16 storage for all equipment and all hazardous liquids must be locked away, ensuring the health and safety of residents is protected. Individual bedrooms were spacious, bright and airy. Rooms were adequately furnished, and had sufficient space to accommodate the required furniture and were personalised by the occupant. All rooms were lockable which staff can override in an emergency. Appropriate screening was provided in all shared rooms. Regular water temperature checks are made at all water outlets. The home has a sluicing facility and laundry, which was clean. Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 17 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, 29,30 There is a good match of qualified staff offering consistency within the home. Recruitment processes are robust and offer protection to people living at the home. EVIDENCE: Staff were observed to respect residents and were accessible and approachable. One resident spoken to stated that the staff were very approachable. The home has a ratio of 50 and above of NVQ trained staff. The home uses agency staff to cover sickness and annual leave. Three staff files were inspected and indicated residents were protected through the use of robust staff recruitment processes. Staff received a comprehensive induction programme. Staff training was well organised and individual staff training needs were monitored. Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 18 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): 33, 37, 38 The systems for Service User consultation are good with evidence that Service User views are sought and acted on. The security of records needs to be urgently reviewed by the home. The welfare of staff and service users are promoted by the homes policies and procedures at all times. EVIDENCE: The quality assurance system includes seeking the views of residents and relatives, by the home holding separate monthly meetings for each group. The minutes of relatives meeting were displayed in the main reception area and include ways in which issues raised will be actioned by the management team. Reports regarding monthly visits in accordance with Regulation 26 visits are received by CSCI. These are comprehensive, giving a good picture of how the organisation assesses itself. Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 19 Record keeping by the home was kept up to date and was in good order. However, care plans were not locked away or kept in a secure place. Care plans were observed to be lying on the main reception desk and on the dining room floor. This was identified as a matter of serious concern and it was advised that care plans as a matter of urgency are kept in a secure and lockable cupboard to comply with the Data Protection Act 1998 and maintain client confidentiality. The home has a maintenance person who takes overall responsibility for ensuring relevant checks are carried out. It is clear from the records seen that all relevant legislation is complied with and reportable incidents are reported to the appropriate authorities. The home has a written policy regarding safe working practices. Fire signs and safety posters are evident throughout the home. All members of staff have health and safety training as part of the induction process. Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 20 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 X 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 x 3 3 1 2 3 3 3 2 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X 1 3 Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 21 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 OP10 Regulation 12(a) Timescale for action The registered person shall make 23/12/05 suitable arrangement to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users at all times. Policies and procedure for 23/12/05 handling dying and death are in place and accessible at all times. Re-stated Cultural dietary needs must be 23/11/05 catered for as agreed on admission in consultation with the resident admitted. Meal choices and alternatives must be communicated to them appropriate to their communication needs and their language. The complaints procedure must 23/12/05 be up dated to include the address and details of The Commission for Social Care Inspection. All bathrooms and toilets rooms 23/10/05 must be include an emergency call system. Re-stated. Suitable provision is made for 23/12/05 storage for the purpose of the DS0000015597.V252292.R02.S.doc Version 5.0 Page 22 Requirement 2 OP11 12 (2) (3) 3 OP15 12 (4) (a) (b) 4 OP16 22 (7) (a) (b) 5 6 OP21 OP22 13 (4) 23 (2) (L) Ladyville Lodge Nursing Home 7 OP26 13 (4) (a) 8 OP37 17 (1)(3) care home and all bathrooms and toilets are kept free of any stored equipment. The registered person shall 23/11/05 ensure all parts of the home to service users have access to are so far as reasonably practicable free from hazards to their safety. In that all hazardous liquids are kept in locked cupboards around the home and bathrooms and toilets are kept free of all cleaning liquids. Individual records are kept 23/12/05 securly in accordance with the Data Protection Act 1998. 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 OP15 Good Practice Recommendations All opened foods are stored in airtight containers. Ladyville Lodge Nursing Home DS0000015597.V252292.R02.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. 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